GA UPDATE FOR NJSSPA JUNE 2019 FROM PORZIO GOVERNMENTAL AFFAIRS (PGA)
June is “crazy season” in Trenton… the Governor and Legislature must agree on a balanced budget by June 30th, and lawmakers are also compelled to tackle critical legislative priorities before going on summer break. With an election in November, members of the Assembly will start to focus more on campaigning and won’t spend quite so much time working on policy issues in Trenton. As such, June is one of those months where anything can happen. NJSSPA and our lobbyists at PGA have been working hard to advance our priority bill (see below), ensuring that PAs are included as qualifying providers in legislation when appropriate, and keeping our membership updated on legislative and regulatory activity that affects the profession.
The most exciting news is the final passage of an updated POLST law, which changes the “P” from Physician to Practitioner and allows PAs to signOrders for Life-Saving Treatment. This has been NJSSPA’s priority legislation for two years. The bill passed the Senate 36-0 in April of 2018 and passed the Assembly 75-0 on June 20th. S1109/A2144 is now on the Governor’s desk. NJSSPA and our lobbyists are setting up a meeting with the Governor’s Counsel Office to discuss the importance of this legislation and encourage him to sign it into law!! Many thanks also go to our bill sponsors, Senator Teresa Ruiz (D-Essex) and Assemblywoman Nancy Munoz (R-Union).
A second item that NJSSPA and our lobbyists have been tracking closely in Trenton, which finally reached a resolution on June 20th as well, is the expansion of the medical marijuana program. The Legislature and the Governor’s Office have been working for almost 18 months to develop policies surrounding medical marijuana expansion, legalization of recreational adult-use marijuana, and expungement of marijuana-related criminal offenses. This package of bills was tied together, and though each proposal was a separately crafted bill, the Administration and Legislature agreed to move all three bills through the legislative process simultaneously. Progress came to a halt in late March, when the Senate could not come up with 21 votes to pass adult-use legalization. At that point, the Administration and the Legislature decided to move forward with their individual plans for medical marijuana expansion on their own.
In early June, the Department of Health announced that it will be seeking applicants for 24 new cultivation licenses, 30 new manufacturing licenses, and 54 new dispensary licenses, to be distributed evenly throughout the Northern, Central and Southern regions of New Jersey. One of the main issues between the Governor and the Legislature was how many new licenses to authorize. The Legislature wanted a more moderate expansion than the 108 new licenses which the Administration was proposing. Furthermore, there are some areas of the medical marijuana program that the Administration itself cannot address, and that includes changing certain statutory requirements such as which healthcare providers can certify that a patient qualifies for medical marijuana.
Through various additional compromises, the Legislature came up with a bill which the Governor has indicated that he will sign (A20 Downey (D-Monmouth) / S20 Vitale (D-Middlesex)). The legislation will expand the list of authorized prescribers from physician to health care practitioner and would include, “physician, APN or PA.” This bill is currently on the Governor’s Desk and we expect action to occur shortly, as this is a pressing issue for many legislators and NJ residents.
Other bills that have recently passed in their Chamber of Origin (either the Senate or the Assembly):
A4493 Pinkin (D-Middlesex) – Authorizes expedited partner therapy, under which sexual partners or patients diagnosed with sexually transmitted disease are treated without prior clinical examination. PAs are included as health care professionals authorized to provide expedited partner therapy and issue prescriptions for medications used in expedited partner therapy. This bill received a vote of 77-0 on June 13th. The Senate bill was heard in Senate Health on June 3rd and second referenced to the Senate Budget and Appropriations Committee.
A5369 Chiaravalloti (D-Hudson) – The “Patient Protection Act” establishes requirements concerning the transfer and referral of certain patients receiving health care services to out-of-state-providers. An effort to protect patients and their families against unexpected costs for transfers to out-of-state health care facilities, this bill requires that “health care professionals” inform patients in advance of financial liabilities and care options. It passed in the Assembly with a vote of 55-13-3 and is awaiting passage in the full Senate.
A5446 Land (D-Atlantic) – Requires reporting of opioid deaths: PAs would be part of the definition of health care professional in this bill so you would have the reporting responsibility. This bill passed in the Assembly 75-0 on June 20th and is awaiting a hearing in the Senate Health Committee.
A5459 Speight (D-Essex) – Concerns continuing education requirements for certain health care providers concerning best practices and advances in care of pregnant women with respect to prescription opioids: PAs are included in this bill and would have to comply with the CE requirements along with physicians, APNs, dentists and optometrists. This bill passed the Assembly 69-1-3 on June 20th and is awaiting a hearing in the Senate Health Committee.
S2442 Diegnan (D-Middlesex) – On Monday, June 17 the Senate Education committee heard a bill which requires a student-athlete who sustains a concussion to return to regular school activities prior to returning to competition, and also requires school districts to implement a five-step return-to-competition process. Last legislative session, NJSSPA lobbyists successfully got the bill amended from having only physicians do the return-to-activity evaluation to allowing physicians and other health care providers trained in the evaluation and management of concussions, so properly trained PAs are included. However, only physicians can sign the written clearance. The bill received a vote in the full Senate on Thursday, June 20th, passing 38-0. The bill has not yet moved in the Assembly.
Finally, an update on various other pieces of legislation that received hearings in June:
A5458 Mazzeo (D-Atlantic) – Establishes pilot program for integrated system of treatment for opioid use disorders: Establishes office-based treatment providers who will be responsible for the ongoing treatment of the patients. These entities must be comprised of at least one physician, PA or APN authorized to prescribe, administer and dispense narcotics. Office-based treatment providers will be supported by a MAT team made up of at least one APN or behavioral health professional with master’s level training (but not further defined). This bill had an informational Committee hearing in both the Senate and Assembly, but no votes were taken.
A5460 Houghtaling (D-Monmouth) – Concerns prescriptions of certain schedule II controlled dangerous substances and opioids: Under the bill, an immediate-release opioid drug for acute pain is to be prescribed for the shortest period possible, as determined by prescribing health care practitioner. "Practitioner" is defined as an MD, DO, dentist, optometrist, podiatrist, PA, certified nurse midwife, or APN, acting within the scope of practice of their professional license. This bill is ready for a vote in the Assembly and is awaiting a hearing in the Senate Health Committee.
S1961 Vitale (D-Middlesex) – The “Consumer Access to Health Care Act” would eliminate the joint protocol with a physician for APNs to prescribe medication. It is awaiting a vote in the full Senate and has not yet moved in the Assembly.
Finally, on June 3rd, the New Jersey Division of Consumer Affairs released new rules surrounding continuing education requirements for physicians and PAs on opioid topics. This rule adoption will require 1 hour of CME every renewal period in programs or topics concerning, “prescription opioid drugs, including responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion.”
QUIJANO MEASURE PERMITTING PHYSICIAN ASSISTANTS TO SIGN PHYSICIAN ORDERS
FOR LIFE-SUSTAINING TREATMENT RECEIVES FINAL PASSAGE
Would Mandate Continuing Education Credits for Licensure
June 20, 2019: (TRENTON) – In an effort to further empower patients with respect to their healthcare, a bill that would allow physician assistants to sign, modify, or revoke Physician Orders for Life-Sustaining Treatment (POLST) forms in the same manner as physicians and advanced practice nurses (APNs) passed 74-1 in the full General Assembly on Thursday. The legislation is sponsored by Assemblywoman Annette Quijano (D-Union).
The bill (A2144), the Practitioner Orders For Life-Sustaining Treatment Act, also requires physician assistants to complete two credits of continuing medical education relating to end-of-life care as a condition of continued licensure.
"Granting physician assistants with these privileges strengthens the healthcare delivery process," said Quijano. "In many instances, patient volume or similar issues prevent a physician or APN from immediately tending to a POST form request. Equipping physician assistants with administrative powers concerning these forms adds another means whereby a patient's wishes can be acted upon more quickly."
As defined in the bill, a POLST form is a standardized printed document that is uniquely identifiable and has a uniform color. It complements an advance directive by converting a person's wishes regarding life-sustaining treatment into a medical order. Currently, a POLST form may be created, modified, or revoked by a patient or, if the patient has lost decision-making capacity, the patient's representative, and must be signed by a physician or APN. The bill would allow a physician assistant to sign a POLST form as well.
After passage in both houses, the bill now goes to the Governor for consideration.