Jan. 26, 2017: State Advocacy Update

So far in 2017, Interstate Medical Licensure Compact bills have been filed in Mississippi, Nebraska, North Dakota and Washington. If passed, these states would join the 18 states that will allow physicians to participate in the Compact's expedited licensure process. The Interstate Medical Licensure Compact Commission—the entity charged with administering the Compact—hopes to start accepting applications for physicians to be licensed through the Compact process by the end of this month.

At the same time, four states—Colorado, Minnesota, Montana and Nevada—are pursuing or will pursue legislative fixes to the Compact to clarify that each state's medical board, not the Commission, will be the entity to access the Federal Bureau of Investigation's criminal background check system, as the Compact requires. Legislation has been filed in Minnesota; similar legislation or regulation is expected in the other states.

The AMA supports the Compact and will support any state medical association interested in pursuing Compact legislation. For more information please contact Kristin Schleiter of the AMA.

Almost 100 pieces of legislation have been introduced so far in 2017 to expand the scope of practice of advanced practice registered nurses (APRN). These bills range from minor changes to APRN rules and regulations, to expansions of prescriptive authority, to bills granting APRNs the authority to practice independent of physician collaboration, supervision or oversight.

One bill in particular stands out from the pack in its grant of authority for nurse practitioners to perform vasectomies.

The AMA is here to help state and specialty medical associations address any and all of these issues. Contact Kristin Schleiter for more information or resources.

Physician assistants (PA) will continue recent efforts to move from "supervision" to "collaboration", with legislation expected in states, including New Mexico. Only Michigan has enacted such legislation to date. At the same time, the American Academy of Physician Assistants (AAPA) Task Force on Full Practice Authority and Responsibility (FPAR) continues to solicit feedback from PAs regarding whether AAPA policy should support legislative movement towards full independence—full practice authority—for PAs. The task force is developing policy for consideration at the May 2017 meeting of the AAPA House of Delegates.

Please contact Kristin Schleiter if you anticipate PA legislative activity in your state.

State health officials in Louisiana and Utah this week issued a "standing order" for naloxone to increase access to those who need the life-saving opioid overdose antidote. A standing order typically allows participating pharmacists to dispense naloxone—without a patient-specific prescription— to laypeople including caregivers, family and friends of a person at risk for overdose.

"This is an important step in our fight against the opioid epidemic," said Rebekah Gee, MD, MPH, secretary of the Louisiana Department of Health. "By making this medication and education widely available, people who overdose can get the antidote quickly and administer it safely. This will save lives."

"Opioid overdose can be reversed and death prevented by timely administration of naloxone," said Joseph Miner, MD, executive director of the Utah Department of Health. "As authorized by state law, this standing order is intended to increase access to naloxone for those who might be at risk of an overdose or who might be in a position to assist somebody at risk of an overdose."

Read the Louisiana standing order (PDF).

Read the Utah standing order (PDF) or a press release issued Tuesday.

For additional information about standing orders, including an AMA legislative template, please contact Daniel Blaney-Koen at [email protected] and visit the AMA website.

New York Attorney General Eric Schneiderman announced an agreement this week with Anthem that will end the payer's policy of requiring prior authorization for medication-assisted treatment (MAT) for opioid use disorder, which follows a similar agreement with Cigna in 2016.

The AMA Task Force to Reduce Opioid Abuse has urged increased access to MAT and requested payers provide comprehensive access to MAT, including for Medicaid patients, the incarcerated and those who have failed with previous treatments.

One encouraging sign is that more physicians continue to become trained to provide in-office buprenorphine for patients with substance use disorders. According to the U.S. Substance Abuse and Mental Health Services Administration, more than 36,000 physicians have the necessary training to provide MAT services. This includes more than 2,700 who can now treat up to 275 patients.

Following recent deaths in the state, Pennsylvania's top health officials last week issued a statewide warning about the dangers posed by carfentanil, a synthetic opioid that is 10,000 times more powerful than morphine. The warning includes signs of carfentanil exposure and support for first responders to carry and administer naloxone.

The Pennsylvania Medical Society also promoted the statewide warning, highlighting the need for caution and how "carfentanil can be extremely dangerous to emergency and medical responders if exposed," said Charles Cutler, MD, President, Pennsylvania Medical Society. Dr. Cutler further emphasized the need for those with substance use disorders to seek treatment.

Read more about the medical society's efforts to reverse the opioid epidemic in the commonwealth.

• Jan. 26, 2017: Advocacy spotlight on Physician work helps halt insurance merger, preserve competition 
• Jan. 26, 2017: National Advocacy Update  
• Jan. 26, 2017: Judicial Advocacy Update