01/26/2023
OSMA's Top Advocacy Priorities for 2023
OSMA’s Government Relations team serves as the voice of Ohio’s physicians of all specialties—advocating for the practice of medicine at the Ohio Statehouse, advising state departments, and influencing state policy on health care issues.
We are now in a new general assembly, with numerous new elected officials in office! We anticipate several familiar issues to remain major OSMA advocacy priorities in 2023, and are always monitoring the legislative and regulatory spaces for new and emerging topics that arise throughout the year.
Here’s our current advocacy forecast:
1) Insurance Issues
OSMA Prior Authorization “Gold Card”/Major Insurance Reform Initiative
The OSMA advocacy team has spent more than a year preparing to embark on a major legislative initiative dealing with the continued issues Ohio physicians are facing related to prior authorization. We have heard so many concerns from our members about significant administrative burdens that are creating considerable hassle in their day-to-day practices. After extensive information collecting and research, we are ready to make this a major priority in 2023, and it will be one of our primary proactive advocacy focuses this general assembly. The “prior authorization gold card” legislation will further streamline the prior authorization process and remove some of these “roadblocks” so physicians and medical staff can focus more on patient care. OSMA is excited about this endeavor and we will need continued physician input and participation as this process kicks off and gets underway. Please stay tuned for more details as the language of this legislation is finalized and introduced.
Insurance Reform – Takebacks and Downcoding
OSMA is also preparing to take legislative action regarding other insurance-related issues such as downcoding and takebacks. We have collected a lot of feedback and information from members about how these issues are causing administrative burden on practices, and hope to create meaningful changes in the legislative space that will alleviate these difficulties for Ohio physicians.
Non-Medical Switching
As a reminder, non-medical switching occurs when patients are forced to switch to a different medication in the middle of a plan year for no medical reason due to formulary changes from the health insurer. OSMA has partnered with Ohio Association of Rheumatology in support of legislation which would prohibit insurers from engaging in the practice of non-medical switching. We anticipate supporting this legislation this year and advocating for its passage to avoid the disruption of a physician’s ability to exercise their medical expertise and help their patients caused by abrupt and unwarranted treatment changes.
Co-pay Accumulator
Another returning priority will be legislation concerning co-pay accumulator policies. Health plans and pharmacy benefit managers (PBMs) may apply co-pay accumulator adjustment policies when patients attempt to use copay assistance programs. These prohibit a patient’s copay assistance amount from count toward their deductible and maximum out-of-pocket cap. OSMA anticipates legislation which would require insurers and PBMs to count all payments made by patients directly or on their behalf toward their deductibles and out-of-pocket cost will be reintroduced this year. This is essential to increasing predictability as vulnerable patients face high out-of-pocket costs for their prescriptions.
Biomarker Testing
OSMA expects to support legislative efforts which would require state-regulated health insurance plans, including Medicaid, to provide coverage for biomarker testing when medically appropriate. Biomarker testing is increasingly used in diagnosis and treatment of a variety of conditions, including cancer. Insurance coverage would, for example, help reduce treatment costs and improve quality of life for Ohioans diagnosed with cancer.
2) Scope of Practice Issues
APRNs
We expect that, as it has been for years, scope of practice for APRNs and other allied practitioners will continue to be an area of focus in our advocacy agenda moving forward. OSMA is prepared to continue to advocate for physician-led, team-based care in 2023 and beyond.
Midwives
OSMA anticipates that legislation to license certified midwives in Ohio and regulate their practice may be reintroduced. Our members previously had numerous concerns about provisions in this bill regarding scope of practice, eligibility criteria, and license requirements.
Physician Assistants
We also believe that Ohio may see legislation related to increasing the scope of practice of physician assistants (PAs), allowing them to practice independently and without physician oversight. OSMA will oppose and advocate against any legislation which would eliminate physician supervision of PAs and dismantle the team-based approach to care.
“Certified mental health assistants”
Legislation is in the works to create a new type of mental health care provider in Ohio – the certified mental health assistant. The medical community has significant concerns with this concept, particularly because this would be an entirely new allied practitioner designation that does not exist elsewhere in any other state. The certified mental health assistant would operate under a two-year license and under the direct supervision of a physician. We will be active in advocacy efforts regarding our concerns about this issue moving forward.
3) State Budget
With the start of a new general assembly, this also means that it is also time for the Ohio Legislature to conduct the biennial budget process. Governor DeWine will release his proposed state operating budget, and by June, it must move through the chambers of the legislature, where it will undergo revisions and additions before becoming law. We will, as always, closely monitor the budget process, as provisions related to health care and medicine typically are deliberated at this time and may be included in the budget bill.
4) Public Health Issues
Vaccines
OSMA has fought against a series of dangerous anti-vaccination proposals over the past two years. We expect the issue to continue to be in the spotlight in 2023, both for COVID-19 vaccinations, and others (including childhood vaccines).
Tanning Ban for Minors
OSMA has joined the Ohio Dermatological Association for the past several years to support a measure that would prohibit individuals under age 18 from using tanning beds (HB 159 & SB 336). If enacted, this proposal would protect the youth in our state from exposure to dangerous ultraviolet radiation that drastically increases the chance of developing skin cancer, particularly when exposure occurs before adulthood. We anticipate to advocate for similar legislation again this year, and will push to finally pass it into law in Ohio.
Health Equity
The pandemic and elevated conversations about racial justice have brought the issue of healthcare equity to the forefront. OSMA remains dedicated making sure health care is fully inclusive and attainable so that everyone has access to necessary medical services regardless of race, ethnicity, sexual orientation, or any other defining characteristic.
Mental Health and Substance Use Disorder Treatment
OSMA has worked over the past several years to try to shift the focus of the response to the drug abuse and overdose crisis in the state, promoting reduction of barriers to mental health and substance use disorder treatment (including medication-assisted treatment), utilization of telehealth, and access to harm reduction services. We will continue this work in 2023, especially with many new legislators in office.
Additionally, the OSMA Foundation, in partnership with the Ohio Physicians Health Plan (OPHP) and the American Foundation for Suicide Prevention (AFSP), launched the Well-being CARE Service (Checkup And Referral Engagement) last year. This is a free, simple and anonymous tool to help physicians and all Ohio-licensed health care providers check up on their mental and emotional health.
5) Criminalization of Medicine/Legislative Interference and Overreach in Medicine and the Physician-Patient Relationship
Several concerning issues have arisen in recent years which infringe upon or criminalize the physician’s ability to exercise their own best judgment based on expertise, education, and experience, to work with each individual patient to determine best treatment options and procedures.
We continue to advocate for appropriate legislative and regulatory oversight of the practice of medicine which does not prevent physicians from providing best practice, high-quality care and making the best possible treatment decisions for unique patient care circumstances.
6) Tort Reform
This year marks the 20th anniversary of Ohio’s landmark tort reform legislation coming to pass, an initiative that OSMA led the charge on, on behalf of physicians all over the state. As always, OSMA will continue to monitor the medical liability climate in Ohio and support stability for Ohio physicians.