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Health Care Legislative Update − 2012

By Hawley Troxell,

In the 2012 Session, the Idaho Legislature passed several bills that affect Idaho’s health care community. While none of the new laws (summarized below) dramatically alter Idaho’s health care landscape, three are noteworthy for their potential impacts on particular segments of providers.

A. Economic Credentialing − HB 541

Effective July 1, 2012, Idaho’s hospitals and their governing boards will be prohibited from engaging in what is often called “economic credentialing.” Economic credentialing is the practice of conditioning a physician’s appointment or reappointment to the facility’s medical staff on the potential economic impact of the physician’s practice on the health care entity.

Idaho Code § 39-1392g is a newly-enacted section that prohibits a health care organizations from basing decisions to: (1) appoint or re-appoint physicians to the medical staff; (2) grant privileges to physicians; (3) revoke or suspend privileges; on the applicant’s or member’s ownership interest in or affiliation with other competing health care organizations or the fact that the applicant or member is a competitor with other members of the entity’s medical staff.

This section also includes two express limitations. First, it does not require a health care organization to grant privileges to physicians for services that are subject to an exclusive contract or that are not offered at the facility. Second, it does not change the privilege, confidentiality, discoverability and admissibility of information and records described in I.C. § 39-1392b (peer review statute).

Notably, the new section applies to numerous organizations because the statute defines “Health care organization” broadly, to include a hospital, in-hospital medical staff committee, medical society, managed care organization, licensed emergency medical service, group medical practice, or skilled nursing facility. Idaho Code § 39-1392a.

B. Prescription Drug Orders − HB 503

Prior to its amendment, Idaho Code § 54-1733 provided that a prescription drug order was valid only if it arose from a prescriber-patient relationship that included “a documented patient evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to treatment.” The statute further provided that “treatment, including issuing a prescription drug order, based solely on an online questionnaire or consultation outside of an ongoing clinical relationship does not constitute a legitimate medical purpose.” I.C. § 54-1733.

Effective July 1, 2012, Section 54-1733(4) permits prescriptions outside a traditional prescriber-patient relationship in certain defined situations. These exceptions include:

(a) Writing initial admission orders for a newly hospitalized patient.

(b) Writing a prescription for a patient of another prescriber for whom the prescriber is taking call.

(c) Writing a prescription for a patient examined by a physician assistant, advanced practice registered nurse, or other licensed practitioner with whom the prescriber has a supervisory or collaborative relationship.

(d) Writing a prescription for medication on a short-term basis for a new patient prior to the patient’s first appointment.

(e) In emergency situations where life or health of the patient is in imminent danger.

(f) In emergencies that constitute an immediate threat to the public health including, but not limited to, empiric treatment or prophylaxis to prevent or control an infectious disease outbreak.

(g) If a prescriber makes a diagnosis of a sexually transmitted disease in a patient, the prescriber may prescribe or dispense antibiotics to include: the infected patient’s named sexual partner or partners for treatment of the sexually transmitted disease as recommended by the most current centers for disease control and prevention (CDC) guidelines.

C. Physician Incentive Fund − HB 393

House Bill 393, the “Rural Health Care Access and Physician Incentive,” modified Idaho Code §§ 33-3723 and 39-5902 through 5912, to encourage physicians to establish primary care practices in Idaho’s rural and underserved communities. The changes allow the existing rural physician incentive fee assessment to be collected into a fund that will also administer grants to allow primary care physicians in rural areas to repay their student loans.

Prior to the enactment of HB 393, Idaho Code § 33-3373 included a provision allowing the State Board of Education to assess and collect a fee from medical students who are supported by the State pursuant to the State’s participation in the interstate compact for professional education. The fee is capped at 4% of the annual average medicine support fee paid by the state.

HB 393 renames this fund the “Rural Health Care Access Fund and the Physician Incentive Fund.” A new stated purpose of the fund is to allow for grants for improving access to primary care services, including physician loan repayment, in areas designated as primary care health professional shortage areas and medical underserved areas.

The new legislation also expands the grants currently available to address health care access in rural areas. In particular, HB 393 amended Idaho Code § 39-5905 to provide for grants directly to primary physicians for repayment of student loans. The details are in newly-added subsection (2) of Idaho Code § 39-505, which provides:

(1) Annual awards for up to four years, with a four-year maximum award amount capped at the lesser of $50,000 or the amount of the physician’s debt.

(2) Eligible physician must spend an average 28 hours per week providing primary care services in one or more eligible areas.

(3) The award amounts are set by Joint Health Care Access and Physician Incentive Grant Review Board (“JHCAPIGRB”).

(4) Priority is given first to physicians who were Idaho resident students and who paid the fee during medical school, followed by physicians who were Idaho residents prior to completing medical school out of state and who did not contribute to the fund, and then to physicians from other states who were not Idaho residents.

(5) Physician must demonstrate physician shortage in the eligible area, as well as demonstrated difficulty in recruiting physicians to serve in the area.

(6) Physician must also demonstrate support from the medical community and community leaders in the eligible area.

(7) Application must include letter of support.

Notably, a physician will not be eligible for this program if she is receiving student loan repayment funds from the federal government or another state. In addition, the physician is obligated to repay the award if the physician ceases to practice in the eligible area during the contract period.

If you would like more information about this topic or other legal issues, please contact a member of our Health Law Group or call 208.344.6000.