2016 IDAHO LEGISLATURE
UPDATE
February 8, 2016 through February 12, 2016
Throughout the 2016 Idaho Legislative Session, Nurse Leaders of Idaho and the Idaho Nurses Association
will provide periodic updates on legislation and activities of interest to nurses, especially in the area of
healthcare policy. In addition to these Updates, e-mail communications will alert NLI and INA members
to take action in communicating to legislators about bills of interest.
Located at the end of the Updates, is a Call to Action section that will provide background information to
assist in communicating with legislators. With bills of interest to nursing being introduced, hearing
agendas are updated daily.
Week 5
A variety of bills continue to be introduced including the three proposals by the Board of Nursing. They
are scheduled for hearings in the House and Senate Health & Welfare Committees next Monday,
February 15th. The focus on Medicaid Expansion and PCAP continues and culminated with the joint
House and Senate H&W Committees Public Hearing Friday morning. Here are highlights from this
week’s session:
Board of Nursing Legislation Scheduled for Hearing Monday, February 15
The three bills proposed by the Idaho Board of Nursing are scheduled for hearings in the Senate Health
& Welfare Committee Monday afternoon, February 15th at 3:00 PM MT.
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Nurse Licensure Compact S1251
http://www.legislature.idaho.gov/legislation/2016/S1251.htm
Advanced Practice Nurse Licensure Compact S1250
http://www.legislature.idaho.gov/legislation/2016/S1250.htm
Revision to the Definition of Nursing S1252
http://www.legislature.idaho.gov/legislation/2016/S1252.htm
The two licensure compact bills adopt new language to align Idaho’s compact agreement adopted by the
National Council of State Boards of Nursing to recognized those holding a valid nursing license in
another compact state to obtain an Idaho license. The Nursing Compact has been in place since 2001
for RNs and LPNs. The Advanced Practice Nursing Licensure Compact is new for APNs.
The bill to revise the definition of nursing adopts language that is more descriptive of the broad role of
nursing practice that the previous antiquated language:
“Practice of nursing” means assisting individuals or groups of individuals to promote, maintain or restore
optimal health throughout the life process by assessing and evaluating their health status, planning and
implementing a strategy of care to accomplish defined goals, and evaluating responses to care and
treatment the autonomous and collaborative performance of acts and services requiring specialized
knowledge, judgement, and skill that assist individuals, groups, communities or populations to promote,
maintain or restore optimal health and wellbeing throughout the life process. Nursing practice
encompasses a broad continuum of services delivered in, but not limited to, areas of clinical practice,
education, administration, research, and public and volunteer services. Nursing practice occurs at the
physical location of the recipient.
The Idaho Medical Association is opposing the Definition of Nursing bill concerned that the definition is
too broad.
Board Composition – Response to North Carolina Dental Board Supreme Court Decision
Two bills (H480 and H482) were introduced that effects the Board of Nursing, the Board of Pharmacy
and the Board of Medicine to comply with a U.S. Supreme Court decision regarding the North Carolina
Dental Board.
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Executive Director Licensure H480
https://www.legislature.idaho.gov/legislation/2016/H0480.htm
Board Member Qualifications H482
https://www.legislature.idaho.gov/legislation/2016/H0482.htm
The U.S. Supreme Court decision addressed concerns raised by licensees that license decisions were
potentially influenced by members of the licensing board who had “active market participation” creating
an adverse conflict. The bills introduced clarify board membership qualifications and the qualifications
of executive directors of boards by removing requirements that board members or executive directors
be licensed in the particular field they are representing. So for the Board of Nursing the requirement
that the executive director of the Board of Nursing must be a nurse would be removed from statute.
There would not be a restriction on a nurse holding a position, but the requirement in statute that it
must be a nurse, would be removed to comply with the Supreme Court decision.
Behavioral Health – Report from Office of Performance Evaluation
In 2015 the legislature asked the Office of Performance Evaluation to study the transition to Behavioral
Health Managed Care under the contract with Optum. The Optum contract is limited to management of
outpatient behavioral health services. Exclusions to the study included inpatient behavioral health
including State Hospital and Intermountain Hospital, and any behavioral health services provided to
inmates. In 2000, the state paid $8.8M in outpatient behavioral health services. By 2012, the cost had
increased to $76.2M. With initiation of the Optum contract, the 2015 cost was reduced to $3.5M (a 50%
cost reduction) while at the same time the number of clients served increased. The contract includes
performance incentives and shared savings between Optum and the state. In 2015, $5.1M was
reinvested into the community. The Office of Performance Evaluation looked to see if the cost reduced
could be attributed to cost shifting. They found no evidence of cost shifting. The Office recommended
extending managed care to inpatient behavioral health services as a next step toward major system
transformation.
Joint Hearing on Healthcare Issues
Friday morning, the House and Senate Health and Welfare Committees held a joint public hearing on
healthcare issues. Testimony was heard from the public. Three issues dominated the testimony,
overwhelming support for the Healthy Idaho Plan for Medicaid Expansion (Senate Bill 1205) issues with
the Foster Care program, and Suicide Prevention and access to Behavioral Health services (tied to the
Medicaid expansion).
Here is the testimony presented to the Joint Committee on behalf of INA and NLI:
Testimony before the Joint House and Senate Health and Welfare Committee on
behalf of the Idaho Nurses Association and the Nurse Leaders of Idaho
February 12, 2016
Chairman Heider, Chairman Wood, Members of the Committee,
Thank you for allowing me to address the Committee. My name is Mike McGrane. I represent the Idaho
Nurses Association and Nurse Leaders of Idaho.
55,000 nurses are licensed in Idaho. They practice in a variety of settings including public health,
community health, rural clinics, homes, schools and universities, industrial settings, nursing facilities and
hospitals, in addition to many, many other areas. The Idaho Nurses Association represents the broad
spectrum of nurses across our state.
Nurse Leaders of Idaho is an association of nurse executives and managers, nursing program directors,
deans and professors, and leaders from public health, industry, and advanced practice.
As nurses we are the backbone of providing healthcare. Healthcare professionals and the public look to
nurses as the trusted guardians of our health. We are the ones on a daily basis who screen and monitor
patients, coordinate care, instruct wellness and assure compliance. Nurse Practitioners fulfill a necessary
role in providing care in Idaho’s rural communities. Nurses have the upmost concern for the health of
Idaho’s citizens and Idaho communities.
The Idaho Nurses Association and Nurse Leaders of Idaho strongly support the Healthy Idaho Plan (Senate
Bill 1205) as the right choice for the 78,000 uninsured Idaho residents to gain appropriate, comprehensive
healthcare coverage to include preventative care, prescription coverage, and access to specialty and
inpatient care. While much is unknown about the impact of any of the proposed plans, what we do know
it that early intervention, preventive measures, care coordination and care management reduces reliance
on emergency care and hospitalization and ultimately reduces cost. This was most recently demonstrated
in savings to the catastrophic fund from those enrolled in the Healthcare Exchange. We are all paying the
high cost of uncoordinated, inappropriate and unnecessary healthcare by having no plan to address the
uncovered. The Healthy Idaho Plan provides access and coordination for those who find themselves
barely making ends meet and unable to access private healthcare. It also extends the Health Insurance
Exchange, through reliance on the private health insurance market for those who otherwise do not qualify
for coverage. It provides access and personal responsibility that relies on existing programs. The Idaho
Nurses Association and Nurse Leaders of Idaho urge you to adopt the Healthy Idaho Plan as the best
option for coverage of those falling in the gap.
That being said, we applaud the Governor and Director Armstrong for proposing an initial alternative, the
PCAP program. Although the program is very limited and will create barriers to providing equal and
adequate care to all participants due to the significant coverage gaps it includes, it does capture elements
of personal responsibility, the Medical Home model, prevention and early management of chronic illness.
It is better than the current situation of no coverage. If the vote is PCAP or nothing, we would support
voting “Yes” on PCAP.
As nurses we have no financial stake in one plan over another. What we care about is providing access to
necessary, cost effective healthcare for Idaho’s citizens.
Thank you again for allowing me to address you.
Michael McGrane, RN
Idaho Nurses Association and Nurse Leaders of Idaho
Primary Care Access Program (PCAP)
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Primary Care Access Program H484
https://www.legislature.idaho.gov/legislation/2016/H0484.htm
The Governor’s proposal to address coverage for those in the gap between Medicaid and health
insurance subsidy under the Healthcare Exchange was introduced Friday.
CALL TO ACTION
How to Find and Track Bills
The pace of the legislature is picking up with more bills being introduced every day. The Health and
Welfare Committees meet daily, so watching committee calendars and tracking bills is a daily task. You
can go online to www.legislature.idaho.gov
The Bill Center lists bills by number, by topic and by status. You can easily find the bills by their
respective numbers that have been listed in these Updates.
You can also set-up a Bill Tracker that will track the progress of bills. The Bill Tracker will notify you by email whenever there is a change in a bill’s status. These are easy ways to find and track bills of interest.
As you hear of issues or have question about the legislature, please let Mike know by e-mail at
mcgraneconsulting@gmail.com.