Ohio Senate Follows Through on Veto Overrides; More Votes Looming
As previously reported, the Ohio House of Representatives met in July and voted to override 11 of Governor Kasich’s 47 line item vetoes in House Bill 49, the State Operating Budget for Fiscal Years 2018 and 2019. The Ohio Senate did not immediately convene to follow suit, however Senate President Larry Obhof (R-Medina) indicated that votes were likely in August and September. The Ohio Senate met last week and took 6 of the 11 House veto overrides; this now marks the first time in four decades that the General Assembly has voted to override a Gubernatorial line item veto. President Obhof has scheduled session on September 6th to consider the remaining veto overrides and the House can still call up any other veto to override when legislators return next month. Among Governor Kasich’s vetoes is language that would have frozen Medicaid Expansion enrollment beginning in July 2018; the House could take this up next month.
The Senate action preserves language requiring the Ohio Controlling board, a spending oversight panel, to approve the release of funds for Medicaid Expansion in the future; another veto override will place limits on funding increases that the Board can act on without legislative approval. Two veto overrides will result in increased Medicaid reimbursement for nursing homes and neonatal service provides, respectively. Governor Kasich’s Office of Health Transformation has been pushing to redesign behavioral health service reimbursement within Medicaid, however that effort will not be delayed until July 2018 under another veto override. Finally, the last veto override will retain language requiring future expansions of Medicaid eligibility to be approved by the legislature. These veto override votes come as Governor Kasich travels across the nation promoting a bipartisan healthcare reform plan with Governor John Hickenlooper (D-Colorado).
Governor Kasich Announces New Opiate Prescribing Rules
Following months of action by the State Medical Board of Ohio, the State of Ohio Pharmacy Board, and other regulatory bodies, Governor Kasich announced the adoption of rules limiting the amounts of opiates that can be prescribed for acute pain. The Ohio Chapter of the American College of Surgeons provided comments throughout the development of these rules and was able to achieve a number of positive changes. These rules are the latest effort by Governor Kasich and legislative leaders to stem the diversion and abuse of prescription opiates. Thankfully, the number of opiate prescriptions and resulting overdose deaths are on the decline. Under the new rules, opiate prescriptions for acute pain are generally limited to five days for children and seven days for adults. Further, the rule caps the total Morphine Equivalent Dose of an opioid analgesic prescription at 30 MED.
If a physician believes that a longer prescription or higher MED is appropriate, then he or she may prescribe above these limits so long as the rationale is noted in the patient’s medical record. These rules become effective on August 31st. These rules only apply to acute pain; chronic pain and prescriptions related to treatment for cancer, palliative or hospice care, or drug addiction are exempt. Another rule, developed by the Pharmacy Board and effective on December 29th, would require the first four alphanumeric characters of a CPT code to be included on any schedule II opiate prescription. This requirement expands to all controlled substances beginning July 1st, 2018. The Ohio Chapter of the American College of Surgeons expressed opposition to the Pharmacy Board CPT Rule and we continue to work with other physician organizations that have similar concerns over the cost and necessity of this mandate.