House Health Services Subcommittee and Senate Public Health

Share kind of sees a quorum will go and get started because I know we got along public health agenda this afternoon and will give everybody time to get out to eat the First of all up represent Pilkington hasn't made it in yet he's supposed to be here will give him a chance recognized comments in a minute and I'll save my comments when we get down to the actual discussion of why we're here in kind of what the goal objective is so percent do is ask for motion second to adopt the meeting the minutes from the August second twenty twenty one meeting please forget a motion second motion second any discussion any corrections. All favor say aye. Imposed okay. So the the comments for this For those you have been around a while that is set through any public health meetings of any nature scope of practice can be a contentious discussion it can also be a smooth discussion a lot of it depends on the effort that's gone into everything before it happens and what to talk to representative Pilkington and one of things we thought that would be good is to go ahead and start now having a discussion about scope of practice because part of the issue and this is the chair's opinion of part of the issue is that we kind of wait to the last minute and then we'll get all the scope of practice bills thrown in on top of us and it can create for a lively discussion in the committee meeting and also just a lot of back and forth outside of the committee meeting so we thought it would be good just to have an open air conversation of those that are interested show up about our scope of practice and about the procedures and processes what I'd like to ask you to do and fill has pulled up. And and there is really this really genuinely is just an open Mike discussion today to kind of set the tone we've Ford I will say this that we did invite the entities that have scope of practice issue that we can get a hold of they were extended an opportunity to be here don't expect this will be the last meeting hopefully will be a meeting that we can progress over time and filled our knowledge do we have a scope of practice bills that have been introduced for interim study proposals right now. No okay one of things like to draw attention to you got a hand out of the of the rules for dealing with scope of practice you should effect ever got a copy that anybody need to copy that. Okay one of the things draw to your attention is that there is a little bit of a difference of handling of the scope of practice if you look at the house rules and Phil I thank as it highlighted on everybody's but if not if you look at page sixty seven in the in the handout So is except as provided in subsection B. no action may be taken in the Provides for licensure of any profession profession occupation class health care providers not currently licensed or expands the scope of practice a profession so on so forth and get down the line twenty six of the look of such legislation at least thirty days prior to convening the next legislative session so. There have been I. S. P. that would be introduced thirty days prior to. The next legislative session by House rule on the house side. Bill providing for the licensure of any profession occupation class healthcare but are not currently licensed or expanding the scope of any practice of any profession occupation or class of health care providers may be acted upon without initiate without. Maybe may be acted upon without the initiation of a feasibility study required of subsection a upon two thirds vote of the House Public Health the Senate we flip over to J. eight. Phil from not stating this right you direct me out. When you go over to when you go to J. A. the Senate operates by the joint rules that are outlined their view down page twelve No such bill shall be introduced after the fifteenth day of the regular biennial session lessons introduced first approved for three fourths vote of the full membership of each House of the General Assembly. Prior to that there are lines eight through eleven. the regular simply at the regular biennium session shall be introduced General Assembly during the first fifteen calendar days of the regular biennium so we have the house operated by one set the rules we got the Senate operate by different set of rules and Phil reminded us reminding me that there has been a situation where bills introduced. Not right. I have a second house. Thank you at the table if you don't mind. All right. Yes you're reminded of something that was passed so she goes straight out so what I just said. Yes can you name and title for the record please. Good morning this is just a bill to be of Legislative Research Senator Irvin our state senator Irvin not this past session but in two thousand nineteen. She added the identical saying of all the ISPs to the Senate rules. Okay so if somebody wants to introduce a scope of practice bill just walk us through and how's that different than than what I just read well and you their different roles in the house in the Senate regarding the ice peas that is inaccurate but the house in the Senate have rules that require the ISP to be introduced thirty days will approved. Introduced and approved by the. Sorry. by the house public health committee. And best chambers. So thirty days prior to. To the upcoming session okay and that's in both the house and of the Senate yes Sir okay so what I would ask the members any questions about there any questions one is just. Gestion lighted up there. Thank you Mr so my question is on the House rules I guess and and you're saying that Senate has adopted identical rules I mean yes I didn't realize at best still you said adopted and approved by a public health that's not what I'm reading here on the rule says that right or is it just has to be initiated. Because what I'm looking at no I don't have it before me right now so I can't say the okay language so unless the House Committee on Public Health well welfare labor has initiated a study of the feasibility of such legislation at least thirty days prior to convening then that's not what it is up to the decision of the chairs of both the house and the Senate a public health as to how that language has been interpreted. Tucker interpret that in past sessions the chairs of public health have interpreted that to mean filed and then heard before the committee but it's up to the chairs of public health how to interpret that language thank you for okay so I'm I'm really not trying to put you on the spot. But how is how is that really left up to the chairs if I mean these are these rules of the whole House and the pretty clearly says initiated so are you saying it's it's a of the determination of what initiated means. By the chairs Public Health. Yes Sir okay okay I have no interpretation yes. If they look really not trying to Jones but I mean I have no interpretation session or have them just that is outside my now yeah okay thank you. But typically and typically there's a public health meeting where they bring all I. S. P. is the chair state they bring all ISPs that they might consider scope of practice and they hear them before the committee and either approve them or. Will serve proof the either adopt them or that they don't adopt I'm. And and in the past a health if they adopted them that it's been initiated however the chair's could determine a different interpretation of that. Go ahead just. Our good year the yes I mean I guess if we wanted to challenge that as a member we would just I'm in the house and taken before the house rules committee take it take it to the Speaker what would that process look like because you would probably need to talk to the Speaker and house parliamentarian as to how to appeal a decision of the committee of the chair of the committee okay. Okay thank you. Me ask you just could look of what you've got for a real quick because I wanna make sure we're on the same page as far as information being given out that what you said what's in there is the same thing. Yes Sir okay without the House role this the central excuse me without the Senate role but the Senate role. Other than you know the House it looks exit add dental code to House rule seventy two year. Okay so just just for the benefits that were on the same page here we are sitting in November we got a general session coming up in twenty three. Just walk us through the process just so we're all on the same page as to if somebody wants to file scope of practice how does that play out based on the rules of promotion based on what you said. Are you. Go ahead. Well as an employee of bill are you know I'm not speak for or against anything we're not going to make sure that you guys knew there's also the role in the Senate but based on these rules what would happen is an I. S. P. would be filed. It would be brought to the public health committee the public health chairs to determine whether they thought that would be a scope of practice I SP. They typically this doesn't mean that they would have to this this upcoming they typically hold a meeting where they consider all skip possible scope of practice ice fees. They usually hold that in November or December before the upcoming sessions I would be November December twenty twenty two. they would not approve or not approve. The SP. and then. In the first fifteen days of session a member with that file and I would send file the bill. And on that separate practice legislation. There is also I believe it's in the joint rules. Where. After the first fifteen days they cannot touch that scope of practice bill for additional fifteen days. Sixty days. What did you say I'm sorry did you say sixty days what did you say fifteen fifteen okay sorry but if you're in my part. If you add it all together would be sixty but your it's not really sixty. All right members having. Represent Gonzales. Sorry. Thank you Mr so understand that process for for currently serving member how would a newly elected legislator file a scope of practice bill and get it heard. Is it possible. I'm member who is not a member of the current sitting legislature cannot file an ISP. So if you have someone that's that's elected in November eighth they can't work with B. L. are in and anyway until they're actually sworn in the office in January so that would preclude them from. Filing an ISP or running any type of scope of practice legislation correct well the newly elected member for. See right now we're in the ninety third General Assembly if their newly and elected member for the ninety. Forrest General Assembly they can't find anything until the ninety first General Assembly starts. Whether or not we could work with that would be something that would be up to Marty okay I had to do this. however they cannot find anything okay yes so there's two is in session they cannot follow anything then there's no way that's a so we're essentially limiting what type of bills that a new legislator can can run I have no opinion or interpretation of that I just. I'm not asking for an opinion and it's it's of the factor it's not as a. And can there can may not. But let me let me or being. By rule the way it's written now they would they would not have the ability unless they got another member who is a sitting member right to be able to intervene for them but your point I think is well taken that if you're out there running and you get elected and you want to get started on scope of practice you are the process of elimination consideration to your second term that's right should be a good thing to. The okay okay thank you. Representation. Thank you Mr dry just like that they could if they could garner two thirds support in both chambers correct yes Sir thank you okay thank you Mr thank you for that out well and that's without finding an icy. They can file an I. S. P.. If their newly elected. Member for the ninety fourth General Assembly they could not follow S. P. or build during the well thank you file a bill but they could not file for the early filing deadline for the early the early vote the pre filing but they can follow Vice P. in the ninety third General Assembly. Seventy cents. Okay we'll let me ask you something by rule by rule the way it's written right now let's say a new member gets elected comes in he he or she can get the two thirds vote. Could. Could the bill be killed because there was not a I S. P. that preceded it the way the rules are written. Well the way the the way the rules are written is that a bill and and this is in the House role seventy two bay bill providing for the licensure of any profession occupation or class of health care providers not currently licensed or expanding the scope of any practice of any profession occupation or class of health care providers may be acted upon without the initiation of a feasibility study which is an I. S. P. E. R. has traditionally been been considered ISAPI. M. required in subdivision a upon a two thirds vote of the house public health welfare and labor committee membership. If the chair makes a different determination of that. Right it is up to interpretation of of the chair as to how to interpret the language of the world. Okay all right any other questions for Jessica. Do not hang around a second just case the conversation create some other questions so you'll have to a thank you ran from your office over here five are you over there anyway okay. All right any other questions this time. Senator Bledsoe. Thank you Mr chair. Can the chair of public health B. overrule. You know an appeal the chair public house and opinion I'm not sure if certain of the procedures that feel may have a better knowledge of that the rules do not explicitly state that you could or could not it it would have to get a feel for the procedures and the House you may want to call the house or the Senate as to how that would work thank you. Fieldy one weigh in on that are you having like okay. Okay. All right any other questions for just right now. Our thank you if you don't mind will keep around a minute two we get through here Members the. Just the the conversation that we just had a again one of the reasons for this meeting today is to begin to get the creative juices flowing as far as if there are things that we think that we would like to do because this is the committee that would be handling the scope of practice ISPs that'll be coming down you know one of the things that I've heard over the years that I've said I'm public health is that the I. S. P.'s get filed really late in you know the year and there's not adequate time to really have the discussion with regards to the content of some of the proposed legislation what I'd like to ask you to think about just bring back to the next meeting some of your thoughts as far as if there are things that we need to look at with regards recommendations of changing the rules based on on that comment and some others I'll just ask Is anybody have an opinion about that. And then let me ask you this. While we're sitting here are there things that you think that the committee needs to take up for discussion regarding the process of how we deal with I. S. P.'s that you would like other members of the committee to be thinking about and why you're thinking of that if you haven't thought about that give me a minute one of the things I would like to do is to incorporate the different medical professions and bring them into the committee meetings to hear what they have to say and I'm just gonna be real honest about this if we schedule some meetings and won't be a lot but if we provide a platform for those entities to be able to come into the Committee and share with us as a committee things that they think that we ought to be considering and they don't show up and they don't express their opinion and they don't share their thoughts when the rubber meets the road for the ayes piece to be taken up and considered especially when it gets into the general session and they haven't done anything to participate by bringing forth any ideas we're going to accept the status quo is what they want to live with and I would want to use that as a point of reference to say we gave you an opportunity but you didn't take advantage of it so don't complain to us about it if you don't like it some of the things I would like for us to discuss at a future time is any proposed changes or reflection any proposed changes to any scope of practice needs to reflect consideration of the regional and the national of professions as to whether it has helped increase quality of life on a regional level are on national level any supporting documentation to show how the proposed change of the scope of practice will increase quality of life outcomes would like for there to be a conservative for to resolve differences prior to legislation being introduced so that way. They come into the Committee they will at least be able to provide some evidence that they have worked it out with the other side I don't mean to pick on to but optometrist ophthalmologist would be one key example nurses doctors that they can show to the Committee good faith effort that they've actually tried to work it out before they dump it in our lab of the other one is how our scope of practice policy is aligned with the region and at the national level I'd like for the committee to take that up just as a a research project so that we can do our own analysis and and take a look in you says comparison to some of the scope of practice bills that'll be brought before and I would like to give the different medical professions the opportunity to submit things that they would like maybe for us to consider in the discussion I'll just open it up and asked to any members have any any thoughts regarding any of that conversation by the chair. All right anybody else Kay thank you wanna bring up for the committee for this one this is just to get the door open start with some other creative juices thinking about our scope of practice and how we handle it represent Gonzalez. I thank Mr of the one of. I feel like I'm just taken over here but I do have an opinion and I think but probably most of us do and I don't know the joker about mine but I think that this is a. More less unnecessary rules I would like to see it just done away with period the way that we've used in the past it's it's. Really not been used amend the ISPs were filed and I think it was mentioned here they're all heard and in a single meeting it seems like we just adopt them them and in my past most of the time so we don't. Use the process of this was designed to to set out in and do I think it could be beneficial to use that ISP process if the member wants to but I do think it's kind of ridiculous that we limit what a member can files just based on on it being a scope of practice I realize that is a very important issue but we deal with a lot of important issues in the legislature that we don't have the same roadblocks to the filing a bill on so. My opinion is I'd like to see it completely on way. Okay. Bills. All right nothing else forces just kind of set the set the starting point to further discussions moving forward anybody from the audience have anything to say for me the medical professional groups are here. All right. No other business where John thank you.