HELENA — As the 67th Montana Legislature got underway this winter, Montana Nurses Association Executive Director Vicky Byrd set to the task of soliciting input from health care professionals about desired changes to state law. One theme that emerged from those conversations was the denial by some health care facilities and insurance companies of medical form signatures from advanced practice registered nurses — denials that flew in the face of a law passed in 2019 granting Montana APRNs signature authority parity with physicians.
“They were literally printing off Senate Bill 94 and stapling it to the form that got denied,” Byrd said, referencing the 2019 law.
The trouble sprang from discrepancies in how different state laws define health care providers, prompting Byrd and her staff to pore over Montana’s code for additional wrinkles. They identified more than 270 statutes that failed to reflect current practice in Montana’s health care system, some of which Byrd said haven’t been changed since the mid-1990s. The association subsequently recommended that lawmakers initiate a wide-reaching regulatory cleanup during the legislative interim.
“If we have 270-plus now and we keep passing more laws and don’t update this, we’ll never catch up,” Byrd said.
The resulting proposal, House Bill 495, passed the Legislature with bipartisan support and was signed into law last month. Unlike a raft of new high-profile health care laws implementing direct regulatory changes in telehealth, primary care practices and prescription drug access, to name a few, HB 495 leaves the work of combing through Montana law to a new health care provider task force made up of representatives from state agencies and industry boards. Members have been tasked with recommending ways to resolve the various duplications, conflicts and inconsistencies that have taken root during decades of policy making
“It not only just eliminates unnecessary codes,” said HB 495 sponsor Rep. Mary Caferro, D-Helena. “It will have an impact on increasing access to health care, especially in rural Montana, providing better care and efficiency in the overall system, because right now the codes not only duplicate each other, not only are antiquated, but they’re inaccurate.”
Caferro points to the original issue about APRN signature authority as a prime example. In rural Montana, Caferro said, an APRN is often the only health care provider close by, making their ability to sign medical paperwork or issue referrals to specialists a significant advancement in health care access. Differing statutory definitions have continued to result in challenges. Caferro recalled a story involving a pregnant woman who was referred to a specialist by an APRN only to have that specialist deny that referral based on a portion of state law. Caferro said the woman had to secure an appointment with a physician to obtain a referral, then return to the specialist.
“Because of the scope of practice being defined inaccurately all along, it could have been one trip and it ended up being three,” Caferro said. “Time ticks for these particular situations, and that’s not in the best interest of the health care of that mother and her baby.”
Rich Rasmussen, president of the Montana Hospital Association, offered another example of how the task force’s work could help to streamline health care regulation and delivery in the state. Under current law, Rasmussen said, oversight of paramedics falls to the Montana Board of Medical Examiners at the Department of Labor. Regulation of paramedic education programs and the emergency medical services that employ first responders, however, is housed at the Department of Public Health and Human Services. With Montana’s EMS system “crumbling,” Rasmussen said, bringing those responsibilities under one roof could allow the health care community to begin addressing one of Montana’s major issues “in a holistic manner.”
Another priority for the task force will be identifying incongruities between state law and federal regulation. Montana health care providers have to comply with rules adopted by scores of U.S. agencies, from the Department of Agriculture to the Nuclear Regulatory Commission, and any violation tied to conflicting state policies can have serious financial consequences. With that in mind, Rasmussen said, a periodic review of Montana health care statutes “makes sense.” He added that the task force also presents a chance to discuss and eliminate any state health care regulations that have proven unnecessary or burdensome, something he notes Gov. Greg Gianforte has identified as a priority for his administration.
“The governor has talked about how can we reduce regulation, and I think any industry would welcome reducing regulation as long as it led to smarter government,” Rasmussen said. “This gives us an opportunity to do that.”
The task force, which comprises five members representing the Department of Labor, DPHHS and the state insurance commissioner’s office, has yet to begin its review. But according to Rasmussen, members will have an opportunity to discuss and act on any issues that can be resolved through agency rulemaking or regulations. And as outlined in HB 495, the task force is expected to produce a report for the Legislature’s Children, Families, Health and Human Services Interim Committee by Sept. 15, 2022, including any draft bills addressing needed changes that require legislative action next session.