Medical Association’s Top 10 Highlights for the 2022 Regular Session

While the Medical Association advocated on and monitored hundreds of bills and resolutions during the 2022 Legislative Session, below is a “Top 10” list of some of the major issues on which the Association was involved.

2022 Legislative Session

Scope of Practice Expansion

• Scope Expansion of Podiatry: This bill (SB 101) would expand the scope of the practice of podiatry to include treatment of disorders of the foot and ankle. This bill has passed Senate Healthcare Committee and is awaiting a vote in the Senate.

• Scope Expansion of Optometry: This bill (SB120) would provide further for the scope of practice of optometry and for the exclusive authority of the board to regulate the practice. The bill has passed the Senate and is assigned to House Health Committee.

• Scope Expansion of Nurse Anesthetist: This bill (HB 268) would specify that a CRNA practices in coordination with a licensed physician or a podiatrist. This bill has passed the Alabama House of Representatives and the Senate and is in conference between the 2 chambers.
  
• Pharmacy Prescribing Bill: This bill (HB 402 / SB 307) would authorize a pharmacist to prescribe vaccines and immunizations; and to require pharmacists administering vaccines or immunizations to children under nine years of age, to also recommend annual well-child visits with a pediatrician. This bill was carried over in the House Health Committee, but passed Senate Healthcare Committee.

Lawsuits and Liability

• Private Right of Action: This bill (HB 16) would provide a private right of action against an employer for any adverse reaction, injury, temporary or permanent disability, or death of an employee arising from an employer mandate that the employee receive a COVID-19 vaccine.

• Texas Style Abortion Bill: This bill (HB 23) would prohibit a physician from performing an abortion if a fetal heart beat has been detected or if no test for a fetal heartbeat has been performed, except in circumstances where a medical emergency exists. This bill would provide a private cause of action for enforcement of this act by any person who performs or induces an abortion or who knowingly engages in conduct that aids or abets the performance or inducement of an abortion, including paying for or reimbursing costs of an abortion. This bill would provide injunctive relief and provide damages in an amount of not less than $10,000 for each abortion performed or induced and attorneys’ fees

• Private Right of Action: This bill (HB 29) would provide a private right of action against an employer for any adverse reaction, injury, temporary or permanent disability, or death of an employee arising from an employer mandate that the employee receive a COVID-19 vaccine.  This bill would also prohibit this state from recognizing certain federal mandates.

• Alabama Health Freedom Act: This bill (HB 31) creates the “Alabama Health Freedom Act” that prohibits discrimination based on vaccine status by employers, places public accommodation and occupational licensing boards.

• Employee Vaccine Mandate: This Bill (HB 32) is duplicative of at least part of SB 9, passed in the 2^nd 2021 Special Session.  It prevents an employer from compelling an employee to receive a COVID vaccine if that employee objects “for any reason of personal conscience, based on religious belief, or for medical reasons, including prior recovery from COVID-19.”

• Transgender Procedures: This bill (SB 5) would prohibit the performance of a medical procedure or the prescription or issuance of medication, upon or to a minor child, that is intended to alter the appearance of the minor child’s gender or delay puberty, with certain exceptions. This bill would provide for the disclosure of certain information concerning students to 16 parents by schools. This bill would also establish criminal penalties for violations. This bill has passed the Senate and awaits a vote in the House.

Public Health

• Practice of Midwifery: This bill (HB 164 / SB 328) would remove vaginal birth after a cesarean as a procedure that is a prohibited practice outside the scope of licensed midwifery. This bill was reassigned to the House Boards, Agencies, and Commissions Committee and the Senate version is in Senate Healthcare Committee.

• Student Masking Requirement: This bill (HB 18) would enable a parent or guardian of a student at a public K-12 school to opt out of any requirement that the student must wear a face covering at the school, at a school function, on school bus, or at school bus stop.

• Parent Consent on Vaccines: This bill (HB 19) would require consent of a parent or legal guardian for any minor to receive a vaccination.   

• My Child My Choice Vaccination Act: This bill (HB 30) creates the “My Child My Choice Vaccination Act” and amends Ala. Code Section 16-30-3, expanding the religious exemption from childhood vaccines required for school attendance to a broader exception that is applicable in all circumstances.

• Abolishment of the Certificate of Need Program: This bill (HB 130) would repeal the certificate of need program and abolish the Certificate of Need Review Board, the State Health Planning and Development Agency, the Statewide Health Coordinating Council, and the Health Care Information and Data Advisory Council, which all exist to operate the certificate of need program and collect data to support the operation of the certificate of need program.

• Prior Authorizations: This bill (SB 27) would require a health insurer to communicate to a physician or other health care professional with authority to prescribe drugs, within three business days of receiving a request for insurance coverage of a prescription drug benefit, that the request is approved, denied, or requires supplemental documentation. This bill would also require a health insurer to communicate to a physician or other health care professional with authority to prescribe drugs, regarding the approval or denial of the request, within three business days of receiving sufficient supplemental documentation.

• Maternal and Infant Healthcare: This bill (SB 180) would establish the Maternal and Infant Health Board to reduce maternal and infant mortality rates and improve the health and health outcomes of pregnant women, newborns, infants, and mothers of newborns and infants in the Black Belt region of Alabama. This bill would provide for membership and duties of the board. This bill would provide for community health clinics that include birthing centers in certain counties, provide for a home visitation program to provide prenatal and perinatal care to mothers and infants in underserved areas, provide for telehealth services, and provide for greater utilization of advance practice nurses in these settings. This bill would also require the board to award grants and tuition reimbursement to health care professionals providing maternal and infant health care services.

• Medicaid Expansion: The bill (HB 183) would expand the state Medicaid program and provide assistance to all persons for whom matching funds are available to the state under the Patient Protection and Affordable Care Act.

• Extension of Postpartum Coverage Under Medicaid: Companion bills ( SB 284 & HB 360) would extend the period during which a pregnant woman who is eligible to receive medical assistance under Medicaid may continue to receive Medicaid assistance from 60 days to one year after giving birth

• State Health Officer: This bill (SB 255) will require certain emergency rules, orders, or directives issued by the State Health Officer be approved by the Governor and a copy filed with the Secretary of State before the emergency rule, order, or other directive has the full force and effect of law; and to make non-substantive, technical revisions to update the existing code language to current style.

• Every Mothers Act: This bill (HB 401) would support certain services for women before and after childbirth; to require a physician, prior to the performance of an abortion, to confirm that a woman upon whom an abortion is to be performed has received a free resource access assistance offer; and to provide for the provision and contents of the offer.

• Telehealth: Companion bills (SB 272 & HB 423) officially recognizes telehealth as an approved means for the practice of medicine in Alabama. The Senate bill has passed the Senate Committee on Fiscal Responsibility and Economic Development and awaits a vote in the Senate.

2022 Advocacy Agenda

As the professional association for some 7,000 physicians of all specialties in Alabama, the Medical Association of the State of Alabama exists to serve, lead, and unite physicians in promoting the highest quality of healthcare for the people of Alabama through advocacy, information, and education.

The Medical Association of Alabama is proud to advocate on behalf of physicians and their patients and, despite the challenges to care delivery and daily life brought by the COVID-19 pandemic, is committed to moving medicine forward in 2022.

General Policies Supported

The Medical Association supports the physician-led health team model and maintaining the highest standards for medical care delivery across all specialties of medicine. The Association supports reforming the “certificate of need” process to increase physician ownership of equipment and facilities and expand access to quality, affordable care. The Association supports continued physician compounding and dispensing of drugs in physician offices. The Association supports prohibiting deceptive health care advertising and requiring health professionals identify their license to patients.

The Association supports physician autonomy in patient care and medical practice decisions as well as fair reimbursement for services. The Association also supports reducing the administrative tasks required of physicians by insurers which increase annual health spending and negatively impact patient health. Specifically, the Association supports reforming prior authorization processes and step therapy protocols and ending non-medical switching and co-pay accumulator programs.

Further, the Association supports increasing health insurance options for Alabamians, including expanding Medicaid. The Association supports increasing access to quality mental health care and continued state funding for the Maternal Mortality Review Committee and the Infant Mortality Review Committee. Recognizing the long-term effects of social determinants of health on individuals, families and ultimately communities, the Association supports comprehensive solutions to addressing these challenges, with emphasis on pipeline programs, tax credits and loan forgiveness proposals benefitting rural and underserved areas.

Finally, by ensuring medical liability environment stability and pursuing further civil justice reforms, the Association believes Alabama can continue to attract highly-qualified physicians.

Specific Policies Supported

For 2022 , the Association specifically supports:

General Policies Opposed

The Medical Association opposes any scope of practice expansion for non-physicians that would fracture the physician-led health team model, lower quality of care and/or increase costs for patients. The Association also opposes any interference with the physician-patient relationship and attempts to reduce a physician’s autonomy in patient care or medical practice decisions.

The Association opposes legislation or other initiatives that could increase lawsuit opportunities against physicians, including the establishment of statutory standards of care or any statutory dictums for medical care delivery. The Association also opposes any state-level increase of requirements for Maintenance of Certification. Finally, the Medical Association opposes tax increases disproportionately affecting physicians.

Specific Policies Opposed

For 2022, the Association specifically opposes:

• New lawsuit opportunities against physician employers and medical practices over employment policies
• Efforts to reduce and/or politicize physician involvement in health regulatory affairs
• Expanding Prescription Drug Monitoring Program (PDMP) access for law enforcement
• Statutory requirements for mandatory Prescription Drug Monitoring Program (PDMP) checks
• Changes to workers’ compensation laws negatively affecting treatment of injured workers and medical practices

Discussions with Decisionmakers: Sen. Sam Givhan

What first prompted you to consider running for office?

Now going through one term I see that the freshmen class is making a difference.  We have a special bond and it makes the work more enjoyable.  I try to focus on legislation that avoids us from having unintended consequences. 

How does your background help serve you on the Health Committee and also the Legislature?

I have a lot of physicians in my district.  I also think my background in legal knowledge has helped.

What are some of your legislative priorities this term?

Several counties need more additional circuit judges.

What are some health-related issues important to your district and your constituents?

My district and Huntsville are one of the medical centers for the state of Alabama.  The availability of medical staff is important.  It’s also important to have incentives for physicians to go to rural Alabama.

What do you think people understand the least about our health care system?

Reimbursements.

If you could change anything about our state’s health care system, what would it be?

More physicians and a medical school in Huntsville.

How can the Medical Association – and physicians statewide – help you address Alabama’s health challenges?

Doing what you all do and reaching out to us in a logical non-emotional manner.

What is the one thing you would like to say to physicians in your district?

I am appreciative of the support I have received from so many of them via phone or contact by email. They are very personalized and informative.