Posts Tagged legislation

2021 Legislative Session

2021 Legislative Session

Scope of Practice

  • ATHLETIC TRAINERS: This bill (SB73) provides for the licensing and regulation of athletic trainers relationship with a supervising physician, creates a joint committee of the two state boards, and expands the ability of athletic trainers to treat injuries sustained by physically active individuals. The Association worked with the ATs prior to the session and are supporting these bills. SB73 was signed by the Governor. 
  • OPTOMETRY: These bills (SB174 & HB402) would have allowed optometrists (who do not undergo any surgical residencies anywhere in the U.S.) to perform surgeries and injections on the eye. This legislation was being pushed by Senator Jim McClendon, the chairman of the Senate Health Committee and an optometrist himself. You may recall the controversy surrounding similar legislation last year when Sen. McClendon rammed the bill through committee without calling a proper vote (video). We stood opposed to these bills. Thank you for reaching out to your legislators! These bills did not pass.
  • PODIATRY: These bills (HB291 & SB371) would have allowed podiatrists who have completed as few as 2 years of podiatric residency (significantly less than a general orthopaedist and orthopaedic surgeon) to perform surgery on the foot and ankle. The same legislation was introduced last year but failed to receive a vote. We worked with the Alabama Orthopaedic Society to oppose this legislation.  Thank you for reaching out to your legislators! These bills did not pass.
  • PHYSICAL THERAPY:  This bill (SB237) was brought by Sen. Jim McClendon and expands the services a licensed physical therapist can render without a prescription or referral in two ways: (1) it extends the current time limit for which services can be provided from 90 days to 120 days; and (2)  it allows physical therapists to treat patients without referral upon their determination that the patient is “medically stable” and “deemed suited to receive physical therapy.” We believe that a medical diagnosis is important and should always come before treatment. This bill did not pass.

Public Health

  • EMERGENCY TIMEFRAME & AUTHORITY: This bill (SB97) limited the timeframe for which a state of emergency can be declared (by the State Health Officer or Governor) to only 14 days. The bill also gave the Legislature the sole authority to extend such declarations. This bill did not pass.
  • COUNTY HEALTH OFFICERS: These bills (SB184 and HB168) would prohibit a county health officer from issuing orders or directives during an epidemic or disease outbreak if the State Health Officer has issued one already. The bill also applies to orders or directives on the county level that are more protective than the state’s guidance. The Association supports County Health Officers and believes local physicians are best suited to make decisions for their local population. These bills did not pass.
  • ABOLISHING MLC & RESTRUCTURING BME: This bill (SB239) was brought by Sen. Jim McClendon and would abolish the Medical Licensure Commission, have the Board of Medical Examiners take on the duties of the Commission, and forbid leaders of any physician specialty organization from serving on the “new” board. By consolidating two, separate agencies into a single regulatory body, this legislation overhauls the current congressional representation requirements, revokes the appointment powers of the Lt. Governor and Speaker of the House, and decreases the board composition by more than half. The amount of issues the Association has with this legislation are lengthier than the bill itself. The bill was defeated by a vote of 8-3 in committee. Thank you to everyone who contacted their Senator and told them to oppose the bill!
  • ABOLISHING & RESTRUCTURING STATE BOARD OF HEALTH: This bill (SB240) was brought by Sen. Jim McClendon and would abolish the State Board of Health, the State Committee of Public Health, the County Boards of Health, and the position of the State Health Officer (among other things). With the two boards and physician oversight no longer existing, the bill creates a new State Health Advisory Board made up of a laundry list of individuals who have some type of relationship to healthcare. County Boards of Health are instantly gone, too, turning such over to the determination of the County Commission. Strangely enough, the State Health Officer position would not exist, but two roles take its place, with the highest (termed “Secretary of the Alabama Department of Public Health”) now appointed by the governor with no requirement that he/she be a physician. We support our state and local boards of health, we support our State Health Officer, and we will vehemently oppose this bill. Thank you for reaching out to your legislators! This bill did not pass. 
  • IMMUNIZATION REGISTRY (ImmPrint): This bill (HB184) by Rep. Paul Lee would require health care providers to report immunization data to the ImmPrint registry and to review the registry before a vaccine is administered. Annual influenza vaccinations are exempt from the review requirement for adults, but are still required to be reported. The Association worked with members of our President’s Council and other specialties in support of this bill. This bill did not pass.
  • COMMUNITY PARAMEDICINE: These bills (HB141 & SB115) would authorize ADPH to establish and administer a community paramedicine program that allows paramedics to provide certain services to patients. The Association worked ACEP and other specialties in drafting the bill. HB141 was signed by the Governor.
  • MEDICAL MARIJUANA: This bill (SB46) by Sen. Tim Melson, M.D. (R—Florence) would authorize medical marijuana in the state. The House Judiciary Committee, the first of two House committees expected to vet the bill, conducted a public hearing Wednesday. Rep. Mike Ball (R—Madison), a Judiciary Committee member and retired law enforcement officer, is shepherding the bill in the House. SB46 was signed by the Governor.
  • SEXUAL ASSAULT SURVIVORS BILL OF RIGHTS: This bill (HB137) creates the Sexual Assault Survivors Bill of Rights and provides certain rights to all victims of sexual assault. The bill also creates a task force responsible for developing recommendations for improving the coordination of the dissemination and implementation of best practices and protocols to hospital administrators, physicians, forensic examiners, and other medical associations and leaders in the medical community. The Association worked with the bill sponsor to amend the bill and ensure physician liability was not expanded. HB137 was sent to the Governor.
  • PHARMACY BENEFIT MANAGERS: This bill (SB227) would prevent practices of pharmacy benefit managers relating to patient steering to use mail-order pharmacies and would prevent price discrimination. It would also require the PBM to act as a fiduciary to clients and would prevent them from stopping pharmacists from disclosing prices. SB227 was signed by the Governor.

Lawsuits & Liability

  • COVID-19 LIABILITY PROTECTION: This bill (SB30) provides liability protection to physicians, health facilities, and businesses from claims arising from COVID-19 and the state’s response to the pandemic. The Medical Association, with the help of Starnes, Davis, Florie, LLP, worked with Sen. Arthur Orr in drafting this bill. SB30 was signed by the Governor. 
  • GENDER CHANGE THERAPY:  These bills (HB1 & SB10) would make it a felony for doctors to treat transgender youth with hormonal therapy and puberty blockers to help their transition. More specifically, the bills would prohibit the use of puberty-blocking drugs, hormonal therapy and surgery to treat transgender minors. Violators could face up to 10 years in prison. A House Judiciary committee amendment was added to narrow the focus of the bill and remove “counseling” a patient and “dispensing” medication to a patient from the list of prohibited activities. Read more on these bills at AL Daily News,, and KFF. These bills did not pass.
  • BORN ALIVE ABORTION: This bill (HB237) would make it a Class A felony if a physician does not exercise reasonable care to preserve the life of a child born alive after an abortion or attempted abortion in an abortion or reproductive health center. HB237 was sent to the Governor.
  • CHEMICAL ABORTION: This bill (HB317) expands a physician’s standard of care to mandate three types of required patient disclosures when performing or attempting to perform chemical abortions or abortions due to a medical emergency. A physician performing or attempting to perform an abortion who violates these rules recklessly or knowingly is guilty of a Class C felony, and does not have a medical emergency exception authorizing abortion to be “a claim or diagnosis that the woman will engage in conduct which she intends to result in her death or in substantial and irreversible physical impairment of a major bodily function.” This bill did not pass.
  • CHEMICAL ABORTION PROHIBITION ACT: This bill (HB377) would prohibit the manufacture, distribution, prescription, dispensing, sale, or transfer any type of generic or non-generic abortifacient medication in Alabama. HB377 has a public hearing in the House Judiciary Committee next week. We oppose. This bill did not pass.
  • GENITAL MUTILATION: This bill (HB252) creates the crime of “genital mutilation” as a Class B Felony in Alabama. Although the list of acts that constitute “genital mutilation” is long, nothing in the bill applies to procedures medically necessary procedures or procedures performed during labor. The legislation adheres to the ACOG position on genital mutilation and also contains Medical Association language explicitly stating that nothing shall be construed to establish a standard of care for hospitals or physicians. This bill did not pass.
  • MEDICAID FALSE CLAIMS ACT: This bill (SB241) was brought by Sen. Jim McClendon and prohibits certain fraudulent activities affecting the Alabama Medicaid program. Furthermore, liability for violations of these prohibitions includes (1) a civil penalty of $5,500-$11,000 per claim, and (2) treble damages. These prohibitions and penalties are different and much more drastic than what currently Medicaid and Medicare law provides, creating very serious liability and monetary concerns for physicians. This bill did not pass.
  • MINOR DNAR: This bill (HB224) would require physicians to obtain consent of parent or legal guardian of a minor prior to entering “do not attempt resuscitation” order. HB224 was sent to the Governor.
  • VACCINE PASSPORTS: This bill (SB267) as substituted would prohibit state and local government entities from requiring an individual to receive an immunization to receive certain government benefits. It would also prohibit businesses from refusing service based on immunization status. SB267 was sent to the Governor.

Finance & Taxation

  • CARES ACT TAX EXCLUSION: These bills (SB98 & HB170) exclude any money received from the CARES Act or other similar COVID-related relief measures from Alabama income tax. “We are not going to tax any of the stimulus monies that came in for businesses, for individuals, for anyone,” said Senator Dan Roberts (R-Mountain Brook). HB170 was signed by the Governor.

Federal Legislation

  • MEDICAID EXPANSION: On March 11, 2021, President Biden signed the American Recovery Act of 2021. The legislation includes a short provision outlining that states, for a length of five years, can extend Medicaid eligibility to women for 12 months after giving birth. The bill also provides an incentive for states that newly expand Medicaid by temporarily increasing the state’s base FMAP by 5% for two years. Please join the Cover Alabama Coalition in supporting Medicaid expansion in Alabama.

Posted in: Advocacy

Leave a Comment (0) →

Association Secures Significant Changes to Midwife Board Rule

Association Secures Significant Changes to Midwife Board Rule

The Medical Association and a coalition of health organizations this week convinced a legislative committee with oversight of state board regulations to make changes to a dangerous proposed regulation by the newly-formed Alabama State Board of Midwifery.  The Midwifery Board was established by law in 2017 to license non-nurse midwives.

The proposed regulation – if adopted by the legislative committee as it was proposed by the Midwifery Board – would have allowed non-nurse midwives to practice pediatrics and procure, store and use drugs, neither of which is allowed by state law. In addition to striking these two provisions from the ASBM’s proposed regulation, the legislative committee also added a requirement that, in the event a woman attempting to give birth at home with a non-nurse midwife transfers to a facility, the non-nurse midwife is required to accompany her client. As well, the legislative committee struck language in the Midwifery Board proposed regulation that would have limited the ASBM’s disciplinary “look back” period to only 18 months. No professional health licensure boards in Alabama have such a limited timeframe for “look back.”

The Medical Association and others in the health coalition had worked with the Midwifery Board for more than six months in an attempt to get the Board to voluntarily bring its proposed regulation into compliance with state law. While the Midwifery Board chose not to accede to the coalition’s requests, the Medical Association supports the changes made to the proposed regulation by the legislative committee this week as being in the best interest of both pregnant women and their babies.

The Midwifery Board meets next week to take up the revisions the legislative committee made to its proposed rule. At that meeting or before the Dec. 4 deadline, the Midwifery Board will have to decide whether to adopt the changes the legislative committee made to its proposed regulation or to start over with the rulemaking process.

Posted in: Advocacy

Leave a Comment (0) →

What’s the Future for Physicians without Net Neutrality?

What’s the Future for Physicians without Net Neutrality?

Net neutrality has changed the digital landscape for millions of Americans, specifically physicians and health care professionals, but that could all change on June 11. In December, the Federal Communications Commission voted to repeal the net neutrality rules set in place by the Obama Administration, and on June 11 the repeal of net neutrality is set to take effect. Many professionals are unaware of the positive impact net neutrality has had in areas of the health care profession, such as telemedicine and technology education since it passed in 2015. Despite these technological advancements, many doctors still do not understand net neutrality, or the potential effect the repeal will have on their practice.

What is net neutrality?

Net neutrality is the concept that Internet Service Providers (ISPs) like Verizon, Comcast and Spectrum are required to handle all data equally. Meaning ISPs cannot slow down some websites and speed up others. Net neutrality operates all websites loading at equal speeds and treats all content online fairly. Also, it protects the consumer from paying more money for slower internet speeds. Net neutrality keeps everyone on a level playing field with everyone having the same rights to the equally fast internet, and all websites are available at the same speed and quality.

Life without net neutrality

Without net neutrality, non-profit and educational websites and databases run the risk of being de-prioritized for commercial websites, meaning the importance of educational materials and research is left up to the internet service providers. Allowing ISPs the ability to decide the importance of internet content leaves the potential for the medical and academic community to suffer. Additionally, we can expect slower internet speeds affecting the ability to live-stream, upload and download promptly. Overall, a divide will be created between those who can afford faster internet service and those who are stuck with the slower bandwidth.

What does this mean for physicians? 

For physicians and health care professionals, the repeal of net neutrality could be detrimental. First, professionals run the risk of paying significantly more for high-speed internet capable of downloading, uploading, sending and receiving digital medical records. Also, all the advancements made in telemedicine recently could become stagnant. Despite the recent advancements, the future of telemedicine remains uncertain because even if the doctor can afford the high-speed internet to treat patients, many patients may not be able to afford the high-speed internet capable of live-streaming with their doctor.

Likewise, the education of doctors will be impacted significantly. For medical students, there is potential for an increase in tuition since it will cost more for high-speed internet capable of downloading and uploading medical books and research vital to their education. For doctors, it will become harder to stay up-to-date on the most recent research and studies in their field. Educational and non-profit websites will be overshadowed by commercial websites paying ISPs, making it harder to access scholarly research. Finally, the competition created between commercial websites and educational and non-profit websites will hinder and slow-down research. Overall, net neutrality has created a level playing field on the World Wide Web. It has made possible technological advancements that empower physicians with the education and tools they need to best care for their patients.

How can you make a difference?

On Wednesday, May 17, 2018, the Senate voted to reinstate the net neutrality rules repealed in December. The legislation is currently in the House where it is given little hope of advancing. Contact your district’s representative and express your concerns over the end of net neutrality and the effects it will have on physicians and healthcare professionals.

Posted in: Advocacy

Leave a Comment (0) →

What If No One Was On Call…2017 Legislative Review

What If No One Was On Call…2017 Legislative Review

In times of illness, injury and emergency, patients depend on their physicians. But what if no one was on call? Public health would be in jeopardy. However, the same holds true during a legislative session. What would happen if the Medical Association was not on call, advocating for you and your patients at the Alabama Legislature? Keep reading to find out.

Moving Medicine Forward

Patients and their physicians want assurances about not only the quality of care provided, but also its continued availability, accessibility, and affordability. Patients want to make health decisions with their doctors, free from third-party interference. Continued progress toward these objectives requires constant vigilance in the legislative arena, where special interest groups seek to undermine physician autonomy, commoditize medicine and place barriers between physicians, their patients and the care their patients need.

If no one was on call… Alabama wouldn’t be the 20th state to enact Direct Primary Care legislation. DPC puts patients and their doctors back in control of patients’ health and helps the uninsured, the under-insured and those with high-deductible health plans. SB 94 was sponsored by Sen. Arthur Orr (R-Decatur) and Rep. Nathaniel Ledbetter (R-Rainsville).

If no one was on call… the Board of Medical Scholarship Awards could have seen its funding slashed but instead, the program retained its funding level of $1.4 million for 2018. The BMSA grants medical school loans to medical students and accepts as payment for the loan that student’s locating to a rural area to practice medicine. The BMSA is a critical tool to recruiting medical students to commit to practice in rural areas. As well, the economic footprint of every physician is at least $1 million, which improves both community health and local economies.

If no one was on call… Medicaid cuts could have been severe, possibly reducing access for patients within an already fragile system in which less than 20 percent of Alabama physicians participate. Due to work done during the 2016 second special session and the 2017 session, sufficient funds were made available for Medicaid without any scheduled cuts to physicians for 2018. Increasing Medicaid reimbursements to Medicare levels – a continued Medical Association priority – could further increase access to care for Medicaid patients.

Beating Back the Lawsuit Industry

Personal injury lawyers are constantly seeking new opportunities to sue doctors. While Alabama’s medical liability laws have fostered fairness in the courtroom and improved the legal climate, each year personal injury attorneys seek to undo parts of the very law that helps keep “jackpot justice” and frivolous suits in check.

If no one was on call… an $80 million tax increase on physicians to fund a new government-administered malpractice claims payout system called the Patients Compensation System could have passed. The PCS would administer damage claims for physical injury and death of patients allegedly sustained at the hands of physicians. Complaints against individual physicians would begin with a call to a state-run 1-800 line and would go before panels composed of trial lawyers, citizens and physicians to determine an outcome. In addition, any determinations of fault would be reported to the National Practitioner Databank. The Patient Compensation System would undo decades of medical tort reforms, which the Medical Association championed and is forced to defend from plaintiff lawyer attacks each session. The PCS deprives both patients and doctors of their legal rights.

If no one was on call… physicians could have been exposed to triple-damage lawsuits for honest Medicaid billing mistakes. The legislation would create new causes of civil action in state court for Medicaid “false claims.” The legislation would incentivize personal injury lawyers to seek out “whistleblowers” in medical clinics, hospitals and the like to pursue civil actions against physicians and others for alleged Medicaid fraud, with damages being tripled the actual loss to Medicaid. The standard in the bill would have allowed even honest billing mistakes to qualify as “Medicaid fraud,” creating new opportunities for lawsuits where honest mistakes could be penalized.

If no one was on call… physicians would have been held liable for the actions or inactions of midwives attending home births. While a lay midwife bill did pass this session establishing a State Board of Midwifery, the bill contains liability protections for physicians and also prohibitions on non-nurse midwives’ scope of practice, the types of pregnancies they may attend, and a requirement for midwives to report outcomes.

If no one was on call… the right to trial by jury, including jury selection and jury size, could have been manipulated in personal injury lawyers’ favor.

If no one was on call… physicians could have been held legally responsible for others’ mistakes, including home caregivers, medical device manufacturers and for individuals following or failing to follow DNR orders.

Protecting Public Health and Access to Quality Care

Every session, various pieces of legislation aimed at improving the health of Alabamians are proposed. At the same time however, many bills are also introduced that endanger public health and safety, like those where the legislature attempts to set standards for medical care, which force physicians and their staffs to adhere to non-medically established criteria, wasting health care dollars, wasting patients’ and physicians’ time and exposing physicians to new liability concerns.

If no one was on call… legislation could have passed to lower biologic pharmaceutical standards in state law below those set by the FDA, withhold critical health information from patients and their doctors, and significantly increase administrative burdens on physicians.

If no one was on call… allergists and other physicians who compound medications within their offices could have been shut down, limiting access to critical care for patients.

If no one was on call… numerous scope of practice expansions that endanger public health could have become law, including removing all physician oversight of clinical nurse specialists; lay midwives seeking allowance of their attending home births without restriction or regulation; podiatrists seeking to amputate, do surgery and administer anesthesia up the distal third of the tibia; and marriage and family therapists seeking to be allowed to diagnose and treat mental disorders as well as removing the prohibition on their prescribing drugs.

If no one was on call… state boards and agencies with no authority over medicine could have been allowed to increase medical practice costs through additional licensing and reporting requirements.

If no one was on call… legislation dictating medical standards and guidelines for treatment of pregnant women, the elderly and terminal patients could have been placed into bills covering various topics.

Other Bills of Interest

Rural physician tax credits… legislation to increase rural physician tax credits and thereby increase access to care for rural Alabamians did not pass but will be reintroduced next session.

Infectious Disease Elimination… legislation to establish infectious disease elimination pilot programs to mitigate the spread of certain diseases failed to garner support on the last legislative day.

Constitutional amendment proclaiming the State of Alabama’s stance on the rights of unborn children… legislation passed to allow Alabamians to vote at the November 2018 General Election whether to add an amendment to the state constitution to:

“Declare and affirm that it is the public policy of this state to recognize and support the sanctity of unborn life and the rights of unborn children, most importantly the right to life in all manners and measures appropriate and lawful…”

If ratified by the people in November 2018, this Amendment could have implications for women’s health physicians.

Coverage of autism spectrum disorder therapies… legislation passed to require health plans to cover ASD therapies, with some restrictions.

Portable DNR for minors… legislation establishing a portable DNR for minors to allow minors with terminal diseases to attend school activities failed to garner enough votes to pass on the last legislative day.

If the Medical Association was not on call at the legislature, countless bills expanding doctors’ liability, increasing physician taxes and setting standards of care into law could have passed. At the same time, positive strides in public health — like passage of the direct primary care legislation — would not have occurred. The Medical Association is Alabama physicians’ greatest resource in advocating for the practice of medicine and the patients they serve.

Posted in: Advocacy

Leave a Comment (0) →