Showing 15 posts by Andrew B. Wilson.
Delaware’s Death with Dignity/End of Life Options/Physician-Assisted Suicide Debate Continues with House Bill 140
Representative Paul Baumbach yesterday re-introduced his “End of Life Options” legislation as House Bill 140. This marks the third iteration of the bill, which began as House Bill 150 “Death with Dignity” in 2015, which was re-filed in 2017 as House Bill 160 “End of Life Options.” While there have been tweaks along the way, the major fundamentals have remained the same – a process for a patient expected to die within six months to self-administer medications to end their life. The question now is if there are enough new “yes” votes amongst the fifteen new legislators to clear a chamber, and maybe even move the bill all the way to Governor Carney.
Each new filing has moved the bill a little further towards becoming law. In 2015, Rep. Baumbach was the only bill sponsor in either chamber; the bill was last tabled in House Health Committee after a hearing. There it stayed until it was removed from the books along with every other bill that failed to make it through the process to then-Governor Markell’s signature before the election.
In 2017, Rep. Baumbach won re-election and re-filed the bill, with some adjustments, and was joined by two House colleagues, Rep. Earl Jaques and Rep. Bryon Short, as well as three Senators, Sen. Henry as the Senate prime and Sens. Hansen and Sokola joining as well. Unlike its predecessor, House Bill 160 did come out of committee. Although committee votes are not publicly-recorded by member, the vote tally itself is interesting: one favorable, five on its merits, and two unfavorable. There were fourteen members of the committee, so eight votes were needed, and eight votes it received, with two making the unusual move of voting to release unfavorably, to allow the bill to reach the floor for a debate. More ›
Andrew Wilson, Healthcare and Government Relations attorney at Morris James LLP, and Carol Morris, Delaware’s Director of Telehealth Planning & Development, discuss legal, business, and practical considerations for using telehealth in medical practices. This Primer uses Delaware’s telemedicine law as a model and to address federal infrastructure.
Andrew B. Wilson works on a range of healthcare issues throughout the practice of medicine, assisting clinicians, practices, and other entities through licensing questions, regulatory compliance, and how to innovate using tools such as telehealth.
As Delaware courts test the anti-discrimination provision of the medical marijuana statute, the state legislature has been taking a hard look at marijuana as well. Legalization, decriminalization, and expansion to the medical marijuana program are all on the table.
Regarding the potential for Delaware legalizing recreational marijuana, we renew our 2018 prediction that this is still not likely in 2019. Especially with the retirement of both the House and Senate champions at the end of last session and a failed floor vote in the House in June. That said, it is possible that with so many new faces in legislative hall, fifteen out of sixty-two, there are surprise support votes that come to light. No bill has been filed, but one is anticipated.
As the legalization pathway or non-pathway becomes clearer, the legislature is taking another pass through decriminalization and medical marijuana.
First, Senate Bill 45 extends previous adult decriminalization to persons under the age of 21. If passed, the penalty for possession, use, or consumption of a “personal use” quantity of marijuana would go from criminal to civil.
As frustration builds on the legalization side, pressure also mounts to streamline and enlarge the medical marijuana program. While new dispensaries are opening, now numbering four around the state, the statutory pathways to qualify for a card for their use are being revisited. More ›
As Joe Biden once quipped, “[d]on’t tell me what you value; show me your budget and I’ll tell you what you value.” January 24th is budget day in Delaware. The day to see Governor Carney’s values.
The Governor gave his address at 11 am at the State Archives to a packed room of journalists, legislators, and stakeholders. That afternoon, the two “money bills” representing the state budget were filed. So, let’s talk healthcare and the Governor’s Recommended Budget (GRB) of $4.433 billion. More ›
Delaware Governor John Carney delivered his third State of the State address yesterday, January 17th, in the Senate Chamber. For the healthcare world, what was in it was just as interesting as what was not in it. Highlights included re-emphasis of his existing benchmark proposal as well as Lt. Gov. Hall-Long’s work on mental health and addiction. Looking forward, he signaled a shift in focus to promoting healthy lifestyles, stating support to “raise the age for purchasing cigarettes from 18 to 21.” We’ll unpack these a little more below, but interestingly what didn’t make it in there was any talk about the outcomes of the Medicaid Buy-In Task Force (to not buy the lede – Delaware may become an individual mandate state) or the Primary Care Collaborative, both of which released major reports just a few weeks ago. More ›
Earlier this month the FDA announced that use of electronic cigarettes (or “e-cigs”) reached epidemic proportions among teenagers and it is cracking down. It placed the burden on five manufacturers to prove their devices are not being sold to minors and sent out notices to retailers reminding them of the prohibition against selling to minors under federal law. Delaware has had this same debate in slow motion starting in 2014, attempting to leverage its three main regulatory strategies: sales to minors, Clean Indoor Air Act, and taxes.
Delaware’s three major mechanisms are as follows:
- 11 Del.Code §§ 1115-27 - Prohibition of Tobacco Sale to Minors
- 16 Del.Code §2901 et al. - Clear Indoor Air Act
- 30 Del.Code § 5301 et al. - Tobacco Excise Tax
In a previous post, we discussed how the opiate crisis has been blurring the lines in historic health policy, most recently as it comes to the tenability of taxes and fees on medications. Let’s now put on another pair of glasses and look at health policy through the eyes of law enforcement, particularly as it pertains to the prescription monitoring program, patient privacy, and House Bill 458.
House Bill 458 is a short bill. The meat of it is an innocuous strike-through of four words from the prescription monitoring program statute: “by an identified suspect.” Before we jump into exactly why that matters, let’s set a little context.
What’s a prescription monitoring program (PMP, or, in some states, a PDMP – Prescription Drug Monitoring Program)? Simply put, it’s a database of all controlled substances prescribed and dispensed to patients in Delaware. As section 4798 of Title 16 of the Delaware Code states, “It is the intent of the General Assembly that the Delaware Prescription Monitoring Act established pursuant to this section serves as a means to promote public health and welfare and to detect the illegal use of controlled substances. The Delaware Prescription Monitoring Act shall have the dual purpose of reducing misuse and diversion of controlled substances in the State while promoting improved professional practice and patient care.” More ›
With the primary senate sponsor of House Bill 110, Sen. Margaret Rose Henry, retiring this year, it remains to be seen if there will be any last-minute legalization of the adult use of cannabis in Delaware. While in the down-revenue budget last year marijuana was touted as a $22 million budget-booster, in the up-revenue budget this year the legislature is seeing green, but it doesn’t seem to be marijuana. However, a June amendment after a series of eight task force meetings makes it clear that the advocates and sponsors are not backing down from their goal.
The amendment is long and winding. It makes adjustments from the task force meetings through sales tracking, dollars to law enforcement, clarifications of implications for employment, and banning of candy to curtail concerns about children’s use. It’s a loud amendment, getting more press attention than nearly all filed bills short of gun control. More ›
The multi-year effort to address the addiction crisis, specifically opiates in recent years, continues in earnest. Some policies do seem to be working: as reported by Delaware officials in April, opiate prescriptions are down 14%. The larger addiction public health crisis continues, however, with the News Journal estimating that one person a day still dies from overdose in Delaware. The legislature, the Behavioral Health Consortium led by Lt. Governor Bethany Hall-Long, and Attorney General Matt Denn have not let up in their efforts. This year, a new tactic is coming to the forefront: taxes and fees. More ›
No topic has been hotter in the Delaware legislature this year than gun control. Some view gun violence as a public health crisis and several industry groups have taken positions on the various gun bills. While we’ll briefly touch on some of the broader subjects being discussed, we’re going to hone in on how legislation this session has the potential to change the Delaware healthcare landscape in terms of healthcare professionals’ reporting requirements. Right now our general overall summary of the session from a tangle of proposals (with a few weeks to go) can be summed up as: yes red flag laws, maybe with many caveats on gun accessories, and no to weapon bans. Our major recommendation so far to the Delaware healthcare industry is that mental health professionals seek legal guidance in revamping their policies and procedures for dealing with patients who may be a danger to themselves.
The total number of filings on bump stocks, magazine sizes, purchase age, bans, and protection orders has already reached the double digits. While most of these bills that make it to the agenda clear the Democratic supermajority House, they seem to be stalling in the Senate – a la SB 163 the assault weapon ban that failed to even get out of committee – or get “ping ponged” back to the House with new wrinkles and amendments. Perhaps a reminder that the Senate is a one-vote Democratic majority and that Delaware is in many ways a purple state. One bill emerged as a clear exception to all the rules. House Bill 302, the “Beau Biden Gun Violence Prevention Act” sponsored by Representative David Bentz, mustered unanimous votes and was signed into law in April. Known as a “red flag” law, it is the successor to House Bill 88 of 2013 which was proposed out of then-Attorney General Beau Biden’s office. House Bill 88 passed the House unanimously, but failed in the Senate. More ›
Continuing the Morris James’ government relations team’s seven days of updates on the 149th Legislative session with today’s topic: where is Delaware when it comes to foundational health policy?
Under the Markell administration Delaware received a $35 million State Innovation Model (SIM) grant from the federal government to transform its delivery system. A lot of work went into strategies surrounding healthy neighborhoods, healthcare IT, workforce, practice transformation, and the shift away from fee for service using tools like common scorecards for quality metrics. Some dollars were committed to actual implementation, but the SIM grant’s strongest value to the state was in planning and sharing stakeholder vision.
When Governor Carney entered office in 2016 his focus moved away from the SIM conversation and into his own vision of the healthcare benchmark (more on this when the administration’s report comes out at the end of the month). It started a related, but new conversation about how to put downward pressure on the overall healthcare cost inflation rate. More ›
Over the course of the next few weeks Morris James is going to tell you everything you need to know about healthcare bills that should be on your radar as we close out this legislative session. Guns, mental health, opiates, primary care reform, marijuana, and “the Benchmark” are all on the radar screen. If the world was created in seven days, we can give you that many days of posts to set the healthcare law table on the 149th on each of these topics. Of course, there are always a few “June Surprises” as well that we’ll stay on top of for you.
First, to understand these bills, let’s place them in the right historic context; nothing does that like the budget. In the words of Delaware’s own Vice President Joe Biden, “Don't tell me what you value, show me your budget, and I'll tell you what you value.” So this first post will be about the 2018 Budget and “one time investments.” After the 2017 “shared sacrifice” budget battle and cuts that led to the first late budget in nearly fifty years, it is hard now to reconcile that the state has nearly $430 million in “surplus” revenue as we enter the final month of the 149th Session. For many legislators, this is the first session in their careers that is not predicated on finding cuts and generating revenue. In that context, Governor Carney has been strongly urging caution. “One-time revenues for one-time investments” is the mantra from the executive branch. Governor Carney consistently urges that the fundamental budget still has long-term structural flaws and that putting budget dollars into continued programming may lead to the legislature having to cut that very same programming in the near future. More ›
Delaware's healthcare providers may normally think more about treatment options than their government relations strategy, but the industry makes its voice heard. It should come as no surprise that healthcare tops the charts for lobbying activity in Delaware. Morris James' Government Relations group is in the thick of it for a variety of clients. In the beginning of September, the Delaware State News reported that not just the top spot, but the top two active lobbying organizations in Delaware grapple with healthcare issues. The hospital organization holds the number one spot for activity. Delaware's physician organization, the Medical Society of Delaware, holds the number two spot. More ›
Budget Impasse Leads to Health Cuts & “Sin” Taxes
By 1:30 a.m. on July 3rd, the Governor had signed a budget. It included litany of cuts, including several in healthcare. Public health programs were cut 10%, including funding for prescription drug abuse prevention, needle exchange, immunizations, infant mortality, cancer counseling, and nurse-family partnerships. Also included was $5 million in unspecified “savings” from Medicaid, to be determined by Secretary Walker. However, the DIMER/DIDER/DIVME program, which reserves slots for medical training for Delawareans in neighboring states’ schools, was restored after being cut two years ago. More ›
Marijuana is in the spotlight in Delaware. The question is here: will Delaware legalize? Our best prognostication: not soon.
A comprehensive bill, House Bill 110, has been filed by Rep. Helene Keeley and Sen. Margaret Rose Henry. It cleared its first step this week: passage through House committee, but has a long path ahead yet. A 2016 University of Delaware poll suggests that 61% of Delawareans support legalization, arguably the final step after both medical marijuana and decriminalization were passed under Governor Markell. But the answer to the likelihood of legalization is hazy, according to Governor Carney at a recent round table; he would like to continue to gather data before deciding. More ›