More licensure changes — This time from the Board of Medicine

By Melissa Davlin, Idaho Reports

Idaho’s physician shortage has been a long-simmering problem in the state, especially in rural areas. But the Board of Medicine is removing licensure barriers for doctors from other states and countries in an attempt to improve that deficit.

Anne Lawler, executive director of the Idaho Board of Medicine, presented rule changes to the House Health and Welfare Committee on Thursday morning, citing then-Lt. Gov. Brad Little’s 2017 Licensing Freedom Act executive order as incentives for removing some requirements for medical license applicants.

Among the numerous changes: Broadening allowances for international medical school graduates, raising the dollar amount of malpractice settlement reporting requirements from $50,000 to $250,000, and eliminating a requirement that applicants report past health conditions.

Previously, applicants who attended international medical schools had to show that those institutions had been graduating students for at least 15 years. Just one other state had that requirement, Lawler said, and it had prevented at least one physician from getting her license in Idaho.

The Board of Medicine also repealed multiple rule sections that Lawler described as redundant, as those issues are addressed elsewhere in Idaho’s administrative rules. Those rule sections addressed telehealth, supervising and directing physicians registration, complaint investigations, and more.

The committee adopted the rule changes on a voice vote, with Rep. John Green, R-Post Falls, praising Lawler and Little for slimming down the regulations.

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Board of Pharmacy changes get bipartisan praise, and interest from private business

By Melissa Davlin, Idaho Reports

Don’t want to go to urgent care for that nagging cough? Now, you might not have to.

Changes in rules governing Idaho pharmacists received bipartisan praise on Monday, as presenters noted how experiences for patients and pharmacists alike have improved since those rules took effect last year.

At a House Health and Welfare meeting, Idaho Board of Pharmacy chairwoman Nicki Chopski presented rule changes that allow, among other things, pharmacists to prescribe certain medications and the removal of a $250 law exam once required for pharmacists to get their license.

These changes, along with ones in previous years, have already made a difference, according to those who testified in front of the committee.

Former board chairman Mark Johnston, who currently represents CVS, said the Board of Pharmacy and legislature’s actions caught CVS’s attention — particularly a modification from last year that allows pharmacy technicians to do data entry work remotely.

As a result, the company is opening up a mail order facility in west Boise. That facility is scheduled to open in late summer, Johnston said, and will eventually employ an estimated 150 people.

The facility won’t have any drugs on-site, Johnston told Idaho Reports. Instead, employees will do data entry and other work for CVS shipping facilities located around the country.

That wouldn’t have been possible before last year, said Alex Adams, former executive director of the Board of Pharmacy.

We used to have a law that required anyone working for a pharmacy had to be physically at the pharmacy,” Adams said. But doing data entry in the busy atmosphere of a pharmacy can be distracting, and allowing technicians to do that work elsewhere has resulted in more accurate reports, Adams told the committee.

Currently, only a handful of states allow technicians to do data entry and paperwork away from pharmacies, Johnston said. That was key in attracting the CVS facility to Boise. Since the rule change went into place, other companies have expressed interest in opening similar branches in Idaho, Adams said.

Another change that allows pharmacists to write prescriptions for certain common maladies — such as minor acne and mild coughs — has proven popular among patients and pharmacists alike, Chopski said.

Adams cited one case in which a pharmacist in McCall was reportedly able to help a woman with an ailment, saving her from driving to Boise for care.

“The first prescription was written within hours of this rule taking effect,” Adams said, and has resulted in zero complaints.

Chopski said the Board of Pharmacy has cut six licensure categories. “This year, you’ll see us continue in that same direction,” she said.

Committee members of both parties praised the Board of Pharmacy for its actions.

“I feel like the Board of Pharmacy is taking the lead in slashing regulations and promoting a free market,” said Rep. Bryan Zollinger, R-Idaho Falls.

Rep. Sue Chew, D-Boise and the legislature’s only pharmacist, agreed.

“It’s so nice to get outside of the lines we’ve been constricted to and do the things we’re more than capable of doing,” Chew said.

 

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Council on Indian Affairs: Dental legislation, government shutdowns, and grim history lessons

By Melissa Davlin, Idaho Reports

In the early morning hours of Jan. 29, 1863, US soldiers massacred more than 400 Shoshone men, women and children in what is now southeast Idaho.

If you didn’t know that piece of Idaho history, you’re not alone, Chairman Darren Parry of the Northwest Band of the Shoshone Nation told the Idaho Council on Indian Affairs on Thursday. The Bear River Massacre is often glossed over in US history.

But Parry hopes to change that with the Boa Ogoi Cultural and Interpretive Center, for which he’s currently fundraising. His goal: $5 million. He currently has $2 million of that, plus another potential $1 million from the Utah Legislature. The Church of Jesus Christ of Latter-Day Saints has also donated $1 million, he said.

Parry isn’t asking for money from the Idaho Legislature, he said, but he did want to share the story of his people with the committee, which is made up of representatives from Idaho’s five tribal nations and representatives from the Idaho Legislature.

Though the Northwest Band of the Shoshone Nation is recognized as a Utah tribe, the people were historically indigenous to what is now southern Idaho and northern Utah.

“When the Mormons discovered Cache Valley in 1855, that was pretty much the death knell for our tribe,” Parry said. After years of simmering tensions and fights between the tribe and Mormon settlers, soldiers from Fort Douglas attacked the village near Bear River.

The Boa Ogoi Cultural and Interpretive Center will be located in Idaho, Parry said, where the tribe purchased 700 acres near Preston last year.

Parry said the interpretive center will be “much more than a visitor center, but a place of learning.”

Also at the meeting, Gov. Brad Little made an unannounced appearance, spending most of his time in front of the committee answering questions from tribal chairmen on the state’s position on Indian Child Welfare Act, natural resources, transportation and education.

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Gov. Brad Little addresses the Idaho Council on Indian Affairs on Thursday. Melissa Davlin/Idaho Reports

While Little offered few specifics, he said he hoped to continue working with tribal leaders on these issues, pointing out common concerns regarding clean water, foster care, schools and road safety.  

Nez Perce Chairman Shannon Wheeler took the opportunity to remind Little of the Nez Perce Treaty of 1855, which guaranteed the tribe access to renewable resources. “We (want to) protect those things and a way of life that we’ve had for thousands of years, and we would like definitely the state perspective on that,” Wheeler said.

The committee heard a presentation on proposed legislation on dental health aide therapists, which would allow a new category of dental practitioners to practice on reservations. The idea, said Tyrel Stevenson, legislative director for the Coeur d’Alene Tribe, is to provide culturally respectful care in underserved communities on reservations.

“The whole idea is to provide better care,” Stevenson said. “Not lesser care. Better care.”

A few members of the committee also brought up the federal government shutdown, which has furloughed employees of the Bureau of Indian Affairs. After the meeting, Fort Hall Business Council Vice-Chairman Ladd Edmo of the Shoshone Bannock Tribe told Idaho Reports that the shutdown is affecting not just BIA employees, but basic transactions like land purchases, for which tribal members rely on the BIA.

Wheeler also addressed the federal government shutdown. “We’re having some tough times with the shutdown,” he told the committee. “We’re looking forward to the government getting going and start working at the behest of all of us.”

 

Watch Idaho Reports in coming weeks for more information on the dental health aide therapy proposal.

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New filing in Medicaid lawsuit doubles down on constitutionality question

By Melissa Davlin, Idaho Reports

There is a new filing from Bryan Smith in the lawsuit on the constitutionality of Proposition 2. Read the reply brief to the state’s response here.

Smith, who represents plaintiff Brent Regan, says as written, the new statute that expands Medicaid gives authority to the federal government to change Idaho Code without the legislature’s input.

The gist of the argument: If the federal government changes the parameters of Medicaid, Idaho law could automatically — and, Smith argues, unconstitutionally — change without input from the legislature.

“The issue is not whether states may voluntarily choose to comply or not comply with
changes made by the federal government in Medicaid law,” Smith writes. “The issue is whether Idaho gets to voluntarily choose before or after the federal law already has become Idaho law.”

The Idaho Attorney General’s Office has called Regan’s lawsuit frivolous and without merit, saying it’s based purely on hypotheticals. The Idaho Supreme Court will hear oral arguments on Jan. 29th.

In the new filing, Smith doubles down on the argument that Medicaid expansion opens the door to allowing the federal government to change Idaho law, which he says is unconstitutional.

“(The state) does not dispute Petitioner’s claims that the federal government does
possess unilateral power to change federal law that will flow into the provisions of Section 56-267… Specifically, (the state) admits that the hypotheticals ‘may or may not happen’ and ‘may never come to pass.'” Smith writes. “The fact that they can happen and could come to pass establishes the federal government has unilateral power to change federal law that affects Idaho and Section 56-267 in particular.”

There are a handful of potential ways Congress could tweak laws surrounding Medicaid, such as the cost-sharing mechanisms between the federal government and the states, as well as eligibility.

But Medicaid expansion isn’t the only law on Idaho’s books that could be affected by potential federal government changes. Tax, commerce, foster care, and child support issues are just some of the laws on Idaho’s books that interface with federal code.

Smith didn’t return a request for comment on Wednesday, but in his filing, he focused solely on Medicaid expansion, not other areas of Idaho Code.

“Requiring the legislature to revisit Section 56-267 (Medicaid expansion) and adopt changes, if necessary, preserves Idaho lawmaking power,” Smith continues. “Moreover, it requires the legislature to exercise its lawmaking power proactively and deliberately, rather than reactively, and prevents turning our lawmakers into “zombie legislators” whose failure to act results in new Idaho law.”

On Wednesday, Rep. Bryan Zollinger told Idaho Reports said the potential exists for a ruling in Regan’s favor to open up “Pandora’s box” for other laws that require federal conformity.

Still, “it’s an easy fix,” said Zollinger, who practices law with Smith in Idaho Falls. The Legislature would merely have to adopt changes every year.

In the filing, Smith also addresses the timing of the lawsuit, saying Regan couldn’t have sued before the initiative was signed into law because of a previous ruling, Noh v. Cenarrusa, that says the court can’t rule on the constitutionality of propositions until after voters pass them.  Smith also says Regan has standing to sue as a “qualified elector” — which means anyone who is legally qualified to vote.

The Idaho statute on initiatives specifically allows for this, saying “Any qualified elector of the state of Idaho may, at any time after the attorney general has issued a certificate of review, bring an action in the supreme court to determine the constitutionality of any initiative.” 

“Waiting until the voters passed the initiative allowed the lawmaking process to proceed without unconstitutional judicial interference, while at the same time honoring the legislature’s intent to allow (a) qualified elector to challenge the constitutionality of the initiative, but only after its passage,” Smith wrote.

 

 

 

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This week: New leaders, same challenges

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Sen. Todd Lakey and Rep. Tom Dayley, chairmen of the judiciary committees in the Senate and House, join Melissa Davlin on the December 14th episode of Idaho Reports. Photo by Troy Shreve.

 

Idaho’s judiciary has faced challenges for years — overburdened public defenders, lawsuits over public defense, overcrowding in prisons and county jails, the opioid crisis, and a recidivism rate that the state is struggling to reduce, to name a few.

In 2019, new leaders will face those challenges. The Idaho Legislature has two new judiciary committee chairmen: Rep. Tom Dayley in the House, and Sen. Todd Lakey in the Senate. Josh Tewalt is replacing Henry Atencio as Idaho Department of Correction director, and, of course, Governor-elect Brad Little takes office in January.

So is this a time to be innovative and assertive with new policies to reduce incarceration trends, or a time to be cautious while these new leaders figure out their roles? This week, I sat down with Lakey and Dayley, as well as Kathy Grismyer of ACLU-Idaho and Cindy Wilson of the IDOC Board of Correction to discuss those challenges.

Tune in to Idaho Reports at 8 pm Friday on Idaho Public Television, or watch online at idahoptv.org/idreports after it airs.

Also, I’ve put together a newsletter with Idaho political and legislative news, with links to reporting from across the state. New issues come out at noon — most days, anyway. Subscribe here: nzzl.us/i92ej36

 

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Madison County precinct that posted signs sees lowest turnout in county

By Melissa Davlin, Devon Downey, Idaho Reports

In a year that broke midterm election voter turnout records, eastern Idaho’s Madison County saw the lowest turnout in the state, with just 44.5 percent of registered voters showing up. One area of Rexburg in particular had remarkably low turnout: University Precinct, which encompasses the BYU-Idaho campus, had just 13.4 percent turnout — one of the lowest turnouts in the state.

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Copy of signs posted in Madison County precincts near BYU-Idaho. 

Madison County made the news on election day with signs at precincts near Brigham Young University-Idaho discouraging students from registering to vote in Idaho. The sign prompted a letter from the ACLU-Idaho and cries of voter suppression on social media.

Secretary of State Lawerence Denney told Idaho Reports he was concerned about the signs and asked that they be taken down. Though there can be consequences to out-of-state students registering to vote in Idaho, such as losing in-state tuition for graduate or medical school in their home states, that education should take place well before election day, Denney said.

There is no way to accurately measure who might have seen the signs and decided not to vote, nor what turnout would have been had the signs not been up for half the day.

But is the low turnout among university students that abnormal? Yes and no. In the last midterm general election, in 2014, University precinct had 17.6 percent turnout, while Madison County as a whole had a 42.3 percent turnout. In other words, the precinct had a slightly better showing, while the county had a lower percentage.

Precinct boundaries were redrawn and renamed after 2010, but in that year’s election, precincts near the BYU-Idaho campus also had low turnout, with one precinct seeing just 7 percent of its registered voters show up on election day.

College students are tricky voting demographic to reach, but other university towns across the state had higher turnouts. This year, in Moscow, home of the University of Idaho, no single precinct dipped below 34 percent. Idaho State University’s Pocatello didn’t have a precinct below 36 percent, and in Ada County’s Bronco County, precinct 1710, which includes Boise State University, still had 49 percent turnout.

Madison County Clerk Kim Muir told Idaho Reports on Monday that she wasn’t aware of Madison’s relatively low turnout compared to the rest of the state.

“I really don’t know what the factors were for that,” Muir said. “We don’t have a lot of college students show up except for presidential elections.”

She did note that the signs directed at students have been up in multiple elections, and that the county has split precincts since the 2016 presidential election.

Blaine County had the highest turnout at 76.3 percent. Statewide, the turnout was 66.7 percent.

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IDHW board approves pending birth certificate, vaccination rule changes

By Melissa Davlin, Idaho Reports

 

On Thursday, the Idaho Department of Health and Welfare Board of Directors voted to officially adopt proposed rule changes establishing a process to change the sex on birth certificates issued in Idaho.

The rule comes after a March U.S. District Court ruling, which ordered Idaho to allow transgender people born in the state to change the gender markers on their birth certificates.

Last week’s vote moves that rule change forward to the Idaho Legislature for final approval during the 2019 session.

Elke Shaw-Tulloch, administrator for the Division of Public Health at IDHW, said since the initial rule proposal, the state of Idaho has received 66 applications to change birth certificates. Of those, 40 have already been processed, while the rest are still pending. Most of the applications have been for adults, though 11 have been on behalf of minors.

Shaw-Tulloch noted that because the rule was the result of a court order, it did not go through the typical administrative negotiated rule-making process.

Another rule change adds a booster of meningococcal vaccination to the immunization requirements for students entering the 12th grade. The board also adopted rules clarifying that parents may submit a signed statement exempting their children from immunization requirements, as opposed to a form provided by the school or licensed daycare facility.

The department received 9 comments opposed to the meningococcal vaccination requirement, and 44 comments supporting the change.

Like the birth certificate rule, those rule changes, which have been in effect since May, will be presented to the Idaho Legislature for final approval during the 2019 session.

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