How COVID-19 impacted legislative motion on well being care legal guidelines this 12 months

SALT LAKE CITY — After a year of the COVID-19 pandemic, Utah legislative leaders this session took measures to allow more mental health and medical providers to respond to the health care shortage.

Residents’ emotional distress level has increased during the pandemic due to various situational and life stressors including concern about job loss, physical health and social isolation. Many also need to “wear multiple hats” as their kids’ schools moved to remote learning, according to Rachel Lucynski, a director with Huntsman Mental Health Institute crisis services, which manages the Utah Crisis Line.

“I think Utah is really well-positioned and ahead of the curve, where we already have a statewide crisis line and a statewide warm line for not suicidal crises, but emotional support. So we already had many statewide services, and during the pandemic especially, we’ve really seen the demand for these services grow,” she said.

“We’re excited to see the ongoing support and investment in expanding the services to make sure we’re equipped to handle what we anticipate will be an even higher increase in demand for services when (national mental health hotline) 988 launches and they’re easier to access,” Lucynski said.

Mental health response

The Legislature passed a group of bills sponsored by Sen. Daniel Thatcher, R-West Valley City, that seeks to bolster emergency response resources for those experiencing mental health emergencies.

SB53 will allow EMTs and firefighters to receive training specifically to respond to mental health calls. Agencies throughout the state will be able to form teams made up of those trained EMTs, who would be dedicated specifically to mental health emergencies. Such teams would be voluntary under the bill.

“This is one of the most important bills I’ve ever carried. This is an issue I’ve been working on for years, and we’ve finally found the missing piece. And the missing piece is the Department of Emergency Medical Services,” Thatcher said in the Senate chamber in January.

“Our EMS train and certify EMTs, advanced EMTs and paramedics who are able to give us a tiered response to physical health crisis. They’re able to support and work with our doctors, our nurses, and our other medical professionals, and they’re a critical part of how we care for Utahns,” he said.

But for behavioral health calls, they don’t have an outlined “tiered response.” The state does have Mobile Crisis Outreach Teams staffed with licensed clinical social workers, and when they’re used, there’s a 70% chance patients are stabilized and sent home, Thatcher said. But there aren’t enough of those teams to go to every behavioral health call.

“So the solution is to have our same heroes with our EMS department that go up every single day and respond to these critical calls, have these same heroes trained and certified for a behavioral health response unit,” Thatcher said.

Under the bill, dispatchers would determine whether to send those teams to help those who call the mental health crisis hotline at 988, or call 911. Another bill sponsored by Thatcher, SB155, ensures funding for the 988 crisis line, which states are required to implement by 2022.

“So that helps support ongoing funding for our crisis services and works to expand the Behavioral Health Crisis Response Commission to have a specific 988 planning and implementation task force,” Lucynski said.

Through SB47, also sponsored by Thatcher, Utah will create a council to standardize crisis intervention training for law enforcement across the state, as agencies each have their own versions of it.

HB248, sponsored by House Minority Whip Karen Kwan, D-Murray, requires the Division of Substance Abuse and Mental Health to administer a grant program to provide mental health resources for first responders. The bill originally included a one-time appropriation request of $1 million from the general fund, but lawmakers have instead provided $500,000 for the program.

After concern from some lawmakers that elementary students are too young to participate in suicide prevention programs, the Legislature passed a revised version of House Minority Leader Brian King’s HB93 to require elementary schools to put in place some such programs.

The bill will direct elementary and secondary schools to implement life-affirming education, including on the concepts of resiliency, healthy habits, self-care, problem-solving and conflict resolution, among other concepts.

The Utah Department of Health offers suicide prevention help at utahsuicideprevention.org/suicide-prevention-basics. The National Suicide Prevention Hotline is 1-800-273-8255. Help is also available through the SafeUT app.

Health care delivery

Two bills that seek to expand the scope of physician assistants to allow them to respond to health care shortages passed after their sponsor, Sen. Curt Bramble, R-Provo, worked throughout the session with those who initially opposed them.

SB27 allows P.A.s to work without the supervision of a physician. Under the bill, they would first need to work with a physician for 4,000 hours, and then work another 6,000 with the supervision of either another P.A. with 10,000 hours of experience, or a physician.

Though originally opposed by members of the physician community who decried letting those with less training and education practice independently, the bill passed after Bramble worked throughout the session with the Utah Medical Association and other stakeholders to add the training requirements.

Kim McFarlane, P.A. and president-elect of the Utah Academy of Physician Assistants, called the bill a “modernization act.”

“It allows P.A.s to function in the way that we currently practice and more correctly reflects the modern practice of medicine for P.A.s.,” McFarlane said during a committee hearing for the bill.

“And as we’ve noticed during COVID season, there were a lot of changes that needed to be made rapidly in order to redeploy P.A.s to where they were needed, and we think that this legislation will enable P.A.s to be more flexible and to provide health care where they are needed when they are needed,” according to McFarlane.

Similar to SB27, SB28 adds P.A.s to the state’s Mental Health Professional Practice Act and allows them to independently offer mental health care if they receive certain training and experience.

HB287, sponsored by Rep. Doug Welton, R-Payson, allows nurse practitioners to prescribe Schedule II controlled substances without consulting with a physician after receiving certain training and experience.

Senate Majority Leader Evan Vickers, R-Cedar City, called the trio of bills “big moves” for the state in making health care more accessible.

“Those will be big for us moving forward,” Vickers said.

HB365, sponsored by Rep. Steve Eliason, R-Sandy, will start a process to merge the Utah Department of Health and the Department of Human Services agencies into one Department of Health and Human Services in July 2022. The Department of Workforce Services would then handle all Medicaid eligibility work, while the new department would handle patient interactions.

Bill sponsor Rep. Paul Ray, R-Clearfield, has said the change is needed to reduce redundancy and make services more accessible to clients.

“We feel that the best way to be more efficient and effective as we deliver services to the public is to combine these two agencies together and try to break down the silos and get the communication going so people aren’t going to two, three, four different places to get services,” Ray said in a House committee hearing.

The agencies are required under the bill to form a merger plan to present to the Legislature by December. Ray and department leaders say jobs won’t be eliminated. The merger would take place in mid-2022.

The Legislature passed at least one bill meant to help prevent opioid overdoses. HB15 was prompted after bill sponsor Rep. Ray Ward, R-Bountiful, a doctor, was on call one night when a patient on the on-call list at his practice died due to taking three different sedatives prescribed by three doctors.

Ward’s bill requires a medical practitioner to check the controlled substance database to see if their patient is already taking an opioid. If so, the doctor would need to consult with other practitioners when issuing a prescription longer than 30 days for an opiate or a benzodiazepine.

A ban on employer-required COVID-19 vaccinations stalled in the Senate after receiving early support. SB208, sponsored by Sen. Mike Kennedy, R-Alpine, would prohibit employers from requiring employees, prospective employees or blood relatives of employees or prospective employees to accept or decline a vaccine, with an exemption for those in health care and employers who contract with the Department of Defense. The bill did not receive a final vote in the Senate or move to the House for consideration.

Another bill sponsored by Ward, HB117, sought to strengthen the state’s vaccine database to help patients and their doctors learn which vaccines they’ve gotten and when. The bill would have required vaccine providers to report vaccine information, with people who don’t want that information recorded able to opt out. The bill also did not reach a final vote before the end of the session.

An industrial hemp plant is displayed at the Utah Department of Agriculture and Food in Salt Lake City on Friday, July 19, 2019. Scott G Winterton, Deseret News

Medical marijuana

The Legislature passed two bills that will modify the state’s medical marijuana program, implementing changes called for by patient advocates a year after the program began. A third bill did not advance.

• SB192, sponsored by Vickers, makes dozens of minor technical tweaks and larger policy changes to the medical marijuana law. Among larger changes, the bill: requires the electronic verification system for those registered to communicate dispensing information to the controlled substance database; allows for a 15th medical pharmacy to be licensed in a specific location; and removes a requirement that cannabis products are packaged in opaque material.
• SB170, sponsored by Senate Minority Whip Luz Escamilla, D-Salt Lake City, would allow any doctor to recommend medical marijuana to up to 15 patients without becoming a qualified medical provider in the Utah Medical Cannabis Program. It would also add podiatrists to the list of specialists who can recommend the plant for pain conditions.
• HB210, sponsored by Rep. Gaye Lynn Bennion, D-Cottonwood Heights, would allow those who suffer opioid addiction to receive medical marijuana for pain management after procedures, surgery or with certain conditions. The bill did not receive a committee hearing.

Andy Byrnes, a contracted EMT with the Utah Department of Health, tests Audriana Nakai for COVID-19 outside of the Montezuma Creek Community Health Center in Montezuma Creek, San Juan County, on Friday, May 1, 2020.Kristin Murphy, Deseret News

Family, reproductive health

While most legislative sessions in Utah bring at least a few abortion bills — which usually spark heated debates among lawmakers and advocates — two such bills this session didn’t receive hearings. HB231, sponsored by Rep. Cheryl Acton, R-West Jordan, sought to make it a class B misdemeanor to transport aborted or miscarried fetal remains outside of the state for reasons other than burial, while HB253, sponsored by Rep. Steve Christiansen, R-West Jordan, sought to modify the informed consent process for women considering abortion.

The Legislature, however, passed one bill described by its sponsor as “pro-life without being anti-abortion.”

Rep. Brady Brammer’s HB113 requires biological fathers to share pregnancy and delivery costs with the mother equally only if the mother seeks payment. If third-party groups or insurance plans cover costs outside of premiums, the man would not need to split those bills.

Some who opposed the bill expressed concern it will create an unwanted tie to the father for some mothers, but Brammer, R-Highland, said it will create no more risk than current child support laws.

The Legislature also passed a bill to require jails to give female inmates the contraceptive medication they received before their incarceration after sponsor House Minority Assistant Whip Jen Daily-Provost, D-Salt Lake City, decried the medication being left out of standard care despite the constitutional requirement that all inmates receive health care. The final version of HB102 adds a sunset date in June of 2022.

Through SB158, Escamilla hoped to create a Children’s Coverage Outreach Pilot Program to reach families with uninsured children who qualify for coverage, offer application assistance and run a media campaign to raise awareness for insurance plans available to Utah children. But after passing the Senate, the bill with a $5 million price tag failed to get funded by the Legislature.

The Legislature did pass a similar bill sponsored by Welton. HB262 will create the Children’s Health Care Coverage Program. Under the bill, the Utah Department of Health, Department of Workforce Services,and State School Board will be directed to create a program to promote health insurance coverage for schoolchildren when they apply for free or reduced price school lunch, and enroll in or register for school.