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Pandemic Edition: Top 10 Legislative Issues in Ambulatory Healthcare


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By Mark Crafton, Executive Director, Strategic Alliances

The Joint Commission actively monitors state legislative and regulatory activities for the purpose of identifying additional opportunities for state reliance on Joint Commission accreditation/certification.

The Joint Commission’s various accreditation/certification programs are recognized and relied upon by many states as part of their quality oversight activities. Recognition and reliance refers to the acceptance of, requirement for, or other reference to the use of Joint Commission accreditation, in whole or in part, by one or more governmental agencies in exercising regulatory authority. Recognition and reliance may include use of accreditation for licensing, certification or contracting purposes by various state agencies.

As you might imagine, conversations about oversight and accreditation issues have taken a different turn since 2020. From my standpoint, the following issues are top of mind for ambulatory care organizations in most states.

10. Workplace Violence. Unfortunately, this is an issue for every healthcare organization in the country and instances of violence are escalating. Many states have enacted or are considering felony charges for threatening health care workers. A recent blog post outlines the journey of one accredited Oklahoma organization in changing their legislation.

The types of workplace violence that are most prevalent in healthcare settings are:

  • criminal intent
  • patient on worker
  • worker on worker 
  • personal relationships

9. Equity/Social Determinants of Care. With greater recognition of the role social determinants play in healthcare, expect more legislation covering:

  • clean water for underserved communities
  • reconnecting communities split by highways
  • affordable housing/homelessness

8. Maternal Health. Improving maternal health is a huge priority right now, with legislation ranging from:

  • Medicaid coverage for postpartum care up to one year
  • licensure of freestanding birth centers
  • establishment of maternal disparity task forces
  • coverage for perinatal doula/midwife services

7. Prescription Drug Reform. Many states are grappling with the high cost of prescription medications. Legislation in several states has focused on Pharmacy Benefit Management (PBM) companies, including requiring them to obtain state licensure and restricting their ability to require multiple accreditations for specialty pharmacies.  

6. Senior Care/Serious Illness. The aging Baby Boomer population is beginning to utilize senior care services at unprecedented rates. Relevant legislation includes:

  • training in Alzheimer’s/memory care for licensed professionals
  • reimbursement for family caregivers
  • authorization for nursing home residents to install video cameras
  • Right to Try, a law for patients with life-threatening diseases who cannot participate in clinical trials to try unapproved treatments

5. Patient-Resident Visitation During Declared Emergencies. Fueled by strict  visitation restrictions during the pandemic, there is a great deal of activity on the subject of visitation. We expect continued conversations on all sides of this issue in the months and years to come, especially since Florida Governor Ron DeSantis recently signed into law SB 988 which calls for:

  • no restrictions allowed for birth, imminent death or pediatrics
  • rules for visitors no more strict than those for staff
  • no vaccination mandate

4. Workforce Attrition/Retention. Healthcare has been facing a shortage of workers long before it became a national issue. Legislative discussions in this arena will likely continue for a long time and priorities include:

  • pay raises, bonuses and waivers of licensing fees
  • scholarships, tuition reimbursement and loan forgiveness
  • apprenticeship for certified nursing assistants (CNAs)
  • recognition of out-of-state licenses

3. Temporary Staffing Agencies. Given the staffing shortages, temporary staffing has come into play as a solution. Issues under regulatory discussion include:

  • unlawful merchandising practices
  • rules regulating temporary staffing agencies
  • out-of-state providers working under out-of-state licenses
  • work while waiting for background check completion

2. Telehealth. Our industry switched to telehealth almost overnight and we’ve all learned a lot about the benefits of telehealth as well as what needs to be refined. Current and future legislation is centered on:

  • reimbursement equal to in-person visits
  • use of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) as distant site providers
  • remote patient monitoring
  • Store-and-forward,” or the collection of clinical information and sending it to another site for evaluation

1. Behavioral Health. Mental health needs are paramount right now and affects every sector of healthcare. Most mental health and substance abuse care is provided by primary care providers in office settings.  This topic is highly relevant to the prison health services we accredited under the ambulatory program.

Key topics include:

  • substance use disorder treatment, crisis and school-based services
  • access to Naloxone
  • behavioral healthcare services within the criminal justice system
  • increased flexibility in buprenorphine prescribing

The last few legislative seasons have been intensely busy and we’re not expecting it to lessen anytime soon. It’s gratifying to see some movement on long-standing issues in ambulatory care and we welcome your involvement. Please follow state regulatory recognitions at this website.

Mark Crafton is Executive Director, Strategic Alliances at The Joint Commission. He has worked for the organization for more than 20 years.