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2017 Legislative Session Updates
June 2, 2017
Gov. Mark Dayton once again demonstrated the political shrewdness of his legislative operation along with his disdain for the Minnesota Legislature. Facing both a constitutional and self-imposed deadline to sign or veto the budget bills passed in both the Regular and Special Session, the governor held a press conference on Tuesday, May 30, to announce his decision on the budget bills and an outstanding policy issue. Several issues of concern to pharmacy were affected by the Legislature’s and the governor’s actions.
The governor decided he would sign the budget bills totaling more than $46 billion for the next biennium. Many of his progressive allies were urging him to veto the entire budget and start over again in negotiations with the GOP Legislature. The governor wisely realized the deal he had in hand was likely better than anything he could possibly accomplish in yet another Special Session. The governor also recalled the 20-day government shutdown in 2011, when he was unable to reach a budget agreement with the GOP-controlled legislature. In 2011, the governor ended the stalemate by caving to GOP demands to not raise taxes to address a $5 billion deficit. This year should have been much easier for compromise with a $1.6 billion surplus.
The governor also announced he would allow the GOP Omnibus Tax Bill to become law without his signature; however, after consulting with Minnesota’s attorney general, he signed the tax bill. The tax bill provides nearly $650 million in tax cuts. The bill provides tax cuts to seniors and students — and among other reforms, eliminates the automatic escalator on tobacco and commercial industrial property taxes. The governor wanted to veto the legislation. However, legislative leaders (who felt burned by the governor’s veto of the tax bill in 2016) inserted a provision in the Omnibus State Government Finance bill voiding funding for the Department of Revenue if the tax bill failed to become law.
While the governor is provided the option of allowing a bill to become law without his signature during the first year of a two-year session, bills passed in a Special Session that adjourns “Sine Die” do not come with the same options. The governor’s legal team originally suggested because the bill passed within three days of adjournment of the Regular Session, the Special Session rules did not apply.
In response to the legislative “poison-pill” included in the tax bill, the governor line-item vetoed the budget for the Minnesota Legislature. In his nearly three-page Governor's Letter to Leaders, read at his press event, Dayton suggested he would call the legislature back for another Special Session to restore their funding. However, he would only do so once they agreed to remove items, according to legislative leaders, agreed to during the final budget negotiations. Those demands included the removal of the repeal of the automatic inflators on tobacco and property taxes, reforms to the Estate Tax and the adjustment of the tax on premium cigars. The governor also demanded changes to language he had agreed to regarding teacher licensing and limiting access to driver’s licenses for illegal immigrants.
As of the morning of June 1, legislative leaders have suggested they have no intention to re-start any budget negotiations with the Dayton Administration. They have indicated they plan to raise a legal objection to the governor’s decision to line-item their budget for the next two years. Legal experts are suggesting the legislature likely has a convincing argument the governor has violated the separation of powers between the legislative and administrative branch when he virtually eliminated their existence with his veto.
The House and Senate have roughly $10 million in budget reserves that would allow them to continue operations until mid-August. The veto not only cancels legislative pay, but also cancels pay for all employees of the legislature, partisan and non-partisan staff, legislative councils and the legislative auditor. In 2011, during the 20-day government shutdown, the court-appointed special master ruled the legislature was an essential service and ordered its operations be funded even without the existence of a state budget. Many legal experts believe at a minimum, the courts would come to a similar conclusion if the stalemate with the Dayton Administration cannot be overcome.
The outcome of the governor’s actions has clearly created a constitutional crisis, which will not likely be resolved without the intervention of the Minnesota Supreme Court. The legislature will continue to be funded through June 30, 2017, from the budget adopted in 2015. It is likely lay-off notices will be sent to all legislative employees in the coming days.
Health Care and Pharmacy Provisions
The HHS Omnibus bill signed by the governor includes the opioid bottle warning label mandate language. The bill contains the revised language that is acceptable to the Minnesota pharmacy community. The original vetoed HHS omnibus bill (SF800) language contained provisions that included the CMS compliance/pharmacists reimbursement (increase) language; however, in final negotiations the legislature had to come up with an additional $400+ million in additional HHS budget savings. While much of the needed savings was taken from the Medical Insurance Action funding that funds MinnesotaCare, the legislature needed additional savings from its originally passed/vetoed HHS budget bill. One casualty was the CMS reimbursement provisions that had been scored at a $7 million expense for the biennium. We will work hard next year to see that these provisions are adopted and funding appropriated.
Provisions that survived the negotiation process and were signed into law included the reimbursement of injectables through PBM language, a scaled-down opioid abuse reduction grants provision and the 4-day maximum opiate prescription mandate. Additionally, the legislature adopted and the governor signed the Biosimilars bill, SF1184 and HF712. The statute puts Minnesota in compliance with similar laws across the U.S.
While much recent news from the governor dealt with the budget, the Gov. Dayton also announced his decision to veto the Uniform State Labor Standards Act, also known as pre-emption. The legislation was a GOP and business community legislative priority. Supporters of the legislation hoped the decision to combine the proposal with several Dayton Administration legislative priorities would convince the governor to sign the bill. The legislative package included the governor’s proposals for paid parental leave for state employees, the ratification of an outstanding contract, a version of the governor’s wage theft proposal and much-needed reforms to Minnesota’s public employee pension system. The governor’s veto of the legislation demonstrates the influence Minnesota’s labor unions have over the Dayton Administration.
The veto also means the Minneapolis and St. Paul Paid Sick Leave Ordinances will go into effect on July 1, 2017. Those ordinances will create numerous challenges to Minnesota employers. The fact that the two cities were unable to pass identical ordinances means employers with employees in both cities will need to create and manage separate benefit programs.
If other Minnesota cities move ahead with their own ordinances, Minnesota will become a patchwork of local labor laws. Minnesota employers continue to hold out hope the courts will throw out the Minneapolis ordinance. Legal arguments in the Minneapolis case are scheduled for later this summer. In the meantime, last week the Minneapolis City Council directed their staff to prepare an ordinance to create a $15/hour minimum wage for businesses with employees working in the city.
Adding more fuel to constitutional questions regarding the governor’s actions, the Dayton Administration is also arguing the legislature approved the contract and benefit provisions included with the pre-emption proposal. The administration is suggesting the mere fact they were included in legislation adopted by both the House and Senate is enough, regardless of whether the governor signed or vetoed the bill with the provisions. This decision by the governor will also likely face a constitutional challenge in the courts. The decision could create a situation where future labor agreements could be passed by the legislature when opposed by an administration. The decision could eliminate the role the administration plays in negotiating future labor agreements. While the decision by the Dayton Administration clearly benefits labor this time, future contracts could be at risk if they were dealt with in a comparable manner.
May 26, 2017
Legislature Concludes Special Session
The Minnesota Legislature concluded its special session in the early morning hours of Friday, May 26. The Health and Human Services (HHS) omnibus bill is among 10 bills that make up the state budget. Legislative leaders said they would send all 10 to Gov. Mark Dayton at the same time. Because the final language of the HHS bill was completed so late in the process, we will provide a more detailed report in next week’s edition of Small Doses.
2017 Legislative Session in its Final Week…PATF Provisions Included in HHS Bill
PATF Lobbyist Buck Humphrey reports that the Minnesota legislature is working feverishly to come to a compromise on State budget targets. This includes the Minnesota House and Senate HHS Conference Committee Omnibus bill the legislature will pass on each floor at the end of budget negotiations and send to Gov. Dayton for signature and ultimately, enactment. A week ago, both the Republican-controlled House and Senate passed SF800, the HHS Omnibus finance bill. As with all state government finance funding bills passed by the legislature to date, the HHS Republican budget bill was vetoed by Gov. Dayton.
Technically, this means the legislature has to start over on the various finance bills. However, multiple bills are still on the House and Senate floors that could/will be used as vehicles to pass the omnibus finance bills once the legislative leadership reaches agreement with the governor. A worst-case scenario would be no agreement between the legislature and governor by the constitutionally mandated legislative adjournment date of midnight on Monday, May 22. If they can’t get an agreement, the governor would then need to call a Special Session of the legislature, presumably sometime in June, to avert a July 1 government shutdown.
The legislature and Dayton administration will work through the weekend to hopefully come to a compromise on how to fund the government and move to adjournment. Stay tuned…
Humphrey reports that the HHS Omnibus bill includes the opioid bottle warning label mandate language. Simultaneously, the opioid labeling legislation is also being taken up on the floor of the House and Senate to ensure passage. The governor has said he will sign the bill if it reaches his desk. The Senate passed the revised language that is acceptable to the Minnesota pharmacy community. The House is set to take up the Senate’s bill at any time, most likely Friday or over the weekend.
Other provisions of note include the CMS pharmacists reimbursement compliance (increase) language, language for the reimbursement of injectables through a PBM, opioid abuse reduction grants and the 4-day maximum opiate prescription mandate in the vetoed, bill. Both legislative and administrative leadership have not indicated that these provisions will not survive final negotiations. Additionally, it is confirmed that the Senate will take up Biosimilars language included in SF1184 and HF712 Friday or this weekend, already adopted by the House. When this legislative language is enacted, it will put Minnesota in compliance with similar laws across the U.S.
Lastly, the House HHS Finance Committee had an informational hearing on May 24 on HF747. The bill would make changes to the Prior Authorization (PA) system that would ban Pharmacy Benefit Managers (PBMs) from taking drugs off a plan sponsored/contracted formulary before the benefit contract expires. Currently, PBMs can and do take drugs off their formularies, mid-contract, at any time. Rep. Rod Hamilton (R-Mountain Lake), who has had a long history of issues with PBMs and obtaining and maintaining his MS medication regimen, introduced the legislation and passionately testified in support of the PA and PBM reforms. The Minnesota Medical Association, Mental Health Association of Minnesota, Independent Physicians Association and Academy of Family Physicians all testified in support of the PA reform legislation. Representatives from the Minnesota Chamber of Commerce, Express Scripts, Health Partners and Prime Therapeutics all testified in opposition to the bill. This issue is certain to be taken up next year.
March 31, 2017
MPhA Among 100+ Pharmacy Organizations to Thank Members of Congress for Sponsoring DIR Legislation
Nearly 120 pharmacy organizations from all parts of the United States — including the Minnesota Pharmacists Association, the American Pharmacists Association, the National Community Pharmacists Association and the National Alliance of State Pharmacy Associations — joined this week to send letters of thanks to the sponsor and original cosponsors of H.R. 1038/S. 413.
Not only is this total significantly higher than September’s letter endorsing the legislation in the last Congress, but the array of signatories represents a broader spectrum of the health care industry demonstrating that the effects of retroactive DIR fees are widespread.
MPhA Legislative Action Update
Top priority legislation for MPhA and the Pharmacy Advocacy Task Force (PATF) which would give pharmacists the authority to prescribe naloxone, self-administered contraceptives, nicotine replacement products and travel medications appears to be stalled for this legislative session — which is not a complete surprise, given the anticipated opposition from the Minnesota Medical Association. Our legislation remains alive through this and the 2018 legislative session. We will continue to build support with legislators, other stakeholders and patient advocacy groups through the interim and into next year's legislative session.
As budget bills are built and negotiated, we continue to work behind the scenes to assure that the language enacting the increase in Medicaid reimbursement which was worked out with DHS staff last fall is included in the final budget. We remain optimistic about its inclusion.
Legislation allowing pharmacists to substitute biologic medications that have been deemed interchangeable by the FDA has passed out of committee in both the House and Senate in identical form and awaits approval by both bodies. This legislation also removes problematic language from the 1970s regarding the pricing of generic products. We anticipate approval by both bodies and by the Governor.
Several bills were introduced this year intending to deal with the opioid addiction crisis in Minnesota, some of them quite problematic for pharmacies in their initial form. We continue to monitor these bills and have worked with the authors to find compromise that appears to have some traction. Our legislators have a strong desire to enact solutions to the many facets of this health crisis. We continue to work to show that the pharmacy community wants to be part of the solution and to assure that legislation that is passed is effective toward the solution without placing undue burdens on pharmacies and pharmacists.
March 24, 2017
Your Action Needed Today to Include Changes in Medicaid Reimbursement in the State Budget!
It is critical that members contact the Chairman and staff of the House Health and Human Services Finance Committee TODAY to urge support for including HF 1819 (Pharmacy Reimbursement Modernization) in the House HHS Policy Omnibus bill currently being drafted. These changes were mandated in the CMS Outpatient Covered Drug rule, passed several years ago, and provide much needed relief for pharmacies from Minnesota's chronically low Medicaid reimbursement. Without your urgent help, Minnesota will not be on track to comply with the CMS Covered Outpatient Drugs Rule as required by April 1.
You don't need to be an expert on the bill or go into a lengthy explanation. Just call or email one or more of the three people below, tell them who you are, and tell them something to the effect that you urge them to include HF 1819, Pharmacy Reimbursement Modernization, in the HHS (Health & Human Services) Omnibus bill that is currently being drafted, and then thank them. That's it!
Please share this alert with your pharmacy team and ask they that they call and send an email TODAY!
House Health and Human Services Finance Chairman Matt Dean, firstname.lastname@example.org
March 17, 2017
MPhA Legislative Action Alert Succeeds!
On March 6, MPhA asked our members to contact Minnesota Representative Joe Schomacker to request a hearing on House File 1819. You called and emailed — and your voices were heard! The bill was heard in his committee and passed on to the finance committee, where it was heard and rolled over for inclusion in the overall (omnibus) HHS finance bill. We are relatively confident of a hearing in the Senate.
March 3, 2017
Prescription Drug Price Transparency Act Introduced
Reps. Doug Collins (R-Ga.) and Dave Loebsack (D-Iowa) have introduced H.R. 1316, the Prescription Drug Price Transparency Act. The bill’s other original sponsors are Reps. Brian Babin (R-Texas), Rod Blum (R-Iowa), Buddy Carter (R-Ga.), John Duncan, Jr. (R-Tenn.), Cathy McMorris Rodgers (R-Wash.), and John Sarbanes (D-Md.). The bill would:
The National Community Pharmacists Association has announced strong support for the bill.
February 24, 2017
Pharmacy Advocacy at Work at the Minnesota Legislature
SF 1049 was introduced in the Minnesota Senate on Feb. 16. This is the companion to HF 1140, and would grant pharmacists the authority to prescribe self-administered hormonal contraceptives, nicotine replacement products, opiate antagonists, and travel medications. Our authors in the Senate are Tony Lourey of Duluth, Julie Rosen of Vernon Center, John Hoffman of Champlin and Jim Abeler of Anoka. The bill has been referred to the Health and Human Services Finance and Policy Committee; three of the authors serve on this committee.
February 17, 2017
Pharmacy Advocacy at Work at the Minnesota Legislature
Thanks to everyone who attended this week’s Minnesota Pharmacy Legislative Day on Feb. 15! We nearly set a new record for attendance. Participants met with many key legislators to explain the need for HF 1140.
The week of Feb. 6 was spent finalizing the Pharmacy Advocacy Task Force (PATF) legislative language with Rep. Roz Peterson's office and the House Research and Revisor's staff. The "jacket" with the PATF legislative language/bill was walked around for signature with help from MPhA members and others.
Buck Humphrey and volunteers met with legislators to secure their sponsorship of our legislation and to further educate additional legislators about what we are seeking and what our legislation is trying to accomplish. On Feb. 10, Humphrey dropped our legislation, chief-authored by Rep. Roz Peterson, in the Hopper for introduction in General Orders on Feb. 13. Additional sponsors in the House include Rep. Dave Baker (R-Willmar), Rep. Tony Albright (R-Prior Lake), Rep. Rod Hamilton (R-Mountain Lake), Rep. Erin Murphy (D-St. Paul), Rep. Jennifer Schultz (D-Duluth), and Rep. Mary Franson (R-Alexandria). Senators Tony Lourey (D-Duluth), Julie Rosen (R-Vernon Center), Jim Abeler (R-Anoka) and (I can’t remember the name of the fourth senator) have agreed to serve as authors for our legislation in the Senate. If work goes as planned, our companion legislation will be introduced in the Senate by Feb. 20 or sooner.
A meeting with Minnesota Medical Association (MMA) lobbyists Dave Renner and Eric Dick went as anticipated, with the lobbyists saying they would most likely not be able to support legislation that calls specifically for pharmacist prescribing authority through a Board of Pharmacy (BOP) statewide protocol. They indicated they could potentially support a statewide protocol administered through the Department of Health for each medication category (this would include the Department's Chief Medical Officer — a doctor — signing off on the protocol). We will continue to seek common ground with MMA if possible. The MMA meeting also included discussion of a few recently introduced bills both groups could support. PATF members also had a conference call with a member of the Minnesota section of the American Congress of Obstetricians and Gynecologists (MN-ACOG); we will continue to work with MN-ACOG as members have indicated a willingness to help.
During the week of Feb. 13, PATF representatives also planned to meet with the Minnesota Nurses Association, Minnesota Nurse Practitioners and Minnesota Clear Way to brief them on the PATF bill and ask for support. In addition, PATF will continue to work with Cody Wiberg and the Minnesota BOP to further our legislative agenda.
February 10, 2017
Pharmacy Dispensing Fee Reimbursement
From the Minnesota Retailers Association: The CMS outpatient drug rule pharmacy reimbursement language and proposal for compliance with federal law was not included in Gov. Dayton's budget proposal.
The Minnesota Retailers Association (MnRA) is working with Administration officials and other stakeholders proactively on next steps to ensure this important measure is included is budgetary discussions this session. MPhA is also monitoring this issue.
As a reminder, to comply with the final pharmacy reimbursement ruling from Center for Medicare and Medicaid Services (CMS), last year the Minnesota Department of Human Services (DHS) outlined the following methodology:
Pharmacy Reimbursement - RETAIL AND LTC
Pharmacy Reimbursement OTC Drugs
Annual Financial Impact by (Pharmacy Type)
Annual Financial Impact by (Prescription Type)
TOTAL FISCAL NOTE STATE IMPACT AT LEGISLATURE
Uniform State Labor Standards Passes House Committee
From the Minnesota Retailers Association: After four hours of testimony, HF 600 (the Uniform State Labor Standards Act) passed out of the House Jobs Committee and was sent to its next committee stop. Several retailers, MnRA and others provided testimony surrounding the difficulties created by a patchwork of local labor regulations. MnRA Board Members Steve Rush, Holiday Companies, and Dave Reuter, Thrifty White Pharmacy, provided House Committee members context surrounding the importance of a statewide approach to labor law uniformity.
MnRA Government Relations Director and Legal Counsel Brian Carr told Committee members during his testimony, "Retailers will be greatly impacted by the new significant increase in their administrative duty to comply with an additional third layer of local labor laws, in addition to already complying with state and federal law." HF 600 would preempt local municipalities from establishing independent policies on wage, leave, and scheduling by solidifying the State has the sole authority to act in these areas. See MnRA's press statement thanking legislators in both parties for beginning the conversation on labor law uniformity.
February 3, 2017
CMS Posts Medicare Part D/DIR Fact Sheet
The Centers for Medicare and Medicaid Services (CMS) has posted a fact sheet about Medicare Part D – Direct and Indirect Remuneration (DIR). The fact sheet provides information about trends in DIR, including charts and links to additional information. In recent years, CMS has observed a notable growth in DIR fees collected and reported by Part D sponsors.
Pharmacy Advocacy Task Force Report
The 2017 session of the Minnesota Legislature is off to a fast start. The House, Senate and Governor agreed on an emergency health care premium relief package, Health & Human Services (HHS) reform proposals are being introduced on a daily basis and all four HHS legislative committees are holding hearings. The Governor released his budget proposal last week, and the Republicans are responding with their own budget numbers and through the budget process hearings, which are set by the Chairs.
Representing the Pharmacy Advocacy Task Force (PATF), Buck Humphrey and Todd Hill, both with Capitol Hill Strategies, along with other pharmacy ambassadors (including MPhA Past President Jeff Lindoo) have been making visits to House and Senate members plus members of the governor’s staff who will be key to introducing and passing our agenda.
PATF representatives will also meet with the OB-GYNs, medical manufacturers and other stakeholders to inform them about our agenda and ask for their support. Buck Humphrey is working with MPhA Interim Executive Director Marsha Millonig and her very capable group of UM pharmacy students to complete the National Governors Association (NGA) legislative scope of practices change tool. The pharmacy students are a great help in this effort. The House HHS policy committee held an entire hearing this past week about the use of the tool for scope of practices proposed changes.
The PATF has also been working with Minnesota Board of Pharmacy Executive Director Cody Wiberg in a technical advisory capacity to draft our legislative language. Rep. Roz Peterson's office is helping with the Revisor's office to draft the legislation. This bill language can be modified if need be throughout the legislative process. Watch for more information soon.
January 27, 2017
U.S. House Introduces Pharmacy Provider Status Bill
From information provided by the National Alliance of State Pharmacy Associations and other sources: On January 20, Representatives Brett Guthrie (R-KY), G. K. Reed (D-NC), Todd Butterfield (R-IN), and Ron Kind (D-WI), along with 104 of their colleagues have reintroduced the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 for the second straight Congress). Among the bipartisan co-sponsors are Representatives Tom Emmer, Erik Paulsen, Collin Peterson and Tim Walz from Minnesota.
Here are some resources to help:
Both of Minnesota’s senators have signed on as co-sponsors of the companion bill in the U.S. Senate (S. 109).
If your representative has not yet signed on, please contact him or her to ask for support on this bill. Here are some resources to help:
The Minnesota Pharmacists Association is a partner in the Patient Access to Pharmacists’ Care Coalition (PAPCC). PAPCC is a group of more then 35 national and 70 state organizations representing patients, pharmacists, pharmacies, and other interested stakeholders.
Help Keep Pro-Pharmacy Provisions of ACA
From the National Community Pharmacists Association: Urge your U.S. Senators and Representatives to support bipartisan pro-pharmacy provisions of the Affordable Care Act (ACA). Congress is moving toward repeal of the ACA, and the following measures would no longer be available unless they are included in replacement legislation:
Congress intends to move swiftly on this issue, so make your voice heard today! Visit the NCPA Legislative Action Center — you’ll be able to send messages to both Senators and your Representatives with just a few keystrokes!
January 20, 2017
CMS Releases Analysis of Part D DIR Fees
The Centers for Medicare & Medicaid Services (CMS) released an analysis related to Part D Direct and Indirect Remuneration (DIR) fees and the impact of these fees on the Part D program on January 19. Read the summary. Among the findings: CMS “has observed a growing disparity between gross Part D drug costs, calculated based on costs of drugs at the point-of-sale, and net Part D drug costs, which account for all DIR.”
January 13, 2017
Provider Status Legislation Reintroduced in U.S. Senate
From information provided by the American Pharmacists Association and the National Association of Chain Drug Stores: On Thursday, January 12, the Pharmacy and Medically Underserved Areas Enhancement Act (S. 109) was reintroduced in the U.S. Senate with the bipartisan original co-sponsorship of more than one-quarter of the body — including Minnesota Senators Amy Klobuchar and Al Franken. The companion legislation is expected to be reintroduced in the U.S. House of Representatives soon. The National Association of Chain Drug Stores (NACDS) strongly backs the legislation.
“NACDS truly appreciates the leadership of Senator Chuck Grassley (R-IA), Senator Susan Collins (R-ME), Senator Sherrod Brown (D-OH), and Senator Bob Casey (D-PA) in re-introducing the Pharmacy and Medically Underserved Areas Enhancement Act as lead sponsors,” said NACDS President and CEO Steven C. Anderson, IOM, CAE. “NACDS thanks all of the 27 Senators who have made a powerful statement about this legislation by signing on as original cosponsors and sustaining this bill’s momentum from the 114th Congress into the current 115th Congress.”
Thanks to the work of pharmacists across the nation, provider status legislation had 296 co-sponsors in the House and 51 co-sponsors in the Senate at the end of 2016. Once the bill is reintroduced in the House, the American Pharmacists Association and other pharmacy organizations will ask pharmacists and others to contact your Members of Congress to encourage them to support the legislation by becoming a co-sponsor or to thank them if they are already a co-sponsor.
Visit www.pharmacistsprovidecare.com to learn more about the profession’s provider status campaign. More information is also available through the “Provider Status” tag on NACDS.org, as well as on the website of the Patient Access to Pharmacists’ Care Coalition, a group of organizations representing patients, pharmacists, pharmacies and others. NACDS is a founding member of the Coalition and serves on its Steering Committee.8
December 16, 2016
President Signs Bill Aimed at Speeding Process for Drug, Device Approval
From American Pharmacists Association: On Dec. 13, President Obama signed a far-reaching law that will speed the process for approving drugs and medical devices and increase funding for medical research. The 21st Century Cures Act also provides funding for mental health and substance use disorder prevention and treatment. Although the bill does not specifically mention pharmacists, several provisions could have implications for our profession. Read the full article.