Heart Disease and Stroke - 2011 Update of State Legislative Policy Options
Cardiovascular disease is the nation’s No. 1 killer of men and women across all racial and ethnic groups. As the first and fouth leading causes of death for all Americans, heart disease and stroke contribute to rising health care costs. In fact, one-third of the nation's population have some form of cardiovascular disease. Total cardiovascular disease medical costs in 2010 were an estimated $300 billion, according to the Centers for Disease Control and Prevention. State governments pay a share of the burden for their state employees and Medicaid enrollees.
Affordable Care Act: Controlling high blood pressure, cholesterol levels and diabetes reduces the risk of developing heart disease. For most people, heart disease and stroke can be prevented through lifestyle and behavior changes. Early detection and treatment is key to reducing risk for heart disease and stroke. As part of health reform, the Affordable Care Act (ACA) requires new health plans to cover a number of preventive services at no cost, including many that can help reduce risk of cardiovascular disease, such as:
Testing for high blood pressure and cholesterol.
Counseling on the use of daily aspirin.
Counseling and medication to quit smoking.
Counseling on diet and weight loss and managing obesity.
The ACA also created the National Prevention, Health Promotion and Public Health Council to develop a National Prevention Strategy. The strategy makes recommendations to help shift the nation’s focus from sickness and disease to wellness and prevention to help reduce preventable death and disability in the United States.
Legislative Trends: Heart disease and stroke legislative trends in 2011 consist of studying chronic disease management programs in patient-centered health homes; improving stroke prevention to reduce the number of atrial fibrillation (AFib) related strokes; services for state employees with heart conditions; requiring screening and reporting of congenital heart disease; and requiring insurance coverage for children with an underlying congenital heart condition. Legislators also have encouraged citizens to learn about heart disease and stroke signs and symptoms, learn how to perform CPR and use an automated external defibrillator (AED), and to be physically active.
The legislation detailed below includes three categories of status:
Resolutions and other non-binding measures which often encourage or request activity, or recognize an event or special date. Approved measures are listed as “adopted.”
Signed statutes, which have the force of permanent law. These passed bills are listed as “enacted,” and include both a bill number and a chapter or act number where available.
Filed measures still pending (as of September 15, 2011). These include the notation “pending”
Other 2011 measures that did not pass are excluded from the list.
State Laws and Policies
Public Awareness of Heart Disease and Stroke
AL SJR 55 (2011, adopted, Act No. 2011-086) - Recognizes May 1-7, 2011, as “Physical Education and Sports Week,” and the month of May as “Physical Fitness and Sports Month.” Encourages all Alabamians to become involved in the "Let's Move in School" campaign to promote quality physical education programs in schools.
AK HCR 5 (2011, adopted) - Details current research on the impact of adequate Vitamin D levels on a range of health issues, including heart disease and highlights the central role of Vitamin D in a preventive health model. Encourages the Alaska Department of Health and Social Services and health care providers to increase attention to Vitamin D deficiency and the importance of Vitamin D blood testing to promote awareness of health benefits.
CA ACR 8 (2011, adopted, Resolution Chapter No. 2) - Recognizes the month of February 2011, as “American Heart Month” and February 4, 2011, as “Wear Red Day,” to raise awareness that heart disease is the leading U.S. cause of death for women. Encourages public support for “Go Red for Women” events.
CO SJR 10 (2011, adopted) - Recognizes Friday, February 4, 2011, as “National Wear Red Day” and encourages all citizens to show support for women and the fight against heart disease by wearing red.
GA SR 14 (2011, adopted) – Recognizes Friday, February 4, 2011, as "National Wear Red Day" and encourages all citizens to show their support for women and the fight against heart disease by wearing red.
GA HR 569/SR 392 (2011, adopted) - Recognizes Tuesday, March 22, 2011, as “Georgia Rides to the Capitol Day” and commends the local and state officials for improving trails and promoting cycling as an alternative mode of transportation.
HI HCR 209/ HR 180 (2011, adopted) – Encourages organizations that participate in “Women's Health Month” to incorporate events that raise awareness and educate the public about women's health issues. The month of events will include education workshops, health fairs, lectures, fitness activities, and other special events to support women in living a healthy lifestyle.
KY HR 63 (2011, adopted) - Designates the month of February as "Heart Healthy Month for Women." Encourages every woman to adopt a lifestyle that will decrease the risk of heart disease.
MI SR 4 (2011, adopted) - Recognizes February 3, 2011, as “Go Red for Women Day.” Encourages all citizens to wear red in recognition and support of family, friends, and neighbors who have suffered from heart disease. A copy of the resolution will be sent to the Go Red for Women Leadership Committee to show appreciation for their dedication and commitment to fighting heart disease.
MI HR 23/SR 5 (2011, adopted) - Recognizes February 2011, as “Heart Health Awareness Month.” Encourages all citizens to help educate and support family, friends and neighbors with who have suffered from heart disease.
MS SCR 592 (2011, adopted) - Recognizes February 4, 2011, as "National Wear Red Day" and encourages all citizens to bring awareness to the effects of cardiovascular disease in women.
NC HR 670 (2011, adopted) – Creates awareness about the benefits of reducing sodium in the diet to decrease the risk of heart disease and stroke. Recognizes the Stroke Advisory Council of the Justus-Warren Heart Disease and Stroke Prevention Task Force for developing recommendations to support initiatives to increase public awareness about stroke risk factors, such as high blood pressure; assist individuals in identifying risks factors; and encourage people to live a healthy lifestyle and limit sodium intake.
ND SCR 4009 (2011, enacted, Chapter Number 561) - Recognizes February 2011, as "American Heart Month" and Friday, February 4, 2011, as "National Wear Red Day". Encourages all citizens to wear red to raise awareness of cardiovascular disease.
NJ AR 2674 (2010, pending) – Would designate walking as the New Jersey State Exercise.
NJ AJR 47 (2010, pending, Assembly Committee on Health and Senior Services) – Would designate April of each year as "Shape Up New Jersey Month." The resolution requests the Governor to annually issue a proclamation calling upon public officials, health care professionals and citizens to observe this month with appropriate activities and programs designed to raise public awareness about the importance of physical exercise to maintaining good health.
OK HR 1031 (2011, adopted) - Recognizes May 5, 2011, as “Wear Red Day.” Encourages all citizens to show their support for women and the fight against heart disease by wearing red.
PA HR 36 (2011, adopted) - Recognizes February 4, 2011, as "Wear Red Day." Encourages all citizens to show their support for women and the fight against heart disease by wearing red.
PA HR 57 (2011, adopted) - Recognizes the month of February 2011, as "American Heart Month" to emphasize the importance of the ongoing fight against heart disease. Encourages all citizens to acknowledge the importance of calling 9-1-1, learning cardiopulmonary resuscitation and being trained to use a AED to increase survival rates from cardiac arrest.
PA HR 220/ SR 99 (2011, adopted) - Recognizes May 2011, as "American Stroke Month” and encourages all citizens to familiarize themselves with the risk factors associated with stroke, recognize the warning signs and symptoms, and the importance of dialing 9-1-1 immediately.
PA SR 21 (2011, adopted) - Recognizes Friday, February 4, 2011, as "National Wear Red Day" and encourages all citizens to show their support for women and the fight against heart disease by wearing red.
PA SR 22 (2011, adopted) - Recognizes February 2011, as "American Heart Month" and encourages all citizens to learn to use automated external defibrillators and make healthy lifestyle choices that will increase survival rates from cardiac arrest.
PA HR 158/SR 69 (2011, adopted) - Recognizes April 6, 2011, as "National Start! Walking Day" and encourages all citizens to show their support for the fight against heart disease by walking at work.
PA HR 137 (2011, adopted) - Recognizes April 8, 2011, as "National Start! Walking Day" and encourages all citizens to show their support by walking to fight against heart disease.
TN HR 11 (2011, adopted) - Recognizes February 4, 2011, as “National Wear Red Day” and encourages all Tennesseans to educate themselves on preventing cardiovascular disease.
TN HR 41 (2011, adopted) - Recognizes February 27, 2011, as the second annual “Matters of the Heart” red dress day in Nashville. Encourages all citizens to educate themselves on ways to prevent cardiovascular disease.
TX HR 232/ SR 157 (2011, adopted) - Recognizes February 4, 2011, as “National Wear Red Day” and encourages all Texans to show their support for women and the fight against heart disease by wearing red.
TX HR 1182 (2011, adopted) - Recognizes April 6, 2011, as “National Start! Walking Day” and encourages all Texans to take charge of their health by taking time to walk.
TX SR 710 (2011, adopted) - Commends the American Heart Association on its commitment to improving Americans' health and extends best wishes for a successful National Start! Walking Day.
UT SCR 12 (2011, adopted) – Proclaims February as “Wear Red Month” in recognition of the fight against heart disease among women.
VA HJR 198/ SJR 124 (2010, adopted) - Designates April 25, 2010, and each succeeding year as “Youth Fitness Day.” Encourages youth and other citizens to engage in physical activity on this day as a symbol of their commitment to fitness and healthy living.
WI AJR 7/SJR 6 (2011, pending) - Proclaims February 2011, as “American Heart Month” and February 4, 2011 as “Wear Red Day.” Encourages all citizens to show their support for women and the fight against heart disease by wearing red and recognizing the importance of learning to use an automated external defibrillator to help increase survival rates from cardiac arrest.
State Employee Health and Wellness
MA SB 495 (2011, pending, to Joint Committee on Health Care Financing) –Would mandate health benefit coverage to active or retired commonwealth employees for screening tests that detect cardiovascular disease. The minimum coverage required is up to $200 for one of the following noninvasive screening tests that measure the structure and function of arteries: computed tomography (CT) scanning to measure coronary artery calcification or ultrasound to measure carotid artery thickness and plaque. A contract between a subscriber and the corporation under an individual or group hospital service plan would provide benefits on a nondiscriminatory basis for the screening procedures. The following people would receive coverage for the screening procedures: males older than 45 years of age and younger than 76 years of age; females older than 55 years of age and younger than 76 years of age; are diabetic or at risk of developing coronary heart disease based on the Framingham Heart Study coronary score of intermediate or higher.
NY AB 3781 (2011, pending, to Assembly Committee on Governmental Employees) - Would amend the Retirement and Social Security Law in relation to heart disease related disabilities for members in the New York State and Local Employees' Retirement System who currently have heart disabilities sustained in the performance of duty and all members in the New York State and Local Police and Fire Retirement System. Would extend the same criteria that exist for determining accidental death benefits for firefighters to police officers.
Improve Quality of Care and Access to Care
2009 IL HB 1444 (2011, enacted, Public Act No. 1502) – Creates the Chronic Disease Nutrition and Outcomes Advisory Commission to inform the department on how to incorporate nutrition into state health policies as a chronic disease management strategy. The goal is to avoid unnecessary Medicaid hospitalizations and measure health care outcomes required by new federal health legislation. The Commission will submit an annual report with recommendations to the Department on or before July 1, 2011 and on or before July 1 of each year after. The Department will provide administrative and staff support to the Commission. This Act took effect January 1, 2011.
RI HB 5173/ SB 60 (2011, enacted, Chapter 86,Public Law No. 206) – Directs the department of health to develop a cardiovascular disease screening and lifestyle intervention pilot program housed in one of Rhode Island's six core cities, Pawtucket, Providence, Woonsocket, Newport, West Warwick or Central Falls. Requires the program to be based on the federal WISEWOMEN program administered by the Centers for Disease Control and Prevention. Directs the department to prepare an annual report and submit it to the legislature by January 3rd, each year summarizing the scope and reach of the pilot program, including a fiscal analysis and recommendations outlining the benefits and cost of expanding the pilot program throughout the state after the program has been in existence for three years. The pilot program expires July 1, 2014. Implementation of the women's cardiovascular screening and risk reduction pilot program is subject to appropriation.
VA HJR 82 (2010, adopted) - Directs the Joint Commission on Health Care to study the feasibility of health care homes to treat chronic disease. The commission will review information about programs in other states to develop recommendations related to standards for chronic health care homes, including the use of primary care practitioners, care coordinators and other professionals to provide high quality, patient-centered care. This also includes using health information technology; evidence-based health care practices; incorporating quality outcome, and cost-of-care measures; standards for certification of health care facilities as chronic health care homes and ongoing reporting requirements; developing a chronic health care home collaborative to provide opportunities for state agencies to exchange information about quality improvement and best practices; enrolling state medical assistance recipients; and costs associated with implementing a successful demonstration program to determine improvement in health care quality and patient outcomes. Directs the commission to complete its meetings for the first year by November 30, 2010, and for the second year by November 30, 2011 and to submit an executive summary to the Division of Legislative Automated Systems no later than the first day of the next regular session of the General Assembly for each year.
Address and Eliminate Disparities
TN HJR 245 (2011, carry over to 2012 session, to the House Committee on health and Human Resources) - Recognizes April 2011 as "Minority Health Awareness Month" in Tennessee.
Emergency Medical System and AED
GA SR 590 (2011, adopted) - Encourages the Georgia Department of Education to implement cardiopulmonary resuscitation (CPR) classes in public schools.
NC HB 914 (2011, pending, to Senate Committee on Health Care) – Would create a Survival Public-Private Task Force that identifies and pursues funding to place automated external defibrillators (AEDs) in state agencies and institutions. The funding would also be used to train state employees how to recognize signs and symptoms, and perform CPR/AED when witnessing a sudden cardiac arrest, heart attack or stroke. Would ensure coordination with local emergency medical systems about placing AEDs in state buildings, facilities and institutions. This act would become effective July 1, 2011.
NJ AR 13 (2010, pending, Assembly Committee on Education) – Would encourage boards of education to include cardiopulmonary resuscitation (CPR) training as part of the high school curriculum.
Stroke Systems of Care
AZ HB 2157 (2011, enacted, Chapter No. 47) - Requires the department of health services to adopt rules for coordination of stroke care services between emergency medical services providers and hospitals by January 1, 2014. Directs the Arizona emergency medical services council to establish emergency stroke care protocol standards for the assessment, treatment and transport of stroke patients to certified stroke facilities within the state’s four local emergency medical services coordinating regions. Directs the department to seek health care provider and other stakeholder input when developing these standards. Requires the creation of a statewide stroke quality improvement databases to collect data about stroke care, consistent with the National Department of Transportation Emergency Medical Services database and stroke consensus metrics prescribed by national organizations that focus on heart disease, stroke care and prevention.
CA AB 861 (2011, pending, Senate Committee on Health) - Would require the state department of health to administer and establish a registry that collects stroke data on quality improvement measures for acute stroke treatment. The bill would require the program be implemented only to the extent funds from federal or private sources are made available.
CA ACR 54 (2011, enacted, Chapter No. 67) – Would encourage people to take action during American Stroke Month 2011, and participate in "Take 2 to Save 2", take two minutes to send a health message about stroke warning signs to two people who smoke, are overweight, have high blood pressure, diabetes and a family history of heart disease or stroke. Would also promote the "Power to End Stroke" program to reduce stroke in African Americans by empowering them to reduce their risk, recognize the warning signs and respond quickly.
CO HJR 1023 (2011, adopted) - Encourages hospitals in Colorado to adopt the national standards for heart disease and stroke treatment such as "Get With the Guidelines for Coronary Artery Disease and Stroke" and seek accreditation as stroke centers from the Joint Commission's Accreditation of Hospitals program. Recognizes that the Department of Public Health and Environment has developed a comprehensive strategic plan to reduce stroke in Coloradans. Encourages the department to collaborate with organizations that provide services and assistance to non-English-speaking patients and callers to determine how to improve the ability of EMS responders. Encourages the department to provide training to EMS providers ensuring they can identify and treat stroke victims immediately and continue supporting the use of telemedicine in rural areas. Recommends that the department partner with the Colorado Department of Education to introduce stroke awareness and prevention education in public schools.
IA HR 55 (2011, adopted) - Requests the Department of Human Services and the Department of Public Health to assess chronic disease management of stroke prevention in atrial fibrillation patients, with the intent of identifying opportunities to improve quality of care and reduce the financial and clinical burden of AFib-related strokes on public assistance programs, including Medicare and Medicaid. Requires a report of findings and recommendations to the General Assembly so that it can evaluate the effectiveness of the current quality of care within public assistance programs, including Medicare and Medicaid.
IL HR 245 (2011, adopted)- Requests the Illinois Department of Healthcare and Family Services to assess chronic disease management of stroke prevention in atrial fibrillation patients, with the intent of identifying opportunities to improve quality of care and reduce the financial and clinical burden of AFib-related strokes on public assistance programs, including Medicare and Medicaid.
MO SCR 12 (2011, adopted) - Requests the MO HealthNet Division to assess chronic disease management of stroke prevention in atrial fibrillation patients, with the intent of identifying opportunities to improve quality of care and reduce the financial and clinical burden of AFib-related strokes on public assistance programs, including Medicare and Medicaid. A report of findings and recommendations will be given to the General Assembly by December 31, 2011.
NC HB 697 (2011, pending, Senate Rules and Operations of the Senate Committee) – Requests the Department of Health and Human Services, Division of Public Health to assess chronic disease management of stroke prevention in atrial fibrillation patients, with the intent of identifying opportunities to improve quality of care and reduce the financial and clinical burden of AFib-related strokes on public assistance programs, including Medicare and Medicaid. The Department will report findings and recommendations to the 2012 regular session of the 2011 General Assembly.
NC HB 443/S 240 (2011, pending, to House Committee on Appropriations) - Would appropriate $400,000 annually for FY2011 -2012 and FY2012-2013 from the general fund budget to the Department of Health and Human Services, Division of Public Health to the Heart Disease and Stroke Prevention Branch for continuation of community education campaigns and communication strategies in partnership with the American Heart Association/American Stroke Association on stroke signs and symptoms and the importance of immediate response. Would also appropriate $50,000 annually from the general fund to the Department of Health and Human Services, Division of Public Health for continued operations of the Stroke Advisory Council. This act would become effective July 1, 2011.
PA HR 354 (2011, pending, House Health Committee) – Would promote awareness of atrial fibrillation and would urge the Secretary of Health to prioritize atrial fibrillation and implement programs, evaluation, assessment and policy changes to reduce the burden of this costly, progressive disease.
SC SB 588 (2011, enacted, Act No. 62) – Requires establishment of a Stroke System of Care Advisory Council by the director of the health department to advise the department on the development and implementation of a statewide system of stroke care. Included will be a list of primary stroke centers and stroke enabled centers through telemedicine, available to each licensed emergency medical services provider in South Carolina, North Carolina and Georgia before June 1 each year; adoption and distribution of a nationally recognized, standardized stroke-triage assessment tool that will be posted on the department website, a copy of the tool will be given to all licensed emergency medical services providers before January 31, 2012. Each licensed emergency medical services provider will establish a stroke assessment and triage system that incorporates the departments approved stroke-triage assessment tool to comply with all sections of this article before June 1, 2012. As a subcommittee of the Stroke System of Care Advisory Council, a Stroke Registry Task Force will be established to maintain a statewide stroke registry database that compiles information and statistics on stroke care. The director will provide a formal progress report of the statewide system of stroke care to the General Assembly by January 15, 2014.
Congenital Heart Disease
MD HB 714 / MD SB 786 (2011, enacted, Chapter No. 553/ Chapter No. 552) – Requires that the Department of Health and Mental Hygiene adopt certain federal recommendations about screening newborns for congenital heart disease. Requires the State Advisory Council on Hereditary and Congenital Disorders to develop recommendations for critical congenital heart disease screening of newborns; requires the Advisory Council to convene experts and examine the impact of implementing mandatory critical congenital heart disease screening measures; requires the Advisory Council to submit a report to the General Assembly.
NJ AB 3744 (2010, enacted, Chapter No. 2011-74) – Requires that the state birthing facilities perform simple newborn screening along with current screening methods for congenital heart disease. Directs the Commissioner of Health and Senior Services to require each birthing facility licensed by the Department of Health and Senior Services to perform a pulse oximetry screening at least 24 hours after birth on every newborn, and to adopt rules and regulations, consistent with the “Administrative Procedure Act,”
TN SB 65 (2011, carry over to 2012 session, in House for second read) – Would direct the genetic advisory committee is directed to develop a newborn screening program for congenital heart disease before January 1, 2012. A child born in a hospital or other birthing facility will be screened for congenital heart disease prior to discharge from that facility. All screening providers or entities will report their screening results to the department of health. The department of health would be required to refer any child who does not pass the screening to appropriate providers for appropriate follow-up. The commissioner of health will promulgate rules and regulations in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. This act shall take effect July 1, 2011, the public welfare requiring it.
TX HB 1644 (2011, pending, House Committee on Insurance) – Would require health benefit plans to provide coverage for screening medical procedures with minimum coverage to each covered individual who is older than 10 years of age and younger than 18 years of age and who is a student at a middle school in Texas; or has not been diagnosed with heart disease and has not undergone an electrocardiogram or echocardiogram within the past two years. The minimum coverage required is up to $150 for examinations once every five years and intended to detect asymptomatic underlying congenital cardiovascular conditions that are associated with sudden cardiac arrest in children, including abnormal structure or function of the heart, the arteries, or the electrical pathways in the heart. This Act would take effect September 1, 2011 and includes any health benefit plan delivered, issued for delivery, or renewed before January 1, 2012.
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