March 11, 2005

Governor Matt Blunt's Missouri State Reform Commission has begun its task of overhauling Missouri government. It's only the third time that a reform of this kind has taken place in Missouri. The first was in 1945, the second in 1974. The Governor wants the panel to come up with ideas to improve productivity and efficiency, and realizes the Commission will probably go along with his call for the elimination of some state government positions. The Commission's report is due a year from now. Members say they'll hear from the public over the next few months, consider what's been presented, and they hope to issue their final report to the Governor by year's end.

 Anemic revenue numbers for the fiscal year-to-date bring out talk of withholdings of funds to state services and could impact the next budget lawmakers are putting together. Commissioner of Administration Mike Keathley says February's numbers show an increase of just 2.4-percent for the fiscal year-to-date - significantly lower than the 3.8-percent legislators thought they would get. If the current trend continues to the end of the fiscal year, the state could end up $70-Million short, forcing withholdings to balance the budget. But Keathley remains optimistic the numbers will come through. And, he admits if the growth stays anemic, the consensus revenue estimate for Fiscal Year '06 put together in December might have to be revised down.

 Senators Considering Medicaid Changes Told Of Questionable Practices
Senators considering changes that would kick tens of thousands of people off the Medicaid program have heard allegations of questionable operations in a state Medicaid office. Doctor David Ingelking was a member of the Medical Review Teams that looked at applications for state medical assistance for people too disabled to continue with meaningful employment. He noticed early in his career that the Springfield office, which handles cases for western Missouri, was giving approvals at a rate of two to three-times the rate allowed by the Jefferson City office. He says he learned why when he became part of the Springfield review team. He says the Springfield office wrote its own guidelines for acceptance. And he charges the program coordinator there, who is not a doctor, has ignored the doctors doing medical revues. Ingelking has told a Senate committee the woman told team members to approve some things automically, or almost automatically. He says he complained to the State Supervisor of Medical Review Teams, then to the State Director of Family Support. He says his complaints led to his firing. The senior member of the committee has called for a legislative investigation of those practices.

House Approves Abortion Legislation
The House approved and sent to the Senate a bill to create civil liability for those intentionally helping a minor obtain an abortion without required parental consent. House Bill 100 also would require physicians performing abortions to have clinical privileges at a hospital providing gynecological/obstetrical care within 30 miles of the location of the abortion procedure. Also, clinics performing more than a certain number of abortions would need to be licensed as an ambulatory surgical center.

Senate Approve Auto Safety Bill
The Senate gave first round approval to the Senate Committee Substitute for Senate Bills221, 250 and 256 this week. The proposal authorizes law enforcement officers to stop a vehicle solely because of a violation of the law mandating seat belt use. The bill also expands laws requiring the use of child safety seats.

 House Committee Reverses Some Budget Cuts
The House Appropriations Committee for Health, Mental Health and Social Services approved a budget plan this week that eliminates or softens a number of the Medicaid and mental health budget cuts proposed by Governor Blunt earlier in the legislative session.

In his State of the State address in January, the governor had asked legislators to lower the income standard used to determine Medicaid eligibility for those who are elderly or disabled. The current standard is 100 percent of the federal poverty level. Governor Blunt’s proposal would reduce the standard to the federally mandated minimums of 74 percent of the poverty level for singles and 80 percent of the poverty level for married couples. The House committee allocated $46 million in state and federal funds to raise the income standard for this population to 85 percent of the poverty level.

Another Medicaid budget restoration adopted by the committee would restore coverage of a number of services, including hospice care, oxygen and respiratory equipment, wheelchairs, diabetic supplies and equipment, prosthetics and emergency ambulance services. Those services had been eliminated for all beneficiaries except children, pregnant women and the blind. State and federal funds allocated for the restoration total $83 million.

The committee’s plan reverses the original budget’s new copayment requirements for several mental health and in-home care programs. The change is estimated to cost $41 million in state and federal funds.

The committee also added $57 million in state and federal funds to reverse budget cuts for community programs funded by the Department of Mental Health to treat psychiatric and substance abuse patients. MHA had told legislators to expect the proposed cuts in community mental health programs to result in a substantial increase in psychiatric patients using hospital emergency departments. Left without community-based supervision, many of these patients discontinue their psychotropic medications and end up as psychiatric emergencies in hospital emergency departments. This is a serious and growing problem in many facilities.

To provide the revenue necessary to fund the budget restorations, the committee endorsed the following program initiatives.

• The state would act as a pharmaceutical administrator for those enrolled in the new Medicare Part D prescription drug plan. The proposal allows the state to receive rebates from pharmaceutical manufacturers.

• The state sales tax would be applied to in-home services, with the proceeds used to generate federal Medicaid matching funds.

• The trend factor paid to Medicaid managed care plans for their pharmaceutical costs would be reduced to 11 percent from 15 percent.

• Eligibility for all Medicaid enrollees would be verified annually, generating projected savings of $29.1 million in state and federal funds.

• More stringent admission criteria would be used in determining a Medicaid patient’s need for nursing home care.

• The State Children’s Health Insurance Program (SCHIP) would charge premiums for coverage of children living in households with incomes greater than 150 percent of the federal poverty level. Premiums would be capped at 5 percent of household income. Currently, SCHIP premiums are charged for children with household incomes between 225-300 percent of the federal poverty level.

Medicaid Reform Proposal Advances
The Senate Pensions, Veterans Affairs and General Laws Committee approved Senate Bill 556, which creates a Medicaid Reform Commission to develop recommendations to modify the state's Medicaid program. The commission would be comprised of 12 state legislators and 3 state agency directors. It is to complete its work by September 1, 2005. The measure is sponsored by Senate President Pro Tem Michael Gibbons, R-Kirkwood.

Jam/ Jellies
Senator Klindt’s Jam and Jellies bill has received initial approval in the Senate and is being “rammed” through by Senator Klindt who has a personal “gripe” with health authorities in his area.

Blunt Announces Choice To Head Department Of Social Services
Governor Matt Blunt's choice to head the State Department of Social Services is a former Missouri state employee who moved to Wyoming and who has served as Director of the Wyoming Department of Family Services. If confirmed by the Senate, Gary Sherman will take over a department that is facing some tough challenges involving cash flow, particularly in the area of Medicaid. Sherman also wants to work hard to deal with concerns affecting children. Sherman is a native of Rolla who worked as Director of the Missouri Department of Aging from 1985 to 1988. Prior to that he worked with the Missouri Division of Youth Services, serving as Director of that agency from 1983 to 1985. He earned a bachelors degree in psychology from the University of Missouri-Rolla and a Masters degree in guidance and counseling from Southwest Missouri State University.

Death Records
HB 581 was heard Wednesday morning in the House Veterans Committee.

HB 581 prohibits a person from charging a veteran's immediate family a fee for copying the veteran's death certificate if the copies are to be used by the family to file for benefits.

The family member must provide a written notarized statement specifying the exact number of copies needed and indicating how many will be used to file for benefits.

This popular bill will decrease the fees coming into local health departments. However, it is a politically sensitive bill.

 Physicians Assistants
HB 503, Representative Sater, was heard Wednesday morning . HB 503 expands the definition of "supervision" of physician assistants to allow supervising physicians to be available via telecommunications for consultation, assistance, or intervention.

Supervising physicians must be present a minimum of 20% of the clinic's hours for practice supervision and collaboration when utilizing physician assistants. No physician will supervise more than three physician assistants; however, this provision does not apply to physician agreements with hospital employees.

Physician assistants must practice within 30 miles of the supervising physician, with the mileage limit for practicing in federally designated health professional shortage areas being 50 miles.

The bill requires, after January 1, 2006, that applicants for a physician's assistant license have a master's degree in a health or medical science related field.

The P.A.’s had several witnesses in support and Jerry Burch (MHA) also testified in support.

MAOPS testified against the legislation as well as physicians supplied by MSMA.

Dr. Cooper, Representative Sater and Representative Chuck Portwood seemed to be leaning toward support of the bill. In addition, an exchange took place between Sater and Richard McIntosh of MAOPS.

House Children and Families Committee
 Three bills impacting children’s health were heard Wednesday in the House Children and Families Committee

HB 568 changes the laws regarding the protection of minors while in the custody of their parents. The bill:

(1) Prohibits a child under the care of the state or the jurisdiction of a juvenile court from being reunited with a parent or being placed back in the home with a parent who has been found guilty or plead guilty to specific crimes of sexual offenses or offenses against the family when the child was the victim;

(2) Allows the Children's Division to exercise discretion in awarding custody or visitation or the placing of a child back in the home of a parent, or any person residing in the home, who has been found guilty or plead guilty to any other offense;

(3) Removes when a parent has had a full order of protection entered against them from the list of conditions preventing a child from being returned to a parent;

(4) Allows the juvenile officer or division to file termination of parental rights when a noncustodial parent is delinquent in the payment of child support in excess of $10,000;

(5) Prohibits the court from awarding custody or unsupervised visitation to a parent when that parent has been found guilty or plead guilty to specific crimes of sexual offenses or offenses against the family when the child was the victim; and

(6) Prohibits the court from granting visitation rights to the noncustodial parent if that parent or any person residing with the parent has been found guilty or plead guilty to specific crimes of sexual offenses or offenses against the family when the child was the victim.

HB 574 changes the laws regarding reports of child abuse and neglect which resulted in the termination of parental rights. The Family Support Division of the Department of Social Services is required to determine if an applicant for state or federal funds for providing child care services in their home has had their parental rights terminated due to a finding of child abuse or neglect and to deny their application.

The Children's Division of the department is authorized to release to certain individuals, businesses, or agencies only information on substantiated reports which resulted in the termination of the parental rights of that person. Currently, all substantiated reports can be provided. A court can authorize the disclosure of information regarding substantiated reports not resulting in the termination of parental rights if it determines that the release of the information is required because of the severity of the allegations, the sufficiency of evidence for substantiation, and the immediate risk to the safety of children if the person's employment puts him or her in contact with children.

HB 586 prohibits the expenditure of public funds to existing or proposed health and social services programs that directly or indirectly subsidize abortion services. An entity that is affiliated with another entity that provides abortion services may only receive public funds if the affiliated entity is an independent affiliate. Entities that provide counseling to pregnant women and receive public funds may only provide non-directive pregnancy counseling and may not display or distribute material promoting abortion services.

Entities that receive public funds are required to maintain records that demonstrate strict compliance with this section. An independent audit of these entities must be conducted at least once every three years. If the recipient of public funds is affiliated with an entity that provides abortion services, an audit must be conducted each year to ensure compliance. The bill includes exceptions for reimbursement to entities that provide services that are required under federal Medicaid regulations and certain services required under the federal Public Health Services Act.

Next Week
The legislature breaks upon adjournment for the 2005 Spring Recess. The House and Senate will both attempt to address major legislation before the break. The legislature will resume March 29 th.

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