March 28, 2009

The House and Senate reconvened after the legislative spring recess with eight full weeks until the May 15th adjournment.

Activity in the House focused exclusively on the Budget. Budget Chair Icet ruled with an “iron fist” defeating all Democratic movements to change the House Budget Committee recommendations.

News this week includes:

The Missouri House worked virtually all week to pass the $22.8 billion budget which now goes to the Senate for consideration.  It is widely anticipated that the Senate will, as usual, write their own budget with the differences being ironed out in conference committee during the first week in May (the deadline is May 8 for final completion of the budget).  Of significance, House Republicans refused to include in the final budget Governor Jay Nixon’s use of hospital Federal Reimbursement Act funds to add 57,000 additional adults and children to the state’s Medicaid program.  House members utilized over $9 million that was to go to ethanol producers to increase monies for school transportation, developmentally disabled programs and to increase funds for tourism.

A report made public by the Missouri Department of Public Safety (DPS relating to state militia activity was the center of a political firestorm this week, culminating in a call from Lt. Governor Peter Kinder to have DPS Director John Britt placed on administrative leave pending an investigation into the report.  The report angered conservatives by suggesting that domestic militias subscribe to ideologies endorsed by Christian views and opposition to immigration, abortion and federal taxes.  The report noted that it was not uncommon for militia members to support third-party political candidates, specifically naming presidential candidates Ron Paul, Bob Barr and Chuck Baldwin.  The Missouri State highway patrol has retracted the report and promised an investigation into how the report was produced and distributed. 

In an eight hour floor debate that concluded at 2:30 a.m. Thursday morning, the Missouri Senate gave first round approval to what has evolved into the omnibus education bill (SCS/SB 291).  The underlying legislation, sponsored by Senator Charlie Shields (R-St. Joseph) would add virtual schools in the calculation and distribution of education funding, took on twenty-eight amendments during the course of debate.  Notably, the Senate defeated a proposed amendment to permit school districts to revert to a four day school week.

On Monday, the Senate debated an anti-abortion coercion bill for over five hours as democrats organized a filibuster that eventually resulted in the laying over of the bill by sponsor Rob Mayer (R-New Madrid).  Not so coincidentally, the debate was held as the Vitae dinner, featuring former presidential candidate Mike Huckabee, was holding its annual event in Jefferson City. 

Health Banks
Meanwhile, the Senate Health, Mental Health, Seniors and Families Committee held an abbreviated hearing on Senate Bill 548. It would authorize the Missouri Department of Social Services to select and engage not-for-profit organizations to establish and manage regional health banks in Kansas City and St. Louis. These regional health banks are to be a repository of electronic patient health data. The legislative sponsor indicated the bill is intended to start discussions as to how Missouri can best compete for federal planning and implementation grants to fund the development of electronic health record systems. Earlier in the week, the sponsor convened a meeting of stakeholders, including MHA, to discuss the proposal.
The committee also reviewed legislation to require health insurers to provide coverage of routine patient care costs that are part of Phase I clinical trials for cancer treatment. Senate Bill 375 also makes various changes to the current law governing the obligation of insurers to cover treatments in Phases II, III and IV clinical trials for cancer treatment.
Legislation to change laws concerning pharmacy practice also was discussed by the committee. Senate Bill 369 would permit pharmacists to administer vaccines for pneumonia and shingles under the authority of a physician’s written protocol.

Governor Nixon’s news release…
Gov. Nixon signs SB313 into law, codifying special state treasury funds for federal recovery dollars

Gov. Jay Nixon today signed into law SB313, which codifies the two special funds the Governor created in February to track every dollar received by the State Treasury under the American Recovery and Reinvestment Act: the Federal Budget Stabilization Fund and the Federal Stimulus Fund.

On Feb. 26, Gov. Nixon opened these funds in anticipation of the state's first disbursement of federal recovery funds. Gov. Nixon established the funds proactively - before SB313 was passed - because the state received its first recovery funds the same day, and it was important that these transparency measures be in place before the federal funds began to flow into the State Treasury. The bill Gov. Nixon signed today codifies these two funds as the means to identify, segregate and track stimulus funds as they arrive in the State Treasury to ensure transparency and accountability to the taxpayers.

"The funds we receive under the federal recovery act are intended to create jobs and transform Missouri's economy, and I am committed to ensuring that each and every recovery dollar is used in an open and accountable manner to accomplish those goals," Gov. Nixon said. "These funds will be an important tool to help state officials, government agencies and all Missourians ensure that our recovery funds are put to the best use possible to help turn our economy around. I appreciate the work of Sen. Nodler, Sen. Bray and Rep. Icet to steer this bill through the legislature. And I look forward to continuing my work with the General Assembly to jumpstart our economy and get Missourians back to work."

In addition to establishing separate State Treasury funds for all federal recovery dollars, Gov. Nixon has established a special Web portal - Transform.mo.gov - where Missourians can track state recovery disbursements, submit their ideas and proposals for recovery projects and find additional resources about the federal recovery act and its impact on Missouri. To date, more than 3,250 proposals and ideas have come in through Transform.mo.gov.

House Approves State Operating Budget
Key issues affecting healthcare concerned efforts to reverse spending cuts made by the House Budget Committee. The most high-profile debate focused on an effort to expand coverage under the MO HealthNet program to parents in families with household incomes between 20 percent and 50 percent of the federal poverty level. The state’s cost of this proposed expansion would be funded by hospital FRA and redirected DSH payments. The amendment was defeated by a margin of seven votes, 73-85. Another amendment to restore a coverage proposal for uninsured children under the State Children’s Health Insurance Program also was defeated.

Health Data Disclosure
A Senate committee has approved a new version of Senate Bill 149, which addresses the topic of health care data disclosure standards. It would require all health care providers to furnish, upon a patient’s written request, an estimate of the projected cost of elective or nonemergency services. The estimate would include a disclaimer that actual costs may differ from the estimate. The bill also would create new standards governing insurers’ disclosure of data on the quality and cost-efficiency of health care providers. It also has various directives to promote and regulate the practice of telemedicine, as well as language authorizing a demonstration project to direct nonemergency patients to community-based care settings as an alternative to hospital emergency departments.

Senate Committee Discusses State Civil False Claims Measure
A Senate committee held a hearing today on a bill that would create a state civil false claims law modeled after a federal anti-fraud law of the same name. Senate Bill 568 would allow those bringing allegations and documentation of government payment fraud to state prosecutors to share in the proceeds of the state’s civil recovery or settlement agreement. The bill sponsor, who presented the committee with a new version of the bill that exempts MO HealthNet claims from this proposed new law. Instead, alleged MO HealthNet fraud would be governed by existing Medicaid fraud standards.

Seat Belts
House Bill 665 (Deeken) was not voted upon this week. The vote will take place next week

Eating Disorders
The Senate Small Business Committee heard SB 463 Days requiring health carriers to provide coverage for the treatment and diagnosis of eating disorders.

This legislation was contested by the insurance companies as a mandate. However, it does open interesting territory.

Septage Removal
HB 604 Wood was voted DO PASS by the House Natural Resources Committee.

This legislation requires residential and commercial septage removal companies to register with the Department of Natural Resources.

Businesses removing sewage must maintain a record of the removal and disposal of waste which must, upon request, be made available to the department, the Department of Health and Senior Services, and any county health department.  The record must include:

1. An estimate of the amount of waste removed;
2. The date or dates of removal; and
3. The location, date, and time when the waste was discharged,
   land-applied, or treated.

Beginning June 1, 2009, the department must annually provide each county health department with an updated list of registered waste disposal businesses.  The list may be posted on the Internet and notice given electronically to the county health departments.

Giving Physician Assistants Prescription Authority
The Senate Financial and Governmental Organizations and Elections Committee approved legislation that would authorize physician assistants who meet specified training requirements to prescribe Schedule III, IV and V controlled substances under a physician supervision agreement. The Senate Committee Substitute for Senate Bill 406 also revises the requirements for monitoring collaborative practice arrangements between physicians and advance practice nurses. Currently, APRNs must submit 10 percent of their cases involving prescribing practices for review by the supervising physician every two weeks. This bill adds that if the APRN is prescribing controlled substances, 20 percent of the APRNs cases must be submitted for review.

Committee Hears Measure On Physicians Performing Abortions
While the Senate engaged in a filibuster of a bill establishing new requirements before an abortion is performed, a House committee discussed a different abortion measure. House Bill 570 would require additional information be included in reports filed by physicians on each abortion they perform.

 Bill Proposes Naming Sperm, Egg Donors On Birth Certificates
The House of Representative’s Health Policy Committee held a hearing on House Bill 355. It would require that, for those conceived using sperm or egg donation, the original birth certificate would name the sperm or egg donor. Various processes would be established for an adult conceived by sperm or egg donation to gain access to information about the donor. Committee members raised several concerns about the proposal.

Next Week
Seven weeks remain in the 2009 legislative session. Legislation will begin moving from one chamber to the opposite chamber.

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