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April 4, 2009

The focus of this past week has once again been the economic development bill with no resolution. Senator Crowell has basically stopped all movement by debating at length on SB 45. To the exasperation of the Senate he offered a 50 page amendment that he insisted be read word for word and the Senate discontinued debate.

Senator Dempsey’s SB 306 was debated throughout the day. This is the health coverage proposal to add 35,000 working adults to the MO HealthNet roles. The bill would raise the coverage on working adults to approximately $9,000 per year. There would be no cost to general revenue as a result of the medical provider tax plus the federal match. This proposal has generated considerable debate. The House has rejected the legislation and the Senate will support the measure. This will “free up” additional General Revenue dollars. However, with the General Assembly ideas that make sense many times do not receive approval.

News this week includes:

Committee Advances Cancer Clinical Trials Measure
The Senate Health, Mental Health, Seniors and Families Committee unanimously approved Senate Bill 375. The bill would require health insurers to provide coverage of routine patient care costs that are part of Phase I clinical trials for cancer treatment. The bill also makes changes to current law governing the obligation of insurers to cover cancer treatments in Phases II, III and IV clinical trials.

Pharmacist Vaccination Proposal Advances
Legislation to change laws on pharmacy practice was approved by a Senate committee Tuesday. The Senate Committee Substitute for Senate Bill 369 would permit pharmacists to administer vaccines for pneumonia, meningitis and shingles under the authority of a physician’s written protocol.

Emergency Provider
House Bill 697 was heard on Monday.

This bill adds state and political subdivision employees to the term "volunteer" as it relates to persons who can dispense medications for the Department of Health and Senior Services during emergencies.  If the employee is not a health care professional and is not otherwise covered by the State Legal Expense Fund, the individual will be considered an unpaid employee and will be covered by the fund.

I testified on behalf of MOALPHA for Dr. Cooper’s legislation. Nancy McAnaugh testified for the DHSS.

Dr. Cooper and DHSS were very appreciative of MOALPHA’s support.

This legislation corrects an oversight from last year’s legislation.

Senate-Health/ Mental Health/ Seniors & Families
Several health related bills were heard Wednesday:

  • SB 547   Modifies several provisions of law relating to health insurance. Modifies several provisions of law relating to health insurance. - Hearing conducted

Senator Schmitt presented this bill and stated that this bill would help to lower the amount of the uninsured citizens in Missouri and also provide cheaper means of getting health insurance for employers and employees. There was no opposing testimony or testimony for informational purposes only.

  • SB 410   Modifies various laws governing medical malpractice insurance. Modifies various laws governing medical malpractice insurance. - Hearing conducted

Senator Stouffer presented this bill and stated that this bill change the legislation regarding medical malpractice insurance. Senator Stouffer also stated that this bill could lower the cost of medical malpractice insurance provided by the JUA from the Missouri Department of Insurance. A physician from Kansas City spoke in favor of this bill and reiterated the points that Senator Stouffer had made. The Missouri Hospital Association testified in opposition to this bill stating that this bill capped the requirement for malpractice insurance at $500,000 dollars. This witness did not believe that $500,000 would be sufficient coverage for malpractice insurance. A representative of Missouri Association of Trial Attorneys spoke in opposition to the bill citing that the bill made it more difficult to get information regarding issues surrounding medical malpractice. Brent Kabler spoke for informational purposes only and testified that the data collection components of this bill could be very useful. A representative of the medical malpractice insurance industry also testified for informational purposes only and stated that he was working with Senator Stouffer to create a committee substitute.
The Committee then went into executive session and passed. 

Seat Belts
HB 665 (Deeken), the primary seat belt law was passed in the House Transportation Committee. However, opponents loaded up the legislation with over 20 amendments.

These included a ban on cities having red light camera systems for safety added by Representative Yates. This bill is doomed with all the garbage added.

Physician Assistants
Senator Scott’s SB 406 was given final approval by the Senate on Thursday.

The bill authorized physician assistants to prescribe controlled substance III, IV and V. The bill also modifies the review of advanced practice registered nurses prescribing controlled substances.

Senate Bill 306
Senate Appropriations Chair Nodler in a shrewd move incorporated the Governor’s plan endorsed by the hospitals into the appropriations process by agreeing to fund SB 306 (Dempsey) legislation utilizing DHS and FRA revenue increase of $50 million to drawn down the $90+ million federal match.

The Senate bill will be sent to the House with a one year funding clause forcing House Republicans to either vote for the non General Revenue health plan  for 35,000 working adults or not.

Then he will still include the funding in the appropriations bill that they must approve. Either way they will be supporting the plan.

Birth Records
House Amendment #2 added to HCS HB 187 & 235 was adopted on Wednesday.

Below is a copy of the amendment for review.

Representative Grill offered House Amendment No. 2.

House Amendment No. 2

AMEND House Committee Substitute for House Bill Nos. 187 & 235, Section 41.950, Page 6, Line 69, by inserting after all of said section, the following:

193.087.

  1. In addition to the requirements of subsection 2 of section 193.085, when a birth occurs to an unmarried mother, whether in an institution or en route to an institution, the person in charge of the institution or a designated representative shall:
    1. Provide a form or affidavit prescribed by the state registrar that may be completed by the child's mother and father to voluntarily acknowledge paternity of the child pursuant to section 193.215;
    2. File the form, when completed, along with the certificate required by this section. Such completed form for the voluntary acknowledgment of paternity is not a public record; except that, a copy of such voluntary acknowledgment of paternity shall, upon request, be made available to the child's mother, the father listed on the child's birth record, and the attorney representing such mother or father. Upon payment of the fee established by rule by the department under section 454.455, RSMo, a copy of such voluntary acknowledgment of paternity shall be provided by the state registrar to the child's mother, the father listed on the child's birth record, and the attorney representing such mother or alleged father; and
    3. Provide oral and written notice to the affiant required by section 193.215.
  2. Any institution, the person in charge or a designated representative shall be immune from civil or criminal liability for providing the form or affidavit required by subsection 1 of this section, the information developed pursuant to that subsection, or otherwise fulfilling the duties required by subsection 1 of this section.
  3. The family support division may contract with the department of health and senior services to provide assistance and training to the hospital staff assigned responsibility for providing the information, as appropriate, to carry out duties pursuant to this section. The family support division shall develop and distribute free of charge the information on the rights and responsibilities of parents that is required to be distributed pursuant to this section. The department of health and senior services shall provide free of charge to hospitals the acknowledgment of paternity affidavit, and instructions on the completion of the affidavit.
  4. If no contract is developed with the department of health and senior services, then the family support division shall provide the assistance and training activities to hospitals pursuant to subsection 3 of this section.
  5. Any affiant who intentionally misidentifies another person as a parent may be prosecuted for perjury, pursuant to section 575.040, RSMo.
  6. Due to lack of cooperation by public assistance recipients, the family support division shall either suspend the entire public assistance cash grant, or remove the needs of the adult recipient of public assistance from the cash grant, subject to good cause exceptions pursuant to federal law or regulations.

193.215.

  1. A certificate or report registered pursuant to sections 193.005 to 193.325 may be amended only pursuant to the provisions of sections 193.005 to 193.325, and regulations adopted by the department.
  2. A certificate or report that is amended pursuant to this section shall be marked "Amended" except as otherwise provided in this section. The date of amendment and a summary description of the evidence submitted in support of the amendment shall be endorsed on or made part of the record.
  3. Upon receipt of a certified copy of an order of a court of competent jurisdiction changing the name of a person born in this state and upon request of such person or such person's parents, guardian, or legal representative, the state registrar shall amend the certificate of birth to show the new name. The court order shall include such facts as are necessary to locate and identify the certificate of birth of the person whose name is being changed.
  4. When an applicant does not submit the minimum documentation required in the regulations for amending a vital record or when the state registrar has reasonable cause to question the validity or adequacy of the applicant's sworn statements or the documentary evidence, and if the deficiencies are not corrected, the state registrar shall not amend the vital record and shall advise the applicant of the reason for this action and the applicant's right of appeal to a court of competent jurisdiction.
  5. When a certificate or report is amended pursuant to this section, the state registrar shall report the amendment to any other custodians of the vital record and their record shall be amended accordingly.
  6. Upon written request of both parents and receipt of a sworn acknowledgment of paternity notarized and signed by both parents of a child born out of wedlock, the state registrar shall amend the certificate of birth to show such paternity. The acknowledgment affidavit form shall be developed by the state registrar and shall include the minimum requirements prescribed by the secretary of the Department of Health and Human Services pursuant to 42 U.S.C. Section 652(a)(7). The acknowledgment form shall include provisions to allow the parents to change the surname of the child and such surname shall be changed on the birth record if the parents elect to change the child's surname. The signature of the parents shall be notarized or the signature shall be witnessed by at least two disinterested adults whose signatures and addresses shall be plainly written thereon. The form shall be accompanied by oral notice, which may be provided through the use of video or audio equipment, and written notice to the mother and putative father of:
    1. The alternatives to, the legal consequences of, and the rights and responsibilities that arise from signing the acknowledgment;
    2. The benefits of having the child's paternity established; and
    3. The availability of paternity establishment and child support enforcement services. A rescission of acknowledgment form shall be filed with the bureau of vital records pursuant to section 210.823, RSMo, to vacate the legal finding of paternity. The bureau shall file all rescissions and forward a copy of each to the division of child support enforcement. The birth record shall only be changed pursuant to this subsection upon an order of the court or the division of child support enforcement.
    The completed voluntary acknowledgment of paternity is not a public record; except that, a copy of such voluntary acknowledgment of paternity shall, upon request, be made available to the child's mother, the father listed on the child's birth record, and the attorney representing such mother or father. Upon payment of the fee established by rule by the department under section 454.445, RSMo, a copy of such acknowledgment shall be provided by the state registrar to the child's mother, the father listed on the child's birth record, and the attorney representing such mother or alleged father.
  7. The department shall offer voluntary paternity establishment services.
  8. Upon receipt of a certified copy of an order of a court of competent jurisdiction changing the name of a person born in this state and upon request of such person or such person's parents, guardian or legal representative, the state registrar shall amend the certificate of birth to show the new name.
  9. Upon receipt of a certified copy of an order of a court of competent jurisdiction indicating the sex of an individual born in this state has been changed by surgical procedure and that such individual's name has been changed, the certificate of birth of such individual shall be amended.”; and

Further amend said bill, Section 452.930, Page 62, Line 3, by inserting after all of said section the following:

454.445.

  1. No deposit or other filing fee, court fee, library fee, or fee for making copies of documents shall be required to be paid by the division of child support enforcement, or any attorney bringing action pursuant to a referral by the division of child support enforcement, by any circuit clerk or other county or state officer for the filing of any action or document necessary to establish paternity, or to establish, modify or enforce a child support obligation.
  2. Notwithstanding any other provision of law, a copy of an affidavit acknowledging paternity shall, upon request, be made available to the child's mother, the father listed on the child's birth record, and the attorney representing such mother or father. The department of health and senior services shall establish by rule the fee for making a copy of an affidavit acknowledging paternity. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2009, shall be invalid and void.”; and

    Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

On motion of Representative Grill, House Amendment No. 2 was adopted.

Senate Appropriations Committee utilizes Federal Economic Recovery Funding to Restore Some Critical Services
The Senate Appropriations Committee began “mark-up” of the Budget Bills this week. The committee is utilizing federal economic recovery funding to restore some critical services to the Health, Mental Health and Social Services Budgets.

Some of the Highlights:

  • Medicaid for Parents to 50% FPL: The Senate Appropriations Committee included coverage for 34,000 low income parents up to 50% of the federal poverty level in Medicaid using Hospital FRA funding. The House passed budget bills did not include this. The item will be determined in Conference Committee (members are not selected yet as the Budget Bills are not final in the Senate yet).
  • Child Care funding was not determined. The Governor recommended using $3.5 million in state general revenue to maintain current income eligibility for child care for low income families, up to 127 percent of the federal poverty level and transitional benefits to 139% FPL. The House passed budget included $2.13 million in general revenue funding to maintain child care at current levels. The reduction as compared to FY 2009 may result in the elimination of transitional child care for families with incomes that increase slightly above the income eligibility guideline of 127 percent of the FPL.[1]
  • Children’s Health Care: SCHIP Premiums & Outreach funding was not determined. The Governor recommended using $22.7 million in state general revenue to support access to health care for 27,000 children by eliminating premiums for children in families between 150 – 225 percent of the FPL, and reducing premiums for children in families with incomes from 226 – 300 percent of the FPL. In addition, a portion of the funding would be utilized to conduct outreach to enroll children who are currently eligible for Medicaid or CHIP, but who remain uninsured.

Next Week
Only six weeks remain in the 2009 session of the Missouri General Assembly.

There has been a great deal of activity with few results.

 

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