May 1, 2009

As the legislature slowly winds down to the May 15th adjournment, differences between the two chambers on the budget have yet to be resolved.

This week the House did release the budget bills so that the Senate could go to conference and work out the differences between the two different versions.

The House and Senate conference committee will focus on the operations budget for the state. Additional budget bills dealing with stimulus funds may or may not be addressed by the May 8th budget deadline.

In yet another version of the stimulus funding disbursement (HB 22) the House defeated on Thursday their own spending package.

Rumors abound of a special session for stimulus funds after the regular session. In addition, “talk” in the halls are mentioning the possibility of withholding of funds for this year’s current budget.

News this week includes:

“Fair Tax”
HJR 36 was heard in the Senate Ways and Means Committee on Wednesday.

Representative Ed Emery is sponsoring this legislation promoted by billionaire Rex Singquefield.

As reported earlier this legislation negates all other taxes within political subdivisions and replaces them with a sales tax which would have to be raised to a revenue neutral level.

This would result in possible major reductions in revenue streams for political subdivisions.

Senator Vogel, Chairman, does not plan on moving the legislation out of committee.

Immigration
I have had numerous meetings with Representative Nolte regarding the problems we are having with continuous filing of notarized documentation for local public health contracts with the state.

Representative Nolte contacted the Office of Administration to inquire as to why they were asking for E-verify documentation on every contract and any revisions made to contracts.

O.A. commented that this was their interpretation of the law (HB 1549).

Nolte is developing language for us. I will attempt to amend a “fix” onto any legislation that fits our subject.

Unfortunately, it is very late I the session and it will be difficult to accomplish this task given the timelines.

Panel Approves Nurse Compact Measures
Senate Bill 237, was passed by a House committee. The bill is similar to House Bill 514. Both bills would authorize Missouri to join an interstate compact on reciprocal nurse licensure recognition among participating states. Bordering states that have joined the compact are Arkansas, Iowa, Kentucky, Nebraska and Tennessee. The Senate bill was amended to include a statement requested by the Missouri Nurses Association stating, This compact is designed to facilitate the regulation of nurses, and does not relieve employers from complying with statutorily imposed obligations. This compact does not supersede existing state labor laws.

Tax Cuts/ Budget
On Thursday, in a stunning bi-partisan vote, the legislators killed HB 22 which contained numerous extra dollars $336 million to fund special projects not on-going programs.

The bill will be reconsidered next week in numerous negotiations.

In a related development the House narrowly passed a state tax reduction of 6% to 5.5% for two years to be funded with the stimulus money.

The amendment to Senate Bill 71 passed 86-66. However, the Senate wants to “shore up” the state budget that is in dire straits. Consequently, this tax cuts chance of passage are slim.

Coverage
The budget battle has begun to fund an additional 35,000 working poor to the state MO HealthNet program.

Hospital FRA funds and DSH funds would fund the program and receive a $90 million federal match.

The statutory language change (SB 306) is in the House Health Insurance Committee and will be voted on next week.

Nursing Loans
Senator Clemens HB 247 was taken up and passed in the Senate on Monday.

The bill modifies the requirements for collaborative practice arrangements between advanced practice registered nurses and collaborating physicians. Advanced practice registered nurses are required to submit a minimum of ten percent of the charts documenting their delivery of health care services to the physician for review every fourteen days. The collaborating physician shall review twenty percent of the charts in which the advanced practice registered nurse wrote a prescription for controlled substances every fourteen days. The charts reviewed for prescription of controlled substances may be counted in the number of charts required to be reviewed for prescribing practices.
The specific rule-making authority granted to the board of healing arts and the board of nursing with respect to collaborative practice arrangements does not extend to collaborative practice arrangements of advanced practice registered nurses and physicians providing certain population-based health services.
This act modifies the definition of eligible student for the nursing student loan program to include doctoral students and to allow full time or part-time doctoral students to be eligible for the loan program.
Provisions of this act are similar to SS/SCS/SB 406 and SCS/SB 509.

House Approves Licensure Bills For Nurses, Pharmacists and Physician Assistants
House Committee Substitute for Senate Bill 296 was approved by the House. Changes made to the bill by the House must now be accepted by the Senate before moving to the governor. The measure encompasses language from the following bills.

• House Bill 275 and Senate Bill 406 would authorize physician assistants who meet specified training requirements to prescribe schedule III, IV and V controlled substances under a physician supervision agreement.
  
  
• A provision not associated with any filed bill corrects a problem on waivers for physician assistants working in a collaborative practice arrangement with a physician. It allows for no renewal of the required waiver unless there is a change in supervising physicians or the primary practice is moved more than 10 miles from its original location.
  
  
• House Bill 513 would authorize pharmacists to administer vaccines for pneumonia, meningitis and shingles under the authority of a physician’s written protocol.
  
  
• House Bill 226 provides that licensed pharmacies cannot be forced to prescribe abortifacient drugs including, but not limited to, RU486 and emergency contraception, such as the Plan B drug.

• House Bill 514 and Senate Bill 237 would authorize Missouri to join an interstate compact on reciprocal nurse licensure recognition among participating states. Bordering states that have joined the compact are Arkansas, Iowa, Kentucky, Nebraska and Tennessee.
  
  
• House Bill 852 would authorize the Missouri State Board of Nursing to collect and analyze information to study the nursing workforce shortage in Missouri. An amendment drafted by MHA would require that the collected information cannot identify any specific health care providers, including nurses and hospitals.

• House Bill 247 would modify the definition of “eligible student” for the Nursing Student Loan Program to include full- or part-time doctoral students. This bill also was given final approval by the Senate as a stand-alone bill. If the changes adopted during Senate debate are accepted by the House, the stand-alone bill will move to the governor.
  
  
• Senate Bill 509 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.

Conference Committee Nears Agreement On State Budget
This week, a conference committee composed of Senate and House members reviewed and amended the 13 appropriations bills that create the state’s operating budget for the fiscal year beginning July 1. The committee is planning a final meeting Monday to vote on the 13 bills and complete negotiations on a final item.

The House version of the budget did not include funding for the $52 million coverage expansion. The Senate version of the budget restored this item. The conference committee agreed to take the Senate position on the $52 million funding item 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 Federal Reimbursement Allowance and redirected disproportionate share payments. However, the committee did not reach agreement on the “language” that the Senate included in its version of the budget. This language authorized the coverage expansion item be spent for either Senate Bill 306 or the governor’s expansion proposal if Senate Bill 306 does not pass during the current legislative session. The committee will make a decision on this item Monday.

Missouri’s constitutional deadline for approving the state budget is next Friday. Both the Senate and House must approve the bills as negotiated by the conference committee. 

Senate Committee Advances House Bill On Newborn Screening
Senate Committee Substitute for House Bill 716 would establish the Brady Alan Cunningham Newborn Screening Act. The bill, advanced by a Senate committee, would require the Missouri Department of Health and Senior Services to expand newborn screening requirements to include certain lysosomal storage diseases such as Krabbe, Pompe, Gaucher, Niemann-Pick or Fabry disease by July 1, 2012. The department is authorized to increase the current fee associated with the screening tests to cover the additional costs of the expanded tests.

The committee amended the substitute to include language that requires the MO HealthNet program and the State Children’s Health Insurance Program to examine and improve hospital discharge and follow-up care procedures for premature infants born earlier than 37 weeks gestational age. In addition, the amended language requires the DHSS to prepare written educational materials containing information about possible complications, proper care and support associated with newborn infants who are born premature at earlier than 37 weeks gestational age. These materials would be distributed to children’s health providers, maternal care providers, hospitals, public health departments and medical organizations.

Next Week
Only two weeks remain until adjournment May 15th. The House and Senate will work continuously for five days each week.

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