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May 19, 2010
The 2010 session of the Missouri General Assembly ended Friday, May 14th at 6:00pm. Legislators will return home and begin the campaign season after this tumultuous legislative session.
The “Ethics” bill was passed on Friday. Many describe the proposal as a “feel good” piece of legislation that did not dealing with major issues. Donations were not addressed as far as limitations. Although funds may not go from PAC to PAC they can still send money from candidates to PAC or other candidates. The “revolving door” for legislators becoming lobbyists was not closed. Consultants can still work on legislative staffs. However, as Senator Purgason (West Plains) commented on the Senate floor “you cannot legislative ethics”.
Economic development legislation did not pass. The Senate would not pass an economic development bill until there was a modification of state tax credits or a merger of the two major state retirement systems MPERS and MOSERS none of which passed.
The state foundation formula for schools did not pass as a new modification needed due to the extreme budget cuts.
The state budget was the focus of a majority of the legislative session. House Budget Committee members cut $200 million from the Governor’s budget and the Senate Appropriations Committee an additional $300 million. Current figures suggest that the Governor will withhold an additional $2-500 million from the 2011 budget. The Senate planned on several consolidation bills to add savings that were incorporated into their budget. The vast majority of the bills such as the retirement consolidation, combining the higher education and K-12 departments and the tax credit consolidation and reduction all did not receive approval.
This year alone Governor Nixon withheld $900 million in funds from the 2010 budget. Nixon’s office announced another $350 million in cuts for the 2011 budget before he will sing the recently passed budget.
Consequently, the 2010 legislature will be known more for what it did not do rather than accomplishments. There were numerous “bad” proposals introduced which were not passed and that is a positive. However, numerous major questions remain and next year due to term limits approximately 75 new legislators with no historical perspective will be left to deal with major issues that will be back in the next session.
A recap includes:
House General Laws
SB 884 Tobacco Master Settlement (Schaeffer) Representative Diehl presented in Schaeffer’s absence. All tobacco manufacturers must contribute to Escrow Act. Heard, voted DO PASS 9-0.
Attorney General’s office, March of Dimes, Petroleum Marketers, MHA are all in favor.
No one was against. Dirt Cheap testified for information. This legislation was given approval after 6 years of introduction in the legislature.
Fair Tax
The first major run at passing legislation of the “Fair Tax” resulted in failure by the billionaire Singqufield’s group. Representative Emery and Senator Chuck Purgason led the efforts in the House and Senate.
The Senate bill received several periods of debate on the Senate floor. Several more exemptions to the statewide sales tax were added resulting in the need for a higher state sales tax to recover the costs of the exemptions.
The proponents were ‘testing the waters” and will return with an eye on the 2012 budget. The sponsors will need to be new as term limits will remove Emery and Purgason.
TABOR
House Joint Resolution, the TABOR (Taxpayer Bill of Rights) received approval in the House sponsored by Budget Chair Icet.
This statewide cap on revenues will be back next year. However, the sponsor Representative Icet will be term limited and a new sponsor with similar “clout” will be needed.
Lobbyist
House Bill 1872 was defeated early in the session. The legislation would have prohibited any entity receiving public funds from being represented by a lobbyist. Obviously this legislation would have free speech issue.
Expedited Partner Therapy
On Friday, I visited with Margaret Donnelly on the expedited partner therapy (HB 1375- Cooper).
I congratulated her on the passage and she was very appreciative of MOALPHA’s assistance on HB 1375 and against Senator Engler’s food inspection at ranches amendment.
The bill (HB 1375) changes the laws regarding sexually transmitted diseases.
HUMAN PAPILLOMAVIRUS BROCHURE
The Department of Health and Senior Services is required to develop an informational brochure relating to the connection between human papillomavirus (HPV) and cervical cancer and that an immunization against the infection is available. The department must make the brochure available on its web site and must notify each public school district of the availability of the brochure and that it must be provided directly to parents as the district deems appropriate. The brochure cannot be directly distributed to students.
EXPEDITED PARTNER THERAPY
A licensed physician is allowed to use expedited partner therapy under certain conditions by dispensing and prescribing medications for the partner of a person diagnosed with certain sexually transmitted diseases even when there is no existing physician/patient relationship. The physician must provide an explanation and guidance to the patient on the preventative measures that can be taken to stop the spread of the disease. A physician using expedited partner therapy will be immune from civil liability unless the action is negligent, reckless, in bad faith, or with malicious purpose.
SCHIPS (State Children’s Health Insurance Program)
SB 583 (Champion) requires all insurance companies to cover adopted children the same as other dependent children was passed.
It also requires the Department of Social Services to provide information on eligibility for SCHIPS to licensed childcare providers receiving federal or state money and all public schools.
When application is made for free and reduced lunches and a child is enrolled in school this information should be distributed and a check to see if a child is insured.
If a child is eligible for SCHIPS the school district will supply application information to the parent.
Alcohol/ Tobacco
Another “rebooting” initiative to move the Bureau of Alcohol and Tobacco from Public Safety to Department of Revenue with no funding died.
Enforcement of alcohol and tobacco laws would have fallen to sheriff’s departments and police departments with no funding. Another mandate.
Streamlined Sales Tax (Internet Sales)
Senator Bray and Representative Sutherland continued their effort pass an internet sales tax this year.
It did not pass but gained traction. Opponents (Senator Crowell) claim this is a new tax.
Missouri is long out on $180-$200 million in sales tax.
You may see momentum on this bill next session in a non-election year.
Local Public Health
In one of the few bright spots this session the legislature kept fund for the local public health departments “flat” this year.
The Governor had recommended a $300,000 cut. After working the House Appropriations and Budget Committee Representatives Dethrow, Weter and Hobbs put the funding back in and the Senate concurred.
Your contacts and efforts made a difference with the Budget and House Committee members. I was very pleased at this rare development.
Diseased Animals
House Bill 1662 dealing with the movement of diseased animals passed.
Link to the bill: http://house.mo.gov/content.aspx?info=/bills101/bilsum/truly/sHB1662T.htm
TB Services
Senate Bill 1007 was passed and addressed.
The Department of Health moved placement and treatment of tuberculosis patients
Among its provisions SB 1007 modifies provisions relating to public assistance programs administered by the state.
TUBERCULOSIS
This act changes the references to the University of Missouri Board of Curators as it relates to the treatment and commitment of tuberculosis to the Department of Health and Senior Services. In addition, state payment shall be available for the treatment and care of individuals with tuberculosis committed for public health reasons only after benefits from all third-party payers have been exhausted. Sections 172.850, 199.010 TO 199.260
THIRD PARTY PAYERS/SUBROGATION
Under this act any third party payer, such as third party administrators, administrative service organizations, health benefit plans and pharmacy benefits managers, shall process and pay all properly submitted MO HealthNet subrogation claims using standard electronic transactions or paper claims forms for a period of three years from the date services were provided or rendered. However, such third party payers shall not:
- Be required to reimburse for items or services which are not covered under MO HealthNet;
- Deny a claim submitted by the state solely on the basis of the date of submission of the claim, the type or format of the claim form, failure to present proper documentation of coverage at the point of sale, or failure to obtain prior authorization;
- Be required to reimburse for items or services for which a claim was previously submitted to the third party payer by the health care provider or the participant and the claim was properly denied by the third party payer for procedural reasons, except for timely filing, type or format failure to present proper documentation of coverage at the point of sale, or failure to obtain prior authorization;
- Be required to reimburse for items or services which are not covered under or were not covered under the plan offered by the entity against which a claim form for subrogation has been filed.
Such third party payers shall reimburse for items or services to the extent that the entity would have been liable as if it had been properly billed at the point of sale, and the amount due is limited to what the entity would have paid as if it has been properly billed at the point of sale. The MO HealthNet Division shall also enforce its rights within six years of a timely submission of a claim.
Certified computerized MO HealthNet records shall be prima facie evidence of proof of moneys expended and the amount due the state. Section 208.215
This provision is identical to provisions in CCS/HCS/SCS/SBs 842, 799, & 809 (2010), CCS/SCS/HB 2226 (2010), and CCS/SCS/HB 1868 (2010).
Additional Legislation
In addition to these developments other legislation reviewed and acted upon includes the following. The Governor has until July 14th to approve or veto enacted bills.
LEGISLATION ENACTED
Prompt Payment
Referendum to Block Federal Coverage Mandate
- Block enforcement of a federal coverage mandate. The measure is subject to voter approval at the August 3, 2010, ballot. The General Assembly’s ballot description says the proposal would “deny the government authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services.” If enacted, the law is intended to foster a federal court challenge regarding federal versus state sovereignty. (HB 1764)
MO HealthNet Payment Changes
- Eliminate the requirement that MO HealthNet pay the Medicare deductible and coinsurance amounts for hospital outpatient treatment of those eligible for both Medicaid and Medicare. Some or all of the lost Medicaid payment can be recouped from Medicare. (SB 842, SB 1007)
Nursing Practice Issues
- Authorize advanced practice registered nurses to write prescriptions for physical therapy services (HB 2226)
- Require those hiring a registered nurse, licensed practical nurse or advanced practice nurse to perform duties requiring a nursing license to verify that he or she has a valid license. Employers will verify licensure status at the time of licensure renewal. (HB 2226)
Physician Assistant Supervision
- Clarify that if a physician-physician assistant team working in a federally-designated rural health clinic has received a waiver from the State Board of Registration for the Healing Arts, the applicable physician assistant supervision standards will be the minimum federal standards for rural health clinics. Waiver reauthorizations will not be required if the initial waiver was granted on or after August 28, 2009, but the board may void a waiver for violation of federal or state standards. (HB 2226, SB 754)
Practitioner Disciplinary Action
- Require nursing homes, home health agencies and other entities that employ or contract with health care practitioners to tell the appropriate licensing board of disciplinary action taken against a practitioner or that he or she has resigned in response to a complaint or report that might lead to disciplinary action (HB 2226)
Vital Records
- Require the use of an electronic death registration system six months after the system is certified by the state Department of Health and Senior Services as being operational and available to all providers. Repeal current law calling for the implementation of an electronic birth and death record registration system by December 31, 2009. (HB 1692, SB 754)
MO HealthNet Subrogation
- Revise time lines and standards for payment of MO HealthNet subrogation claims by insurers or other third-party payers (HB 1868, HB 2226, SB 583, SB 842, SB 1007)
- Recognize in statute a “Sexual Assault Forensic Examination Child Abuse Resource Education” network. The SAFE CARE network will develop recommended processes for emergency forensic examinations of children who may be victims of sexual abuse and distribute them to hospitals, practitioners and child advocacy centers. (HB 2270)
Women’s Health
- Expand a women’s health disease screening program to include heart disease risk assessments for women who meet age and income eligibility guidelines. Implementation is contingent on federal funding. (HB 1898)
Legislative Committees
- Create a Joint Committee on the Reduction and Reorganization of Programs within State Government to develop recommendations for eliminating or consolidating state programs and departments. The committee’s authorization will expire January 1, 2011. (HB 1868)
- Create a legislative Joint Committee on Missouri’s Promise, to produce annual reports and recommendations regarding long-term strategies and plans for improving various aspects of economic prosperity (HB 1965)
- Create a legislative Joint Subcommittee on Recovery Accountability and Transparency to monitor how federal economic stimulus funds are spent in Missouri (HB 1965)
Abortion
- Create various new requirements regarding printed materials and information that must be provided to a woman in the course of getting prior informed consent to an abortion, and establish time deadlines and verification standards for doing so. (SB 793)
- Require the circumstances of a medical emergency that results in an abortion to be documented and certified by the physician, with the certification maintained at the facility for seven years (SB 793)
- Direct the Department of Health and Senior Services to maintain a toll-free 24-hour telephone hotline to provide regional information about programs to provide alternatives to abortion. The information also will be posted on the department’s Web site. (SB 793)
- Prohibit a health insurance exchange established or operating in Missouri from offering policies of coverage or optional riders that include coverage of elective abortions (SB 793)
LEGISLATION NOT ENACTED
MO HealthNet Managed Care Expansion
- Authorize MO HealthNet demonstration projects to enroll aged, blind and disabled enrollees in managed care plans in the Kansas City and St. Louis regions (amendment to HB 2205)
- Direct by appropriation that children and non-disabled, non-elderly adults covered by MO HealthNet would be enrolled in managed care plans in state fiscal year 2011. The proposed expansion of MO HealthNet managed care would affect the northern and southern tiers of Missouri counties where fee-for-service coverage is now in place for these populations. (HB 2011)
Quality of Care Data
- Prohibit health care providers from refusing to contract with insurers based on their disclosure of comparative quality of care data or otherwise obstructing such disclosure. (HB 2072 and various amendments)
- Prohibit MO HealthNet health care providers from refusing to contract with insurers based on their disclosure of comparative quality of care data or otherwise obstructing such disclosure. (Amendments to SB 842 and others)
Disclosure of Comparative Pricing Data
- Use competitive bidding to select a vendor to be given exclusive rights to state data in creating a health care information Web site for consumers (SB 1044)
Occupational Licensure
- Create a system of occupational licensure for clinical laboratory personnel (SB 1063)
Peer Review
- Include emergency medical practitioners under the state’s peer review law (HB 1286)
Liability of Volunteers
- Provide liability protection for licensed health care professionals who provide volunteer services for a sponsoring organization. (HB 1329)
Next Session
The legislators will spend the summer campaigning and the Governor has announced numerous additional cuts will be needed (approximately $350 million) to the recently passed budget in the next few weeks.
Several committees will meet this summer to discuss consolidations, retirement and the foundation formula for schools.
Although veto session is three months away rumors are that several consolidation bills could be discussed if compromises are agreed to first.
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