May 22, 2008

The 2008 legislative session will go down in history as one of the most interesting in recent memory.

At the beginning of the last week only 17 bills had been given approval. By the end of the week 117 bills out of 2200 measures filed had been given final passage. Of these 117 bills, 60% were passed in the last few hours of the legislative session.

The Missouri legislature adjourned its Second Regular Session of the 94th General Assembly at 6: 00 p.m. on Friday, May 16. With hundreds of bill poised for final action on Friday, the members of the House and Senate truly agreed to and finally passed 70 bills, far surpassing the 47 bills (excluding budget bills) that had been passed during the preceding four and one–half months of session. Veteran capitol lobbyists were amazed at the number of bills passed on Friday.

The Governor will be presented with the majority of the bills passed some time around June 1 and will have 45 days from presentment to analyze the bills and recommend passage or veto. Most all of these measures will be approved by the Governor and will become effective on August 28.

Governor Blunt declared the session to be a success, having previously warned legislators that he would call them into special session unless they delivered legislation addressing illegal immigration and property tax reform. Both measures passed on Friday. Other significant bills that passed include:

• Legislation addressing Internet harassment and cyber-bullying;
• Economic development legislation creating up to $240 million in tax credits for mega-projects (Bomardier);
• Legislation addressing energy efficiency issues and establishing the Show me Green Sales Tax Holiday.
• Legislation that permits the retroactive licensing of a power plant in Cass County;
• Legislation repealing the campaign contribution limits in Missouri;
• Legislation repealing the controversial "village law" that passed last session;
• An omnibus bill relating to a myriad of transportation–related issues, including the use of ignition interlock devices for second offense DWIs;
• Economic development legislation authorizing an additional $48 million in tax credits for the Quality Jobs Program and the Enhanced Enterprise Zone Program;
• Passage of an electronic logging program for pyseudoephrine drugs;
• Legislation creating the crime of mortgage fraud;
• Legislation that changes a Supreme Court ruling that allowed dependents of injured workers to receive benefits even after the disabled worked had died.

Issues that received a lot of attention, but which were not passed included:

• Legislation designed to address access to health care (Insure Missouri program);
• Legislation mandating the showing of a photo ID for voting;
• Legislation to regulate and legalize the practice of midwifery;
• Legislation changing consent requirements for abortion;
• Legislation raising the minimum teacher salaries to $31,000;
• Legislation altering the "Missouri Plan" method for selection of judges;
• Legislation capping the number of licenses for gaming facilities and removing the loss limits;

Needless to say the "truly agree to and finally passed" bills will need to be given close screening. The link to the "truly agreed to and finally passed" bills is: http://www.senate.mo.gov/08info/BTS_Web/TrulyAgreed.aspx?SessionType=R

The session was lackadaisical until the past week. The House did not even begin afternoon sessions until the last month.

As 2008 is a major election year leadership particularly in the House was not inclined to move a great deal of legislation. Not necessarily a "bad thing" for Missourians.

The House became increasingly tense in the last three days as a move was briefly made to ouster the term limited Speaker Rod Jetton. Incoming Speaker Ron Richards managed to "settle" the dispute.

This move stemmed from a provision Speaker Jetton made to exempt a wealthy landowner from any government control of his property allowing him to form his own village.

The House and Senate spent an incredible amount of time attempting to repeal the statute and were blocked repeatedly by Speaker Jetton. The repeal effort was ultimately successful and other legislation was addressed.

News upon adjournment of the 2008 legislative session includes:

APNs

Senate Bill 724, Scott, was given approval after a great deal of wrangling regarding a current rule exemption for local public health centers.

The provisions limited a collaborative arrangement with physicians to three nurses and required one month working directly with a physician. The public health centers received a waiver on this portion after numerous intense meetings towards the end of the session.

Helmets

As in the previous eight years the "helmet law" did not receive approval. Two bills were filed, HB 1393 and SB 1067.

The House similar to previous sessions passed the repeal of the helmet law for those 21 and older. However, the Senate stopped the legislation once again.

Status of Selected Health Care Legislation

The following describes the outcomes of various legislative proposals affecting health care. The governor has until Monday, July 14, to approve or veto enacted bills.

LEGISLATION ENACTED

Appropriations

• Fund a system of presumptive eligibility for benefits under the State Children’s Health Insurance Program (HB 2011)
• Increase MO HealthNet payment rates to physicians by $39 million in state and federal funds, an increase of 7 percent. The increase will raise MO HealthNet physician payment rates to 62.5 percent of Medicare payment rates. (HB 2011)
• Appropriate an additional $13 million in state and federal funds to implement a program for women's health services (HB 2011)
• Authorize $2.3 million in funding to pay hospitals and physicians to conduct forensic examinations of sexual assault victims to gather evidence for prosecutions (HB 2010)

Emergency Care

• Authorize a system to transport stroke or STEMI (a type of heart attack) patients to hospitals where specific treatments can be delivered within time deadlines correlated with significantly better patient outcomes. The legislation amends current law on trauma centers, but the designation of stroke, STEMI and trauma centers will be independent. The legislation promotes development of regional or community–based stroke and STEMI plans by area hospitals, physicians and emergency medical services providers.

Physician Assistant Supervision

• Clarify that the percentage of time a physician assistant must be directly supervised by a physician will be measured during a calendar quarter. Also, physician-physician assistant teams that have received an initial waiver from the default supervision requirement will not be required to increase the percentage of on-site supervision to renew the waiver. (SB 788)

Legislation Not Enacted

Insure Missouri

• Enact laws to authorize an "Insure Missouri" initiative to extend health insurance coverage to employed individuals ages 19–65 who have been uninsured for at least six months, within limits set by legislative appropriations, state Medicaid plan amendments and federal Medicaid waivers. Coverage would be offered through private health plans, and enrollees would be expected to contribute to accounts used to offset some of their medical care costs. (SB 1283, HB 2314, HB 2398)
• Authorizes Funding for Insure Missouri in the fiscal year that begins July 1, 2008 (HB 2011)

Medical Errors

• Require hospitals to report the occurrence of one of the 28 "serious adverse events in health care," as defined by the National Quality Forum, to a federally–designated patient safety organization. The PSO would analyze the incident and develop and promote recommendations to prevent future occurrences. Data held by the PSO would not be admissible in legal proceedings, and PSO reports would not identify individual facilities. (SB 1283)
• Permit the MO HealthNet Division to deny payment for treatment costs associated with preventable medical errors (SB 1283)
• Allow a state committee of providers to make recommendations to the MO HealthNet Division about standards and policies for denying payment for preventable medical errors (SB 1283)
• Enact a statutory prohibition against hospitals billing patients or insurers for the cost of treatments associated with one of the 28 "serious adverse events in health care" defined by the National Quality Forum (SB 916, SB 1283)
• Waive state prompt payment laws if a potentially reportable incident occurs and payment issues are under review by the hospital and insurer (SB 1283)

Quality of Care Data

• Establish new standards governing the release of data comparing the quality of care among providers (SB 1272, SB 1283 and others)
• 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 (SB 1283 and others)

Disclosure of Comparative Pricing Data

• Require health care providers to give their patients an estimate of the cost of their nonemergency treatment upon request. Failure to do so is grounds for nonpayment. (HB 2394)

Health Care Workforce Initiatives

• Fund a "Preparing to Care" appropriation initiative to expand the capacity of Missouri's public two–year and four–year colleges and universities to train additional health care workers (HB 2003)

Infection Control

• Require hospitals to have a plan addressing the control of MRSA (HB 1546, HB 1516) originally local health was included. However, I worked on its removal based on cost. Representative Schaaf backed off.
• Authorize the use of an alternative indicator to measure hospitals' efforts to prevent ventilator–assisted pneumonia in intensive care patients (HB 1546, HB 1516)

Employee Background Checks

• Add to the list of crimes that preclude health care employment and require health care employers to conduct background checks on its workforce to verify compliance with the new standards (HB 1516 and others)

Access to Public Meetings and Records

• Make organizations receiving at least 51 percent of their budget from state or federal sources to be subject to the state's Sunshine Law on public access to meetings and records (HB 2210)
• Mandate that public entities provide data requested under the open records law in a way that is "easily accessed and manipulated by programs commonly available to the public." This would limit their ability to use proprietary data programs. (HB 2210)
• Require public entities to provide all information requested in an electronic format (HB 2210)
• Apply the open meetings and records law to private organizations that manage public facilities or services (HB 2210)
• Make associations that receive funding through dues from public entities subject to the open meetings and records law (HB 2210)

MO HealthNet Services

• Require the MO HealthNet program to cover prescribed physical, occupational and speech therapy services that are medically necessary (SB 1283)
• Provide financial assistance for the cost of transportation and ancillary services associated with the medical treatment of a seriously ill child (HB 1516)

Immunization

• Distribute information to parents of sixth–grade girls about the human papilloma virus (HPV) and the availability and implications of vaccination (SB 778, SB 1283)

Regulation of Abortion

• Create the crime of coercion to perform an abortion (HB 1831, SB 1058)
• Require an obstetric ultrasound be conducted before the 24–hour waiting period for an abortion (HB 1472)
• Exempt abortions from the various medical malpractice liability restrictions included in state law (HB 1339)

Smoking Prevention

• Earmark a portion of tobacco settlement revenues to fund youth smoking prevention programs (SB 843, SB 946 and others)

Medical Records

• Raise the cap on fees that may be charged for copying medical records (HB 1815)

Pharmacy Rates

Senate Bill 1068 did receive approval. The legislation deals with Pharmacy Rebates and depositing any revenue received by the state from pharmacy manufacturers to be placed in the MO HealthNet pharmacy program.

An exemption was requested by DOH for the "Ryan White" fund used and administered for AIDs programs.

Birth Certificates

Representative Schoeller's HB 1640 was given final approval.

The bill states currently, after a parent adopts a child, a court establishes a decree of adoption that may or may not state that the adopted child's birth certificate may be changed to replace a birth parent's name with the adoptive parent's name. This bill establishes the Debbi Daniel Law which allows an adoptive parent or stepparent of a child to request that no name changes be made to the child's birth certificate following an adoption.

Political Subdivision Fees

An ill–conceived piece of legislation introduced by the Chair of House Local Government did not move past the committee stage due to the "uproar" it created.

Chair Vicki Schneider introduced the bill due to her being upset that an ambulance dispatch building her husband built would have to pay fees for sewer hookup.

Obviously this bill would severely impact political subdivisions across the board.

After several discussions she agreed to modify the bill to encompass water and sewer hookup fees. Amazing.

HB 2544 prohibits a political subdivision from imposing a service charge or fee upon another political subdivision except as otherwise specifically authorized by statute.

STEMI/Stroke Bill, Workers' Compensation And Hospital Board Bills Advance

The Senate has advanced legislation that would authorize the creation of a "time critical diagnosis" system for the initial emergency treatment of stroke and STEMI patients. During a ST–elevation myocardial infarction, a cardiac artery is completely blocked. STEMIs account for about 10 percent of heart attacks. The bill already has received approval by the House. The bill will be ready for the governor's signature when the House accepts the changes made by the Senate.

House Bill 1790 would create stroke and STEMI systems as part of current state law designating levels of trauma centers and directing trauma patients to them. However, the proposal would not require that a hospital be designated as a trauma center to receive stroke or STEMI patients; the systems would be independent. It would permit the Missouri Department of Health and Senior Services to designate hospitals as stroke or STEMI centers of various levels, as defined in state regulations.

The Senate Substitute deleted two other bills, House Bills 1546 and 1805, that previously had been included in the Senate Committee Substitute. House Bill 1546 would have required hospitals to have a plan addressing control of MRSA and authorized the use of an alternative indicator "head–of–bed elevation" to measure hospitals' efforts to prevent ventilator–associated pneumonia in ICU patients. House Bill 1805 would have required that if the usual and customary retail price of a prescription drug is less than the normal insurance co–payment amount, the patient will pay the lesser amount.

Midwife Proposal Advances

The Senate advanced an amendment to authorize midwives to practice in Missouri. The amendment was attached to the Senate Substitute for House Bill 2081. After a final Senate vote, the bill will return to the House for ratification of the Senate changes. Unbelievably, this bill almost came up for a House vote late Friday afternoon. Time ran out.

The proposal creates a system of occupational licensure for "certified professional midwives." The licensure structure is comparable to other health care licensure boards. Among other requirements, licensed midwives must be certified by the North American Registry of Midwives. They also must provide a description of their training, the benefits and risks of childbirth in alternative settings and a client–specific plan for obtaining needed medical care and routine laboratory testing services. Midwives must carry at least $1 million in malpractice liability coverage.

Health care practitioners that provide emergency care arising from care provided by a licensed midwife will be civilly liable only for their negligence or willful or wanton acts in delivering the emergency care.

The amendment also repeals the controversial one–sentence law enacted surreptiously in 2007 to allow those with "tocological" certification to deliver midwifery services.

In Closing

The 2008 Legislative Session was more contentious than usual. The Governor announced that he was not running again. The Speaker had conflict issues and to top it off its an election year. The office will be inundated with campaign money requests and fundraisers throughout the interim. This is the nature of the political business especially since term limits were instituted.

Legislation will be reviewed by the Governor and if singed becomes effective August 28th unless there is an emergency clause attached and then the bill goes into effect upon signing.

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