January 28, 2011

The General Assembly began its heavy committee schedule this week after the Governor’s State of the State budget address.

The House and Senate have started the budget process and will slowly go through the Governor’s recommendations.

As mentioned last week in visits with Linda Luebbering (State Budget Director), she states that the shortfall as of now will be $500 million. The Governor is “hinging” his recommendations on the passage of legislation which may or may not be passed. This will mean an additional $2-300 million more in cuts than what the Governor presented. Nixon has proposed an additional 900 job cuts. Interestingly, House Majority Leader Jones attacked the Governor on his proposed $7 million in Medicaid reductions. Jones commented that just because the state will pay less does not mean costs have gone down. Therefore higher charges will be passed onto Missourians with private insurance.

These facts were provided by the Missouri Budget project:

• After adjusting for inflation, Missouri general revenue is 12 percent lower than it was a decade ago;
• Missouri revenue collections relative to the size of the state economy are at their lowest in 25 years; and
• The decline in revenue collections has been so steep that Missouri revenue will not return to what it achieved in FY 2008 until FY 2016, five years from now

News this week includes:

Senate-Judiciary Civil/ Criminal Jurisprudence
SB 8   Restricts co-employee liability in workers' compensation cases. The committee chairman, Sen. Jack Goodman, R-Mt. Vernon, presented legislation before the committee that would ensure that co-employees are not liable for accidents in the workplace. Senate Bill 8 seeks to turn back court rulings that have added confusion to the 2005 workers' compensation statutes. While speaking on behalf of SB 8, Ray McCarty, president of Associated Industries of Missouri, cited the court case Robinson v. Hooker, which allows employees who sustain work-related injuries to sue co-employees for negligence in a civil action. Tracy King of the Missouri Chamber of Commerce and Industry - who also spoke in favor of the bill - said this type of co-employer liability could cause extreme havoc in the work place, including increased pressure on supervisors and managers for any action or inaction they are faced with. Other witnesses testifying in favor of the legislation were: Missouri Grocers Association and Missouri Retailers Association; Greater Kansas City Chamber of Commerce; St. Louis RCGA and the Associated General Contractors of St. Louis; Associated General Contractors of Missouri; Missouri Insurance Coalition; Centene Corporation; Missouri Restaurant Association; NFIB; Associated Builders and Contractors; Missouri Self-Insurers Association; and Missouri Organization of Defense Lawyers. Testifying in opposition to SB 8 was the Missouri Association of Trail Attorneys. The association stated that passing this type of legislation would not fix all of the problems with the current statutes. They believes there are other issues that need worked out with the 2005 reforms. AFL-CIO also spoke in opposition to the bill, saying the issues was caused because of hastily decisions on workers' compensation reforms of 2005 and legislators should carefully analyze all impacts of this bill. There were no further witnesses and the meeting was adjourned.

“Fair Tax”
On Thursday afternoon a meeting was held with all the “stakeholders” lobbyists regarding the so-called “fair tax”.

A presentation was given by Brian Schmidt of the Joint Committee on Tax Policy. Schmidt provided a non-partisan (non-political) assessment of the fair tax proposal.

Billionaire Rex Singqufield’s lobbying group will promote the legislation in the General Assembly. However, the Senate has many  concerns and unanswered questions.  Consequently, the measure will possibly not receive legislative approval.

The other very realistic threat is the initiative petition drive. Nine different versions of the proposal have been filed. Singqufield’s group will poll the different proposals to see which has the most support and that version will be filed.

Groups from NEA, Civic Council (Kansas City), the Catholic Conference, AARP, Realtors, MO Bar, MATA, hospitals and 40 other groups were represented.

The initiative will remove Missouri’s income tax and place a sales tax on all goods and services. Commissions on all sales including hospital bills, professional services and all goods will subject to a sales tax. The proposal caps the tax at 7%. Various groups including the Joint Tax Policy Committee estimate a sales tax ranging from 11 to 15% on top of local taxes.

The group will be forming a committee of the stakeholders and to strategize a campaign strategy and to begin raising funding.

The Missouri Realtors Association has begun forming a “shell” corporation to begin funding.

House Appropriations- Health
MOALPHA was well represented on Tuesday at the House Appropriations Committee. Testimony was presented explaining the responsibilities and benefits of local health agencies.

Larry Jones had excellent stories to illustrate how the agencies work. Bert Malone and Melanie Hein gave excellent presentations.

Governor Nixon has left our funding at the rate it was after the withholds last June. Last year we worked hard to have funding restored only to have Governor Nixon reduce our appropriation from the legislature.

Below are some of the questions directed to our witnesses from the committee:

Larry Jones, Health Director, City of Independence; Request to maintain existing funding to health departments.  He gave overview of critical services provided by local health departments.  He voiced concern over child immunizations prior to school.  Missouri ranks last in the nation for child immunizations.

Allen: What is cost of community gardens?
A: largest cost is fencing, most other material and land is donated.

Ellinger: Are there offices in every county?
A: Some offices serve more than one county.

Ellinger: Have you considered joining other county offices together?
A: Some counties already work together on projects.

Franklin: How much state funding do you receive?
A: $1.66 per person

Franklin: How much is federal?
A: 50-70% of our funding is local.

Lechtenegger: Are you representing the City of Independence or Health Depts.?
A: Health Depts.

Atkins: Your appropriation is greater than $9M, was there any withholds?
A: Yes, 16%.

Bert Malone, KC Health Dept and MO Public Health Assoc. Representing 450 public health and health professionals.  Keep core funding.  MO is 5th highest in tobacco use, 17th highest in sexually transmitted diseases, 17th highest in cancer incidents, 12th highest in obesity and 21st in diabetes.56.2% of children are improperly vaccinated prior to starting school. There is a high risk of epidemics in child care facilities.

Curls: of the $7.6 M budget, how much was withheld?
A: 16%

Ellinger: Is there also a Jackson County Health Dept.?
A: Yes, we meet regularly and we share many services and we avoid service overlap.

Allen: What is done to inform people and make people accountable?
A: One of our divisions is dedicated to promotion of good health – they work with schools, etc.

Allen: Do you keep records of people who keep coming back?
A: Yes, but those are personal choices

Allen: …and society continues to bail them out….

Melanie Hein, Cooper County Health Dept. Gave examples of critical services provided by Health Departments relating to food, sewer, buildings and bedbugs.  Not asking for more, just don’t cut.

Ellinger: How do you check sewer, do you contract with a chemist/engineer?
A: I have personally gone through training and am a licensed sewer installer/ inspector.  Some counties share responsibility and some contract it out.

TANF
The House gave initial passage to the politically charged mandate on drug testing for TANF (Temporary Assistance for Needy Families) recipients.

It passed overwhelmingly with a few Democratic Representatives commenting that children will suffer if parents are cut off the program.

In addition, nowhere in the language is it specified who pays for the testing. Whether it is the state or the healthcare provider. This will need to be closely monitored.

Senate Transportation
The Senate Transportation Committee as expected on Wednesday voted SB 28 (Brown) “DO PASS” on a 4-2 vote.

The perennial bill exempts motorcycles age 21 and older from wearing a helmet.

In addition, Senator Keaveny heard SB 24 increasing seatbelt fines from $10 to $50. The Missouri Safety Coalition testified in favor. Given negative questioning I do not expect the proposition to move forward.

Dept. of Social Services (DSS) Department Overview
DSS presented an overview of the department’s budget. SR staff made presentations. Below are my notes.

Brian Kincaid, Deputy Director

Mr. Kincaid handed out two packets of information (attached) and gave an overview of the Department; including key functions, mission, and organizational structure.  The presentations followed the larger handout.

Missouri has “one of the best juvenile justice systems in the world”.

The Department makes good use of the provider tax to maximize federal Medicaid funding.  There will be legislation this year to renew the provider tax.

Allison Campbell, Division Director of the Family Support Division

The responsibility of Medicaid eligibility determination falls within the Family Support Division. 

Overall expenditures are down; general revenue expenditures are down 23.4%; used one time federal funds to supplement the decreased general revenue.

Over 40% of children are born out of wedlock.  Division is increasing paternity testing to legally establish paternity to establish child support.

The Division is considering kiosks in communities with no offices so clients can access their child support data locally.

Division is proposing fees for certain services currently provided at no cost.

Proposing to make changes to some administrative hearings regarding in-person hearings and change certain administrative rulings when there’s an error.

Tim Decker: Division of Youth Services

Reduced staff by 40 people.

Moved some state funding sources to federal.

Working with courts helped cut costs by avoiding DYS commitment and strengthening continuum of care to avoid long-term youth commitment.

The division has been successful at keeping the re-commitment rate below 10%.

Cindy Shivley: Children’s Services Division

Used one time federal funding to supplement state cuts.

Most services are provided in the field; not in the office.  Staff location will be key in the future. 

Received private funds to create data management system to aid in performance based management.

Ian McCasland: Mo HealthNet (Missouri Medicaid Program)

“Other Funds” listed on the graph on the handout are primarily from the provider tax.

Of the $6.2 billion projected expenditures for FY11, approximately $2 B goes to hospitals, $1 B goes to Nursing Homes and $1 B to pharmacy programs. 

Missouri is a national leader for technology use; enabling fewer FTE.

All provider taxes are up for renewal this year.  This legislation must pass.  Substantial devastation if not passed.

It is very difficult to get on Medicaid in Missouri compared to other states.

Senior citizens require the most expenditures from Medicaid even though they are Medicare eligible because Medicaid pays for long-term care.

Cyber Access is a successful program.  Physicians can use technology to access patient records to assist in treating patients and tracking hospital, doctor, emergency room visits as well as medications prescribed.  This prevents patients from visiting multiple emergency rooms reporting problems and getting multiple prescriptions for medications such as pain medications.

Flanigan: Do you have statistics on this program? 
A: Yes.The passage of the national healthcare reform will have significant impact and will create new administrative challenges, but is a good thing.

Grisamore: How much of the Department’s overall savings were a result of the Lewin Group’s recommendations?
A: We will have to get that for you.

Grisamore: Will there be an RFP for MO-HITECH technology?
A: Yes there will be an RFP for vendor to operate the exchange which is the secure environment for physicians to exchange information.

Interestingly, McCasland did not broach managed care in his presentation. As reported in the past McCasland is a fan of the program.

CENTENE corporation has over 15 lobbyists hired to promote managed care expansion in Missouri.

Next Week
The General Assembly will intensify their committee hearing schedule. Once again the appropriations committees will be busy reviewing the Governor’s budget.

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