February 2 , 2008

Matt Blunt's announcement on Tuesday to not seek re–election has started a whirlwind of rumors and political maneuverings unlike any seen in recent Missouri political history. Key Republican officeholders rumored to be considering the race for governor include (in no particular order) Lt. Governor Peter Kinder, State Treasurer Sarah Steelman, Congressman Kenny Hulshof (9th District), US Attorney and Former Speaker Catherine Hannaway, Congresswoman Jo Ann Emerson (8th District), Senate Majority Leader Charlie Shields and Speaker of the House Rod Jetton. Former U. S. Senator Jim Talent has indicated that he is not interested in running for the office of governor. Look for some major announcements in the next few days. Lt. Governor Kinder has formally announced his intention to run.

On the Democrat side of things, there are abundant rumors that Blunt's decision could cause Secretary of State Robin Carnahan to reconsider a primary run against Attorney General Jay Nixon, the presumed democratic candidate until last Tuesday.

Governor Blunt's decision could have far–reaching implications if several current officeholders decide to run for the office of governor.

Autism

This fall and summer Senator Rupp chaired a committee focusing on Autism. The Governor has added additional funding in the budget for autism services as well.

The Senate Health Committee heard SB 768 Tuesday which is a result of this interim study committee.

The bill creates the Missouri Commission on Autism Spectrum Disorders to advise and make recommendations to the Governor, General Assembly, and state agencies on matters relating to autism spectrum disorder. The Commission must develop a comprehensive statewide plan for an integrated system of training, treatment, and services for individuals of all ages with ASD. The Commission must issue preliminary recommendations by July 1, 2009. The Commission's membership shall include representatives from the General Assembly, various state agencies, other organizations involved with autism, as well as parents and individuals with ASD.

The Commission's duties include: studying the formation of a comprehensive, coordinated service delivery system; conducting an assessment of the need for certain education and treatment programs; providing recommendations for training programs; and creating a panel to review existing models of evidence–based educational practices. The Department of Mental Health will provide administrative support to the Commission.

Immunization

On Tuesday the Senate Health Committee heard SB 778.

The legislation sponsored by Senator Justus provides that female students enrolling in sixth grade may receive, at the option of a parent or guardian, an immunization for the human papillomavirus (HPV).

The Department of Health and Senior Services shall directly mail age appropriate information to parents or guardians of female students entering grade 6 regarding the connection between HPV and cervical cancer and the availability of the HPV immunization. Such information shall include the risk factors for developing cervical cancer, the connection between HPV and cervical cancer, how it is transmitted and how transmission can be prevented, the latest scientific information about the immunization's effectiveness, information about the importance of pap smears, and a statement explaining that questions from parents or guardians may be answered by a health care provider.

Each mailing shall request that the parents of female students entering grade 6 voluntarily furnish a written statement, not later than 20 days after the first day of school, stating that they have received the information and that the student has received the immunization or the parents have decided not to have the student immunized. Each school district shall submit a report to the Department of Health and Senior Services within 60 days of enrollment which includes a statement about the number of female students who have and have not been immunized against HPV and the number of non-responses to the written statement.

Nothing in the act shall be construed to prevent school attendance if a parent has opted not to have the student receive the HPV immunization or has not furnished the written statement. Any information derived from the parents or guardian shall be used for statistical purposes only and shall not be used to personally identify any parent, guardian or any student.

This act also requires health insurance companies to provide coverage for HPV immunizations for females between the ages of 11 and 21.

This act is substantially similar to SCS/SB 514(2007).

Pharmacy Records

In an effort to establish more accurate real time electronic records of pseudoephedrine and controlled substances prescriptions, Senator Champion had SB 732 heard on Tuesday.

The Deputy Department Director of the DEA testified in favor of the legislation.

SB 732 modifies a number of provisions relating to monitoring of drugs. Current law requires certain documentation relating to the sale of products containing pseudoephedrine. For non–prescription pseudoephedrine products, this act requires that the photo identification that must currently be provided to the pharmacist must be issued by a state or the federal government, or another acceptable document and that such identification must be furnished prior to purchase. The log currently maintained by pharmacists is modified to now include the signature of the purchaser, the name of the product and the time of the purchase. The act also requires that the log be electronic, rather than written. The seller is required to deliver the product directly into the custody of the purchaser.

The act modifies the current gram limits for the sale of pseudoephedrine products. The act provides that the limits do not apply to quantities that must be sold, dispensed or distributed in a pharmacy under a valid prescription or to any purchase by an individual of a single package containing not more than 60 mg of pseudoephedrine. The current 30 day period limit of 9 grams to a person applies without regard to the number of transactions. For mail order or mobile retail sales within a 30 day period, the limit on pseudoephedrine products shall be 7.5 grams without regard to the number of transactions. Within a twenty–four hour period, no person may obtain 3.6 grams without regard to the number of transactions.

The companion bill in the House is HB 1619.

Bill Would Expand Advanced Practice Nurses' Prescriptive Authority

Hospitals joined the Missouri Nurses Association and others in supporting a bill that would authorize advance practice nurses to prescribe controlled substances under the auspices of a collaborative practice arrangement with a physician. SB 724 was opposed by several physician organizations and individual physicians, who argued that advanced practice nurses lack the expertise necessary to prescribe highly addictive and dangerous drugs.

Missouri is one of only a few states that prohibit advanced practice nurses from prescribing at least some controlled substances. In its testimony, MHA noted that the restriction makes it difficult for hospitals to recruit advanced practice nurses to this state.

In reviewing the bill, members of the Senate Financial, Governmental Organizations and Elections Committee encouraged proponents and opponents to develop compromises to address concerns raised by the bill.

Committee Hears Proposed Health Care Data Bill

This week, the Senate Health and Mental Health Committee heard Senate Bills 821, 923 and 987, all sponsored by Sen. Wes Shoemyer, D–Clarence. Each bill would make changes to the MO HealthNet Oversight Committee by adding or changing a member. If passed, they would

• require one of the primary care physician members to be a doctor of osteopathy
• add a representative from a rural health clinic
• add an optometrist member
• add a licensed podiatrist member
• add a licensed nurse member

Missouri Hospital Association Provides Testimony On Blunt’s Insure Missouri Proposal

House Special Committee on Healthcare Transformation Chairman, Rep. Rob Schaaf, R–St. Joseph, continued his series of 23 hearings this week to discuss Gov. Blunt's Insure Missouri proposal. The seventh, eighth and ninth hearings were held this week with the other 14 scheduled Monday through Thursday through the end of February.

The Hospital Association testified this week before the committee. Funding sources for the Insure Missouri program, the Federal Reimbursement Allowance tax and other topics were discussed. Hospitals were asked to return next week for further testimony and questions for the committee.

Testimony was also heard this week from the following organizations:
State Health Insurance Pool
Missouri First
Jackson County Free Health Clinic
St. Joseph Social Welfare Board
Blue Cross/Blue Shield

Next week

Hearings will begin in earnest and hopefully the "politics" will settle down. Don't count on this occurring.

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