February 2, 2007

The Missouri General Assembly finished its fourth week of the 2007 session with the House holding organizational meetings for their respective committees. The House Budget and Senate Appropriations Committee held public hearings for comments on the proposed 2008 budget.

News this week includes:

SJR 18

Senator Shoemyer has introduced Senate Joint Resolution 18.

The resolution if passed would place for a statewide vote language allowing regulations to be adopted by county commission's health ordinances structure then state law.

Undoubtedly, agricultural (CAFO) advocates will fight this proposal. (See below)

Sponsor: Sen. Wes Shoemyer

0582L.02I
SJR18

SENATE JOINT RESOLUTION

Submitting to the qualified voters of Missouri, an amendment to article VI of the Constitution of Missouri, and adopting one new section relating to local government.

BE IT RESOLVED BY THE SENATE, THE HOUSE OF REPRESENTATIVES CON-CURRING THEREIN:

That at the next general election to be held in the state of Missouri, on Tuesday next following the first Monday in November, 2008, or at a special election to be called by the governor for that purpose, there is hereby submitted to the qualified voters of this state, for adoption or rejection, the following amendment to article VI of the Constitution of the state of Missouri:

Section A. Article VI, Constitution of Missouri, is amended by adding one new section, to be known as section 8(a), to read as follows:

Section 8(a). The governing body of any county of this state, including the city of St. Louis, may adopt by ordinance or order regulations affecting public health and welfare which are more restrictive than state law.

Committee Endorses Expanded Access to Metabolic Formula

The Senate Seniors, Families and Public Health Committee has approved a bill that would expand the state’s program of subsidizing costly dietary formula needed to treat phenylketonuria (PKU) and related metabolic disorders. State law requires insurers to cover the cost of such formula through age 5. The state program serves families with older children, but relatively few participants benefit because of modest income eligibility guidelines. The Senate Committee Substitute for Senate Bill 80 would create new categories of eligibility that would include both children and adults who have exhausted their insurance coverage of the dietary formula. Those with household incomes exceeding 300 percent of the federal poverty level would pay premiums and fees.

Pharmacist Medication Therapeutic Plan Bill Passes House Committee

House Bill 545, sponsored by Rep. Jay Wasson, R-Nixa, was heard and passed by the House Special Committee on General Laws this week. The bill, if passed, would allow pharmacists to form collaborative agreements with physicians to design and implement a medication therapeutic plan and advise patients of potential harmful interactions. A committee substitute for House Bill 545 and House Bill 314 (an identical bill) was unanimously approved by the committee.

Medicaid Fraud Legislation Advances

This week, a House committee held a hearing on a bill designed to reduce provider fraud in the Medicaid program. The House Special Committee on Healthcare Facilities then unanimously approved House Bill 353. The House of Representatives is expected to debate the bill next week.

As was the case during the last state legislative session, the House of Representatives and the Senate appear to have significantly different positions regarding Medicaid fraud legislation. The majority of the House members are cosponsors of House Bill 353, which is a less stringent bill and more responsive to provider concerns than the legislation expected to be debated in the Senate. The Senate bill has yet to be filed, but is expected to create a state civil false claims law that mirrors the federal anti-fraud law of the same name. A 2006 federal law gives states a financial incentive to enact laws at least as stringent as the federal law.

The House Committee Substitute for House Bill 353 does not attempt to create a law that would qualify for the federal incentive. Instead, those bringing allegations of fraud would be able to share in 10 percent of the proceeds recovered from the Attorney General's actions under current Medicaid fraud laws. In contrast, last year's Senate proposal would allow a whistleblower to recover up to 35 percent of the proceeds from a settlement or judgment against a provider. Also, the House bill provides that those who report their own or their organization's fraudulent activity to authorities would not be subject to criminal prosecution. The bill also includes new or stronger penalties for destroying records and making false statements to impede an investigation and filing false allegations of fraudulent activity.

Medicaid Coverage Expansion for the Disabled is Approved

The House Special Committee on Ticket to Work reviewed and unanimously approved a bill to extend Medicaid coverage to a portion of the employed disabled population that was displaced by the elimination of the Medical Assistance for the Working Disabled (MAWD) program in 2005. The revamped program would incorporate the use of premiums and employer-sponsored coverage when available and cost-effective. The new program is estimated to cover 4,000 people at a state cost of about $11 million. The bill is the House Committee Substitute for House Bill 39.

Committees Review Health Care Bills

This week, various legislative committees held hearings on the following health-related bills.

House Bill 364 would authorize a state income tax deduction for health insurance premiums paid for coverage of the taxpayer and his or spouse and/or dependents. The deduction would not be available if the expense was otherwise deductible under the federal tax code.

Senate Bill 15 revises current state laws allowing the state to partner with the federal government in creating financial incentives to purchase private long-term care insurance. Previous federal limits had prevented Missouri from implementing the program. With new federal authorization for these partnerships, the bill would allow those who have purchased private long-term care insurance policies to exempt the value of those policies when applying for Medicaid coverage of long-term care.

Senate Bill 122 would create a single-payer health care system modeled after the Canadian system.

State Budget Writer Juggles Job, Cancer

By Virginia Young

POST-DISPATCHJEFFERSON CITY BUREAU CHIEF
01/29/2007

JEFFERSON CITY - Mike Keathley, the state's chief budget writer, slipped out for a nap hours before the plan's unveiling. He was tired. But it wasn't because of long days working on the budget.

In November, doctors figured out that the throbbing in his leg meant the colon cancer he thought he had beaten three years ago had returned. It had metastasized — meaning it had spread — throughout his lymphatic system.

Scans also found five bone tumors. Keathley says doctors told him: "We have to get very aggressive very quickly, to beat it to the organs."

So Keathley, a top adviser to Gov. Matt Blunt, used a laptop and Blackberry to stay in touch while the cancer drugs dripped in during treatments in Columbia. His staff ferried documents to his bedside and took over when he was too sick to work.

The fat book detailing how the governor wants to spend $21.4 billion rolled off the presses on time. Blunt presented it Wednesday night in his State of the State speech.

"It worked because of the team of people here," Keathley said.

Although his name is not well-known, Keathley has played a key role behind the scenes for the past two years. He was part of the transition team that began mapping out Blunt's financial strategy days after the 2004 election.

A former corporate executive, Keathley has a bottom line-oriented philosophy that focuses on running government more efficiently. One recent project: consolidating half-empty state offices in St. Louis to save millions of dollars in rent.

Although some of his moves have been controversial, his style has won fans, even among Democrats. Keathley is candid and optimistic, and that's how he's approaching his cancer, too.

His title is commissioner of administration. That means he supervises everything from purchasing and accounting to long-range planning and facilities management.

He previously served as president of his family's business, IXL Manufacturing Co., in Bernie, Mo. It is touted as the largest manufacturer of ax handles in North America. Two wooden handles hang in a frame in Keathley's Capitol office.

He came to state government in 2002 at the urging of Lt. Gov. Peter Kinder, who was then the Senate's president pro tem. Kinder recruited Keathley to be the Senate's administrator. The two have been friends since 1969, when both attended a Boy Scout Jamboree.

"Mike is an open book," Kinder says. "What you see is what you get. And what you get is a high intellect of the first order on business and management issues."

Although Senate Democrats were leery at first, former Sen. Wayne Goode, D-Normandy, recalls that Keathley "made a real effort to meet people and learn about people and not just come in with a partisan mission."

In the Blunt administration, which doesn't have the warmest media relations, Keathley has a deft touch. In 2005, at his first budget briefing, reporters groused that there were no chairs. The next year, Keathley's office furniture was gone for the briefing; rows of folding chairs filled the room.

Keathley, 49, commutes to the capital each week from his home in Dexter, a four-hour drive. He and his wife, Julie, have two sons, Peyton, 5, and Mason, 4.

Though the family planned to move to Jefferson City, they decided to stay in Dexter when their younger son was diagnosed with autism. The family is building a new house, a project that they sped up when the cancer was diagnosed.

If he's not in the Capitol, Keathley is in touch with the governor electronically, though he adds that Blunt has "eased off sending me the 5:15 a.m. e-mails."

Blunt said in a statement Friday that Keathley was a "man of integrity" who had "done a magnificent job streamlining the cost of state government."

Keathley says that his treatment has gone well and that there are "no living cancer cells anywhere." The next goal is to shrink the tumors.

Although doctors have told him that only 9 percent to 30 percent of people with his type of cancer survive, Keathley is upbeat.

"I believe it's attitude," he said. "You've got to think of it like boot camp: I'm miserable, but I've got X number of weeks, and I'll get through it."

vyoung@post-dispatch.com | 573-635-6178

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