February 11 , 2008

It appears that the “games” have already begun in the legislature. The Democrats in the Senate “filibustered” gubernatorial appointments on Tuesday afternoon. Senator Shields, the Majority Leader, decided to call the Senate back into session for an all night legislative session to teach the Minority Party a lesson.

This all comes only four weeks into the legislative session. Last week all the non-controversial “consent” bills of the Republicans were killed by the Democrats.

It appears this session as predicted will not be a productive legislature.

Items of interest this week include:

State Board of Health
The hearing in the Senate for Senate Bill 962, Champion, was not heard on Tuesday.

The bill repeals the current State Board of Health and the State Board of Senior Services and creates a State Board of Health and Senior Services. The board shall consist of nine members, appointed by the Governor, with the advice and consent of the Senate. No more that five of the members of the board shall be from the same political party. The term of years and make-up of the board are specified.
The board shall advise the Department of Health and Senior Services in the promulgation of rules, formulation of the budget and planning for and operation of the department. The board shall also annually evaluate all boards, councils, committees, authorities, and bodies related to the department.
The Department of Health has agreed to the inclusion of a local health representative. In addition in my visits with Senator Champion she has pledged to keep that representation.

House Bill 1339
Representative Muschany’s HB 1339 was heard in House Judiciary.

This bill changes the laws regarding medical malpractice by revising the definitions of "health care provider" to exclude persons, hospitals, or abortion facilities for medical malpractice claims that involve performing or inducing an abortion and "health care services" to exclude services involved in performing or inducing an abortion.

The bill specifies that the General Assembly will not provide civil liability protections to health care providers who perform or induce abortions.

The bill is aimed at making abortions more restrictive by removing the limits on malpractice awards to in the case of physicians, hospitals, clinics providing abortions.

The Catholic Conference and Missouri Right to Life testified for the bill with Planned Parenthood testifying against.

Pathology Billing Proposal Reviewed
Revisiting a controversial topic from past sessions, legislators on the Senate Health and Mental Health Committee reviewed a proposal, Senate Bill 817 that would prevent physicians from billing or soliciting payment for anatomic pathology services unless they directly perform or supervise the pathology analyses. As in past years, pathologists accused their physician colleagues of inappropriate and misleading billing that is prohibited in federal programs. The primary care doctors responded that the current law is designed to protect the large clinical labs and their pathologists. Points of debate included the cost and quality of various pathology services, the role of physician self-referral, physician compensation trends and whether patients prefer or would benefit from more detailed information regarding their medical bills.

Bill Advances to Expand Prescriptive Authority Of Advanced Practice Nurses
Legislation that would authorize advanced practice nurses to prescribe controlled substances under the auspices of a collaborative practice arrangement with a physician advanced this week in the Senate Financial, Governmental Organizations and Elections Committee. Senate Bill 724 is supported by the Missouri Hospital Association, but opposed by several physician organizations and individual physicians, who argue that APNs lack the expertise to prescribe highly addictive and dangerous drugs.

The bill now awaits debate by the full Senate.

Bills Reversing 2007 Midwife Enactment and Legalizing the Licensing of Midwifes Heard in Committee
In the final week of the 2007 legislative session, legislators passed House Bill 818, a health insurance bill which later was found to include an obscurely worded one-sentence provision buried in the 123-page bill that authorized the practice of lay midwifery:  “Notwithstanding any law to the contrary, any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services as defined in 42 U.S.C. 1396 r-6(b)(4)(E)(ii)(I).”

Miffed that the midwife language had been advanced by some degree of subterfuge by the legislative sponsor, Senate leaders temporarily stripped the sponsor of his committee chairmanship. With little time left to correct the situation, Legislators were unsuccessful in their attempts to remove the one-sentence provision before the end of the 2007 session.  The bill was eventually signed by Gov. Blunt.

A Cole County judge agreed with physician arguments and struck down the midwife law in August, ruling it violated the Missouri Constitution and went beyond the title and original purpose of the health insurance bill. The case is now on appeal before the Missouri Supreme Court.

In a deal struck with Senate leadership, the offending Senator, Sen. John Loudon, filed Senate Bill 870 to repeal the obscure one-sentence provision passed in the 2007 legislative session.  By filing the bill, Sen. Loudon regained the chairmanship of the committee from which he was stripped at the end of the 2007 legislative session.  A similar bill, House Bill 1643, has been filed in the House.  Both bills received hearings this week.

If the Supreme Court upholds the rejection of Loudon's provision, his Senate Bill and the House Bill deleting it from law may be moot.  Arguments in that case are slated for early March 2008, in the Supreme Court.

The same Senate committee which heard Senate Bill 870 also heard a bill that would create a system of occupational licensure for “direct-entry midwives” who provide obstetrical and postpartum care for a fee. Senate Bill 1021, also filed by Sen. Loudon, would require that these licensed midwives be recognized as certified professional midwives by the North American Registry of Midwives. They must provide patients with written disclosure statements describing their experience, training, liability insurance coverage, risks and benefits of home births and a client-specific plan for transfer to medical care. The disclosure would not be required for those who have passed a skills assessment test of the North American Registry of Midwives and practiced midwifery for at least 20 of the 30 years before August 28, 2006.

A licensure board for direct-entry midwives is created in the Division of Professional Registration. Various limitations placed on the practice of a direct-entry midwife, who may not prescribe drugs, use forceps during deliveries, or perform cesarean sections, medical inductions or vacuum deliveries.

The bill limits who may be held liable for a direct-entry midwife’s negligent acts or omissions but does not preclude other providers from being liable for their own negligence in providing follow up treatment. The liability language reiterates current legal standards.

Motorcycle Helmet Law Repeal Advances
This week, a House committee advanced legislation allowing those age 21 and older to ride a motorcycle without wearing a helmet. The bill is House Bill 1393. A similar bill has also been filed in the Senate, Senate Bill 1067. MOALPHA is on record against the bill. Also testifying against the bill are the Safety Council and hospitals.

Bill Would Prohibit Public Assistance for Illegal Immigrants
House Bill 1626, sponsored by Ed Emory, R-Lamar, was heard this week in the House Special Committee on Immigration.  If passed, this bill would prohibit persons who are not citizens or permanent residents of the United States or who do not possess lawful immigration status from receiving state or local public assistance unless it is mandated under federal law.  Documentary evidence accepted by the Department of Revenue for obtaining a driver's license would suffice as proof of citizenship, permanent residency, or lawful immigration status when applying for benefits.  Individuals could temporarily receive public assistance for up to 90 days while obtaining the necessary documentation or indefinitely if the applicant provides a copy of a completed birth certificate application which is pending.

I visited with the sponsor regarding MOALPHA’s concerns specifically regarding tuberculosis patients. Emery would look at language if we provide it to him.

Elections
Representative Bob May’s election committee heard the so-called “Andrew Jackson” voting bill House Bill 1517
Sponsor:  Cox
Currently, nonpartisan elections in political subdivisions and districts, except for municipalities, may be canceled if the number of candidates filing for a position is equal to the number of positions available.  This bill establishes the Andrew Jackson Vote Restoration Act which repeals these provisions and requires elections to always be held.

The committee was skeptical of the bill’s provisions. I visited with the chair and related that this would be a costly measure for local public health agencies. He is not inclined to move the bill.

Next Week
Several bills were reported to the floor and could see Senate debate next week. Issues include changing the current property tax system; giving advanced practice registered nurses the authority to prescribe medications; prohibiting utilities to disconnect service to residential customers on extraordinarily hot days; and extending the sunset on job retention project tax credits under the Missouri Quality Jobs Act.

The Republicans will hold their Annual Lincoln Days Event this weekend in Springfield, MO.

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