February 16, 2007

The Missouri General Assembly spent a great deal of time debating the MOHELA Sale without resolution at this point. In addition the Senate focused on the cable/ telecom legislation and the House focused on a state exemption of taxes on the payment of Social Security benefits. The cost will be approximately $100 million.

Numerous committee hearings were held. Topics included:

Proposal Would Boost Funding for Youth Smoking Prevention

The Senate Seniors, Families and Public Health Committee reviewed a bill that would earmark approximately $7 million in tobacco settlement funds for youth smoking prevention programs. The money would be payments to Missouri from smaller tobacco companies that have agreed to abide by the 1998 Master Settlement Agreement between states and the largest tobacco manufacturers. Senate Bill 109 also creates a commission to review evidence-based youth smoking prevention programs and monitor the progress of prevention efforts.

Licensure of Clinical Laboratory Personnel Considered

The Senate Financial, Governmental Organizations and Elections Committee held a hearing on legislation to create a system of occupational licensure for various types of clinical laboratory personnel. For those meeting the criteria established by Senate Bill 314, licenses would be issued to clinical laboratory scientists, categorical laboratory scientists, clinical laboratory technicians, and clinical laboratory assistant / phlebotomists.

Proponents of the bill argued that clinical laboratory personnel perform complex and exacting tasks and licensure is needed to ensure that practitioners are competent and participate in continuing education. Those appearing on behalf of the bill included laboratory practitioners, academicians and a physician.

Those testifying in opposition included the Missouri Hospital Association and a pathologist representing the Missouri State Medical Association and the Missouri Society of Pathologists. In questioning witnesses, committee members noted that the proposed occupational licensure standards would be more restrictive than the current federal Clinical Laboratory Improvement Act (CLIA) standards. One senator also expressed concern that the legislation might promote the use of out-of-state laboratories.

Emergency Personnel

Representative Dempsey had House Bill 579 heard Tuesday in the Crime Prevention Committee.

This MOALPHA priority allows for the deployment of any health care professional licensed, registered, or certified in this or any other state who volunteers during an emergency declared by the Governor and grants them immunity from civil damages for providing services. Currently, only workers licensed, registered, or certified in this state are allowed to be deployed.

I presented testimony in support of the legislation on behalf of MOALPHA.

Legislators Consider Licensure of Midwives

The Senate Pensions, Veterans' Affairs and General Laws Committee held a hearing on a bill this week that would create a system of occupational licensure for "direct-entry midwives" who provide obstetrical and postpartum care for a fee. Senate Bill 303 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.

The Senate Health and Mental Health Committee Reviewed Several Bills this Week:

• Senate Bill 179 would create a system of reporting the number of uninsured and Medicaid recipients seeking hospital treatment and identifying the employers of those patients. The bill is similar to an executive order issued last year by Governor Matt Blunt.


• Senate Bill 267 would direct the Missouri Consolidated Health Care Plan, the health insurance plan for most state employees and some local government employees, to provide access to coverage for small employer with 1 to 50 workers. These workers would be maintained in a separate pool of coverage from the state and local government workers. Proponents argued that it would expand access to coverage. Opponents and some legislators cautioned against the development of adverse selection in the small employer pool.

The committee also approved a bill heard previously. Senate Bill 274 would create a Health Technology Fund in the state treasury that would be used to fund initiatives involving medical records, e-prescribing, telemedicine and other health technology projects.

Seatbelts

The Senate Transportation Committee heard legislation dealing with safety belts and child restraints.

SB 17 repeals the motor vehicle safety inspection program except for motor vehicles domiciled, primarily operated or registered in an emissions nonattainment area (St. Louis metropolitan area). The safety inspection remains in place for school buses on a state-wide basis and such inspections will be conducted by the highway patrol. The repeal of the state safety inspection becomes effective January 1, 2008.

The act also allows law enforcement officers to stop a vehicle for a seat belt violation if the violation is clearly visible (primary enforcement).

SB 445 exempts church bus drivers that transport children from the child passenger restraint system requirements of Section 307.179. The church bus must have a passenger capacity of over ten persons in order to qualify for the exemption.
The act contains an emergency clause.

SB 252 exempts motorcyclists age 21 and older from wearing a helmet when operating a motorcycle or motortricycle. Under current law, everyone operating a motorcycle or motortricycle must wear a helmet.

This act is substantially similar to SB 635 (2006), SB 12 (2005), SB 744 (2004), SB 226 (2003), SB 646 (2002), SB 18 (2001), SB 610 (2000) and SB 294 (1999).

In addition, HB 155 was heard in the House Homeland Security Committee. HB 90 and HB 155 was voted out DO PASS in the House.

Testimony was taken on SB:

SB 17 Senator Shields' bill about seatbelts and inspections:

• Proponents: Phil Haseltine – National Safety Council, Brent Evans – Mo. Hospital Association, Tom Holloway – Mo. Medical Association, Gary Marble - Mo. Transportation and Development Council and AIM, Mo McCullough – Eastern Mo. Psychiatric Society, George Burruss – Mo. Motor Carriers Association, Patrick Bonnot – Mo. Municipal League, Michael Grote - Mo. Chamber of Commerce, Rodney Gray – HCA of KC, and Insurance, Nancy Giddens – Alliance of Motor Vehicle Manufactures, Childrens' Mercy Hospitals, The Greater KC Chamber, Adam McBride – Mo. Laborers’ Union, Ed Wallace – General Motors, Jim Russell – Ford Motors, John Parris – Associated General Contractors of St. Louis, and Diamond Chrysler.


• Opponents: David Overfelt – Mo. Tire Industry Assocition, Ron Reiling – AASP, Greg Kinder - Citizen, Mike Silva - Citizen, and Michael Right – AAA Auto Club


• Informational: Pete Rahn – Dir. MoDot, Lt. David Perkins – Hwy. Patrol, Dale Finlay – Mo. Safety Council, National Safety Board (All of these are in favor of Seatbelts but not repealing inspections)

SB 252 Senator Ridgeway's Bill on helmets:

• Proponents: Freedom of the Road Riders (If you want to see everyone stop by)


• Opponents: Leanna Depue – MoDot, David Humphrey – Citizen, Eric Hopp – Mo. Motorcycle Safety Program and Mo. Safety Center, Mo McCullough – Eastern Mo. Psychiatric Society, Tom Holloway – Mo. Medical Association, Brent Evans – Mo. Hospital Association, Dale Finlay – Mo. Safety Council and Mo. Coalition for Roadway Safety, Michael Right – AAA Auto Club, Heath Clarkston – Property Casualty Insurers of America

SB 445 Senator Goodman exempts church bus drivers who transport children from the child passenger restraint system requirements.

STDs

Representative Davis' HB 716 presented her perennial legislation this week in the House Committee on Family Services.

HB 716 requires public school course materials and instruction on sexuality and sexually transmitted diseases to be presented to students in a way that portrays the personal, physical, emotional, financial, and psychological risks and consequences of sexual activity and is in accordance with the federal abstinence education law. Charter schools are allowed to determine the policies and the appropriateness of how to present the materials and instruction. School district or charter school personnel or agents are prohibited from providing, permitting, sponsoring, or furnishing abortion services, materials, or instruction to students if that person is a provider of abortion services.

HJR 20

Representative Bearden has filed his taxpayer bill of rights, HJR 20.

This is a House Republican leadership initiative which is aimed according to Bearden at controlling spending in "good times" in anticipation of "down times".

You will recall last year that Bearden made modifications to make the legislation more "palatable" without the "ratchet down" effect of the Colorado TABOR bill which causes hardship to public entities by having a base that is reduced each year.

The bill did not gain traction last year. However, Representative Bearden is committed to moving this legislation this year and has support in the House Republican Caucus.

Speaker Fends Off Criticism of Nutrition Bills

House Speaker Rod Jetton (R-Marble Hill) has pushed through the House a couple of nutrition bills he sponsors, though he has had to fend off criticism he considers unfair. Both bills have passed with overwhelming support in the House, but it was difficult to discern such support during the initial round of debate on the issues.

Once a House Speaker climbs down from the dais to engage in floor debate, he becomes too tempting a target for minority party members to pass up. House Minority Floor Leader Jeff Harris (D-Columbia) questions Jetton on whether his bills will spark unintended consequences. And Harris gets in a jab at Jetton by reminding the Speaker that a state agency estimates it will take at least one if not two new employees to run his tax credit program, which Harris refers to as a "new government program", an obvious slap at Jetton's conservative, small government philosophy. Jetton dismisses criticism of the two nutrition bills, especially one that would provide a state supplemental to food stamps for senior citizens. One critic attacked it as a "pathetic gesture", a phrase that offends Jetton. Jetton says his bill is an attempt to provide real help for real people.

The bill, HB 454, would provide a state supplement for federal food stamps to raise allocations to $30 a month for individuals, $60 for couples, at a cost of three million dollars to the state. Jetton's other bill, HB 453, would provide a tax credit of up to $2,500 for donations of cash or food to a local food pantry. It is capped at two million dollars a year. Both bills now move to the Senate.

House Panel Clears Safety Belt Bill

Legislation known as the Primary Seatbelt Bill has been approved by the House Transportation Committee and sent to the full House. Missouri currently has a secondary seatbelt law, meaning law enforcement can only ticket an unbuckled driver if he or she is committing another offense. House Bill 90 would change that to allow for the ticketing of any motorist solely for failure to buckle up.

One after another, citizens stepped up to testify in favor of the legislation. Among them were high school students and the parents of a young person who had been killed in a crash. They pleaded with lawmakers do what she believes is necessary to save young lives.

The number 90 was chosen for this bill because its sponsors believe a primary seatbelt law would save 90 lives every year in Missouri.

Governor's Plan

House Approves Ticket to Work Bill

A bill to restore health care to more than 4,000 disabled Missouri workers has breezed through the House and heads to the Senate, a third try to restore a program cut two years ago.

Rep. Charles Portwood (R-Ballwin) has been disappointed before, seeing his attempt to resurrect a scaled down version of the Medical Assistance for Workers with Disabilities (MAWD) program fail twice. Portwood tells the body during House floor debate that he doesn't see the obstacles this year that have been the problem before. Portwood's bill, HB 39, re-names the program Ticket to Work. It would cover those receiving up to 350% of the federal poverty level at a cost of $10-point-6 million to the state, well under the cost of the old MAWD program.

Portwood has a hard time convincing House Minority Leader Jeff Harris (D-Columbia) that the delay was beneficial. He says bill improved over the two-year delay, with changes made that covers about 1,500 more people. Harris replies that those disabled workers who lost health insurance weren't better off. The legislature eliminated the MAWD program two years ago during the Medicaid cuts. A clash between House and Senate leaders doomed the bill last year.

Next Week

Committee hearings will dominate the focus of the legislature next week.

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