February 18, 2006

This week the Missouri General Assembly settled down to address issues in committee for referral to the floor for debate.

News this week includes:

Subcommittee Approves Social Services and Health Budgets Without Change
The Subcommittee on House Appropriations - Health, Mental Health and Social Services has spent several weeks hearing public testimony and presentations from state agency officials about the budgets for the departments of Social Services, Mental Health and Health and Senior Services. On Wednesday, the committee began its “mark-up” process, in which members offer amendments to adjust the spending priorities presented in Gov. Blunt’s proposed budget.

Usually, the mark-up process takes a week or more, as the committee works section-by-section through the three budget bills. This year’s mark-up was completed in hours. After extended partisan wrangling over the rules governing the amendment process, in which Democrats appeared to have been thwarted in their attempts to get recorded votes on restorations of last year’s Medicaid cuts, a frustrated Democrat made a motion to endorse the bills without change. It was quickly adopted. The budgets proposed for these departments by the Blunt administration will advance to the House Budget Committee for review.

Committee Reviews Bills on Nursing Practice

This week, the Senate Aging, Families, Mental & Public Health Committee reviewed three bills on the practice of nursing. Senate Bill 566 would allow advanced practice registered nurses to prescribe controlled substances under collaborative practice arrangements with a physician. Proponents argued that 45 states allow APRNs to prescribe at least some controlled substances and that Missouri’s failure to do so keeps patients from getting necessary care, especially in rural areas. Opponents of the measure claimed that APRNs lack the training to prescribe without direct supervision by a physician.

Senate Bill 998 would authorize the Board of Registration for the Healing Arts, which licenses physicians, and the Board of Nursing to initiate a review of a collaborative practice arrangements between physicians and nurses without a complaint being filed. The bill also would require physicians to report their collaborative practice arrangements to their licensure board. The sponsor of the bill, who also chairs the committee, argued that the state should be able to verify that collaborative practice arrangements are being operated under law and regulations, especially if those arrangements are to be used as the basis for authorizing APRNs to prescribe controlled substances.

Senate Bill 710 revamps standards governing licensure actions against nurses by the State Board of Nursing. The bill gives nurses the same rights as physicians and dentists to have unsubstantiated complaints expunged from their records. It also authorizes the board to levy fines of up to $500 for licensure violations. A committee substitute for the bill is expected to authorize expedited licensure actions against a nurse who poses a clear danger to the public. Also, it will require additional entities to inform the state about nurse licensure violations leading to employer disciplinary action. Hospitals and ambulatory surgical centers now are the only entities required to report this information.

MHA testified on behalf of all three bills.

Committee Reviews Midwife Standards

The Senate Pensions, Veterans Affairs & General Laws Committee held a hearing on a bill authorizing midwives to provide obstetrical and postpartum care for a fee. Under current law, the practice of midwifery is illegal. Senate Bill 637 is identical to a bill that was reviewed and approved last week by a House committee.

The bill would require that most midwives be recognized as certified professional midwives by a certification organization called the North American Registry of Midwives. However, those with more than 15 years experience as a midwife need only pass the Registry’s skill assessment component. Midwives must provide patients with a written disclosure statement describing their experience, training, liability insurance coverage and client-specific plan for transfer to medical care. The disclosure would not be required for members of a religious sect recognized by the federal Social Security law.

Legislators Consider Conscience Clause Protections

Two bills were presented to legislative committees this week that would grant health care practitioners expanded rights to refuse to deliver services that conflict with their moral beliefs. Those covered by these “conscience clause” protections would be protected from employer or legal actions for their refusals. Violations would incur civil liability.

Senate Bill 609 applies to pharmacists and pharmacy workers of all types. It would provide protection for refusing to provide any service associated with a drug or device which the practitioner has a good faith belief would “contribute to the death of a human being by abortion or otherwise.” The bill includes an exemption for instances in which the pharmacy or health care facility can demonstrate that it is unable to reasonably accommodate the refusal without undue hardship on its operations.

House Bill 1539 is broader, applying to all health care practitioners and workers, health care facilities and health insurers. It would protect refusal to provide any service that violates the person’s or facility’s conscience. Similarly, a health insurer could refuse to pay for a service to which it has a conscientious objection. The conscience of a facility or insurer would be defined by mission statements and similar corporate documents.

The proponents’ featured witness at each hearing was a pharmacist who allegedly was fired for refusing to fill a prescription for Plan B emergency contraceptive.

Legislators Consider Health Workforce Planning Commission

House Bill 1388 would create a Health Profession Shortage Planning Commission. It would be made up of legislators and several members representing state agencies and the University of Missouri. It would be charged with analyzing data and trends on health care workforce shortages and the capacity to train practitioners, identifying recruitment and retention strategies, promoting workplace diversity and developing recommendations for legislative initiatives. The bill was presented this week to the House Workplace Development and Workplace Safety Committee. Proponents included various practitioner groups, including practitioner-training programs.

Poison Control Changes Debated

Senate Bill 965 and House Bill 1437 were presented to legislative committees this week. The bills, which are identical, update laws on the governance of the Missouri Poison Control Network. They would repeal a Poison Control Advisory Committee that has not met for many years and provide for coordination of the poison control network by the Department of Health and Senior Services.

Senate Passes Drug Repository Changes

The Senate has given final approval to a bill revamping laws creating a state repository for unused prescription drugs to be donated and used to treat low-income Missourians. The Senate Committee Substitute for Senate Bills 575 & 714 would allow donated drugs not used by an in-state pharmacy, hospital or clinic to be distributed to out-of-state charitable or religious organizations or to foreign medical aid mission groups. The bill also authorizes the Department of Health and Senior Services to develop a program allowing unused prescription drugs from long-term care facilities to be transferred to local government clinics. The measure also removes the current protection from criminal liability for those involved in the program.

The bill now moves to the House of Representatives.

Immunizations

This week I contacted Speaker Jetton and House Rules chair Shannon Cooper to delay House Bill 1071 dealing with immunizations for children entering school. The legislation takes authority away from the Department of Health and designates decisions to the legislature on required school immunizations.

Cooper and Jetton will delay the bill and agreed it was way overboard.

This bill allows the Department of Health and Senior Services to develop rules and regulations changing the manner and frequency of certain immunizations for children. However, the department cannot require immunizations for diseases other than those allowed by statute.

FISCAL NOTE: No impact on state funds in FY 2007, FY 2008, and FY 2009.

PROPONENTS: Supporters say the bill returns to legislators the right to decide which immunizations should be required for school attendance, and the Department of Health and Senior Services will still be able to determine the manner and frequency, including zero frequency of these immunizations. The bill will assure that future immunizations go through a democratic process before enforcing students to undergo vaccinations.

Testifying for the bill were Representative Phillips; and Missouri First.

OPPONENTS: Those who oppose the bill say that it will change current law that allows the department to add, through the rule-making process, immunizations required for school and child care attendance. Forty-five states authorize their state health department to add immunizations through administrative rules, protecting children without long delays in implementation. Since 1996 when the department received the authority to add immunizations through the rule-making process, one vaccine has been added for school attendance and two vaccines for child care attendance requirements.

Testifying against the bill were Department of Health and Senior Services; and Missouri Association of Local Public Health Agencies.

Legislative Committees Take Action on Bills

The following bills received committee action this week:

House Bill 1168 was voted out of committee as a consent bill and would establish the Well-Being Committee to aid pharmacists who suffer from illness, substance abuse, mental illness or physical impairments. This bill must receive a positive vote from the House Rules Committee before being placed on the House Perfection Calendar.

House Committee Substitute for House Bill 1742 would establish the eligibility requirements of an employed disabled person requesting medical assistance under the federal Ticket to Work and Work Incentives Improvement Act of 1999. This bill must receive a positive vote from the House Rules Committee before being placed on the House Perfection Calendar.

House Bills 994 and 1255 were heard in the House Transportation Committee this week and would repeal the requirement that adults wear a helmet while motorcycling. Hospitals, the Missouri State Medical Association, and a number of other organizations testified in opposition to the measure. The Senate companion bill, Senate Bill 635, was voted out of committee Jan. 31.

Health Care Policy

The House Health Care Policy committee heard HB 1245 this week. House Bill 1245 permits school nurses, upon authorization by the school board, to keep on hand and administer prefilled syringes of epinephrine in two dosage strengths. The nurse may administer the medication when, based on training, he or she believes a student is having an acute anaphylactic episode. The prescription must be written by a licensed physician listing the school district as the patient, as well as the nurse's name, and filled at a licensed pharmacy.

Next Week

The House will begin floor debate after having received committee reports on bills that have received approval in committee. The Senate after focusing on a labor initiative last week will also begin more floor debate.

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