February 18, 2011

The Missouri General Assembly continued this week to attempt to catch up from the lost snow week with heavy committee hearings throughout the week.

Missouri House Democratic Leader Mike Talboy is criticizing the state auditor for concluding the cost of replacing the state’s income tax with an expanded sales tax is unknown.

Auditor Tom Schweich said last week he did not believe an accurate cost estimate could be calculated for the tax proposals because it would require too many assumptions.

Schweich, a Republican, says it’s unclear how consumers would react to the tax change. He also says the proposals also would require lawmakers to make decisions that currently cannot be predicted.

Talboy, a Democrat from Kansas City, says it’s “puzzling” that Schweich could not develop a cost estimate and urged him to try again.

Schweich says no objective auditor could develop an estimate. He says Talboy’s criticisms are politically motivated.

News this week includes:

Appropriations Committee- Health, Mental Health, and Social Services
This morning Representative Tom Flannigan (Chair of House Appropriations Health, Mental Health, Social Services) approved an amendment to House Bill 10 to restore funding for our Core Public Health budget from $7.655 million to $9.018 million.

This increase of $1.352 million is fantastic! I visited with Representative Flannigan twice this week and he did confirm that Jasper County had contacted him. He would not confirm yesterday morning however, Tom came through!

We will now need to “work” the House Budget Committee.

Click thumbnail or here to view the 2012 Ammendment Log

The House Workforce Development and Workplace Safety
The House Workforce Development and Workplace Safety Committee met on Monday and voted several bills out of committee.

HJR 6   Proposes a constitutional amendment guaranteeing the right of individuals to vote by secret ballot.

Following the executive session, Rep. Mike Cierpiot, R-Lee's Summit, presented House Joint Resolution 6 before the committee. His resolution would propose a constitutional amendment that guarantees the right of individuals to vote by secret ballot. The issue was prompted because of concern over debate in Washington, D.C., on the Employee Free Choice Act.

HJR 6   would be specifically applicable when it comes to authorization of employee representation. Supporters of the resolution believe that the right to a secret ballot in the union bargaining process is something that should be protected.

Speaking in favor of the resolution were: Jim Kistler, Associated Builders and Contractors; Tracy King, Missouri Chamber of Commerce and Industry; and Nathan Dampf, Associated Industries of Missouri.

Several committee members who have had experience in union operations believe that the resolution is not necessary. They say that elections already use the secret ballot process and since debate has faded on the federal level, there is no reason to enact protective law.

Speaking in opposition were: Herb Johnson, Missouri AFL-CIO; Maurice Schulte, Carpenters` District Council of Greater St. Louis; and Richard Craighead, United Steelworkers District 11.

HB 319   Changes the laws regarding contracts for public construction projects which are funded in any amount with public funds.

Also heard before the committee was House Bill 319, sponsored by Rep. Fisher. HB 319 seeks to change the laws regarding contracts for public construction projects that are funded - in any amount - with public funds. Rep. Fisher discussed similar legislation that was passed several years ago, known as the "Fairness in Public Construction Act," that attempted to level the playing field for non-union employers in the construction bidding process. Since the projects are being paid for with taxpayer dollars, supporters believe every option should be explored in order to save money.

Speaking in favor of the legislation were: Jim Kistler, Associated Builders and Contractors; Jack Atterberry, Associated General Contractors of Missouri; Rich AuBuchon, Missouri Chamber of Commerce and Industry; and Nathan Dampf, Associated Industries of Missouri.

Herb Johnson, Missouri AFL-CIO, spoke in opposition to HB 319.

Details Continue To Emerge On Obama's Budget
More specific details about health care funding in President Obama’s fiscal year 2012 budget were revealed yesterday. Discretionary programs administered by the U.S. Department of Health and Human Services would receive about $80 billion, which is about $1.3 billion less than the programs are currently receiving. Spending for most other programs would be frozen. The president’s budget proposal includes $465 million for implementing the federal health reform law ― about $300 million for the Centers for Medicare & Medicaid Services’ role. The FY 2012 budget proposal also includes the following.

• limits states’ use of Medicaid provider taxes beginning in 2015
• limits durable medical equipment payments under Medicaid to Medicare bid amounts
• nearly doubles funding for fraud and abuse programs for FY 2012
• includes funding for a new Medicare Advantage auditing plan
• raises drug, device safety and other user fees
• includes quality improvement program enhancements
• proposes only a two-year Medicare physician payment remedy

States Consider Drug Testing For Public Assistance Recipients
Lawmakers in at least 10 states, including Missouri, have proposed requiring residents who are seeking public aid to undergo testing for illegal drug use as a condition of receiving benefits. Three states - Arizona, Minnesota and Wisconsin - currently have testing programs for public aid recipients. Missouri's legislation targets welfare recipients for whom there is a reasonable suspicion of illegal drug use.

House Healthcare Policy
The House Healthcare Policy Committee met Tuesday. Below are my notes from the hearing. Among the bills heard this were:

HB 201 (Representative Sater) authorizes the MO HealthNet Division within the Department of Social Services, or a contractor of the division, to implement a statewide dental delivery system to ensure recipient participation and access to providers of dental services under MO HealthNet.

Representative Sater said there is a lack of dentists in the Medicaid program because of the low reimbursement rates. This would provide a carve out for dental the same as pharmacy on Mo HealthNet. Other states have done this and have increased participation by dentists. There are some dentists that provide preventative care free of charge because with the complexity of the paper work it is not worth the low reimbursement.  This bill does not require Mo HealthNet to have the dental carve out but allows them to if they choose.

McNeil: What does carve out mean? A: now we have a fee for service (FFS) program where the dentist submits claim to the Department of Social Services for services.  This would provide the department the ability to contract with a private company to provide services and get reimbursed by Mo HealthNet.

Weter: Does this cover adults? A: yes

Weter: Will administrative services division recruit? A: yes

Sater: Not all counties have dentists that will accept Medicaid.

Franklin: Is the Dept of Social Services embracing this idea? A: 16 other states have done this successfully. This just gives DSS the avenue to do this if they choose. In other states the departments embraced the idea.

WITNESSES IN SUPPORT
MO Dental Association: We regularly hear complaints from dentists because of the extremely low reimbursement, extremely complicated paper work and inconsistent enforcement of rules.

Haefner: Are there standard set fees for services based on region? A: today there are so many subcontractors with their own rules and fees.  This will give continuity and with one administrator there would be consistent rules.  State will provide $x for administration of the program and it is up to the contractor to use those funds appropriately.

Weter: Will there be a preauthorization process? A: Possibly.  We expect a certain amount of preauthorization or a list of things covered and not covered.  We are only talking about kids; not adults.

McNeil: Could you do carve out to include adults? A: It would give the department latitude to do what they see fit.

Wayne Lee: Disability Advocate: medications weaken gums and teeth.  Avoiding dental care is very dangerous.

WITNESSES IN OPPOSITION
Pam Victor: Health Care USA: One of 6 managed care plans in MO.  Dental is part of what we provide on a per member per month basis.  We support keeping dental services

Next Week
The General Assembly will gradually move to more floor debate and committee work will once again take up every hearing room and go from early in the morning until late.

Believe it or nor Jay Leno had a segment in his opening act mentioning Senator Jane Cunningham.

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