February 24 , 2008

This week the state senate has voted to undo something Missouri voters did 14 years ago—without asking the voters if it's okay.

Critics of the campaign donation limits adopted by Missourians in 1994 say that law has bred a series of moves that don't limit campaign donations and, in fact, conceal the identities of the givers.

The senate has advanced the bill removing campaign donation limits but requiring identification of donors.

Senator Wes Shoemeyer of Clarence tried to get the issue taken back to voters but lost on a party–line vote. Shoemeyer is a Democrat.

Sponsor Charlie Shields of St. Joseph says his bill requires that donor names be public records, regardless of the committee to which the money is given. He says something new needs to be done because the 1994 law has not kept big money out of politics. In fact, he says it's bigger than ever and more of it is secretly circulating.

Shields says his proposal will put candidates more in charge of their own campaign finances and will lessen the use of independent committees that are not accountable to the public for the money they spend on behalf of a candidate or an issue.

In addition the state senate says public financing of campaigns is not the way to control big money in political campaigns. It has rejected Senator Jeff Smith's proposal for taxpayer–support campaign funding and is instead working on a bill that removes all donation limits but requires faster filing of reports listing donors and amounts.

Smith says Maine and Arizona, the only two states that have enacted public financing of campaigns, have seen election costs decline while costs in the other 48 states have "skyrocketed."

However, Joplin Senator Gary Nodler says taxpayer–funding of campaigns means some donated money could be used by candidates or for issues that the taxpayer opposes. He prefers a person make donations to a specific cause or candidate. Nodler says public financing of campaigns constitutes "mindless political expression" while donations to specific candidates is "purposeful political expression."

The legislature approved the no–limits campaign finance bill in 2006 as part of a larger bill. However the Missouri Supreme Court threw out the bill because of one provision within it that it ruled was unconstitutional. In its ruling, the court indicated the legislature could re–enact the no–limits campaign funding section.

News of interest includes:

Core Public Health Funding

On Wednesday the Appropriations Committee on Health, Mental Health and Social Services made their recommendations.

Numerous Governor' priorities were cut. However, the local public health funding $2.5 million remains in the recommendation.

City Ordinances—Dogs

SB 886, Senator Justus, was heard in the Senate Local Government.

This bill allows any city, town, or village to adopt ordinances, orders, or regulations to control dangerous dogs, provided that no such ordinances, orders, or regulations are specific to breed. Ordinances, orders, or regulations addressing specific breeds of dogs adopted prior to August 28, 2008, shall be deemed invalid.

Several pit bull dog owners from the Kansas City area and the ASPCA testified in favor. Larry Jones, Independence, Kansas City Health Director and the MML testified against the bill citing local control.

In addition, Jones passed out graphic pictures of a pit bull attack in the Kansas City area where 3 people were horribly injured. The committee took these pictures seriously.

Seat Belts

The Senate Transportation Committee heard Senator Graham's SB 884 Wednesday morning.

The bill requires all drivers and passengers in cars or trucks to wear a seat belt. Under current law, only the driver and front seat passenger are required to use seat belts. Exemptions are allowed for United States Postal Service employees while performing their duties (a continuation of current law) , persons operating or riding a motor vehicle being used in agricultural work–related activities (a continuation of current law), and persons with a medical reason with documentation from a physician (documentation requirement is new in statute).

The act allows for primary enforcement of Missouri's seat belt law by repealing the provision that prohibited law enforcement from stopping or detaining anyone solely to determine compliance with the seat belt law.

The act also clarifies existing language which allows a person to ride without a seat belt when there are more persons than there are seat belts. If there are more persons than there are seat belts, the passengers who are unable to wear seat belts because all existing seat belts are in use shall sit on the rear seat of the motor vehicle. The act also makes the seat belt law applicable to trucks with a licensed gross weight under 12,000 pounds or more.

The MML, hospitals, the Safety Council and MOALPHA are on record in support along with Ford and GM.

SB 738

Senator Nodler's bill has not been voted on in the Senate Agriculture Committee.

The bill directs the Department of Natural Resources to establish and publish a time line for the complete processing of any permit application for a concentrated animal feeding operation (CAFO), if the processing cannot be completed within ninety days of the Department's receipt of the completed application. Publication requirements are described.

Any CAFO, or recycling company that converts animal parts into petroleum, who violates any state air, water, or odor pollution standard at least six times in a 12–month period or 12 times in a 36–month period shall forfeit any CAFO–related permits issued by the Department. CAFOs or recycling companies that violate any air, water, or odor pollution standard more than one time in a 36–month period shall be subject to a surcharge in addition to a civil penalty. The surcharge will be the sum of the civil penalty assessed for the violation plus the sum of any fines assessed during the 36–month period. The funds from the surcharge shall be deposited into funds created and utilized for public education and the enforcement of air and water pollution laws of the state. The act is similar to SB 534 (2007) and SB 591 (2006).

Nodler is taking a shot at the RES plant in Southwest Missouri which renders pig carcasses into fuel and has had numerous violations with DNR.

CAFO's are mentioned giving statewide implications rather than targeting a specific company.

Senator Clemens, the chair, will not be pushing this legislation as evidenced by not having a vote at this juncture.

Ethan's Law

The House Insurance Committee heard HB 1341 sponsored by Representative Marilyn Ruestman.

The legislation establishes Ethan's Law which requires the owner of a for–profit, privately owned swimming pool or facility to maintain adequate liability insurance in an amount of at least $1 million in the event of injury or death of a patron. For each day an owner violates the provisions of the bill, he or she will be subject to a fine of $100 and/or one day of confinement in jail.

This bill comes as a result of a drowning in the Joplin area.

Sunshine Laws

The Missouri Press Association is pushing HB 1440, Roorda.

The bill changes the laws regarding the Open Meetings and Records Law, commonly known as the Sunshine Law. The bill requires each elected or appointed public official who is a member of a public body to complete a one– to two–hour course covering the responsibilities of public officials and the Open Meetings Law as well as a separate one– to two–hour course regarding the responsibilities of the public governmental body to public information laws and open records. Public officials may designate a public information coordinator to satisfy the public information laws and open records course requirement. Each public official must complete the courses within 90 days of taking office. The training must include general principles, procedures, and applicability of the legal requirements for the Sunshine Law. Upon completion of the courses, the entity providing the training must issue a certificate of course completion to be maintained for public inspection by the public governmental body in which the official serves.

The Office of the Attorney General must ensure that training is made available to public officials and may provide courses or approve any acceptable course offered by a public governmental body as well as ensure that at least one course approved or provided is made available in a videotape format and at no cost. Any public official serving prior to the effective date of the bill must complete the training requirements before January 1, 2010.

The bill becomes effective January 1, 2009.

The committee agreed in concept with Sunshine Law training. However, they disagreed with the penalty sections.

The Attorney General's office testified in favor with concerns on the ability to train such a large number of public officials, boards and commissions.

Limitations on State Spending

Representative Icet has filed HJR 70.

No bill summary is available at this time, however, to view the bill in full: http://www.house.mo.gov/billtracking/bills081/biltxt/intro/HJR0070I.htm

Insure Missouri Hangs in Balance

The fate of Insure Missouri, Governor Blunt's proposal to provide health insurance to low income working parents, is unclear. Phase 1 could begin enrolling individuals as early as March. If fully implemented, it will insure an estimated 54,000 low income working parents/caregivers. There are many "ifs" right now.

Insure Missouri was initially opposed by most of the majority leadership, although some appear closer to supporting it now. Some of the majority House members, including Rep. Rob Schaaf (Chair of the Special Committee on Health Transformation), are openly hostile to it. Members of the minority party generally are opposing it because it does not fully restore all the cuts made in 2005. Negotiations continue with Republican and Democratic leadership to gain support.

Blunt's Insure Missouri Program Recommended For Inclusion In Missouri Budget By House Committee

The House Health, Mental Health and Social Services Appropriations Committee completed its work this week regarding its budget recommendations for the following state departments: Health and Senior Services, Mental Health and Social Services. While the committee agreed with the majority of Governor Blunt's budget recommendations, it did recommend the exclusion of certain items for the three departments. Items excluded from Governor Blunt's recommendations were listed in a report the committee sent to the House Budget Committee. Phase I and Phase II for the Insure Missouri Program were not on the list of excluded items, and therefore, recommended for passage to the House Budget Committee. The House Budget Committee will begin its work on the budget next week. The House is expected to complete debate on the budget before leaving for Spring Break on March 13.

The House Appropriations Committee also recommended:

• Expanding presumptive eligibility for the SCHIPs program to FQHCs and Rural Health Clinics
• Covering physical, occupational and speech therapy for MO HealthNet eligibles receiving in–home services
• The Department of Social Services exploring the possibility of using Health Savings Accounts in the MO HealthNet Program to reward participants for engaging in activities that can improve their health. (The state of Florida's Enhanced Benefits Account Program was used as an example of this idea.)

Committee Reviews Health Care And Insurance Bills

The House Special Committee on Healthcare Transformation held a hearing this week on a bill that would prohibit the use of "most favored nation" clauses in contracts between health insurers and health care providers. These clauses say that an insurer has the right to have its enrollees treated for the lowest price offered by the provider to any competing insurer. Failure to give the insurer the best price offered elsewhere in the market will subject the contract to cancellation or renegotiation. Essentially, these contractual clauses ensure that the contracting insurer will always have access to the provider's best price in the market.

A number of health insurers testified in favor of House Bill 1880, arguing that it is needed to keep dominant insurers in a market from using these clauses to block smaller competitors. Representatives of various physician organizations and group practices also spoke on behalf of the bill.

Opponents of the bill argued that the government should not interfere in the ability of insurers and providers to set the terms of their contractual agreements. Also, several larger insurers argued that these clauses allow them to control their costs and keep their premiums affordable for their customers.

The sponsor of the bill, Representative Rob Schaaf, R–St. Joseph, offered the committee a proposed revision of the bill which would expand its scope to encompass all types of providers, including hospitals, clinics etc. The original version had applied only to individual practitioners.

At the hearing, the committee also reviewed and approved House Bill 1805. It says that if the usual and customary retail price of a prescription drug is less than the normal insurance copayment amount, the patient will pay the lesser amount.
The committee also held a hearing on House Bill 1375, which authorizes much higher MO HealthNet payments to physicians who agree to act as a "health care home" to assess and manage the care of MO HealthNet enrollees.

Senate Approves Bill To Expand Prescriptive Authority Of APNs

Legislation was approved this week by the full Senate that would authorize advanced practice nurses to prescribe controlled substances under the auspices of a collaborative practice arrangement with a physician. Senate Committee Substitute for Senate Bill 724 is supported by nurses, hospitals and clinics 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 a committee hearing in the Missouri House.

Senate Advances Combined Measure To Reverse 2007 Midwife Enactment and License Direct–Entry Midwives

Legislation to repeal an obscurely worded one-sentence provision that passed the legislature last year and authorized the practice of lay midwifery was advanced this week by a Senate Committee. However, before approving Senate Bill 870, the committee created a committee substitute and combined it with Senate Bill 1021. SB 1021 would create a system of occupational licensure for "direct–entry midwives" who provide obstetrical and postpartum care for a fee.

Senate Committee Substitute for Senate Bills 1021 & 870 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.

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

The bill would limit who may be held liable for a direct-entry midwife's negligent acts or omissions, but it would not preclude other providers from being liable for their own negligence in providing follow–up treatment. The liability language reiterates current legal standards. The combined bills now move to the full Senate for debate. The midwives lobbyist is attempting to pull local public health as collaborating providers we will need to review.

Committee Advances Legislation To Repeal Motorcycle Helmet Law

The Senate Transportation Committee advanced a bill that would allow adults 21 and older to ride a motorcycle without wearing a helmet. The bill now moves to the full Senate for debate. A similar bill also has been filed in the House.

Senate Committee Hears Bill Requiring Primary Enforcement of Seatbelts

A Senate Committee this week heard legislation that would require all drivers and passengers in cars or trucks to wear a seat belt. Under current law, only the driver and front seat passenger are required to use seat belts. Exemptions are allowed for U.S. Postal Service employees, agricultural work–related activities (a continuation of current law), and persons with a medical reason with documentation from a physician.

Senate Bill 884, sponsored by Sen. Chuck Graham, D–Columbia, allows for primary enforcement of Missouri's seat belt law by repealing the provision that prohibited law enforcement from stopping or detaining anyone solely to determine compliance with the seat belt law. The bill also clarifies existing language which allows a person to ride without a seat belt when there are more persons than there are seat belts. The passengers who are unable to wear seat belts because all existing seat belts are in use are required to sit on the rear seat of the vehicle. The bill also makes the seat belt law applicable to trucks with a licensed gross weight under 12,000 pounds.

Health Professional Peer Review Bill Advances

The Senate Seniors, Families and Public Health Committee advanced legislation modifying the definition of "health care professional." Under Senate Bill 915, the definition of "health care professional" would include physical therapists, emergency medical technicians and emergency medical dispatchers for purposes of determining who is subject to the protections of the peer review law. The bill now awaits debate by the full Senate.

Committees Hear Bills

House Bill 2068 was heard by a House Committee this week and changes the laws regarding the licensure of physical therapists and physical therapy assistants. In its main provisions, the bill:

• specifies the services which may be provided by a physical therapist without a prescription or the direction of an approved health care provider
• creates an inactive license for physical therapists and physical therapy assistants
• allows physical therapists and physical therapy assistants licensed in other states to provide gratuitous services for a period not to exceed 14 days in any one calendar year
• authorizes the State Board of Registration for the Healing Arts to suspend or restrict licenses of those who it considers to be a clear and present danger to the public

Next Week

Two weeks remain before the legislative spring break. Budget bills will need to be completed in the House before the break.

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