February 26, 2006

It has become quite obvious that the House intends to move very slowly this year. Currently only consent bills that are non-controversial have been addressed.

Could this possibly be due to being an election year?

In the meantime, the Senate has been very contentious and undoubtedly the filibuster will be used on a consistent basis this year.

News this week includes:

Medical Malpractice Insurance Reform Legislation to be Introduced, House Bill 1837

House Republicans have taken the wraps off a legislative proposal to reform medical malpractice insurance. State Representative Brian Yates of Lee's Summit, the sponsor, says last year's litigation reform legislation got the ball rolling, and this is the next step in efforts to keep doctors from leaving the state. Yates says his bill will increase the oversight of medical malpractice associations and will foster an environment of openness and accountability. Insurers would be required to submit an annual report to the Department of Insurance. The Department will, in turn, put together a report of its own to present to the Governor and the Legislature to determine if rates, underwriting practices, and claims administration are just, adequate, and reasonable.

Fund Sweep

Senator Gross had his Senate Bill 917 heard this week. No one testified for the legislation. Numerous professional groups that are overseen by the Board of Professional Registration testified against the bill.

Senate Appropriations Chairman Chuck Gross thinks he's found some pots of money to help state government when economic times are bad. The pots are maintained by 220 programs that state law requires the Legislature to fund. Gross says those funds were holding more than $650-Million at the end of fiscal 2005. His bill allows the Legislature to withhold half of the annual appropriations to those funds when state revenue is low, freeing up tens of millions of dollars for general state operations. Gross says his idea would not eliminate some programs, but would allow the Legislature to reduce amounts going to them so the money can be spent on other state programs.

This legislation was later attached to an emissions bill on the floor by Gross. The admissions bill is Senate Bill 583.

Sovereign Immunity

House Bill 1415, sponsored by Representative, has been filed.

This legislation limits the liability for any claim against the state or its public entities and employees involving a motor vehicle operated within the scope of employment or for any claim arising out of any dangerous condition of property the agent, officer, or employee allegedly caused. The maximum liability for all claims against entities or employees will be $2 million; the liability for any one person is limited to $300,000. The maximum award for any claim brought against an agent, officer, or employee of the state arising out of the same accident will be reduced by any amount paid toward the claim by the state, its public entities, any agents, officers or employees, or any person acting on their behalf.

Child Safety Restraints

The Senate Transportation Committee voted Senate Bill 916 DO PASS.

Senator Koster’s bill modifies the law with respect how motorist must restrain children in motor vehicles.

CHILD PASSENGER RESTRAINT LAW - This act modifies the law with respect to the use of child passenger safety restraint systems and booster seats. The act requires children of certain ages, weights and heights to be restrained by either a child passenger restraint system, booster seat or safety belt.

AGE/WEIGHT/HEIGHT CLASSIFICATION:

1. LESS THAN 4 YEARS OLD - This act requires children less than four years old, regardless of weight, to use an appropriate child passenger restraint system.


2. LESS THAN 40 POUNDS - The act requires children weighing less than 40 pounds, regardless of age, to be secured in a child passenger restraint system appropriate for the child.


3. LESS THAN 8 YEARS OLD/80 POUNDS OR UNDER 4'9" - Children (ages 4-7) and who weigh at least 40 pounds but less than 80 pounds, or such children that are less than 4'9" tall must be secured in a child passenger restraint system or booster seat appropriate for that child.


4. GREATER THAN 80 POUNDS OR TALLER THAN 4'9" - Children who are at least 80 pounds or children taller than 4'9" shall be secured by a vehicle safety belt or booster seat appropriate for that child.

The act allows a child to be transported in back seat without a booster seat if the child is secured with a lap belt if the vehicle is not equipped with combination lap and shoulder belt for booster seat installation.

A violation of the child passenger restraint/booster provisions is an infraction and the fine is $50 plus court costs. The fine for violating the safety belt provision of the act is $10. Charges for violating the child passenger restraint and booster seat provisions shall be dismissed or withdrawn if the driver provides evidence that he or she acquired a child passenger restraint system or booster seat prior to or at his or her hearing. The act does not apply to public carriers for hire or students 4 years of age or older who are passengers on a school bus (sections 307.178 and 307.182).

The act also deletes a provision of law which provided that if there were more passengers than seat belts in the enclosed area of the vehicle, then there is no violation of the seat belt law (Subsection 7 of Section 307.178). The act also modifies Subsection 6 of Section 307.178 to apply the $10 fine to persons rather than just drivers. This act is substantially similar to HB 1165 (2006), SS/SCS/HCS/HB 518 (2005), SCS/SB 221 et al (2005), SB 710 (2004), SB 9 (2003), SB 647 (2002) and SB 549 (2001).

Bill Targets Special Fees For Cash

See attached .pdf article.

Committee Approves Nurse Disciplinary Standards

This week, a House committee approved a House Committee Substitute for House Bill 982. The bill directs the State Board of Nursing to expunge complaints against a nurse if the board's investigation concludes the matter is not grounds for disciplinary action against the nurse's license. This would give nurses the same rights as physicians and dentists to have unsubstantiated complaints removed from their records. The legislation also would require long-term care facilities, home health agencies, nursing staffing agencies and subcontractors, and employers of nurses generally, to report final disciplinary actions against a physician, dentist, podiatrist, psychologist, pharmacist or nurse to the appropriate licensure board. Currently, only hospitals and ambulatory surgical centers are required to file such reports. For nurses, dentists and physicians, such reporting would be limited to incidents that constitute a violation of their respective licensure disciplinary standards. Termination of contracted staff services due to complaints or reports also would be reported. The bill's sponsor removed language from the bill that could delay the reporting of incidents of substandard nursing care to the licensure board.

Also, a Senate committee approved the Senate Committee Substitute for Senate Bill 710. It is similar to the House bill but also authorizes the State Board of Nursing to levy fines ranging from $100 to $500 for licensure violations and pursue expedited licensure actions against a nurse who poses a clear danger to the public.

Committee Endorses Licensure of Midwives

The Senate Pensions, Veterans' Affairs and General Laws Committee has approved a bill that would create a system of occupational licensure for "direct-entry midwives" who provide obstetrical and postpartum care for a fee. The Senate Committee Substitute for Senate Bill 637 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 receive Medicaid payments, 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.

A House committee approved a similar bill several weeks ago.

Committees Approve Health-Related Bills

Various legislative committees approved the following bills this week:

• House Bill 994 would allow those age 21 and older to ride a motorcycle without wearing a helmet.
• Senate Bill 562 establishes procedures for physicians to make information available to patients seeking abortions of pregnancies of 20 weeks gestation or more of the capacity for a human fetus to experience pain. The Missouri Department of Health and Senior Services would prepare information materials on the topic.
• The House Committee Substitute for House Bill 1076 includes emergency medical technicians, emergency medical dispatchers and physical therapists under the state's peer review law, which shields peer review discussions from being used in lawsuits.
• Senate Bill 965 would update laws on the governance of the Missouri Poison Control Network. It repeals a Poison Control Advisory Committee that has not met for many years and provides for coordination of the poison control network by the DHSS.

Committees Hear Testimony

Legislative committees continue to focus on reviewing bills. This week’s hearings included the following health-related bills.

• House Bill 1440 would create a Missouri Cervical Cancer Awareness and Treatment Program Fund and allows taxpayers to donate to the fund through a check-off on the Missouri individual and corporate income tax forms.
• House Bill 1472 would allow insurers to intervene in civil lawsuits in which they may be obligated to provide a defense or indemnity for any judgments rendered.

President Promotes Health Savings Accounts

In his fiscal year 2007 budget recommendations, President Bush proposed a number of provisions to encourage the use of health savings accounts, including allowing higher contributions to the accounts and providing tax credits to low-income uninsured individuals enrolled in high deductible health plans associated with HSAs. In a speech last week at Wendy's International headquarters in Dublin, Ohio, Bush promoted his proposed expansion of HSAs and other health care proposals. Wendy's began to offer HSAs in 2005. In his speech, the president said HSAs would provide enrollees with more authority over their health care and expanded use would reduce health care costs, because enrollees would compare prices when they purchase services, prompting providers to reduce prices. The president explained that individuals should have the ability to take HSAs with them when they change jobs and enrollees should not pay taxes on out-of-pocket expenditures for premiums for high deductible plans associated with HSAs. In addition, Bush called for caps on damages in medical malpractice lawsuits, a national system of electronic health records and a proposal to allow small businesses to form association health plans.

In a speech last week to the board of directors of the American Association of Retired Persons, former Health and Human Services Secretary Tommy Thompson said that HSAs are good for certain people, but added that they are not the panacea for everyone. Thompson called for a system of mandated coverage in which states would place the uninsured in pools and insurance companies would be invited to submit bids on how much they would charge to cover them, among other changes.

House and Senate Committees Consider New Collaborative Practice Powers and Reporting Responsibilities

This week, a Senate committee approved a bill that would allow advanced practice registered nurses to prescribe controlled substances in schedules II through V under collaborative practice agreements with a physician. The Senate Committee Substitute for Senate Bill 566 also would require that physicians submit to their licensure board their physician assistant agreements and collaborative practice agreements with advanced practice registered nurses.

The Senate committee also approved the collaborative practice agreement reporting requirement as a stand-alone bill in the Senate Committee Substitute for Senate Bill 998.

In the House, a committee reviewed but took no action on a similar bill calling for the physician licensure board to collect information on all collaborative practice agreements and to audit 10 percent of them each year. The measure is House Bill 1515.

Legislators Consider Conscience Clause Protections

This week, a Senate committee approved a bill that would grant pharmacy workers expanded rights to refuse to deliver services that conflict with their moral beliefs. Senate Bill 609 would apply to pharmacists and pharmacy workers of all types. It would provide protection for refusing to provide any service associated with a drug or device in 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.

Those covered by these "conscience clause" protections would be protected from employer or legal actions for their refusals. Violations would incur civil liability.

In related action in the House of Representatives, the House Rules Committee sent back a much broader conscience clause bill for further review by the House Children and Families Committee, which earlier had approved the bill. House Bill 1539 would apply to all types of health care workers and health care facilities and encompasses any health service that violates the employee's or organization's religious, moral or ethical principles. Health insurers and employer health plans would not be required to pay for services to which the insurer or plan objected.

The apparent impetus for Senate Bill 609 and House Bill 1539 is the dismissal of several retail pharmacists who allegedly were fired for refusing to fill a prescription for emergency contraceptive drugs.

Next Week

The legislature is attempting to hear each respective chamber's bills in committee in the next two weeks. Filing deadline for bills is March 1st.

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