March 9, 2007

The General Assembly is beginning to tackle more time consuming issues on the floor. One week remains before the legislative Spring Break and legislators would like to finish the effort on the Governor’s MOHELA plan.

News this week includes:

Supporters and Opponents of Farm Bill Make Their Cases to Senators
Supporters and opponents of what backers call the Farm and Food Preservation Act are spending time at the Capitol, pitching their cases to Senators who will soon take up this bill. The legislation, SB 364, would prevent counties from enacting health ordinances that would restrict farming activities. It would also shield farming activities from most lawsuits.

Shannon Goosen, a family farmer in Cole Camp in west-central Missouri, says his hog operations are in a bit of a bind - not because of any county ordinances, but because of the threat of lawsuits.

David Morton, a family farmer from Macon in north-central Missouri, wants protection from what he sees as corporate farms moving in and bringing down the value of the property. And, he flatly rejects arguments the easing of the restrictions will be needed to ensure Missouri has an adequate food supply in years to come. Attached are sheets of information passed out by opponents and proponents.

The legislation could come to the Senate floor as early next week.

Interestingly enough Framers and the Farm Bureau split on support of SB 364 which is on the Senate Calendar for debate.

Healthcare Access
Representative Hobbs presented HB 878 on Tuesday.

The bill has been worked over by Representative Hobbs throughout the interim between sessions.

The committee seemed open to the concept. However, many implantation questions will need to be answered.

As written, the bill creates the Missouri Healthcare Access Fund to be used to expand healthcare services in state and federally designated areas with healthcare shortages. The Department of Health and Senior Services has the authority to designate eligible facilities in an area of defined need and is required to re-evaluate eligible facilities every six years. Beginning January 1, 2007, individuals making a donation in excess of $100 to the fund will be eligible for a tax credit.

The provisions of the bill will expire six years from the effective date.

House Bill Seeks to Create Portability for Health Insurance Coverage
House Committee Substitute for House Bill 818, sponsored by Representative Doug Ervin, R-Kearney, was heard this week in the House Special Committee on Health Insurance. This bill changes the laws regarding the Missouri Health Insurance Pool, establishes a re-insurance mechanism to stabilize health insurance rates for small business group plans and establishes the Missouri Health Insurance Portability and Accessibility Act. According to the bill's sponsor, the legislation is considered a "work-in-progress" (as evidenced by the fifth version of the bill presented at the hearing — very different from the originally filed bill).

The bill was opposed by representatives of most of the insurance industry. MHA was among the witnesses providing comments in support of the measure. Its comments focused on the bills effect on underwriting reform for the individual insurance market and expanding access to coverage.

This bill shares some common elements with Senate Committee Substitute for Senate Bill 556, which was heard in a Senate committee last week.

Core Public Health
Representative Wayne Cooper was responsible after MOALPHA provided information to his office for an increase in the House Appropriations - Health, Social Services.

The Sub Committee recommended $500,000 to the full House Budget Committee.

Originally, the staff printed a $5 million increase. However, that was due to a misprint. Nevertheless a $500,000 increase is better than the Governor’s $0 recommendation.

Your contacts are needed.

Animal Abuse
HB 46, Representative Viebrock, was passed in the House.

Currently, any neglected or abused animal may be impounded. This bill prohibits a farm animal weighing more than 50 pounds from being impounded until the district state veterinarian of the Department of Agriculture or his or her designee has examined the animal and determined the animal to be in imminent danger of loss of life or has determined that the condition or conditions deemed to be in violation cannot reasonably be rectified before the disposition hearing. If before the disposition hearing, reasonable attempts to correct the condition have not been made and approved by the veterinarian or his or her designee during a required follow-up visit, the animal may be impounded or destroyed.

If an abused or neglected farm animal in the possession of a caregiver is impounded, the authority having custody of the animal is required to make a diligent effort to notify the owner in writing that the animal has been impounded.

FISCAL NOTE: Estimated Cost on General Revenue Fund of $87,022 in FY 2008, $82,706 in FY 2009, and $85,187 in FY 2010. No impact on Other State Funds in FY 2008, FY 2009, and FY 2010.

Volunteers
A MOALPHA Priority, HB 579, is possibly going to be debated next week.

Majority Leader Dempsey had said that Thursday was a possibility. However it looks like Monday or Tuesday is more likely.

HB 579 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.

FISCAL NOTE: No impact on state funds in FY 2008, FY 2009, and FY 2010.

PROPONENTS: Supporters say that agreements between hospitals permit the sharing of staff and equipment, which only works during small-scale disasters. However, if a large-scale event would occur in the state, each facility is faced with similar problems and couldn't help other local facilities. There are unknown insurance risks that emergency workers must face in order to provide care for individuals during a mega-disaster. The bill will give some protections to reluctant healthcare workers to help during these large-scale events.

Testifying for the bill were Representative Dempsey; BJC Healthcare; Missouri Association of Homes for the Aging; Missouri Healthcare Association; Missouri State Council of Firefighters; St. Louis Area Regional Response System; Metropolitan Ambulance Services Trust; Missouri Association of Trial Attorneys; and St. Louis Regional Commerce and Growth Association.

OPPONENTS: There was no opposition voiced to the committee.

Abortion Bills Advance
The House and Senate advanced bills this week related to abortion. House Bill 412, sponsored by Representative Ed Emory, R-Lamar, was approved in the House Special Committee on Small Business this week. The bill specifies that pharmacies will be immune from liability for refusal to perform, assist, recommend, refer to, or participate in any act or service in connection with any drug or device that causes an abortion.

Senate Committee Substitute for Senate Bill 196, sponsored by Senator Chuck Gross, R-St. Charles, was approved in the Senate Judiciary, Civil and Criminal Jurisprudence Committee. The bill establishes the Unborn Child Pain Prevention Act, and requires physicians to inform their patients who seek non-emergency abortions to the right to review state-provided information regarding capacity of a fetus to experience pain and to discuss the use of anesthetics or analgesics for the fetus. Time frames and procedures for notification are established.

Bill Creates New Standards for Sexual Assault Treatment
The Senate Judiciary and Civil and Criminal Jurisprudence Committee this week voted to advance a Senate Committee Substitute for Senate Bill 429. One section of the bill would revise standards for forensic evidence-gathering examinations of victims of sexual assault. It would require that these exams be done using an evidence collection kit provided by the state. The victim could not be billed for the cost of the forensic examination. Instead, the cost of the forensic examination would be billed to and paid by the Department of Health and Senior Services. Other medical treatment costs would be billed to the patient or insurer. If the patient was uninsured, the medical treatment costs could be billed to the state Crime Victims’ Compensation Fund. A separate appropriations initiative pending in the House of Representatives would add $1 million to the budget to pay for forensic exams following sexual assault.

House Budget Committee Hears Health, Mental Health and Social Services Department Budget Recommendations
The House Health, Mental Health and Social Services Appropriations Committee submitted its budget recommendations to the House Budget Committee this week. The House Budget Committee will begin action on the recommendations next week.

Items of note include the following:

• $2 million increase for smoking cessation from tobacco settlement funds
• $2 million general revenue reduction from the governor’s recommended $10 million for the proposed "Premium Offset" program. The recommended funding for the program is now $8 million from general revenue and $13 million from federal funds, for a total of $21 million. The committee reasoned that the federal waiver application process for this new program would delay its implementation in the new 2008 fiscal year, which begins in July 2007, and therefore would require $2 million less in general revenue funding than was requested by the governor.

Bill Would Establish Health Professional Shortage Planning Commission
House Bill 450, sponsored by Representative Judy Baker, D-Columbia, was heard in the House Special Committee on Workforce Development and Safety this week. This bill establishes the Missouri Health Profession Shortage Planning Commission within the Department of Economic Development. The commission’s duties include monitoring data and trends in the health profession workforce, identifying recruitment and retention strategies for higher education health care programs and identifying recruitment and retention strategies for health care employers. The Missouri Hospital Association, the University of Missouri-Columbia, and the Missouri Primary Care Association testified in favor of the bill. There was no opposition.

Senate Committee Hears Medicaid Reform Proposal
This week, the Senate Health and Mental Health Committee heard testimony on Senate Bill 577, sponsored by Senate Majority Leader Charlie Shields, R-St. Joseph. This bill is intended to implement many of the Medicaid reform proposals advanced by Governor Matt Blunt and the Senate Republican caucus. The bill would rename Medicaid as "MO HealthNet" and create a MO HealthNet Division in the Department of Social Services to replace the current Division of Medical Services. It also repeals the July 1, 2008, expiration date on state laws governing the Medicaid program.

The bill received guarded support from several organizations, including the Missouri Association of Health Plans, AARP, Citizens for Missouri's Children, Area Agencies on Aging Association, National Alliance for Mentally Ill and Missouri Primary Care Association (Federal Qualified Health Centers). Most offered support for the healthy lifestyles incentives and the health care home provisions of the bill, but withheld complete support until further details were revealed. Grass Roots Organizing (GRO), the Epilepsy Foundation and several private individuals testified in opposition to the bill. The Missouri Hospital Association sent a memo to the committee providing comments on the bill. MHA continues to work with the bill's sponsor and committee to address these areas of concern.

The bill is expected to be voted on by committee on Tuesday, March 13.

Nurses Licensing Bills Heard
House Bill 815, sponsored by Representative Tim Meadows, D-Imperial, and House Bill 988, sponsored by Representative Ellen Brandom, R-Sikeston, were heard in the House Special Committee on Professional Registration this week. The bills are identical and now form a House Committee Substitute containing both bill numbers. If passed, this HCS will make several changes to the laws governing the discipline and licensing of nurses. The bill:

• grants the State Board of Nursing authority to:
• ask for an expedited hearing before the Administrative Hearing Commission if the board determines that the nurse has committed an act which is a clear and present danger to the public
• immediately restrict or suspend the license 15 days after the complaint and after a preliminary hearing
• allows for the sealing of records if the board, commission, or a court of competent jurisdiction determines that a complaint does not constitute a violation of the Nursing Practice Act and is unsubstantiated
• defines "temporary nursing staffing agency" and requires them to report disciplinary actions against nurses to the State Board of Nursing

Next Week
The legislature will be on Spring Break starting Thursday. The House Budget Committee will finish mark-up on their version of the state budget.

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