March 9, 2006

The General Assembly has focused more on floor action this week. However, the various House and Senate Committees attempted to finish their respective hearings on each chambers legislation.

News this week includes:

Senate Bill 568

Senator Dougherty's legislation - This act creates the "Children's Environmental Health and Protection Advisory Council" within the Department of Health and Senior Services. The Council will consist of eighteen members, who will be appointed by February 1, 2007. Meetings must be held at least six times a year or at the call of the chairperson or nine members of the Council. The duties of the Council shall include:

• Holding public hearings to gather information relating to the environmental health and protection of children;
• Analyzing statutes, rules, and regulations;
• Making recommendations on regulations that would minimize any negative impact on children's health;
• Reviewing current policies and proposed regulations pertaining to the exposure of children to environmental hazards;
• Gathering and disseminating information on how to reduce, treat, and eliminate a child's exposure to environmental hazards;
• Creating educational programs for parents, guardians, and caregivers; and
• Preparing an annual report to deliver to the Speaker, Pro Tem, and Governor by February 1st of each year.

Members of the Council will serve without compensation but may be reimbursed for any expenses incurred. The Department of Health will provide administrative support and current staff to the Council as deemed necessary. Subject to appropriations, the Council may employ consultants.

NO WITNESSES

Senate Bill 1131

Senator Goodman’s legislation - Under current law, all medical testing results and personal information obtained from any individual shall be held confidential with certain exceptions. This act provides that no consent shall be required for the Department of Health and Senior Services to disclose such testing results and information to a health care provider providing treatment to the individual, notwithstanding any provision to the contrary.
For: 1) DHSS – Chief of Newborn Screening Program

NO OPPOSITION

Senate Bill 574

Senator Coleman’s legislation - This act requires health benefit plans to provide coverage for diagnostic testing and healthcare services for chronic kidney disease patients.

NO WITNESSES FOR

Against:
Mike Winter – MO Health Insurance Plans
Nancy Giddeons – Americans Health Insurance Plans
Bret Butler – MO Insurance Coalition
Steve Bledsoe – Blue Cross Blue Shield KC

Senate Agriculture Committee

Senate Bill 1017 – Clemens - The act changes the official rating agency for the enforcement of standards relating to milk production from the Department of Health to the State Milk Board. The act requires that the board make an official rating survey at least biannually, a change from the current law which requires such a survey be made annually.

For:
Randy Miginness – Dairy Farmers of America
Dave Gronen – MO Dairy Association

NO OPPOSITION

Committee Reviews HMO High-Deductible Plan Authorization

The House Insurance Committee this week held a hearing on House Bill 1792, which would authorize HMOs to offer high-deductible plans of coverage. The Missouri Department of Insurance currently does not permit HMOs to impose deductibles for "basic health services", citing a state law that only authorizes copayments.

Various HMOs and business groups are promoting this legislation, arguing it would give employers a more affordable option for insuring their employees. In some cases, they say employers are seeking high-deductible policies to dovetail with health savings accounts.

At least one commercial insurer, United Healthcare, is opposed to the proposal, citing regulatory inequities between HMOs and commercial insurers. Commercial insurers already are authorized to sell high-deductible plans.

Based on member surveys done in 2005, MHA will express concerns with the proposal. The expanded use of high-deductible policies would be expected to increase health care providers’ collection expenses and accounts receivable. Providers may reduce the discounts they give to HMO plans, further increasing health insurance costs. Also, high-deductible plans may promote adverse selection, as the healthiest enrollees migrate to cheaper coverage.

Committees Advance Bills to Encourage Small Employer Coverage and Expand Health Care Conscience Clause Protections

This week, Senate Bill 622 was approved by a Senate committee. It would authorize a Missouri income tax deduction for farmers and small businesses’ expenses associated with providing their employees with health insurance.

The House Children and Families Committee approved the same version of a "conscience clause" protection bill that had earlier been sent back to the committee for further work by the House Rules Committee. House Bill 1539 would apply to all types of health care workers and health care facilities and would encompass 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.

Legislators Consider Bills on Employee Background Checks

Legislators considered several bills this week affecting Missouri's system for conducting background checks on health care employees.

A House committee voted to approve House Bill 1760, which allows nursing, medical and other health professional schools to check whether their students are on the state's employee disqualification list before sending them to do clinical rotations in hospitals or nursing homes. Those on the state's employee disqualification list have been found by the state to have abused or neglected patients and cannot be employed in most health care settings.

Another House committee reviewed House Bill 1767 this week. Much of the lengthy bill consolidates and updates disparate laws to protect the elderly and others from abuse and neglect in health care settings. Also, health care providers would be obligated to report suspected misappropriation of an elderly patient’s money or property to the state, with immunity from liability for good faith reporting. Hospital employees who are determined by the Missouri Department of Social Services to have abused or neglected elderly patients would be added to the Missouri’s employee disqualification list, just as nursing home employees now are. Additional crimes are added to the list of convictions which preclude employment in health care settings. The sponsor of the bill offered to the committee a proposed substitute that would permit employee disqualification checks on students doing clinical rotations and restrict further disclosure of state employee background check reports.

Senate Committee Passes State "Personal Health Information" Bill

The Senate Pensions, Veterans' Affairs and General Laws Committee this week passed Senate Committee Substitute for Senate Bill 1041, sponsored by Sen. Michael Gibbons, R-Kirkwood.

This act creates the crime of knowingly receiving, selling, or obtaining personal health information without the person’s consent. "Personal health information" is defined as any identifiable information, in electronic or physical form, regarding the individual's health, medical history, medical treatment or diagnosis by a health care provider.

There are exemptions for:

• law enforcement officers or other governmental agencies performing their official duties
• health care providers obtaining, using, disclosing, or permitting access to any personal health information record as otherwise authorized or required by state or federal law

Nothing in the bill would prohibit a health carrier from obtaining personal health information for the purposes of completing insurance applications, underwriting purposes, adjudication claims, and conducting other insurance-related business while complying with the provisions of all federal and state statutes and rules.

Committees Hear Testimony on Health-Related Bills

• House Bill 1822 would establish the Missouri Uniform Interoperability Communications Act and the Missouri Interoperability Communications Board to oversee the creation, administration and maintenance of a Missouri interoperability communications network for the benefit and use by public safety agencies.
• Senate Bill 574 would require health benefit plans to provide coverage for diagnostic testing and health care services for chronic kidney disease patients.
• House Bill 1537 would require 25% of funds received from subsequent participating manufacturers in the Tobacco Settlement Agreement that are deposited into the Life Sciences Research Trust Fund to be expended by the Life Sciences Research Board. The board is required to spend 25% of the moneys in the trust fund for the program that awards grants to establish and expand umbilical cord blood banks. The remaining 75% must fund life science research projects involving the study, use, or therapies involving human stem cells derived from non-embryonic and non-fetal sources. This bill is a companion bill to Senate Bill 774, heard in the Senate Judiciary Committee this week.

Committee Advances Child Safety Seat Bill

This week, a House committee approved the House Committee Substitute for House Bill 1391, which expand the state's requirements to use child safety seats in automobiles. Older children would be required to ride in booster seats if they do not meet minimum height, weight or age standards.

Legislators Advance Uncontroversial Proposals

• House Bill 1099 would authorize the Missouri Infection Control Advisory Committee to recommend alternative quality indicators to better measure the risk of transmitting ventilator-associated pneumonia. These alternatives could replace the current requirement to monitor risk-adjusted infection rates for ventilator-associated pneumonia. After the passage of the infection control reporting law in 2004, various infection control groups began encouraging alternatives to a standard ventilator-associated pneumonia incidence rate as a performance measure. A House Committee Substitute for the bill was approved by a House committee.
• House Bill 1232 was approved by the House and sent to the Senate. It would require notification of individuals who transport dead bodies if a person died of an infectious or communicable disease.
• House Bill 1118 would limit civil liability of volunteer health practitioners who are deployed in Missouri or adjoining states to respond to a declared state emergency. The House passed the bill and sent it to the Senate.

This bill is moving well and will advance to the floor.

• House Bill 1477 would allow health care providers access to Missouri Department of Health and Senior Services data regarding their patients' test results. The bill was approved by a House committee. An identical bill, Senate Bill 1131, also was presented to a Senate committee this week.
• Senate Bill 677 was approved. It removes obsolete references in the radiation safety law.
• House Bill 1515 would require physicians to report to the State Board of Registration for the Healing Arts any collaborative practice or physician assistant agreement they enter into. The board is authorized to conduct random audits to determine if the agreements are in compliance with state standards.

Revised MAWD Passes House

Many disabled Missourians would be able to go back to work and still receive their Medicaid health care benefits under a bill approved by the House and sent to the Senate. The new Ticket-To-Work program is less generous and less costly than the old Medical Assistance for Workers with Disabilities program that the Legislature eliminated last year. Republicans pushed the Medicaid cuts through last session, using their majority status to brush aside objections raised by Democrats. More than 15,000 disabled Missourians received benefits from the old MAWD program. Just over 3,000 would qualify for the new program. Supporters say they want to encourage the disabled to work, but that the old program was too generous and overly taxed the state's budget. The new program should cost the state about $8-Million, which will be matched with federal money.

House Bill 1742 is sponsored by Representative Portwood and will now go to the Senate.

Helmets

House Bill 994 Representative Dusenberg's legislation is on the House Debate Calendar #10.

HB 994 requires only persons younger than 21 years of age to wear protective headgear when operating or riding as a passenger on any motorcycle or motortricycle. Currently, all motorcyclists are required to wear protective headgear.

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

PROPONENTS: Supporters say the bill is an issue of freedom and the right of adults to make their own choices.

Testifying for the bill were Representative Dusenberg; Freedom of Road Riders; ABATE for Missouri; and Joseph T. Bryan.

OPPONENTS: Those who oppose the bill say that head injury is the leading cause of death in motorcycle accidents. While appropriate protective headgear does not prevent every head injury, the National Highway Traffic Safety Administration reports that helmets are 67% effective in preventing brain injuries and 34% effective in preventing fatalities in motorcycle accidents. It has been proven that helmet laws translate into increased helmet usage which in turn saves lives and reduces head trauma.

Testifying against the bill were Missouri State Medical Association; Brain Injury Association of Missouri; Missouri Safety Center; Nancy Koening; Department of Transportation; Missouri College of Emergency Physicians; Missouri Hospital Association; Missouri Coalition for Roadway Safety; and Missouri Safety Council.

As usual this "donor" bill will probably pass the House.

Next Week

The legislature will adjourn Thursday until Monday, March 27th. The house will attempt to conclude their version of the Budget before the chambers adjourn.

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