March 17, 2006

Capitol police were busy this week! On Monday they were called to a committee hearing when testimony and debate got out of hand on a bill that would allow school vouchers for private schools. And on Wednesday they arrested a self proclaimed "U.S. Constitution Ranger" when he threatened to slap a subpoena on the Governor and Lieutenant. The "rangers' " mission is to police offices of public trust, initiate investigations and take action when necessary to prevent violations of law.

This week the House passed the states $21 billion budget with just three days of debate while the Senate focused on elections and ethics. The Senate endured several hours of filibustering by the Democrats on an elections bill that would require photo identification to vote. The Democrats say they will continue to filibuster because it takes rights away from many voters, especially the elderly and disabled, because it is hard for some of them to get a photo id.

The General Assembly adjourned on Thursday for its Spring Legislative Break and will resume March 27th. Two months remain after break.

News this week includes:

Core Functions Budget

Thank you to all who made calls regarding the core functions budget.

As you know from Ross McKinstry’s communication the core function item is in the middle of the life/pro-choice fight with Representative Donelly-D adding family planning, contraceptive language and Representative Phillips changing the language to alternatives for abortion and not for contraceptives.

Ross McKinstry is on target when he commented that this fight removes the actual intention of core functions.

This is now a political "hot-potato" issue in the middle of our simple core function mission.

The Senate Appropriations Committee is the place to have the language “both sides” deleted. However, either side that makes this move will be accused by the other of sympathizing with or against their issue in an election year.

Committee Approves Medicaid Bills

A Senate committee approved two bills relating to the Medicaid program this week. Senate Bill 1049 would create a Disabled Employee's Health Assistance Program. It would restore Medicaid coverage to some of the employed disabled population that was displaced by the elimination in 2005 of the Medical Assistance for the Working Disabled program. Enrollees would have more restrictive income, asset and employment standards than in the MAWD program and would be expected to pay premiums if their incomes exceeded the federal poverty level. Included within the bill is a Medicaid eligibility change that would exclude income earned from employment in a sheltered workshop.

Also approved was Senate Bill 1084, which extends the expiration date of the State Children's Health Insurance Program by one year, to June 30, 2008.

Committee Defeats Bill on Multi-State Nursing Licensure Compact

The House Professional Registration and Licensing Committee defeated a bill, House Bill 1150, that would authorize Missouri to join an interstate compact on reciprocal nurse licensure. Nurses in participating states could practice in any of those states without being separately licensed by each state. The State Board of Nursing is the impetus behind the proposal, which MHA and other groups expressed support for in committee testimony. The Missouri Nurses Association opposes the measure and raised concerns that the proposal would limit Missouri legislators' control over licensing standards. Similar legislation is pending in the Senate.

House Completes Budget Debate

The House of Representatives spent most of the week debating the 12 appropriation bills that create the state's operating budget for the fiscal year beginning July 1. Before leaving for the annual spring recess, the House approved the bills and sent them to the Senate.

During House debate, many budget amendments were offered but few were adopted. One redirected $112,000 in funding for a legislative database to track constituent inquiries to pay for additional staff in the Medicaid provider fraud unit. Another earmarked a portion of the Health Information Technology appropriation for an electronic medical records project in metropolitan St. Louis, subject to the availability of matching funds.

Also this week, the General Assembly finished enacting and the governor approved a supplemental appropriations bill. House Bill 1014 provides funding to make up for higher than expected spending during the current fiscal year. Of the $187 million in supplemental appropriations, $123.5 million is for shortfalls in the Medicaid program.

Legislative Committees Approve Medical Malpractice Insurance Reform Bills

This week, a Senate committee approved a bill that expands on the state's powers to regulate medical malpractice liability insurance coverage. Senate Committee Substitute for Senate Bill 905 expands the amount and detail of data on medical malpractice claims experience, premiums and underwriting practices that would be reportable to the DOI by insurers and self-insured medical liability programs. Under current law, self-insured plans are directed to report claims data to the state but no penalty is established for noncompliance. Senate Bill 905 authorizes administrative penalties for failure to report the required data. The bill also sets standards for insurers regarding notification of premium increases or cancellations of coverage. The DOI would have the authority to deny premium rates deemed to be excessive, inadequate or unfairly discriminatory. Multi-state insurers would base premiums on Missouri claims experience unless doing so would jeopardize the insurer's financial stability.

A House committee also approved a similar bill, the House Committee Substitute for House Bill 1837, this week.

Senate Agriculture

SB1017 - 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.

Voted out DO PASS Consent

Committees Review Health Bills

Among the bills reviewed by House and Senate committees this week were the following:

• Senate Bill 1239 directs the state to compile data on retail prices charged by pharmacies for the 50 most frequently prescribed medications. The data would be collected quarterly through a statistically valid sample. The Missouri Rx program would post on a Web site prices charged by pharmacies for a 30-day supply of the medication for a standard dose.
• Senate Bill 597 would mandate that insurers cover the cost of treating morbid obesity.

Provider Fraud Bills Heard in Committee

The Senate Pensions, Veterans' Affairs and General Laws Committee met this week and heard two similar bills regarding provider fraud, Senate Bill 1210, sponsored by Sen. Chris Koster, R-Harrisonville, and Senate Bill 1244, sponsored by Sen. John Loudon, R-Ballwin. The chairman of the committee made it clear that Senate Bill 1210 would be the vehicle on this issue.

If passed, both Senate Bill 1210 and Senate Bill 1244 would allow any person to bring an action for Medicaid fraud on behalf of the person and the state. The state would review the case under seal and decide whether to join the lawsuit. If the state declines, the action would be dismissed. Senate Bill 1210 states the person who initiated the action is entitled to 20 to 35 percent of the proceeds of any action brought under this section, unless the court finds that the action is based primarily on information not provided by the person initiating the action, in which case the court shall award the person no more than 15 percent of the proceeds. Senate Bill 1244 would limit this "entitled" amount to at least 10 percent, but no more than 20 percent.

However, both bills state a person would not be allowed to bring an action that is based on allegations that are the subject of another civil suit or administrative penalty proceeding which has already commenced, and in which the state is a party. Additionally, they state a person may not bring an action under this act that is based on the public disclosure of allegations or transactions in a criminal or civil hearing, in a legislative or administrative report, hearing, audit, or investigation, or from the news media, unless the person bringing the action is the original source of such information.

Both bills also provide that any person bringing an action to the state would qualify for "whistle-blower" protections. However, such protections would not apply if the court finds that the employee brought a frivolous or clearly vexatious claim, participated in the conduct upon which the action is brought, or is convicted of criminal conduct arising from Medicaid fraud violations.

Senate Bill 1210 also differs from Senate Bill 1244 by adding the following provisions not included in Senate Bill 1244:

• Senate Bill 1210 adds that a person commits a "knowing" violation of sections prohibiting Medicaid fraud if he or she has actual knowledge of the information, acts in deliberate ignorance of the truth or falsity of the information, or acts in reckless disregard of the truth or falsity of the information. Senate Bill 1244 contains no such provision.
• Senate Bill 1210 provides much stiffer penalties for violations, which Senate Bill 1244 does not include:


1. Senate Bill 1210 increases the penalty for first violations from a Class D felony to a Class C felony, with subsequent violations increased from a Class C felony to a Class B felony.
2. Senate Bill 1210 also adds that any person who has committed such violations shall be permanently excluded from participation as a Medicaid provider.
3. Additionally, Senate Bill 1210 adds that no person convicted of such a violation shall be eligible for parole, probation, conditional release, or suspended imposition or execution of sentence until he or she has served at least 85 percent of any term of imprisonment ordered as punishment.


• Senate Bill 1210 also differs from Senate Bill 1244 by adding that any person who willfully prevents, obstructs, misleads, delays, or attempts to do any of the aforementioned with regard to communication of information relating to a violation of Medicaid fraud shall be guilty of a Class D felony, and shall be permanently excluded from participation as a Medicaid provider.
• Senate Bill 1210 authorizes the attorney general to commence state prosecution for alleged violations of Medicaid fraud, and gives the attorney general authority to apply for and obtain warrants to search, seize or copy information relevant to investigations for fraud.
• Senate Bill 1210 also requires that all Medicaid health care providers maintain adequate records regarding services provided, claims submitted, and payments requested for at least five years after the date payment was received or for at least five years after the date on which the claim was submitted, if payment was not received. Any person that conceals or destroys such records before the five year time limit would be guilty of a Class A misdemeanor.

Committees Approve Uncontroversial Measures

A number of "consent" bills were approved by House and Senate committees this week in order to meet legislative deadlines. Consent bills are uncontroversial bills with minimal state cost that are recommended for expedited legislative review.

• House Bill 1936 and Senate Bill 1155 extend the expiration date of a Technical Advisory Committee on the Quality of Patient Care and Nursing Practices in the Department of Health and Senior Services. The group includes nurses, hospital executives, a physician, a public member and a department representative and is designed to provide a forum for discussing nursing care issues. To date, the group has developed recommendations regarding unlicensed assistive personnel and mandatory overtime for nurses and is working on standards for nursing temporary staffing agencies.
• House Bill 1088 clarifies that an enrollee of an HMO or health insurer will not be required to pay more than the retail price for a prescription drug if that price is less than the copayment required under the plan.
• The Senate Committee Substitute for Senate Bill 1085 concerns the use of epinephrine or inhalers by school children to offset an asthma or anaphylactic attack. It requires public school districts to allow affected students to carry the dosage devices at school.
• Senate Bill 1197 allows 16-year-olds to donate blood with parental permission.
• House Bill 1707 and Senate Bill 1177 allow city health department employees to be appointed as local registrars for processing vital records information for the Department of Health and Senior Services.
• Senate Bill 980 would modify payment and eligibility standards of a state loan forgiveness program for nursing students. It would repeal the requirement that 25 percent of the loan would be forgiven for each year of employment in an area of designated need. Proponents said the bill is intended to provide flexibility in using loans to promote nursing practice.

Bills Earn Committee Approvals

Legislative committees voted to advance the following bills this week.

• Senate Bill 1076 would prohibit licensed health care professionals from billing or soliciting payment for anatomic pathology services unless those services are rendered personally by the health care professional or under his or her direct supervision.
• The House Committee Substitute for House Bill 1821 would revise standards of liability for organ procurement activities. Current law provides for immunity from liability if the person or organization acts without negligence and in good faith. The bill removes the requirement that the action be done without negligence and defines "good faith".
• The House Committee Substitute for House Bill 1904 would require health insurers to charge only one co-payment on a prescription if 1.) The required dosage is not available and/or 2.) A combination of dosage amounts must be dispensed to fill the prescription.
• House Committee Substitute for House Bill 1534 would earmark a portion of new money received under the tobacco settlement agreement to be used to fund grants to establish and expand umbilical cord blood banks and to support life science research projects involving the study, use, or therapies involving human stem cells derived from non-embryonic and non-fetal sources.
• House Committee Substitute for House Bill 1162 would deposit all funds collected and currently appropriated for treatment of alcohol-related problems into a newly created and dedicated account entitled the Fund for the Reduction of Alcohol-Related Problems and Underage Drinking.

Next Week

Due to the Legislative Spring break we will resume our weekly legislative reports on Friday, March 31st.

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