March 17 , 2008

The legislature adjourned on Thursday and will return after their annual spring break on March 25th.

As predicted in an election year, the legislative action has been very slow. However, the budget has moved rapidly through the House and will be debated on the House floor the week of March 25th.

Senate Majority Leader Shields has been pleased that the Senate is operating in a bi-partisan manner. However, very few bills have been received attention which is not necessarily a bad circumstance.

Attorney General Jay Nixon at the annual Democratic Hannibal Days announced health care as his top priority. Central to his theme is to reverse the cuts made to the Medicaid System by Governor Blunt in 2005.

News this week includes:

Influenza
SB 1169, Champion, was heard in the Senate Public Health Committee Tuesday.

SB 1169 provides that by July 1, 2009, the Department of Health and Senior Services shall establish a school-based influenza vaccination pilot program. When creating the program, the department shall use a vaccine that will minimize discomfort to those vaccinated, consume the fewest medical supplies, speed administration by health officials, and contain the least potential adverse events. The department shall also take into account the cost and benefits, fiscal impact, and any barriers to implementing such a program.

Republic Superintendent Pam Hedgepeth testified in support and they have initiated a pilot project. Several doctors testified in support as well as the pharmaceutical company making the FluMist- Meta Mune Inc.

The Department of Health has not taken a position.

Smoking Prevention Proposal Discussed In House Committee
House Bill 1709 would create the Tobacco Use Prevention, Cessation, and Enforcement Trust Fund and be used by the Dept. of Health and Senior Services for a comprehensive tobacco control program. Beginning July 1, 2008, certain payments to the state under the

Tobacco
The House Public Safety Committee heard HB 1580 on Tuesday.

This legislation requires a retailer of cigarettes or tobacco products to have a written license issued by the Division of Alcohol and Tobacco Control within the Department of Public Safety, pay an annual $25 fee by May 1, and have a retail sales tax license before selling any products.  The license must be continually and publicly displayed at the retailer's place of business.

The Division of Alcohol and Tobacco Enforcement is promoting the legislation which will generate $200,000 for additional regulators.

The Missouri Petroleum Marketers and “big” tobacco are against the bill.

Medical Record Copying Fee Increase Proposed
House Bill 1815 would raise the statutory limit on fees that may be charged for copying medical records. The bill was presented this week to the House Special Committee on Health Insurance.

Legislature Discusses/Advances Pharmaceutical Proposals

• Senate Bill 918 was heard in a Senate committee and would require that the MO HealthNet program not require prior authorization, step therapy, generic substitution, or quantity limits for immunosuppressive drugs without express written or oral notification and the documented consent of the health care professional and the patient.
• Senate Committee Substitute for Senate Bill 732 approved by the full Senate and advances to the House.  If passed, it would establish a drug monitoring program and modify existing record keeping for controlled substances and pseudoephedrine products.
• House Bill 1805 was given initial approval by the full House this week. It says that if the usual and customary retail price of a prescription drug is less than the normal insurance co-payment amount, the patient will pay the lesser amount.
• House Bill 2240 was heard by a House committee and would require the Dept. of Health and Senior Services to establish rules governing switch communications from health benefit plans and specifies that the term "switch communication" is a communication that recommends a patient's medication be switched to a different medication than originally prescribed by the primary health care professional.

Senate Bill 898
Senator Clemens bill SB 898 had Senator Nodler’s legislation SB 738 amended onto Clemens agriculture bill.

However, Nodler’s legislation dealing with CAFOs specifically is aimed at a rendering plant dealing with converting animal parts into petroleum and is a persistent odor offender in Carthage.

The link to SB 738: http://www.senate.mo.gov/08info/pdf-bill/intro/SB738.pdf

In addition, Senator Callahan added an amendment dissolving all state tax credits in 2011.

Senator Clemens will not take up the bill for final passage with the numerous amendments added on the floor.

House Committee Advances Budget
This week, the House Budget Committee reviewed, amended and approved the 12 appropriations bills that create the state’s operating budget for the fiscal year beginning July 1.

Most of the budget items affecting healthcare are in House Bill 2010 and House Bill 2011. House Bill 2010 contains the budgets for the Departments of Health and Senior Services and Mental Health while House Bill 2011 contains the budget for the Missouri Department of Social Services. Both bills are sponsored by the House Budget Committee Chair, Representative Allen Icet, R-Ballwin. The full House will begin debate on the budget bills when they return from Spring Break on March 25.

Specific funding for Phase One of Insure Missouri was not included in House Bill 2011. Negotiations on the development of a modified coverage plan continue among key legislators, the governor’s office, insurers and the Missouri Hospital Association. As the budget moves to the Senate, it is expected that a more favorable response to coverage expansions will be included. The Senate is expected to finish debating the budget during the last week of April.

Any differences between the Senate and House versions of the budget must be resolved by May 9, the constitutional deadline for the budget’s passage. These differences will be resolved in conference committees during the first week of May.

Following are a few of the more than 80 amendments to the budget bills debated by the committee.

• Attempts to reinstate the Preparing to Care initiative, which addresses shortages of health care practitioners by funding new training programs and capacity in Missouri public institutions of higher education, were unsuccessful and failed on a tie vote of 12 to 12.
• $3.3 million of hospital funds to be redirected to the SCHIP program for presumptive eligibility. 
• $2.25 million was redirected from the MO Rx Plan to the Youth Tobacco Prevention and Tobacco Quitline programs
• $5 million was added to the HealthNet Physician Reimbusement budget increase.

Insure Missouri Legislative Proposals Emerge
Several weeks ago, Governor Matt Blunt withdrew his controversial effort to use emergency regulations to begin offering coverage under the Insure Missouri program this spring. While the delay was disappointing, it has yielded positive benefit by focusing legislative attention on how a program to cover more of the uninsured might be structured.

Selected legislators from the House of Representatives and the Senate have been meeting with the governor’s representatives to discuss the scope and design of legislation to expand coverage of the uninsured. Those discussions have addressed not only coverage of lower income uninsured Missourians, but also those who are uninsurable because of high-risk medical conditions.

In recognition of the work being done to advance the Insure Missouri proposal, Governor Blunt issued a press announcement this week.

Recently, several bills have been introduced in the House and Senate that will provide vehicles for debating the structure of Insure Missouri and other coverage initiatives.

House Bill 2413 is sponsored by state Representative Doug Ervin, R-Kearney, who was one of the most prominent opponents of the governor’s original Insure Missouri proposal. Within limits set by legislative appropriations and federal Medicaid waivers, the legislation would authorize a new “Insure Missouri” system of coverage for those ages 19 to 65 who have been uninsured for at least six months. Coverage could be extended to those with incomes up to 225 percent of the federal poverty level if legislators appropriate the money to do so. However, coverage would not be an entitlement for those with incomes exceeding 85 percent of the federal poverty level.

Coverage would be offered through individual insurance policies offered by commercial insurers. The policies would be subject to medical underwriting and have a deductible between $1,000 and $2,500. The A standard benefit package would also include $300 in preventive care benefits offered without cost to the enrollee.

The state would pay the premiums for the Insure Missouri coverage. However, coverage would be contingent on the enrollee and/or his or her employer making a minimum contribution to an account used to fund deductible expenses. The bill sets limits on the annual deductible contributions based on income and the state would provide some funding for enrollees’ deductible expenses in certain circumstances. If money in a deductible account is not used, it may be carried forward to reduce or eliminate the subsequent year’s deductible contribution.

House Bill 2413 also authorizes a transitional benefit for Insure Missouri enrollees whose incomes grow to exceed 225 percent of the federal poverty level. Essentially, the plan of coverage would continue to be available to the recipient without a premium subsidy.

The bill also would revamp the Missouri Health Insurance Plan, which is the state’s high-risk pool to offer coverage to those unable to qualify for affordable coverage because of medical underwriting risk. The bill would lower the present caps on pool coverage premiums. For those with incomes less than 300 percent of the federal poverty level, the premium would be capped at the standard risk rate. For those with higher incomes, premiums would increase with income to a cap of 125 percent of the standard risk rate. If an applicant for an Insure Missouri individual policy is denied coverage because of medical underwriting, he or she will be offered coverage through the high-risk pool, with premium subsidies available.

The bill also redirects the state premium tax paid by some insurers to be earmarked over time to fund the operation of the high-risk pool. In addition, the pool would offer stop-loss coverage to insurers writing individual policies and, during a two-year pilot project, to insurers providing coverage to small employer groups in Springfield and Kansas City.

Similar language to create an Insure Missouri program has been introduced in the Missouri Senate by Senator Tom Dempsey, R-St. Charles. The bill is Senate Bill 1283. The sponsor has indicated the bill has been drafted primarily as a starting point for legislative discussions.

Senate Bill 1283’s vision of an Insure Missouri program has many of the same concepts as Representative Ervin’s bill. It does propose a broader entitlement to coverage than the Ervin bill and also would give enrollees a larger preventive care benefit. Also, the bill would make much more limited changes to the state laws governing the state high-risk pool.

Yet another Insure Missouri bill has just been introduced by state Representative Rob Schaaf. The Insure Missouri sections of House Bill 2398 follow the general outline of Representative Ervin’s bill.

Hearings will be held on the Insure Missouri bills shortly after the General Assembly returns from its spring recess on March 25th. 

House Committee Advances Proposal to Expand Laws On Abuse, Neglect Protections
The House Special Committee on Crime Prevention and Public Safety advanced legislation this week that revises various state programs designed to protect “vulnerable persons” from abuse and neglect. House Committee Substitute for House Bill 1516 consolidates and reworks various state laws on the reporting and prosecution of abuse and neglect.  The bill now moves to the full House for debate.

The lengthy bill makes several changes affecting hospitals and health providers.

The bill adds a new requirement for various individuals to report suspected misappropriation of a patient’s property or money to the state for investigation.
Under current law, the Missouri Department of Mental Health investigates allegations that pose an imminent danger to health, safety or welfare within 24 hours. This bill revises the standard to require a “prompt and thorough” investigation. If the investigation indicates a crime has occurred, it will be reported by the department to the appropriate law enforcement agency.

The bill prohibits retaliation against a patient, resident or employee for reporting allegations of suspected violations of laws, standards or regulations.

Those required by law to report allegations of abuse, neglect or misappropriation will be subject to criminal penalties for failing to report on a timely basis. Knowingly concealing abuse or neglect is made a felony crime.

Providers are barred from knowingly hiring registered sex offenders after Aug. 28.
The list of crimes that disqualify a person from working in a position involving contact with patients or residents is expanded. With health care employers obligated under current law to verify compliance, they likely will need to verify current employees’ criminal histories.

Next Week
The General Assembly will adjourn until March 25th. Weekly legislative reports will resume March 28th.

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