March 16, 2007

The legislature wrapped up the final week prior to Spring Break with a great deal of activity that led them nowhere.

The Senate filibustered for two days on the Governor's plan to sell the Missouri Health Education Loan Authority assets for capitol improvements at state higher education institutions. All compromises broke down and the legislation will be addressed when the legislature resumes on March 26th.

The debate was very contentious and did nothing to assist camaraderie in the upper chamber.

News this week includes:

Helmet Law

After protracted debate HB 155, Representative Duesenberg, was given initial approval on a voice vote in the House.

An amendment was attempted by Representative Page MD and Representative Schaaf MD prohibiting the use of state money for head injury victims who were not wearing their helmets.

However, the amendment was defeated.

The bill 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 2008, FY 2009, and FY 2010.

Seat Belts

After Spring Break, Majority Leader Dempsey plans to start debate on HCS HB 90, the primary seatbelt enforcement legislation.

Sprinklers

HB 952, Representative Wilson, was heard in the House Crime Prevention.

The bill requires all long-term care facilities licensed by the Department of Health and Senior Services to install and maintain approved sprinkler systems in accordance with the National Fire Protection Association by August 28, 2007, and be equipped with a complete fire alarm system by August 28, 2010. In addition, all long-term care facilities licensed by the department after August 28, 2007, must have electrical systems installed and maintained in accordance with NFPA 70, National Electric Code, by a qualified electrician. The department may require employees and contract personnel of any long-term care facility to be awake, dressed, and prepared to assist residents in case of an emergency and the facility to have an emergency preparedness plan.

The Electrician/Sprinkler System Installer Statewide Qualification Commission, which expires July 1, 2008, is established to study and review the development of a statewide standard for persons practicing as electricians and persons installing or inspecting sprinkler systems. Members of the commission will include the directors of the departments of Health and Senior Services, Economic Development, and Public Safety and persons appointed by the Governor including one individual who has been practicing as an electrician for the preceding five years, one individual who has been practicing as a sprinkler system installer or inspector for the preceding five years, a member of a local jurisdiction for electricians or sprinkler system installers, two representatives from the relevant skill trade organizations, and one public citizen. The commission must submit a report to the Governor and General Assembly with recommendations in support of or opposition to statewide standards by July 1, 2008.

Bill Would Raise Employee Background Check Fees

The Senate Financial, Governmental Organizations and Elections Committee approved a Senate Committee Substitute for Senate Bill 531 this week. Among other changes related to the Missouri Highway Patrol, the bill would authorize increases in the Highway Patrol’s fees charged for conducting criminal background checks. The proposal would affect the Missouri criminal background checks required by law for newly-hired health care employees who will have contact with patients. The current $5 fee for state background checks that are required by law would be raised to $9, with authorization for increases of not more than $1 per year beginning in 2010, to a maximum of $15. The fee for a national criminal background check would increase to $20 from $14, with the $14 fee maintained for foster parent licensing applications and applicants for permits to carry concealed weapons.

Committee Advances Bill on Referral of Hospital Complaints

This week, the House Special Committee on Healthcare Facilities approved a House Committee Substitute for House Bill 508, which creates new standards for the review of complaints regarding hospital care. A hospital, peer review organization or the Joint Commission would need to report to the person filing the complaint the results of any case review of the medical record, including any determination of the appropriateness of care and plans of correction. If no case review is done, the entity would need to notify the complainant of that fact and forward the complaint to the hospital licensure section in the Department of Health and Senior Services. The department would investigate the complaint and report the results to the complainant. Violation would incur fines of up to $5,000 with escalating fines for subsequent violations.

The bill is sponsored by Representative Rob Schaaf, R-St. Joseph, a physician, who chairs the committee. The impetus for the bill is a complaint filed with the Joint Commission by Representative Schaaf on behalf of a family member. In the bill's hearing, Representative Schaaf told the committee that the Joint Commission declined to conduct a case review of the complaint.

Representative Schaaf indicated that in revising his original proposal, he intends to narrow its scope to apply only to the Joint Commission, Primaris and hospitals.

Legislators Review and Advance Bills on Advanced Practice Nurses' Prescriptive Authority

This week, hospitals joined the Missouri Nurses Association and others in testifying before a House committee on behalf of House Bill 190. It would authorize advance practice nurses to prescribe controlled substances under the auspices of a collaborative practice arrangement with a physician. Missouri is one of only a few states that prohibit advanced practice nurses from prescribing at least some controlled substances. In its testimony, hospitals noted that the restriction makes it difficult for hospitals to recruit advanced practice nurses to this state. House Bill 190 was opposed by the Missouri State Medical Association, which argued that controlled substances are too dangerous and collaborative practice arrangements too loosely regulated to adequately protect the safety of the public without additional safeguards.

Also this week, a Senate committee approved a Senate Committee Substitute for Senate Bill 511, which addresses the same topic. The new version of the bill includes a number of safeguards and restrictions on the prescribing of controlled substances by advanced practice nurses. It would not permit APNs to prescribe Schedule II controlled substances, which are the most addictive of the legal pharmaceuticals. It also would mandate that APNs meet specified training and practice standards before being allowed to prescribe controlled substances. The bill would keep a physician from having a collaborative practice agreement with more than three full-time advanced practice nurses and prohibit requiring a physician to enter into a contract or other agreement to serve as a collaborating physician for an advanced practice nurse.

Health Insurance Coverage Portability Bill Advances

House Committee Substitute for House Bill 818, sponsored by Representative Doug Ervin, R-Kearney, was advanced this week by the House Special Committee on Health Insurance. As reported in last week’s Advocate, this bill provides a sweeping revision of state laws governing insurance underwriting in the individual, small group and large group insurance markets. It also expands the ability of associations to purchase health coverage for association members and their dependents. The bill also modifies standards for the Missouri Health Insurance Pool, which is designed to provide a source of coverage for those with high-risk medical conditions. The legislation continues to evolve; the version approved by the committee was the seventh draft produced since the filing of the bill five weeks ago. Its scope has narrowed considerably from the early drafts but continues to generate concern among many in the insurance industry. .

This bill shares some common elements with Senate Committee Substitute for Senate Bill 556.

House Approves Tax Deduction for Health Premiums

The House Committee Substitute for House Bill 364 would authorize a state income tax deduction for health insurance premiums paid for coverage of the taxpayer and his or her spouse and/or dependents. The deduction would not be available if the expense was otherwise deductible under the federal tax code. The House gave first-round approval to the bill this week.

Compromise Proposal Advances on Physician Assistant Supervision

This week, the House Special Committee on Professional Registration and Licensing approved a compromise proposal on the topic of supervision of physician assistants. The House Committee Substitute for House Bill 497 now will advance to House floor debate.

The new bill represents an accord between several physician organizations and the Missouri Academy of Physician Assistants. The compromise was forged in response to actions taken late last year by the State Board of Registration for the Healing Arts, which issues licenses to both physicians and physician assistants. In response to a threatened legal challenge by the Missouri Association of Osteopathic Physicians and Surgeons to its current regulations on physician assistant supervision, the board announced its intention to adopt a strict interpretation of the physician assistant supervision laws beginning in August 2007. The delay until August is intended to give the General Assembly an opportunity to resolve ambiguities in current physician assistant law. The board's new strict interpretation would require that physician assistants be supervised at all times by a physician practicing in the same office facility, with exceptions only as specifically authorized by law for a physician assistant's follow-up visits in hospitals, nursing homes and jails. Current law is being enforced using a 100 percent supervision standard, but with exemptions or exceptions for physician assistants' follow-up visits, practice in federally-funded clinics such as rural health clinics or federally-qualified health centers or practice in a federally-designated health professional shortage area. Most of Missouri is included in a health professional shortage area, negating much of the effect of the default 100 percent supervision standard.

The House Committee Substitute for House Bill 497 would set a default standard that a physician assistant must be supervised by a physician working in the same facility 66 percent of the time the physician assistant is providing patient care, with exemptions for follow-up visits in hospitals, nursing homes, jails and patient homes. The bill also creates a process for waiving the 66 percent standard that involves review and recommendation by the state Advisory Committee on Physician Assistants and a final decision on the waiver application by the State Board of Registration for the Healing Arts. The board's waiver decisions are to be based on uniformly applied criteria regarding the adequacy of supervision, distance between the physician and physician assistant, and the potential for reduced access to services without a waiver. Waivers would be limited to practice settings that at the time of application were included in a designated health professional shortage area. The bill also sets various standards for physician assistant training and contracts and agreements for physician assistant supervision.

Also this week, a Senate committee held a hearing on Senate Bill 537, which mirrors the original version of House Bill 497. The bill likely will be redrafted to reflect the compromise language.

Legislators Endorse Bill to Regulate Discount Medical Plans

The Senate Committee Substitute for Senate Bill 381 was approved by the Senate Health and Mental Health Committee this week. The bill would subject discount medical plans to regulation by the state Department of Insurance, Financial and Professional Regulation. Regulatory standards would address such topics as marketing claims, membership fees, provider participation in plan networks, and solvency standards.

Next week

The legislature will be on Spring Break until March 26th. After the break only 7 weeks remain in the 2007 session. No reports will be sent next week.

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