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March 30, 2007
This week the House concentrated on the House version of the state budget.
In the meantime the Senate spent several late nights debating gambling and abortion issues. In health terminology the legislature is headed toward an arterial clog as major issues have yet to be resolved.
The Governor is determined to pass the sale of the Missouri Health Education Loan Authority for capitol improvements to the University System. In addition, the Governor’s proposed Missouri Health Net to replace the current Medicaid system has yet to be debated on the Senate floor. The budget must be finished by May 11 and only 7 weeks remain in the 2007 session.
All indications point towards a major roadblock at the final few weeks of the session for all legislation. All this in addition to the typical "shenanigans" that occur in the last potion of the session.
If bills are not passed in the next few weeks they will be "bogged down" in the logjam.
News of interest includes:
MO HealthNet
Below is an article giving a fairly good synopsis of the movement of the Governor's revamp of the state Medicaid System.
Health program overhaul creeping
Leaders vow Medicaid legislation is still a priority in state House and Senate.
Jefferson City — There was a lot of talk as Missouri lawmakers convened this winter about the need to overhaul Missouri's health care program for the poor.
So far, there hasn't been much action.
At the Legislature's annual spring break, the much-touted Medicaid overhaul has yet to be considered in the House or Senate. But lawmakers are continuing to talk about it, and Republican leaders vow it's still a priority for the final eight weeks of the session that resumes today.
To use health care terminology, it appears the legislative arteries could be clogged in the Senate. A quick scan of the legislative priorities reveals the following:
- The Medicaid legislation has cleared a Senate committee but is awaiting Senate debate. The House is waiting for the Senate to act.
- Gov. Matt Blunt's college construction plan, financed through student loan agency money, remains stalled in the Senate, where a Democratic filibuster has prevented a vote. Again, the House is waiting on the Senate.
- The House has passed a tax-cut bill so large that even its supporters say it needs to lose weight to survive. That bill is pending in a Senate committee.
The Senate, it should be noted, has been busy. It's passed and sent to the House about 100 bills. Two of those already have become law — one opening the cable TV industry to greater competition, the other setting new criteria for contractors on public construction projects. Both had been contentious in the past but found overwhelmingly legislative consensus after interest groups negotiated compromises.
Both are cited by Republican Senate leaders as accomplishments that can bode well for the remainder of the session.
Senate Majority Leader Charlie Shields, R-St. Joseph, is the lead sponsor of the Medicaid changes. He plans to bring the legislation up for Senate debate in the next couple weeks or so.
The bill would rename Medicaid "MO HealthNet," place a greater emphasis on managed health care, reward enrollees with extra benefits for trying to be healthy and pay some medical providers based on their performance. If lawmakers do nothing, Missouri's current Medicaid program is due to expire after June 30, 2008.
Lobbyists for health care providers and disability groups, among others, have been negotiating privately with lawmakers and Blunt's liaisons to shape as many specifics of the bill as possible before Senate debate.
"Just because it hasn't been on the floor doesn't mean that a lot of work isn't being done on it," said House Speaker Pro Tem Carl Bearden, R-St. Charles.
Democrats have criticized the bill because it would do little to restore coverage to the thousands of low-income people whose Medicaid benefits were reduced or eliminated two years ago in a Republican budget-cutting move.
Debate could be considerable. But Shields believes it won't be partisan, which was the case when Democrats filibustered straight through the night against Blunt's college construction plan during the final week before spring break.
Senate Minority Leader Maida Coleman, D-St. Louis, declared the Democratic blockade of the higher education bill a resounding victory and "one of the most effective filibusters we've had." Some Democrats worry that taking money from the Missouri Higher Education Loan Authority could hurt its ability to help Missouri student loan holders in the future.
The education legislation also would expand Missouri's financial-need scholarships and limit the size of university tuition increases.
Republican leaders vow the bill will be resurrected. If the divide remains largely partisan, Senate Republicans could use a procedural move to shut down a filibuster and force a vote.
"I am determined — and I believe the governor is determined and the leadership of the Senate is determined — to pass this bill," sponsoring Sen. Gary Nodler, R-Joplin, said.
Tax cuts so far have been a larger priority for the House than the Senate. The House-passed bill would cut at least $285 million in taxes, targeted largely to those who receive Social Security benefits and some other pension and retirement payments.
More than a month has passed since that House vote. Senate President Pro Tem Michael Gibbons, R-Kirkwood, said Republican senators are divided about how to cut taxes. Some prefer a Social Security tax cut; others prefer tax cuts more directly targeted to economic development.
That bill "has a long way to go, but it will have its chance," Gibbons said.
The Legislature also has a long way to go on other Republican-identified priorities.
It just so happens the 2007 session is the longest possible under Missouri law — stretching from Jan. 3 to May. 18.
Tobacco
Representative Stevvenson successfully added an amendment (see below: Wednesday, March 28th page 810 of the House Journal):
House Amendment No. 6
AMEND House Committee Substitute for House Bill No. 10, Page 30, Section 10.660, Line 3, by inserting immediately after said line the following:
"In any year after 2007 when the state's tobacco settlement payment receipts as of June 30 for the prior twelve-month period are in excess of the total amount of settlement payments actually received by the state during fiscal year 2007, an amount equal to the excess, not to exceed $5,000,000 shall be appropriated and directed to the Department of Health solely for the purpose of increasing state efforts to prevent and reduce tobacco use and its harms. The funds directed to the department shall be allocated by the department consistently with the Center for Disease Control and Prevention's, or its successor agency's, best practices and guidelines for state tobacco control programs"; and
Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.
Representative Harris (23) raised a point of order that House Amendment No. 6 attempts to legislate through the appropriation process.
The Chair ruled the point of order not well taken.
On motion of Representative Stevenson, House Amendment No. 6 was adopted.
This amendment will basically take funds in excess of last year’s tobacco settlement payment and place them with the Department of Health for smoking prevention.
The amount cannot exceed $5,000.000.00 in one year.
Bill Renaming Missouri Head Injury Advisory Council Passes Senate
Senate Committee Substitute for Senate Bill 333, sponsored by Senator Bill Stouffer, R-Napton, was passed by the Senate this week. It now moves to the Missouri House of Representatives for debate. If passed, this bill would change the name of the Missouri Head Injury Advisory Council to the Missouri Brain Injury Advisory Council and codify the executive order transferring the Missouri Brain Injury Advisory Council to the Department of Health and Senior Services. The bill also would modify the definition of “brain injury” to include a sudden insult or damage to the brain or its coverings, not of a degenerative nature. Cerebral vascular accidents, aneurisms and congenital deficits are specifically excluded from the definition of brain injury.
Medicaid Reform
SB 577, the Governor’s proposed MO HealthNet bill will be heard on Monday.
The bill is in the form of a Senate Substitute. SB 577 will broach designated target rates of utilization for emergency room usage. Senator Shields, the bill sponsor, is committed to having a full debate on the legislation.
Unfortunately, the Speaker has appointed Representative Schaaf as the lead for Medicaid Reform. This means SB 577 will be assigned to Schaaf’s House Special Committee on Health Facilities.
Schaaf will have a series of hearings this week on SB 577 even though the legislation has not passed the Senate. Representative Sater will be the bill handler.
House Approves Emergency Responder Liability Protection
This week, the House of Representatives debated and gave first-round approval to legislation designed to enhance the availability of health care workers to respond to major emergencies and natural disasters. House Bill 579 would grant immunity from medical liability if the health care practitioner volunteers to be deployed by the governor or a state agency to respond to an emergency declared by the governor. Its protections would apply to practitioners from Missouri and other states but would not extend to damages caused by willful or wanton acts or omissions.
The only change made during House debate was to add an emergency clause to the bill, allowing it to become effective as soon as it is signed into law by the governor.
House Completes Work on the State Budget
The House of Representatives finished its debate of the 12 appropriations bills that comprise the state’s operating budget for the fiscal year that begins July 1. The bills now move to the Senate.
- Medicaid coverage to approximately 4,000 disabled and employed persons under a revamped "Medical Assistance for the Working Disabled" or MAWD program
- Medicaid coverage of 950 former foster children between the ages of 18 and 21
- $19 million for covering additional children under the state's SCHIP program
- $32 million in additional General Revenue designed to raise Medicaid physician fees. The amount is about one-third of what would be needed to raise Medicaid fees to Medicare levels.
- $1.4 million for a pilot project regarding the use of telemedicine in rural health clinics
- The budget bill authorizes Medicaid to pay for physician consultations done using interactive video technology, with reimbursements at fee-for-service levels for both sending and receiving sites.
- $12 million for health technology projects and initiatives
- $21 million in state and federal funds to support a "premium offset" program designed to expand access to coverage using both public and private funds
- House Bill 11 budget restricts the ability of Medicaid to limit access to psychotropic medications for Medicaid fee-for-service enrollees.
Other Health Care Related Bills Heard in Committees This Week
- House Bill 821 was heard this week in committee and would establish the Unborn Child Pain Prevention Act, requiring physicians to inform their patients who seek non-emergency abortions of their 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. It is a companion bill to Senate Committee Substitute for Senate Bill 196.
- House Bill 1055 would establish the Missouri Alternatives to Abortion Services Program to provide services or counseling to pregnant women and assistance to women in caring for their children or placing them up for adoption. Counseling and services are available to a woman during her pregnancy and for one year after the birth of her child. The department or departments administering the programs may contract with public or private agencies to provide services or counseling. This bill is a companion bill to Senate Committee Substitute for Senate Bills 370, 345 and 432.
- Senate Substitute for Senate Bill 195, if passed, would allow pharmacists to form collaborative agreements with physicians to design and implement medication therapeutic plans. These plans will be patient-specific and implemented under written protocols from a physician. The bill also authorizes pharmacists to administer vaccines under certain conditions. It is a companion bill to House Committee Substitute for House Bills 545 and 590.
- Senate Bill 634 provides that a pharmacist may not substitute one version of an anti-epileptic drug for the anti-epileptic drug originally prescribed without prior notification and the signed, informed consent of the prescribing practitioner and the patient or the patient's parent, legal guardian or spouse.
- Senate Bill 653 would require the Division of Medical Services to revise the eligibility requirements for the uninsured women's health program to include women who are at least 18 years old with a net family income at or below 185 percent of the federal poverty level.
Nursing Loan Forgiveness Revision Advances
After winning Senate approval this week, Senate Bill 513 moves to the House of Representatives. It revises the standards for a state loan forgiveness program for nursing education costs. If a nurse agrees to work in certain settings for a period of time, a portion of the educational loan will be forgiven. Current law allows nurses to receive loan forgiveness credit for employment in any hospital or in a public or not-for-profit agency or institution that is located in an area of defined need. Senate Bill 513 would allow employment in a for-profit agency or institution in an area of defined need to qualify as well.
Leading Senator Supports Jiffy Lube Health Care Concept
Governor Blunt's Jiffy Lube model for state health care gets support from the Senate President Pro-Tem. Senator Mike Gibbons says the state's actual health care is extraordinarily sophisticated, but he says the business side of health care needs to quit pushing paper and catch up with he 21st century. He says Blunt's CyberAccess Program, which is modeled after a Jiffy Lube concept based on electronic records would give residents technologically-advanced access to their personal health information. Blunt's CyberAccess Program is part of his new plan for state healthcare, MO Healthnet.
Better treatment, care and comfort are obvious advantages of electronic health records for Gibbons. He says accessing the system could work much like a bank card, one swipe could give access to a complete personal health history including all medical records and necessary prescriptions. He says the information could be constantly updated.
Gibbons dismisses fears that such quick and easy electronic access could mean personal health information would be insecure. He says while there are instances of identity theft with bank cards, the number of such cases compared to the number of bank transactions is relatively infrequent.
Gibbons says it is time to get the business side of healthcare up to speed with the 21st century and offer residents the quality and efficiency they deserve with their healthcare.
Next week
Seven weeks remain in the 2007 session of the General Assembly.
Major issues remain to be resolved as soon as possible or most of the legislation awaiting approval will not be approved due to lack of time.
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