March 31, 2006

The Missouri General Assembly began to address legislation again after resuming work after their spring recess. Only six weeks remain in the 2006 session and the Senate is reviewing the House version of next year’s budget.

News this week includes:

Lead Abatement

Senator Engler's SB 906 was heard in the Senate Urban Issues Committee.

The bill modifies provisions relating to lead abatement. Currently, the Department of Health and Senior Services requires as a condition of licensure that all lead abatement contractors, including, but not limited to, those engaged in project design, risk assessment or inspection to purchase and maintain liability and errors and omissions insurance. This act would provide that only persons or entities conducting abatement or deleading activities purchase such insurance.

House Revamps Sexual Assault Forensic Exam Procedures

Before approving House Bill 1317, the House of Representatives adopted an amendment that would change the way hospitals and other providers would be reimbursed for conducting forensic medical examinations following a sexual assault. All charges for the examination will be paid by the Department of Health and Senior Services and the patient may not be billed for the examination itself. The amendment also revises procedures for performing the forensic examination using materials supplied by the Highway Patrol or state crime laboratories.

Legislators Consider Bills on Mandatory Overtime and Nurse Staffing Ratios

House Bill 1977 would prohibit licensed health care facilities from requiring their patient care workers to work longer than their scheduled shift or for longer than 12 hours in a day or 80 hours in 14 days. The few exceptions involve governmentally declared emergencies or disasters or other catastrophic events. Violations would incur penalties of up to $10,000 per violation and liability to the employee.

This week, the House Special Committee on Healthcare Facilities held a hearing on the bill. Opposition testimony focused on the pending hospital licensure regulations that will set new standards for mandatory overtime for nursing personnel. Those standards were developed by the state "Technical Advisory Committee on the Quality of Patient Care and Nursing Practices", a committee of nurses, hospital executives and other health care providers, and endorsed by the governing boards of MHA and the Missouri Nurses Association. MONA testified in opposition to House Bill 1977.

The House Health Care Policy Committee reviewed legislation that would create nurse staffing ratios for hospitals and ambulatory surgical centers. House Bill 1106 is modeled on California law and would create specific ratios by type of unit. Failure to meet the ratios or the requirements of an additional acuity-based staffing system would incur fines of up to $25,000 per violation. MONA again joined MHA in testifying in opposition to the bill, citing the ongoing work of the technical advisory committee on staffing standards.

The sponsors' witnesses for House Bill 1977 and House Bill 1106 were from a labor union representing nurses. At each hearing, they decried hospital practices regarding the nursing workforce.

Uncontroversial Measures Advance

Legislative rules allow expedited review of uncontroversial bills deemed to have little or no cost. The House and Senate approved a number of these "consent" bills this week, which now move to the other chamber.

Senate Bill 1155 would extend the expiration date of the Technical Advisory Committee on the Quality of Patient Care and Nursing Practices in the Missouri Department of Health and Senior Services. The group includes nurses, hospital executives, a physician, a public member and a department representative. It is designed to provide a forum for discussing nursing care issues.

House Bill 1687 would permit unused drugs that are donated to a state drug repository program to be distributed to out-of-state charitable organizations and foreign medical aid missions if they are not accepted by an in-state pharmacy, hospital or not-for-profit clinic.

House Bill 1437 would update laws on the governance of the Missouri Poison Control Network. It repeals a Poison Control Advisory Committee that has not met for many years and provides for coordination of the poison control network by the DHSS.

Senate Bill 1177 would allow city health department employees to be appointed as local registrars for processing vital records information for the DHSS.

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.

Senate Bill 1084 would extend the expiration date of the State Children's Health Insurance Program by one year to July 1, 2008.

Senate Proposal on MOHELA Funding Targets Health Cares

Since Governor Matt Blunt announced plans to sell some of the Missouri Higher Education Loan Authority's loan portfolio earlier this legislative session, legislators have been crafting proposals as to how to spend the $450 million generated by the sale. The governor had proposed funding higher education capital improvements and scholarships. The House leadership had voiced support for more scholarships, fewer university building projects and some debt retirement.

Late this week, the chairman of the Senate Appropriations Committee, Senator Chuck Gross, R-St. Charles, filed a new bill describing a Senate plan for spending the money. Senate Bill 1256 still would direct a substantial portion of the MOHELA money for capital improvements at state universities and colleges. In addition to a number of relatively small health care projects of various types, the bill would allocate $66 million for capital improvement grants to federally qualified health centers. Another $55 million would be placed in a separate fund to provide ongoing support for incentives to train physicians, advance practice nurses and dental practitioners who agree to practice in medically underserved areas.

It appears likely that the conflicting spending plans will come to what Speaker of the House Rod Jetton, R-Marble Hill, described as a "showdown" as the budget is finalized.

Committee Endorses Medicaid Provider Fraud Bill

Senate Bill 1210 concerns Medicaid fraud by health care providers. The bill was developed by a Senate committee appointed to study the issue in the wake of media attention. Among other components, Senate Bill 1210 would create a state civil false claims law that mirrors a federal antifraud law of the same name. This law would allow private citizens with information about alleged fraud to join in the government’s recovery lawsuit and receive a share of the proceeds recovered. The bill also would create new "whistleblower" protections for individuals assisting in a Medicaid fraud action or investigation. In addition, stiffer criminal penalties are established for those found to have perpetrated Medicaid fraud.

This week, a Senate committee approved a Senate Committee Substitute for the bill. The new version includes several changes of benefit to providers. It includes an amendment that directs the attorney general to develop guidelines governing the implementation of the state civil false claims law that are modeled on guidelines developed by the United States Department of Justice for the federal civil false claims law. The Senate Committee Substitute also clarifies that only individuals, not corporations, will be subject to the permanent ban on Medicaid participation for those convicted of a criminal Medicaid fraud charge. Also, criminal penalties are created for those who intentionally file false charges against a health care provider.

Committees Approve Bills on Prescription Drugs, High-Deductible Plans, Tax Incentives

The Senate Pensions, Veterans Affairs; and General Laws Committee approved a Senate Committee Substitute for Senate Bill 1239. It would direct the state to compile data on retail prices charged by pharmacies for commonly prescribed prescription medications. The data would be posted online by the Missouri Rx Plan.

The Senate Small Business, Insurance & Industrial Relations Committee approved Senate Bill 1103, 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 co-payments. Commercial insurers already are authorized to sell high-deductible plans.

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. One commercial insurer, United Healthcare, is opposed to the proposal, citing regulatory inequities between HMOs and commercial insurers.

Also this week, the House Ways and Means Committee approved a House Committee Substitute for House Bill 1677, which would provide for a phased-in individual income tax deduction for premiums paid for health insurance premiums paid by the taxpayer.

Committees Review Bills on PKU Funding, Critical Access Hospitals and Prescription Drug Costs

This week, the Senate Aging, Families, Mental & Public Health Committee held a hearing on Senate Bill 1251. The measure would expand Missouri's program of providing costly dietary supplements needed by children with PKU and related metabolic disorders. Currently, the program serves very few Missourians because of a restrictive income guideline. The bill would raise the income standard to 500 percent of the federal poverty level, with those having incomes between 500 and 750 percent of the poverty level able to qualify by paying fees and monthly premiums. Proponents of the bill discussed various options for paying the projected $1 million cost for the expansion, including raising the Department of Health and Senior Services' fee for newborn screening tests. They also suggested Missouri could allow affected families to purchase the dietary formula using the state's favorable pricing arrangements.

The House Special Committee on Healthcare Facilities held a hearing on legislation that would earmark five percent of the loans, grants and other financial assistance provided annually by the Missouri Development Finance Board. The funds would be used to finance the costs of building new critical access hospitals, including facilities to replace existing CAHs. If some of the five percent allocation is unspent, it may be carried forward to future years until the balance exceeds 10 percent of annual loans, grants and other assistance. The bill is House Bill 1580.

Next Week

The Senate Appropriations staff will attempt to finish the appropriations bills for 2007. Both the House and Senate will be considering the Senate’s recommendations on the expenditure of the sale of MOHELA. This will occupy a great deal of time as a feeding frenzy commences resulting from the $448 million the sale will generate to the state.

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