March 31 , 2008

The Missouri House focused their entire work week on the 2009 budget. This effort took place the throughout this week’s session.

The committee work was greatly reduced as a result and also the shortened week due to the spring break and Easter recess deterred much more in the way of accomplishment. 

This week’s items of interest include:

Open Meetings Bill Heard in House Committee
House Bill 2210 was discussed in a House hearing this week and would amend the state Sunshine Law governing access to government information. In its original form the bill would have required almost all private for-profit or not-for-profit health facilities and their governing boards to abide by state laws requiring public access to their meetings and records.

The sponsor agreed to delete language that expanded the definition of “public governmental body” to include “any organization, corporation or other body receiving at least 51 percent of its annual budget either directly from public tax revenue from governmental bodies or from the United States or any agency or department that is a unit or subdivision of a governmental body.”

He also agreed to delete language which stated that open meetings and records law will apply to organizations that manage a public facility or services.

Committee Reviews and Approves MO HealthNet Telemonitoring Coverage
The House Special Committee on Health Care Transformation held a hearing on House Bill 1933 and then approved the bill. It would authorize the MO HealthNet program to cover medically necessary home telemonitoring services. The amount and scope of coverage would be determined by appropriations. The legislation calls for a Web-based prior authorization system to be used in assessing medical need.

Panel Advances Bills Denying Public Benefits to Illegal Immigrants
Several bills relating to illegal immigrants and public benefits were advanced in a Senate committee this week. Senate Bills 858, 751, 1186, 1255 and 1186 were all combined into one bill and reiterate federal law stating that unlawfully present immigrants are not eligible for state or local public benefits, with certain exceptions. They require that applicants for benefits provide proof of citizenship, residency or lawful presence to receive benefits. The applicant cannot receive benefits until lawful presence is verified by the federal government.

Senate Bill 858 further states that employers who negligently hire unauthorized immigrants are ineligible to receive state-administered or subsidized tax credits, tax abatements or loans from the state. It also creates a private cause of action for those discharged by employers who employ unauthorized immigrants at the time of their discharge. Employers enrolled in a status verification system are exempt from liability. The bill also bars illegal immigrants from attending public universities in Missouri.

Also combined into the new omnibus bill was Senate Bill 1269, which would prohibit illegal aliens from being released pending trial, appeal or any other proceeding. Senate Bill 1268 is also combined into this omnibus bill and would limit the number of personal and dependency withholding exemptions for state income tax purposes to not more than 10 for employees.

Tobacco
Representative Stevenson was successful in adding amendments last week in the House Budget Committee for youth tobacco prevention and a tobacco frontline.

However, the funding was taken from providers and the full amount of $4.5 million will undoubtedly be reduced by the Senate.

This is a step in the right direction.

House Approves Budget Bills
This week, the full House of Representatives 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 hospitals are in House Bill 2010 and House Bill 2011. Budgets for the Missouri departments of Health and Senior Services and Mental Health are in House Bill 2010, while House Bill 2011 contains the budget for the Missouri Department of Social Services. MO HealthNet funding, which is allocated in House Committee Substitute for House Bill 2011, remained at the governor’s recommended funding level of nearly $700 million. The bills now move to the Senate for debate.
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 hospitals. As the budget moves to the Senate, hospitals expect a more favorable response to funding coverage expansions. The Senate is expected to finish debating the budget during the last week of April. The final budget must be enacted by May 9.

Notable amendments including the following.

• Successful removal of $600,000 from the state’s “clawback” payments to the federal government for pharmaceuticals to fund an increase in reimbursement rates for providers of family reunification and intensive in-home services.

• An attempt to restore funding to the “Preparing to Care” health care workforce development program, whose funding was eliminated by the House Budget Committee, failed by a vote of 76 to 77.

Insure Missouri Negotiations Continue
Although selected legislators from the House of Representatives and the Senate have continued meeting with representatives from the governor’s office to discuss the scope and design of legislation to expand coverage of the uninsured, both chambers appear poised to begin debating their own Insure Missouri proposals.

This week, Speaker of the House Rod Jetton, R-Marble Hill, revealed his stance that any Insure Missouri proposal also must include two other elements before moving forward in the House. The first is transparency of provider cost and quality data. The second is promotion of competition, which was defined as reforming the certificate of need program. The speaker suggested that this new Insure Missouri package include the following bills as starting points for discussions.

• House Bill 2355, a certificate of need reform proposal, which MHA opposes
• House Bill 2394, which establishes guidelines for transparency in pricing and quality of health care services
• House Bill 2413 and/or House Bill 2398, which include an Insure Missouri proposal

The Senate has made no similar requirement and continues to develop its own Insure Missouri proposal in the form of a bill introduced by Sen. Tom Dempsey, R-St. Charles. Senate Bill 1283 contains several components unrelated to Insure Missouri, some of which are opposed by MHA. However, Dempsey 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 House Bill 2413. However, it proposes a broader entitlement to coverage and would give enrollees a larger preventive care benefit. In addition, the bill would make much more limited changes to the state laws governing the state high-risk pool.

Both the House and Senate plan to hold hearings on their bills next week.

Next Week
The Senate will begin examining the proposed House Budget. Only six weeks remain in the 2008 session.

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