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April 1, 2005
This week the legislature reconvened after their Spring Recess and it made for a fairly short week.
Items of interest include:
Bill Seeks to Clarify Burial Rights
Senate Bill 366 is a proposal developed by the Missouri Bar Association. It seeks to remove inconsistencies between laws governing who may authorize the burial or other arrangements for the deceased and who may give consent to donate organs or tissues upon death. The state’s two organ procurement organizations and MHA testified on behalf of the measure. The legislation is sponsored by Senator Charles Wheeler, D-Kansas City, a pathologist and attorney.
Uncontroversial Bills Advance
Bills that are uncontroversial and have little or no fiscal effect can be given expedited review as a “consent” bill. This week, both the House and Senate debated consent bills and sent a number of them to the other chamber.
- House Bill 108 would prevent a health insurer from imposing a copayment for a prescription drug that exceeds the cost of the drug.
- House Bill 413 requires the Department of Health and Senior Services to offer a vaccination program for first responders deployed to respond to bioterrorism events.
- House Bill 596 would authorize employers to offer employee health insurance benefits that include lower premiums for employees who do not smoke.
- Senate Bill 323 would authorize, but not fund, a system of grants to support umbilical cord blood banks.
Emergency Personnel
Representative Bruns offered HB 803 to the committee for consideration. HB 803 provides for a licensure and accreditation fee for emergency personnel.
This proposal is an effort to supplant federal grants that are being eliminated.
The additional fees would be used for the administrative and training functions EMTs are now doing that are federally funded. The EMT Association testified in support.
Jams/ Jellies
House Bill 744 by Representative Tilley was heard in the House Agriculture Policy Committee on Tuesday before the House and Senate convened after break.
The bill is identified in SB 88, Senator Klindt. This bill exempts certain food sales from food inspection laws. All foods which are not potentially hazardous foods made by religious, charitable, or nonprofit organizations for sale at their religious or charitable events will be exempt from the state food inspection laws.
Sellers of jams, jellies, and honey will be exempt from specified production requirements as long as they do not sell more than $30,000 worth of jams, jellies, and honey per domicile, per year. These sellers also will be exempt from all other health standards pursuant to Sections 196.190 - 196.271, RSMo, as long as the following requirements are met:
- The jams, jellies, and honey must be manufactured in the domicile of the person processing and selling them;
- The jams, jellies, and honey must be labeled in legible English with certain information;
- A placard must be displayed in a prominent location stating that the product has not been inspected by the Department of Health and Senior Services; and
- A record of jams, jellies, and honey processed and sold must be maintained.
Anyone who violates these provisions may be issued an injunction from selling jams, jellies, and honey by the department.
I visited with several committee members prior to the hearing and Representative Shoemeyer and several others asked pertinent questions. Shoemeyer commented that the $30,000 limit was a business and Representative Whorton believes we are inhibiting private health departments.
This bill is sponsored by Tilley due to perceived harassment of the local Lion’s Club bake sale by the county health department in Farmington, Missouri.
Tilley, unlike Senator Klindt, is willing to work with us. The Department of Health has promulgated rules and regulations regarding this issue due out April 1 st.
Medicaid
Legislation to make the proposed Medicaid budget cuts requires action on parallel tracks: (1) passing Medicaid appropriations as part of the state budget; and (2) revising Medicaid law to give necessary legal authorization for those cuts. Court decisions preclude state budget cuts from overriding contrary state laws.
Wednesday night, a House committee held a lengthy hearing on Senate Bill 539 and voted to advance the bill without any changes. The legislation makes the changes to Medicaid law necessary to implement the Medicaid budget cuts that are under discussion in the appropriations process. The bill is likely to be debated by the House of Representatives next week.
Insurance
The House amended and then approved a bill that would give the Missouri Department of Insurance the authority to disapprove medical malpractice liability insurance premiums that exceed or fall below prescribed limits. House Bill 394 also requires insurers to abide by new standards for providing advance notice of premium increases or cancellation of coverage.
Family Values Candidates Clash In 16th Senate District Race
Special elections scheduled for next Tuesday will fill two vacancies in the State Senate. One of those contests is being held to find a successor to Sarah Steelman, who stepped down from the Senate after being elected State Treasurer. The 16th District is made up of eight counties in mid-Missouri. It's a conservative region - strong on traditional values. State Representative Frank Barnitz, a farmer from Lake Spring, is the Democratic candidate who says he shares those values. Republican Bill Hickle, a lawyer and a municipal judge in Rolla, embraces those traditional values, too. He adds voters also like the idea that Republicans in the Legislature and the Governor's Office are controlling spending. Both Barnitz and Hickle call themselves pro-life and pro-Second Amendment. They list quality education and school funding among their top priorities. Tuesday's 16th District contest is one of three special elections that day to fill vacancies in the General Assembly.
Governor’s Medicaid Bill Clears the Senate
The Senate debated and ultimately passed SS/SB 539, the Governor’s Medicaid reform bill sponsored by Sen. Chuck Purgason (R-Caulfield). The bill decreases the number of Medicaid eligible recipients by lowering the income threshold for some of the programs, eliminating coverage for services such as prosthetics, dental care and hearing aides, and requiring a process of eligibility verification for Medicaid applicants.
During three days of debate and over 16 hours of floor time, Democrats filibustered the bill, insisting that it punishes the most needy individuals and families in the State. Opponents to the bill argued that the state will not realize the savings purported to be realized because the state would be losing federal matching dollars. They also argued that current eligible recipients who would be rendered ineligible by the bill would utilize emergency care, which could also cost state dollars. Democrats offered numerous amendments to restore the eligibility of current Medicaid recipients and to restore funding of the impacted programs, all of which were defeated. Republican supporters estimated that the bill would result in an estimated $600 million in savings to the state’s budget by revising Medicaid eligibility guidelines. They also indicated that Missouri’s Medicaid budget is growing more rapidly than in any other state and amounted to approximately 30% of state expenditures, compared to the national average of 22%. Many speeches by supporters of the bill acknowledged the plight of Medicaid recipients, but also asserted that the cuts are unavoidable in light of the budget shortfall.
The final vote of the Senate was 20 -11 to third read the bill, which is now in the House. The emergency clause was not adopted so the bill will not go into effect until August 28, 2005. The bill has generated a great deal of controversy. This was evident at the House hearing Wednesday night. It appears that Republicans with large Medicaid populations in their districts are having second thoughts about the bill.
CAFOs
Senate Bill 187 was narrowly approved on an 18-12 vote on Wednesday.
Initially, the bill was defeated due to not having the majority of 18 votes needed.
As you will recall the bill preempts the authority of local health departments to determine standards for the location of concentrated animal feeding operations.
Additional contacts may swing the pendulum against the bill in the House.
Mid-Session Review of Key Legislative Issues
The Missouri General Assembly is on its spring break recess this week. The legislative session will end May 13. The following reviews legislative action on key issues affecting hospitals.
- In January, Governor Matt Blunt proposed a state budget that would reduce Medicaid spending by $626 million for the fiscal year beginning July 1, 2005. A House appropriations committee recently voted to restore $242 million in budget cuts proposed for Medicaid and health and mental health programs. In the next few weeks, the House of Representatives will debate the appropriations bills and send them to the Senate for review.
- Making the proposed Medicaid cuts requires action on parallel legislative tracks — passing Medicaid appropriations and revising Medicaid law to authorize those cuts. Court decisions preclude state budget cuts from overriding contrary state laws. Senate Bill 539 is the bill that makes the necessary changes in Medicaid law. It has been passed by the Senate and sent to the House of Representatives for review. The legislation also creates a Medicaid Reform Commission of state legislators and agency officials to restructure the program, with the current Medicaid law slated to end as of June 30, 2008.
- The General Assembly has enacted comprehensive tort reform legislation. Many components address medical malpractice liability. The governor is expected to sign House Bill 393 into law in the coming weeks.
Next Week:
Only 6 weeks remain in the legislative session and as usual the budget has not been completed. We anticipate a “log jam” on legislation, as the budget is the first priority.
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