April 07, 2006

The Missouri General Assembly is now into the last five weeks of the 2006 legislative session.

A special election to fill a State Senate vacancy that was created when Senator Jon Dolan of Lake St. Louis resigned will keep the seat in Republican control. Representative Scott Rupp of Wentzville captured just under 54 percent of the votes cast in his contest with Democrat Representative Wayne Henke of Troy. The Senate district takes in parts of St. Charles and Lincoln Counties. The new make up of the 34 member Senate will have 23 Republicans and 11 Democrats.

News this week includes:

The House also approved a bill that would require physicians to report any collaborative practice or physician assistant agreement they have to the Missouri State Board of Registration for the Healing Arts. The board is authorized to conduct random audits to determine if the agreements are in compliance with state standards. The bill is the House Committee Substitute for House Bill 1515.

The Senate unanimously approved and sent to the House a bill to revamp Missouri's regulation of medical malpractice insurers. The Senate Committee Substitute for Senate Bill 905 also expands on the current obligation of medical malpractice insurers and self-insured plans to provide data on their operations and claims experience to the Missouri Department of Insurance.

Repeal of Motorcycle Helmet Law Gets Preliminary Approval in House

A repeal of the state motorcycle helmet law has won preliminary approval in the House. By a vote of 95-59, the House gave its final approval to House Bill 994. The bill permits those ages 21 and older to ride a motorcycle without wearing a helmet. Historically, the bill runs into problems in the Senate.

Sponsor Gary Dusenberg of Blue Springs says motorcyclists have told him they don't want the state dictating to them that they wear a helmet. Dusenberg's bill would lift the requirement that those 21-years-old and older wear a helmet, while maintaining the requirement for cyclists under 21.

HJR 48

Representative Bearden's legislation to enact a state-spending limit was heard on Tuesday morning.

Bearden's bill prohibits, upon voter approval, appropriations in any fiscal year from exceeding the total state general revenue appropriations from the previous year by more than the appropriations growth limit. The appropriations growth limit is the greater of zero or the sum of the annual rate of inflation and the annual Missouri population growth.

For any fiscal year in which the net general revenue collections are in excess of 1% of the authorized net general revenue appropriations allowed, the excess is to be transferred in equal amounts to the Cash Operating Reserve Fund and the Budget Reserve Fund, which are created by the bill. Any revenue in excess of the specified limits of the funds will be refunded, pro rata, based on tax liabilities reported in the tax year in which the fiscal year ended. Any taxpayer can designate on his or her state income tax return that any refund be credited to the taxpayer's future tax years.

Total state general revenue appropriations may exceed the appropriations limit only if the Governor declares an emergency and the General Assembly approves appropriation bills to meet the emergency. The funds appropriated to meet the emergency will not increase the appropriation limit for the succeeding fiscal year.

New or increased tax revenues or fees receiving voter approval will be exempt from the calculation of the appropriations growth limit for the year in which they are passed.

One-half of the balance in the Budget Reserve Fund on July 1 of each year is to be transferred to the Cash Operating Reserve Fund. If the balance in the Cash Operating Reserve Fund exceeds 5% of the net general revenue collected in the previous fiscal year, the excess amount will be transferred to the General Revenue Fund.

In any fiscal year in which the Governor reduces expenditures below amounts appropriated, the Governor may request an emergency appropriation from the Budget Reserve Fund. If the request is approved by the General Assembly, funds may be restored to any expenditure authorized by existing appropriations. If the balance in the Budget Reserve Fund at the end of a fiscal year exceeds 7% of the net general revenue collections for the previous fiscal year, the excess funds will be transferred to the General Revenue Fund. If the balance is less than 7%, the difference will be transferred from the General Revenue Fund.

Funds appropriated from the Budget Reserve Fund must be paid back within five years of the original transfer date.

Ray McCarty of the Taxpayers Institute, a division of the Chamber, was in support citing the need to preserve a state savings account. Bearden brought in a Dr. Poulson from Colorado to explain how Bearden's bill differs from the Colorado TABOR bill.

The Missouri Budget Project, a fairly radical left learning group testified against the bill. They commented that the Hancock Amendment is a better solution then HJR 48.

Representative Lager has an amendment to phase in any immediate impact over the next five years. Lager also commented that regardless of the party in control, everybody spends every dollar once they are in Jefferson City.

The bill could pass the House. However, it will die in the Senate.

Special Committee on Healthcare Facilities

The House Special Committee on Healthcare Facilities met late Wednesday evening.

House Bill 1327, the "any willing provider" legislation was heard. The legislation prohibits health insurers from discriminating against a provider willing to be a part of a managed care plan.

MAOPS provided witness Dr. Campbell from Springfield's Doctors Hospital. The witness described an oligarchy situation in Springfield where the two major health systems prohibited physicians from joining their insurance plans forcing patients to change physicians.

Representative Nance asked if hospitals and surgery centers were impacted. Schaaf commented that as drafted his bill would not impact hospitals unless they had insurance plans.

Mo McCullough of the Chiropractors Association related that some networks are closed to chiropractors.

Dr. Tom Green, MSMA - Dr. Marsha Taylors, MOSEPs - Ophthalmology, The Family Physicians and the Missouri Pharmacy Association were in favor.

Those opposed commented that this bill would do away with closed plans and managed care thereby losing savings.

The Missouri Health Insurance Plans, Blue Cross Blue Shield, United Healthcare, Aetra, Cigna and the Missouri Chamber testified against the bill.

Schaaf voted a House Committee Substitute for HB 1327 out on a 6-3 vote.

For:
Schaaf, Page, Threlkeld, Hunter, Wright, & Skaggs

Against:
Nance, Wilson & Tilley

Representative Tilley switched only after passage was assured.

Senate Give First Round Approval to Med-Mal Insurance Bill

The State Senate has advanced a bill controlling medical malpractice insurance prices that health care professionals pay. Backers say the bill will keep doctors and others from leaving Missouri to work in states where premiums are lower. The State Insurance Department gets power to throw out malpractice insurance rates that are too high. It also lets the Department order insurance companies to increase rates if it finds they do not provide adequate coverage for malpractice lawsuits. One more positive vote in the Senate sends the bill to the House. Senate Bill 905 is sponsored by Senator Engler.

Bill Would Report On Employees On Medicaid

The House Workforce Development and Workplace Safety Committee held a hearing on legislation directing the Department of Social Services to prepare annual reports on employers with more than 50 workers. The reports would detail for each employer the number of workers and their dependents who are covered under the Medicaid program and the availability of employer-sponsored coverage. Individual workers or dependents would not be identified. The Department of Social Services testified that it has the data required to generate the specified reports but information system reprogramming would be needed to format and link the data elements.

House Bill 1868 is cosponsored by a bipartisan group of 55 legislators. The primary witness appearing on behalf of the bill was the Joint Labor Management Committee, an entity representing workers and management in large grocery chains in St. Louis.

House Endorses Association Health Plan Revisions

The House of Representatives passed House Bill 1827 this week and sent the bill to the Senate. It revises group health insurance laws to promote policies of coverage that can be sold to associations or other groups of affiliated purchasers.

Medicaid Reform Continuation Advances

This week, the Senate unanimously approved Senate Bill 901 and sent it to the House of Representatives. The bill would establish a legislative Joint Committee on Health, which would broaden the purview and continue the work of the Medicaid Reform Commission that met during the latter half of 2005. Statutory authorization for the Medicaid Reform Commission expired December 31, 2005.

Senate Endorses Child Safety Seat Bill

The House Transportation Committee reviewed a bill this week that would expand Missouri’s requirements to use child safety seats in automobiles. Under the Senate substitute for Senate Bill 916, older children would be required to ride in booster seats if they do not meet minimum height, weight and age standards.

Uncontroversial Measures Advance

Legislative rules allow expedited review of uncontroversial bills deemed to have little or no cost. The House and Senate took various actions on these "consent" bills this week.

• a similar bill, the House Committee substitute for Senate Bill 765.
• 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. The bill was reviewed by a Senate committee.
• House Bill 1437 and Senate Bill 965 each were given hearings and a committee substitute for Senate Bill 965 was approved. The bills would update laws on the governance of the Missouri Poison Control Network and repeal a Poison Control Advisory Committee that provides for coordination of the poison control network by the DHSS, but has not met for many years.
• House Bill 1099 was approved by the House and sent to the Senate. It authorizes the Missouri Infection Control Advisory Committee to recommend alternative indicators to better measure the risk of transmitting ventilator-associated pneumonia. The alternatives could replace the current requirement to monitor risk-adjusted infection rates for ventilator associated pneumonia. After the passage of the infection control reporting law in 2004, various federal and other infection control groups began encouraging alternatives to a standard ventilator-associated pneumonia incidence rate as a performance measure.
• House Bill 1477 would allow medical test results held by the Department of Health and Senior Services to be disclosed to a patient's health care provider without patient consent. The bill was passed by the House. A similar bill, the Senate Committee Substitute for Senate Bill 1131, was approved by a committee that limits the scope of the bill to treatments related to newborn infants.
• House Bill 1707 would allow city health department employees to be appointed as local registrars for processing vital records information for the DHSS. The bill was approved by the House.
• 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. The Senate approved the bill this week.

Insurance

The House committee on Healthcare Facilities also reviewed and approved an "any willing provider" bill that would require insurers to include in their provider networks any providers willing to accept the insurers' contractual terms and conditions. The bill is House Bill 1327, sponsored by Representative Schaaf.

Medicaid Fraud

Yesterday, the Senate continued but did not complete its debate of the Senate Substitute for Senate Committee Substitute for House Bill 1210, which expands the state's powers to identify and penalize Medicaid fraud perpetrated by health care providers.

Conscience Clause

For a second time, the House Rules Committee sent back a "conscience clause" bill for further review by a House committee. House Bill 1539 would apply to all types of health care workers and health care facilities and would encompass any health service that violates the employee's or organization's religious, moral or ethical principles. Health insurers and employer health plans would not be required to pay for services to which they have a religious or ethical objection.

This bill is extremely broad and as written is going to face "hurdles".

Next Week

32 days remain in the 2006 Legislative Session.

Easter Break will begin upon Thursday, April 13th adjournment. There will be no session on Monday, April 17th. The House and Senate will reconvene Tuesday, April 18th.

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