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Legislative
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April 7, 2008 The Senate Appropriations Committee began their initial mark up on the budget this week closing some items but leaving open the items that will need extensive discussion. They will finalize their mark up in committee next week and send them to the full Senate for debate. The House worked later than usual Thursday and barely passed a controversial proposed constitutional amendment that would bar state judges from ordering tax increases. The sponsor and other republicans claim a number of judges are increasing taxes and imposing fees and referenced a federal court in 1987 that ordered Kansas City residents and the state to pay for teacher salary increases and several other programs in the Kansas City School District. The proposed amendment also says courts cannot force governments to spend money, unless it has been approved by legislators or voters. Several legislators questioned the amendment saying it might prevent someone from going to court if a local government damaged his or her property. The close vote was 82-68, the minimum number of votes needed for third reading and final passage. The vote was mostly along partisan lines with two Democrats voting for the proposal and five Republicans voted against it. It will now head to the Senate where it faces even more opposition. If the Senate passes HJR 41, it will be on November's ballot. News of interest includes: Dairy The bill specifies that a dairy product, except those produced through organic farming, is misbranded if: (1) A compositional claim cannot be confirmed through laboratory analysis; (2) A compositional claim is supported solely by sworn statements, affidavits, or testimonials; (3) The label contains false or misleading statements, production claims, or production composition; or (4) A statement indicates the absence of a compound not permitted by the United States Food and Drug Administration but it is found present in the product. Immigration reform advances in senate One part of Rupp's bill SB 858 goes after employers who hire them and increases requirements for officials and companies to check on their status. Another part forbids cities from declaring themselves sanctuaries for illegal immigrants. However the bill does not forbid cities or city officers from having unofficial policies of looking the other way. Rupp says his committee "went round-and-round" on whether to allow illegal immigrants to go to state colleges or universities. He says his bill is a compromise that does not penalize people who are here illegally through no fault of their own. Although he says the state does not want to promote the idea that unregistered aliens should bring their children to Missouri to gain access to public education, it does think students who are here through no fault of their own and who have attended at least three consecutive semesters of a Missouri high school should be able to attend a state college or university. However they would not receive in-state tuition rates. Helmet Laws Representative Dusenberg’s legislation has been around for eight years and legislator’s have previously staked out their positions. The House perfected the helmet law again this year. This legislation would allow motorcyclists who are at least 21 years old to ride without helmets. Current law requires all motorcycle riders to wear helmets and for several years lawmakers have tried to repeal it because they think the mandate is an infringement on civil liberties. Missouri is one of 20 states that have universal helmet requirements; 26 states require helmets only of younger riders, and four states have no helmet requirement for any motorcyclists. After being third read it will go to the Senate, where it usually faces bipartisan opposition. Senate Bill 738 SB 738-Any recycling company that converts animal parts into petroleum who violates any state air, water, or odor pollution standard at least 6 times in a 12-month period or 12 times in a 36-month period shall forfeit any air or water-related permits issued by the Department. Recycling companies that violate any air, water, or odor pollution standard more than one time in a 36-month period shall be subject to a surcharge in addition to a civil penalty. The surcharge will be the sum of the civil penalty assessed for the violation plus the sum of any fines assessed during the 36-month period. The funds from the surcharge shall be deposited into funds created and utilized for public education and the enforcement of air and water pollution laws of the state. The act is similar to SB 534 (2007) and SB 591 (2006). Insure Missouri Proposals Receive Hearings Within limits set by legislative appropriations and federal Medicaid waivers, House Bill 2413 would authorize a new “Insure Missouri” system of coverage for individuals between the ages of 19 and 65, and who have been uninsured for at least six months. Coverage could be extended to those with incomes of as much as 225 percent of the federal poverty level, if legislators appropriate funding for this. However, coverage would not be an entitlement for individuals whose incomes exceed 85 percent of the federal poverty level. Coverage would be offered through individual insurance policies offered by commercial insurers. The policies would be subject to medical underwriting and have a deductible between $1,000 and $2,500. A standard benefit package also would include $300 in preventive care benefits offered at no cost to the enrollee. The state would pay the premiums for the Insure Missouri coverage. However, coverage would be contingent on enrollees and/or their employers making a minimum contribution to an account for deductible expenses. The bill establishes limits on the annual deductible contributions based on income, and the state would provide some funding for enrollees’ deductible expenses in certain circumstances. If money in a deductible account is not used, it may be carried forward to reduce or eliminate the following year’s deductible contribution. House Bill 2413 also authorizes a transitional benefit for Insure Missouri enrollees whose incomes grow to exceed 225 percent of the federal poverty level. Essentially, the plan of coverage would continue to be available to the recipient without a premium subsidy. The bill also would revamp the Missouri Health Insurance Plan, the state’s high-risk pool, to offer coverage to individuals unable to qualify for affordable coverage because of medical underwriting risk. The bill would lower the present caps on pool coverage premiums. For those with incomes less than 300 percent of the federal poverty level, the premium would be capped at the standard risk rate. For individuals with higher incomes, premiums would increase with income to a cap of 125 percent of the standard risk rate. If applicants for an Insure Missouri individual policy are denied coverage because of medical underwriting, they will be offered coverage through the high-risk pool, with premium subsidies available. The bill also redirects the state premium tax paid by some insurers to be earmarked over time to fund the operation of the high-risk pool. In addition, the pool would offer stop-loss coverage to insurers writing individual policies and, during a two-year pilot project, to insurers providing coverage to small employer groups in Springfield and Kansas City. House Bill 2413 is being expanded into a proposed House Committee Substitute that will include changes related to health care transparency regarding both cost and quality (portions of House Bill 2394). Senate Bill 1283 contains similar language to that of House Bill 2413 and would also create an Insure Missouri program. The Senate proposal also contains several other components unrelated to Insure Missouri. The bill proposes a somewhat broader entitlement to coverage. It would increase eligibility for custodial parents up to 100 percent of the federal poverty level, and would give enrollees a larger preventive care benefit. In addition, the bill would make more limited changes to state laws governing the state high-risk pool. The sponsor offered a Senate Committee Substitute at the hearing. Following are some of the other items of note.
Infection Control Proposal Passes House Beginning January 1, 2009, the substitute requires every hospital licensed in the state to develop a methicillin-resistant staphylococcus aureus (MRSA) control program to isolate infected patients; reduce the risk of MRSA transmission; establish procedures, protocols, and education for staff known to be MRSA-colonized or MRSA-infected; and establish an infection-control intervention protocol. FISCAL NOTE: No impact on state funds in FY 2009, FY 2010, and FY 2011. House Approves Stroke, STEMI Center Proposal House Bill 1790 would create the stroke and STEMI systems as part of current state law that designates trauma center levels and directs trauma patients to them. However, the proposal would not require that a hospital be designated as a trauma center to receive stroke or STEMI patients; the systems would be independent. The legislation would permit the Missouri Department of Health and Senior Services to designate hospitals as stroke or STEMI centers of various levels, as defined in state regulations. A DHSS task force on time critical diagnoses has been meeting since December to discuss clinical and regulatory standards to implement the framework created by House Bill 1790 or its companion bill in the Senate. Medical Malpractice Insurance Bill Receives Hearing The bill also prohibits insurers from selling policies with rates which are excessive, inadequate, or unfairly discriminatory. It would allow insurers to group risks by classifications for the establishment of base rates and minimum premiums and to modify actual rates based on individual risks for variations in hazards or expense provisions. Committee Advances Legislation For Date-Rape Drug Testing The bill was expanded into a House Committee Substitute to include many additional bills dealing with birth certificates, child abuse, parental rights and child support. The link: http://www.house.mo.gov/billtracking/bills081/bills/HB1839.HTM Panel Advances Forensic Exam Bill In addition, if the medical provider reasonably believes the sexual offender is the victim’s parent or guardian and the victim is under 18, the medical provider is only required to provide written notice of the exam to the nonoffending parent or guardian. Bill Would Create Licensure Procedure for Clinical Laboratory Personnel Core Public Health Funding Calls need to be made Monday to the Senate Appropriation Committee members to retain the funding or of course we would take more as the Governor recommended ($2.5 million) Senate Appropriations Committee Members:
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