April 13, 2007

Less than six weeks remain in the legislative session, and several of Governor Matt Blunt's (R-MO) priorities remain up in the air. Among them: the overhaul of Missouri's Medicaid system to what is called Missouri HealthNet and the Lewis & Clark Initiative (PDF) - the proposal to sell about $350-Million in assets of the Missouri Higher Education Loan Authority (MOHELA) - to fund capital improvements on college and university campuses. Blunt also wants to be able to sign legislation eliminating state taxes on Social Security benefits.

Blunt says that while he would like to see these issues dealt with as soon as possible, he is aware the legislative process can be slow at times. The Governor remains optimistic, saying he feels good about the prospects of these proposals clearing the General Assembly in the time remaining. The legislative session comes to a close on Friday, May 18th.

Each of these major proposals will generate significant debate. The Senate is threatening to utilize a rare parliamentary maneuver called the “previous question” to shut off debate. If Republicans use this tool, Democrats will shut down the Senate with stall tactics. This will basically stop all bills from moving.

News of interest includes:

CAFO
Supporters of local control over large animal farms hope a newly brokered version of Missouri Senate Bill 364 will not come up for a vote before the end of the legislative session.

The substitute bill, crafted during the Legislature’s spring break last month, offers increased state requirements over concentrated animal feeding operations in exchange for no county restrictions.

The bill also offers some protection to the state’s federally managed lakes, such as Table Rock and Stockton, in that CAFOs would not be permitted within five miles of them. No protection was offered for state historic sites and state parks such as Roaring River, where local residents are opposing a 65,000-chicken CAFO. Amendments are being drafted for public drinking water suppliers to have a two mile buffer zone.

State Sen. Gary Nodler, R-Joplin, said last week: “I have received support for the legislation from the Farm Bureau leaders in Jasper County, but I am also aware that rank-and-file members are not necessarily in favor of that bill.

“I doubt a majority of my constituents support that bill. Of course, they could continue to negotiate and come up with a future compromise. But, as this is stated now, I am not leaning toward voting for the bill.”

He said the issue is more contentious in Southwest Missouri than in any other part of the state because of increasing urbanization and the growing concentration of CAFOs in the region.

The Senate started debate last week on the substitute bill but did not reach a vote after two hours of discussion. It has been placed on the informal calendar, where it could be brought up at any time for a vote.

Medicaid Reform
Late yesterday, the Missouri Senate gave final approval to Senate Substitute for Senate Committee Substitute for Senate Bill 577.  The bill is sponsored by Senate Majority Leader Charlie Shields, R-St. Joseph.  As reported last week, the bill would implement many of the Medicaid reform proposals advanced by Governor Matt Blunt and the Senate Republican caucus.  A description of the original bill appeared in an earlier report.  The bill now will be debated in the House of Representatives.

Some changes in the Senate Substitute include the following.

• Language was modified stating that all participants shall be enrolled in the health improvement plan of their choice rather than stating that the participants shall be enrolled in a health improvement plan.

• Language was added stating that if a provider is unable to collect a co-payment, the division shall make full payment to the provider and not reduce the payment as if the co-payment had been received.  The provider must demonstrate that reasonable efforts were made to collect the co-payment.

• The Medicaid fraud language contained in House Bill 353 was added to the bill.  This is language that the Missouri Hospital Association supports. 

• Language was modified regarding the pay-for-performance payment program to specify guidelines for membership on the 15-member committee.  The committee was enlarged to 18 members to prevent the nine physicians on the committee from having a permanent majority.

Senate Bill 85
Senate Substitute for Senate Committee Substitute for Senate Bill 85, sponsored by Senator Norma Champion, R-Springfield, also was given final approval today in the Missouri Senate.  The bill now moves to the House of Representatives for debate.  As reported yesterday, this bill would create a state system for electronically tracking prescriptions for controlled substances.  As amended, the tracking system does not apply to hospital inpatient use of controlled substances or to prescriptions issued upon discharge from the hospital.

Senate Approves Rape Victims Bill
The Senate gave final approval this week to Senate Substitute for Senate Committee Substitute for Senate Bill 429. The bill now moves to the House of Representatives. One section of the bill would revise standards for forensic evidence-gathering examinations of victims of sexual assault. It would require that these exams be done using an evidence collection kit provided without charge by the state. The victim could not be billed for the cost of the forensic examination. Instead, the cost of the forensic examination would be billed to and paid by the Department of Health and Senior Services. Other medical treatment costs would be billed to the patient or insurer. If the patient was uninsured, the medical treatment costs could be billed to the state Crime Victims’ Compensation Fund. A separate appropriations initiative passed by the House of Representatives and pending in the Senate will add $250,000 to $500,000 to the budget to pay for forensic exams following sexual assault.

The bill originally required that the results of these examinations be reported to the county prosecutor’s office within 72 hours. This potentially would have posed a problem if the offense occurred at the beginning of a three-day weekend, since the prosecutor’s office would not necessarily be available to receive the report.

Bill Barring Illegal Aliens From Receiving Medicaid Advances
This week, the Senate Pensions, Veterans’ Affairs and General Laws Committee approved Senate Committee Substitute for Senate Bills 348, 626 & 461, sponsored by Senator Chris Koster, R-Harrisonville. It concerns illegal immigrants and creates the Missouri Omnibus Immigration Act. Among other things, the bill would bar illegal aliens from receiving any type of public assistance or benefit (such as Medicaid) and from attending all public universities in the state. Illegal aliens also would be denied housing and employment. The legislation creates the Division of Immigration Compliance within the office of the Secretary of State to implement the new law. The bill requires law enforcement officers to inquire into the immigration status of any individual detained for any violation unless the inquiry would significantly extend the duration of the detention. The barring of public assistance portion of this bill is similar to House Committee Substitute for House Bill 889, sponsored by Representative Ed Emery, R-Lamar.

Committee Consolidates and Expands Abuse and Neglect Protections
The House Special Committee on Senior Citizens Advocacy approved legislation which revises various state programs designed to protect “vulnerable persons” from abuse and neglect.

The House Committee Substitute for House Bill 769 consolidates and reworks various state laws regarding the reporting and prosecution of abuse and neglect. The lengthy bill makes a number of changes affecting hospitals and health care providers.

• The legislation adds a new requirement for various individuals to report suspected misappropriation of a patient’s property or money to the state for investigation.

• Under current law, the department is to investigate allegations that pose an imminent danger to health, safety or welfare within 24 hours; this bill revises the standard to require a “prompt and thorough” investigation. If the investigation indicates a crime has occurred, it will be reported by the department to the appropriate law enforcement agency.

• The bill prohibits retaliation against a patient, resident or employee for reporting allegations of suspected violations of laws, standards or regulations.

• Those required by law to report allegations of abuse, neglect or misappropriation will be subject to criminal penalties for failing to report on a timely basis. Knowing concealment of abuse or neglect is made a felony crime.

• Schools of nursing and medicine are authorized to check the state’s employee disqualification list for their students doing clinical rotations in health care facilities.

• The list of crimes that will disqualify a person from working in a position involving contact with patients or residents is expanded. With health care employers obligated under current law to verify compliance, they likely will need to verify current employees’ criminal histories. An amendment to the bill extended the deadline for complying with the new standard.

• Providers are barred from knowingly hiring registered sex offenders after August 28, 2007.

Health Insurance Premium Bill Advances
House Committee Substitute for House Bill 95, sponsored by Rep. David Sater, R-Cassville, was approved by the House Special Committee on Health Insurance this week. This bill would establish a health insurance premium assistance program inside the Missouri Medicaid program and is modeled after a similar program in the state of Oklahoma. The bill requires the Family Support Division to apply for waivers from the Centers for Medicaid and Medicare Services for the purpose of increasing access to health care in Missouri, reforming the Missouri Medicaid Program, and enabling small employers and employed uninsured adults to purchase flexible health care benefit packages through a state premium assistance payment plan.

House Gives First Round Approval to Health Insurance Bill
House Committee Substitute for House Bill 818, sponsored by Rep. Doug Ervin, R‑Kearney, was given first round approval this week by the House of Representatives. This bill revises state laws governing health insurance underwriting. It also expands the ability of associations to purchase health coverage for association members and their dependents. The bill also modifies standards for the Missouri Health Insurance Pool, which is designed to provide a source of coverage for those with high-risk medical conditions. The legislation continues to evolve; the version approved by the Missouri House of Representatives was one of several drafts produced since the filing of the bill. Its scope has narrowed considerably from the early drafts but continues to generate concern among many in the insurance industry.

Two amendments were added dealing with prescription drug formularies and health carrier claims information. The first amendment is identical to House Bill 696 and requires any health carrier or health benefit plan that provides prescription drug coverage to notify enrollees in writing of all additions or deletions in its prescription drug formularies at least 30 days prior to the immediately preceding plan year and for each calendar quarter.

The second amendment is identical to House Bill 791 and Senate Bill 100 and requires health carriers to provide a report of the total number and dollar amount of claims paid in the previous three years within 30 days of an employer's request in a manner that complies with all applicable federal and state privacy laws regarding the disclosure of health records.

Senate Committee Advances MAWD Bill
This week, the Senate Health and Mental Health Committee approved the Senate Committee Substitute for House Committee Substitute for House Bill 39, a bill to extend Medicaid coverage to a portion of the employed disabled population that was displaced by the elimination of the Medical Assistance for the Working Disabled (MAWD) program in 2005. The revamped program would incorporate the use of premiums and employer-sponsored coverage when available and cost-effective. The Senate Committee Substitute reduces the program’s family gross income eligibility cap from 350 percent to 250 percent of the federal poverty level. The original bill was estimated to cover 4,000 people at a state cost of about $11 million. The bill contains an emergency clause and is sponsored by Rep. Chuck Portwood, R-Ballwin.

Senate Committee Nears Completion of Work on the State Budget
The Senate Appropriations Committee nearly completed its work on the 12 appropriations bills that comprise the state’s operating budget for the fiscal year that begins July 1. The committee is expected to complete its work next week and send the bills to the full Senate for debate.

Work on Senate Committee Substitute for House Committee Substitute for House Bills 10 (Department of Health and Senior Services) and 11 (Department of Social Services) is almost complete.  At this point, the Senate Appropriations Committee’s recommendations on the Medicaid budget include funding for the following items.

• The $692 million Medicaid appropriation for hospital services remains unchanged.
• Medicaid coverage to disabled and employed persons under a revamped “Medical Assistance for the Working Disabled” or MAWD program remains unchanged.
• Forensic Examinations for Rape Victims increased from $250,000 to $500,000.
• The Committee approved $5 million in General Revenue to support a “premium offset” program designed to expand access to coverage using both public and private funds.  The intent of the committee is to budget this amount for a six-month period in fiscal year 2008.  The Department of Social Services believes this sufficient since the federal waiver process will take several months to complete.
• Medicaid coverage of 950 former foster children between the ages of 18 and 21 remains unchanged.
• $19 million for covering additional children under the state’s SCHIP program was reduced by $7.8 million, removing funding to improve coverage affordability ($7.8 million).
• $32 million in additional General Revenue designed to raise Medicaid physician fees was reduced to $20 million.
• $1.4 million for a pilot project regarding the use of telemedicine in rural health clinics remains unchanged.
• $12 million for health technology projects and initiatives was reduced to $8.25.

Next Week
Adjournment is May 18th and as usual major agenda items have yet to be dealt with with five weeks remaining.

The Senate will focus on the budget which will take up the majority of the floor time.

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