April 15, 2006

The Missouri General Assembly is now in the final 30 days of the 2006 session.

Major issues remain to be decided including the budget eminent domain and dividing up the funds from the Missouri Health Education Loan Authority if the sale is approved.

An impasse has developed between the House that wants to pay off debt and fund higher education and the Governor and Senate who also want to fund education as well as healthcare.

These proposals will consume the majority of the remaining time of the legislature.

Conferees will be named next week for House/ Senate budget committee negotiations.

New of interest includes:

The House began, but had not yet completed at press time, its debate of the House Committee Substitute for House Bill 1837. The bill revamps Missouri's regulation of medical malpractice insurers and expands on the current obligation of medical malpractice insurers and self-insured plans to provide data on their operations and claims experience. An amendment was considered, but withdrawn, to create a board to assess the future feasibility of creating a health care stabilization fund modeled on the quasi-public coverage model used in Kansas. Action is pending on an amendment to grant income tax credits to physicians to offset part of their medical malpractice insurance premium increases.

This morning, the Senate Aging, Families, Mental & Public Health Committee approved several uncontroversial bills that previously had been approved by the House of Representatives. Among them was House Bill 1515 which would require physicians to report any collaborative practice or physician assistant agreements they have to the Missouri Board of Registration for the Healing Arts. The board is authorized to conduct random audits to determine whether the agreements are in compliance with state standards.

After debate spanning several days, the Senate gave first-round approval to Senate Bill 1210, which expands Missouri's powers to identify and penalize Medicaid fraud perpetrated by health care providers. A final amendment adopted today would direct a state committee to assess the feasibility of creating an Office of Inspector General in Missouri.

Senate Tourism, Economic Development and Local Governments Committee

Senator Griesheimer committee heard the following bills:

SCS/House Bill 1707 - Currently, the State Registrar of Vital Statistics may appoint local registrars, each of whom must be person employed by a county health agency. This act allows local registrars to be an employee of either a county or city health agency.

Currently, the recorder of deeds for Jackson County must have a Kansas City office and must record all instruments affecting property within a certain area at such office. This act gives the recorder discretion about recording such instruments at the Kansas City office. Such deeds and instruments may also be recorded at the office located at the county seat office of Jackson County.

This act is similar to SB 1177 (2006) and portions of SCS/SB 1011 (2006).

No Witnesses

Appropriations

The Senate Appropriations Committee did remove the language Representative Susan Phillips added in the house regarding family planning / anti abortion language. Your contacts made the difference.

Unfortunately, the extra $200,000 added for core public health services was removed from the Senate version. As soon as the House Senate conference committee members are named contacts will need to be made to restore the recommendation to the House version, and take the Senate language for the appropriation.

Establishing Limits on Total State General Revenue Appropriations

HJR 48, Representative Bearden, was approved in the House Special Laws Committee. It will have problems in the House and it will not pass the Senate.

HJR 48 - his proposed constitutional amendment 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, 67% of the excess is to be transferred to the Cash Operating Reserve Fund and 33% to the Budget Reserve Fund, which are created by the substitute. 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 within five years.

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

FISCAL NOTE: Estimated Cost on General Revenue Fund of $131,400 in FY 2007, $0 in FY 2008, and $0 in FY 2009. No impact on Other State Funds in FY 2007, FY 2008, and FY 2009.

PROPONENTS: Supporters say that the bill will limit the growth of government spending, provide long-term fiscal planning, provide rainy day funds, help to balance the economic highs and lows, protect programs and funding, provide refunds to taxpayers, and create a better business environment. The bill doesn't apply to local governments and will not limit the power of the legislature to appropriate funds between programs.

Testifying for the bill were Representatives Bearden and Lager; Taxpayers Research Institute of Missouri; Associated Industries of Missouri; and Dr. Barry Paulson, Americans for Prosperity Foundation.

OPPONENTS: Those who oppose the bill say that it places a new constitutional lid on state spending growth that contains an excessive growth restriction formula and is similar to the TABOR adopted by Colorado that hurt the state. Missouri already has a current lid, called the Hancock Amendment, which protects taxpayers. The bill ties state spending to population growth plus inflation, is constitutional, and has a ratchet effect since Missouri's future spending would be tied to today's historic budget levels. Establishing the Rainy Day Fund is beneficial to the state. The bill could result in an increase in property taxes and erode Missouri's ability to fund the new education formula, public transportation, highways, infrastructure, parks, health care, mental health services, and other needed programs. The bill might work for a while, when times are good, but inevitably will become a restriction that prevents needed accommodations to changing economic circumstances and cause the burden for vital services to shift to the local level and individuals.

Testifying against the bill were Missouri Budget Project; AARP; Cooperating School Districts of Greater St. Louis; Covenant House Missouri; Missouri Federation of Teachers and School-Related Personnel; Missouri AFL-CIO; Brad Young; Megan Payne, Lutheran Family and Children's Services of Missouri; Missouri National Education Association; Missouri School Boards' Association; Missouri Association of School Business Officials; Missouri School Administrators Coalition; Southwest Center for Independent Living; Missourians for Tax Justice; Missouri Association for Social Welfare; Citizens for Missouri's Children; American Federation of State, County, and Municipal Employees Council 72; Greater Kansas City Chamber of Commerce; Paraquad, Incorporated; Maternal, Child and Family Health Coalition; and Missouri Planning Council for Developmental Disabilities.

Appropriations Committee Advances Budget

The Senate Appropriations Committee finished its review of the state budget this week. The budget bills next will be debated in the Senate.

The committee made no major changes to Medicaid funding sources or amounts directly affecting providers. If the committee's recommendations are adopted by the full Senate, many of the budget items affecting providers will not be subject to conference committee negotiations, as the House and Senate positions are the same.

Committee Endorses Fee Increase for Employee Criminal Background Checks

A Senate committee approved Senate Bill 873 this week. Among other changes, it would increase the Missouri Highway Patrol's fee for conducting criminal background checks. Health care providers are mandated by law to get criminal background checks when hiring employees who have contact with patients.

At the March 6 hearing on the bill, proponents of the measure argued that the MHP's $5 fee for a criminal background check is one of the lowest in the nation and has not been raised for many years. Senate President Pro Tem Michael Gibbons, R-Kirkwood, who is sponsoring the legislation, said the MHP has seen a large increase in demand for background checks and needs the funds to upgrade its system.

Committee Endorses Tracking of Medicaid Enrollees by Employer

The House Committee Substitute for House Bill 1868 was approved by a House committee this week. It directs the Missouri 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 spouses and dependents who are covered under the Medicaid program and the availability of employer-sponsored coverage. Individual workers or dependents would not be identified.

Senate Approves Medicaid Provider Fraud Bill

After debate spanning several days, the Senate unanimously approved the Senate Substitute for Senate Committee Substitute for Senate Bill 1210, which expands the state's powers to identify and prosecute Medicaid fraud perpetrated by health care providers.

Among other components, the bill would create a Missouri Civil False Claims Act that mirrors a federal antifraud law of the same name. Congress recently enacted significant financial incentives for states to adopt such laws, which allow private citizens with information about alleged fraud to join in the government's recovery lawsuit and receive a share of any award or settlement. The bill also would create new whistleblower protections for individuals assisting in a Medicaid fraud action or investigation. In addition, stiffer criminal penalties are established for Medicaid fraud.

One of the Senate amendments directs a state committee to assess the feasibility of creating a Missouri Office of Inspector General.

Medical Malpractice Insurance Bill Moves to the Senate

The House gave final approval and sent to the Senate the House Committee Substitute for House Bill 1837. The bill revamps Missouri's regulation of medical malpractice insurers and expands on the current obligation of medical malpractice insurers and self-insured plans to provide data on their operations and claims experience. Legislators made several changes, including limiting the scope of some of the bill's requirements to apply only to physician liability coverage. An amendment was considered, but withdrawn, to create a board to assess the future feasibility of creating a health care stabilization fund modeled on the quasi-public coverage model used in Kansas.

Legislators Approve and Remove HMO High-Deductible Coverage Proposals

This week, the Senate approved and sent the Senate Committee Substitute for Senate Bill 1103 to the House of Representatives. The legislation authorizes HMOs to sell high-deductible policies of coverage. Providers are lobbying legislators to require that payment rates of existing HMO contracts be renegotiated for these new high deductible enrollees.

Before approving the House Committee Substitute for House Bill 1651, a large bill on insurance regulation, the House Insurance Policy Committee voted to remove language authorizing HMOs to sell high-deductible policies of coverage.

Committee Review Bill on Occupational License Revocations for Tax Violators

A House committee this week held a hearing on House Bill 2118, which revamps the procedures used by the state to suspend the professional and occupational licenses of those who fail to pay state taxes. The General Assembly passed a law on this topic several years ago and the process of implementing it has presented challenges for licensure boards, licensees and hospitals and other facilities that must verify that health care practitioners are licensed.

Witnesses urged legislators and state administrators to adopt procedures to allow health care providers to identify licensees with pending suspensions before those suspensions take effect. This would give the providers time to take corrective action.

Immunizations

On Wednesday, Representative Susan Phillips attached her childhood immunizations bill, HB 1701, to Senator Champion's SB 878 in committee.

I have visited with Senator Champion and she has agreed that this amendment needs to be removed.

Veterans Birth Certificate

I visited again with Representative Wilson this week regarding his veteran birth certificate legislation.

Wilson may attempt to amend the bill onto another vehicle.

Employee Coverage Legislation is Approved

The Senate Small Business, Insurance & Industrial Relations Committee passed a bill this week on employee health coverage. The Senate Committee Substitute for House Bill 1101 would authorize insurers and employers to offer employee health insurance coverage that includes lower deductibles for employees who do not use tobacco products.

Insurers would be required to furnish a report on the number and amount of claims paid in the previous three years when requested by an employer. The information would not identify individuals and would be subject to federal and state laws governing disclosure of personal health information.

Next Week

The Missouri General Assembly is in its final three weeks of the legislative session for 2006. The budget needs to be completed by May 5th. The general attitude seems to be "go slow as this is an election year". Generally this is not a bad scenario. As previously reported due to the Easter Break, we will resume session on Tuesday, April 18th.

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