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April 18, 2008
This week featured dozens of committee hearings as the House and Senate dealt with numerous consent bills. The deadline for placing House consent bills on the Senate calendar is Tuesday of this week. Last week the House sent approximately 80 such bills to the Senate for consideration. Likewise, the House committees this week dealt with dozens of Senate consent bills. Other major activities this week include:
Perfection and passage of an illegal immigration bill by the House. The bill (HCS/ HB 1549, et. al) would provide additional federal training for Missouri law enforcement; place restrictions on obtaining drivers licenses; require certain applications and forms to be filled out in the English language; contains language prohibiting counties and cities from enacting a sanctuary policy; and contains other provisions relating to law enforcement treatment of illegal aliens.
The Senate devoted hours of debate on Wednesday to SCS for SBs 1234 & 1270, which has been dubbed the "Bombardier" tax credit bill. The bill establishes tax credits and business location incentives for mega projects. The bill received two amendments, one relating to the number of required amount of insurance to be provided by the employer and one relating to certain prohibitions against the employment of elected officials and state government employees. The bill was laid over on the informal calendar for further debate in the future.
The Senate finished their deliberations on the budget this week and voted all 13 bills out of the Senate. Appropriations staffers are busy drafting the bills and plan to turn them in Monday or Tuesday for conference review. The House does not want to start conference on the budget until the week of April 28th; that will allow two weeks for conference and voting the bills out of both chambers before the constitutional deadline of 6:00 on Friday, May 9th.
Finally, if Republicans are to keep the governor's office, they will have to overcome a huge early financial advantage amassed by Democrat Jay Nixon, the state Attorney General.
The Nixon campaign has reported raising one-and-a-half million dollars in the first quarter of the year and now has $2.7 million on hand. Nixon had trailed incumbent Governor Matt Blunt, a Republican, badly in fund–raising. But Blunt has dropped out of the race and the Republicans who have stepped in haven't been able to keep up with Nixon's fund–raising pace. In fact, the Nixon campaign bank account totals more than accounts of Republicans Sarah Steelman and Kenny Hulshof combined.
Steelman, the state Treasurer, reports a bank account totaling $1.4 million dollars, helped in large part by a $570,000 personal loan. Hulshof, the 9th District Congressman, reports raising $900,000 in the first quarter with $730,000 on hand.
News this week includes:
Property Tax
Senate President Pro Tem Gibbons SB 711 was voted "DO PASS" in the House Ways and Means Committee.
The bill mandates tax rate roll–backs by all political subdivisions in reassessment years. The manner in which voter approved tax increases are applied to assessed values is modified. The act modifies eligibility and award provisions of the property tax credit and the time–line for assessment and appeal of property taxes.
MO HealthNet Proposals Advanced
House Bill 2354 was advanced by a House Committee this week. If passed, it would create a medical assistance program for certain individuals with a temporary disability or the parent of a minor child. Eligible individuals are required to:
- Have earned income
- Meet certain asset limits
- Have net income that does not exceed the limit for permanent and totally disabled individuals to receive nonspenddown MO HealthNet Program benefits
- Have a gross income of 250% or less of the federal poverty level
The department is required to obtain any necessary waivers or state plan amendments to obtain the federal funding necessary to provide medical assistance.
Providers under the program are allowed to receive enhanced reimbursement for certain services. The enhanced rate will be 120% of the federal Medicare reimbursement rate for new patients and 110% for established patients. In order to qualify for the enhanced reimbursement, the provider must: (1) Become the health care home for a patient; (2) Complete a patient history and consultation for the patient; and (3) File a treatment plan for the patient.
House Bill 2544
A controversial piece of legislation sponsored by the House Local Government (Chair Representative Schneider) has not yet been heard in committee.
However, Representative Schneider has discussed adding her HB 2544 language to a omnibus House local government bill.
This disastrous proposal has far reaching impacts in all local government transactions.
HB 2544 prohibits a political subdivision from imposing a service charge or fee upon another political subdivision except as otherwise specifically authorized by statute.
HJR 70
HJR70 was passed by the House this week and sent to the Senate. HJR70 is similar to Missouri's Hancock amendment, which places a lid on the amount of revenue the state may collect; HJR70 puts a lid on spending. The amount of allowed growth in spending is linked to inflation and population growth. This is a recipe for (more) disaster. Missouri's population growth is slow, and its population is aging. Both education and health care (where the bulk of Missouri's General Revenue is spent) have inflation rates that are higher than the general rate of inflation. The Senate is the locus of action now, and we are hopeful that Senate leadership will not give this issue traction.
Stroke/ STEMI Center Proposal
Two health care proposals were heard on Tuesday in the Senate Health and Mental Health Committee: a proposal to designate Stroke/STEMI centers and a ventilator-associated pneumonia/infection control proposal.
House Bill 1790 would authorize the creation of a "time–critical diagnosis" system for the initial emergency treatment of stroke and STEMI (ST–elevation myocardial infarction) patients. This condition, in which a cardiac artery is completely blocked, accounts for 10 percent of heart attacks. Based on clinical research showing that patient outcomes improve significantly if certain treatments are administered within specific time frames, House Bill 1790 would permit ambulance transport protocols to direct stroke and STEMI patients to hospitals with the capabilities to deliver timely treatment.
The measure 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 hospitals to 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.
The bill is the product of discussions to address concerns raised by various parties. Among other changes language was added to promote the creation of regional or community–based plans developed by area hospitals, physicians and emergency medical services providers. These plans would be based on assessments of area hospitals' capacity to provide the needed treatment within time limits suggested by clinical research. Departmental approval of a regional or community–based plan would allow waiver of state regulations inconsistent with the regional plan.
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, Senate Bill 1233.
Infection Control Bill
House Bill 1546 would regulate infection control data and practices. The bill originally included several provisions that impacted local health centers during committee hearings. In addition, the bill would have required hospitals to test all ICU patients for MRSA and other patients identified by hospital staff as "high–risk" and to isolate MRSA–colonized or infected patients. These requirements are not included in the committee substitute heard in the Senate committee today. Instead, the bill now requires hospitals to develop a plan addressing control of MRSA.
Senate Approves Budget, Increases Insure Missouri Funding
This week, the Missouri Senate debated and approved the 12 appropriations bills that create the state's operating budget for the fiscal year beginning July 1. The Missouri House has already debated and approved its version of the budget. Differences between the Missouri House and Senate positions on budget items must now be resolved before Friday, May 9, when the final budget must be enacted by both bodies. The legislative session ends Friday, May 16.
Most of the budget items affecting healthcare are in House Bill 2010 and House Bill 2011. Budgets for the Missouri Departments of Health and Senior Services and Mental Health are in House Bill 2010 while House Bill 2011 contains the budget for the Missouri Department of Social Services, including funding for MO HealthNet.
The Senate approved $25 million in state general revenue funding for Insure Missouri. This was a net increase of $11 million from the House version. By moving funds between line items, the Senate's action on Insure Missouri effectively gives legislators a broader range of options for negotiating Insure Missouri funding as the budget is completed next month. Budget negotiators would have the flexibility to designate as much as $39 million in general revenue funding or none. The Senate committee also added language to the appropriations bill specifying that Insure Missouri funding would be contingent on the enactment of any one of several bills that create a statutory framework for the program.
Open Meetings Bill Advanced By House Committee
The House Committee Substitute for House Bill 2210 was advanced by a House Committee this week. It would amend the state Sunshine Law governing access to government information. An electronic version of the bill is not yet available.
In its original form, the bill would have required almost all private for–profit or not–for–profit hospitals and their governing boards to abide by state laws requiring public access to their meetings and records. It defined "public governmental body" to include "any organization, corporation or other body receiving at least 51 percent of its annual budget either directly from public tax revenue from governmental bodies or from the United States or any agency or department that is a unit or subdivision of a governmental body."
Jones also agreed to delete language which stated that the open meetings and records law will apply to organizations that manage a public facility or services. This bill needs additional concerns resolved.
- requiring entities subject to the law to provide any data requested in a way that is "easily accessed and manipulated by programs commonly available to the public." This new language appears to force entities subject to the open meetings laws to use programs that are "commonly available to the public," even if a better or more cost–effective proprietary or "uncommon" product is available. Complex hospital accounting and data software often is proprietary, so that it is not "commonly available to the public."
- requiring entities subject to the law to make public records available in an electronic format to the public. This would appear to force public hospitals to transfer paper files into an electronic format.
- defining a "quasi–public governmental body" to include "any association that receives public funding through dues paid by a public governmental body or its members".
Legislators Review Stroke, STEMI Center Proposal
After winning House approval, the House Committee Substitute for House Bill 1790 was presented to the Senate Health and Mental Health Committee this week. The legislation would authorize the creation of a "time critical diagnosis" system for the initial emergency treatment of stroke and STEMI (ST–elevation myocardial infarction, in which a cardiac artery is completely blocked. STEMIs account for about 10 percent of heart attacks).
The premise of the legislation is that clinical research shows that patient outcomes improve significantly if appropriate treatments can be administered within specified time frames. House Bill 1790 would permit ambulance transport protocols to direct stroke and STEMI patients to hospitals with the capabilities to deliver the appropriate treatments within time deadlines. If distance or other factors are such that transport to a designated center could not be completed in time, the patient would go to the nearest hospital, as under current law. The transport standards would be driven by clinical research and implemented through state regulations or a community or regional stroke/STEMI plan.
House Bill 1790 would create stroke and STEMI systems as part of current state law designating levels of trauma centers and directing trauma patients to them. However, the proposal would not require that a hospital be designated as a trauma center in order to receive stroke or STEMI patients; the systems would be independent. The legislation would permit the Department of Health and Senior Services to designate hospitals as stroke or STEMI centers of various levels, as defined in state regulations.
Senate Insure Missouri Proposal Revised
This week, the Senate took no action on the version of Senate Bill 1283 (the Senate vehicle for Insure Missouri) that had been approved by a Senate committee. A new version of the bill was made available at press time in the form of a Senate Substitute for the Senate Committee Substitute for Senate Bill 1283. An electronic version of the new language is not yet available. Debate of the bill is expected early next week.
The bill would authorize a new "Insure Missouri" coverage system for individuals ages 19–65 who have been uninsured for at least six months, within limits set by legislative appropriations, state plan amendments and federal Medicaid waivers. Coverage could be extended to those with incomes of as much as 225 percent of the federal poverty level, if legislators appropriate funding. It would increase eligibility for custodial parents with incomes of as much as 100 percent of the federal poverty level and would give enrollees a preventive care benefit. Custodial parents under 100 percent of the federal poverty level are authorized to be covered under a state plan amendment as opposed to a federal Medicaid waiver. The bill also makes some changes to state laws governing the state high–risk pool.
The bill's sponsor also has made changes to other components of the bill unrelated to Insure Missouri. (Again, the Senate Substitute version was only made available at press time, but following are some of the noteworthy items/changes outlined in the legislation). The bill:
- Creates a Missouri Health Cabinet, comprised of the governor, education commissioner and the directors of the Departments of Health and Senior Services, Mental Health, Social Services, and Insurance, Financial Institutions and Professional Registration
- Requires "serious adverse events in health care" as defined by the National Quality Forum to be reported to a federally–qualified patient safety organization. The data would be kept confidential and used to develop recommended best practices for patient safety improvement. However, in the latest version of the bill, the sponsor added language that
- requires providers not to charge the patient or his or her insurer for the costs associated with any of the 28 adverse events
- Adds three members to the board of the newly created "patient safety organization": an employer or group representing employers, an insurance company or group representing insurance companies, and a representative of the long–term care industry.
- Requires the patient safety organization to report twice annually to the newly created Health Policy Council, which is a subcommittee of the Missouri Health Cabinet.
- Allows the newly–authorized Professional Services Payment Committee to review and make recommendations to the MO HealthNet Division about standards and policies for denying payment to a health care provider for treatment costs associated with preventable errors. Members of the Professional Services Payment Committee have not yet been appointed by the governor. However, in the latest version of the bill, the sponsor added language which no longer limits the definition of preventable errors to "some or all" of those errors listed by the federal Centers for Medicare and Medicaid Services, but now defines "preventable errors" to include "at a minimum" the errors listed by CMS. Therefore, the list of errors for which the state potentially could deny payment becomes open-ended.
- the health care cost and quality language that was modeled on a Florida law has been removed and been replaced with the same health care quality data language included in House Committee Substitute for House Bill 2413.
- require coverage under MO HealthNet for prescribed medically necessary therapy services, including physical, occupational and speech therapy
- promotes telehealth and free clinic services
- creates a tobacco use, prevention and cessation fund
Next Week
Only four weeks remain in the 2008 legislative session.
The House and Senate budget conferees will be named Monday. Negotiations on the budget will continue throughout the week.
The budget will be then again debated by the House and Senate the following week. It must be completed by May 9th.
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