April 21, 2006

The Missouri Senate began and finished its budget debate in one quick day. The Senators worked well together and voted on the bills one by one, until early evening. With only small deviations from the House and Governor's recommendations, the budget bills will be discussed further in conference committees so five Representatives and five Senators may reconcile any differences that do exist between the House and Senate versions of the bills. It is expected that conference committees will begin meeting next week. The Senate's version of the state's budget would increase Medicaid spending about $200 million, including funding to reverse some of last year's cuts in spending on health care for persons with disabilities. Higher education would receive almost 14 million in additional funding for endowed professorships from money expected to come from the sale of assets by the state's student loan agency. It also includes $19.4 million for additional college scholarships. Elementary and secondary education receives an increase of $127.9 million. Total state general funds earmarked for public schools would rise by $182 million, including $15 million for grants to 115 school districts that have fewer than 350 students. The budget also includes $61 million to fund a pay raise package for state employees equaling 4 percent pay increase; nurses would receive a 12 percent increase, and law enforcement personnel would receive an 8 percent increase. The Senate eliminated the 4 percent raise judges were to receive in the house's budget recommendations. The budget must be passed by May 5th.

Due to a University of Missouri-Kansas City organization use of taxpayer money to protest against the state's Medicaid cuts last year, Senate Appropriations cut $285,000 from its budget within the University of Missouri System. Sen. Luann Ridgeway offered the amendment in committee to teach them a lesson because it is illegal to use state money to support a political event, such as the protest and the legislature has "suggested, requested, even pleaded with groups to not use taxpayer money for this type of activity," Ridgeway said during the debate, "It's highly inappropriate for them to try to influence an outcome of a proposal or measure in this manner." The organization sent out a brochure claiming its members marched around the Capitol and were part of a rally on the south lawn of the Capitol grounds. Ridgeway was among the recipients of the brochure, which was sent to her by the university. "This group is supposed to be helping the disabled, but, through their actions, they have stolen from them," Ridgeway said.

New of interest includes:

House Committee Endorses Senate Child Safety Seat Bill

This week, the House Transportation Committee approved House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill 916, sponsored by Sen. Chris Koster (R-Harrisonville). The bill would expand Missouri's requirements to use child safety seats in automobiles, requiring older children to ride in booster seats if they do not meet minimum height, weight and age standards. Several other bills were added to the House Committee Substitute which should have no impact on the original bill.

Donation of Pharmaceuticals

Senate Bill 575 & 714, Senator Scott, was heard in the House Health Care Policy Committee.

The bill slows for redistribution of medications to local public health agencies.

According to our past meetings it is very difficult for local public health agencies to redistribute medications.

Consequently, the bill is revised to apply to free clinics and FQHC's.

Several members had concerns regarding controlled substances and Department of Health produced rules for distribution.

The committee deferred action until Department of Health and the Board of Pharmacy met to discuss changes.

Committees Advance Uncontroversial Bills

House and Senate committees advanced a number of "consent" bills, which are uncontroversial proposals with little or no costs. Each of the following bills previously was approved by either the House or Senate and is being reviewed by the other chamber.

• The Senate Committee Substitute for House Bill 1118 would grant immunity from liability, with certain exceptions, for volunteer health practitioners who are deployed to respond to a declared emergency or to provide emergency care.
• House Bill 1234 would modify repayment standards of a state loan forgiveness program for nursing students by repealing the requirement that 25 percent of the loan would be forgiven for each year of employment in an area of designated need. Proponents said the bill is intended to provide flexibility in using loans to promote nursing.
• The Senate Committee Substitute for House Bill 1437 would update laws on the governance of the Missouri Poison Control Network.
• House Bill 1687 would allow 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.
• House Bill 1707 and Senate Bill 1177 would allow city health department employees to be appointed as local registrars for processing vital records information for the Missouri Department of Health and Senior Services.
• Senate Bill 1155 would extend the expiration date of the Technical Advisory Committee on the Quality of Patient Care and Nursing Practices in the DHSS. The group includes nurses, hospital executives, a physician, a public member and a DHSS representative. It is designed to provide a forum for discussing nursing care issues.

House Rules Committee

Thursday morning the House Rules Committee met and approved several bills for House floor action.

These include:

• Representative Sally Faith’s legislation, HB 1868 establishing the Health Care Responsibility Act requiring Medicaid applicants to identify their employers.


• Senator Clemens' SB 980 - This act creates the urban flight and rural needs scholarship program to provide scholarships for students entering teacher education programs who commit to teaching at schools with a higher than average at-risk population. Teachers must teach two years for every year he or she receives the scholarship.


• Under current law, student loans are available to students who have applied to be a full-time nursing student. This act redefines eligible student so that only students who have been accepted as full-time nursing students are eligible for the loans. Under current law, 25% of the loan is forgiven for each year of full-time employment as a licensed nurse. This act allows for forgiveness of all of the financial assistance in the event of full-time employment. This act is similar to HB 1234 (2006).


• Senator Gibbon's SB 1084 - This act extends the sunset date for the Healthcare for Uninsured Children Program (CHIPS) from July 1, 2007 to June 30, 2008. This act also extends the sunset date for the consumer-directed personal care assistance services program for non-Medicaid eligible clients from June 30, 2006 to June 30, 2008. This date corresponds to the sunset date for the state Medicaid program.


• Senator Koster's SB 916 - Child Restraint legislation enacts various provisions relating to the safe operation of motor vehicles to ensure the safety of highway workers, emergency workers and other motorists.


• CHILD PASSENGER RESTRAINT LAW - This act modifies the law with respect how motorist must restrain children in motor vehicles. This act modifies the law with respect to the use of child passenger safety restraint systems and booster seats. The act requires children of certain ages, weights and heights to be restrained by either a child passenger restraint system, booster seat or safety belt.

AGE / WEIGHT / HEIGHT CLASSIFICATION
1. LESS THAN 4 YEARS OLD: This act requires children less than four years old, regardless of weight, to use an appropriate child passenger restraint system.
2. LESS THAN 40 POUNDS: The act requires children weighing less than 40 pounds, regardless of age, to be secured in a child passenger restraint system appropriate for the child.
3. LESS THAN 8 YEARS OLD/80 POUNDS OR UNDER 4'9": Children (ages 4-7) and who weigh at least 40 pounds but less than 80 pounds, and are less than 4'9" tall must be secured in a child passenger restraint system or booster seat appropriate for that child.
4. GREATER THAN 80 POUNDS OR TALLER THAN 4'9": Children who are at least 80 pounds or children taller than 4'9" shall be secured by a vehicle safety belt or booster seat appropriate for that child.

The act allows a child to be transported in back seat without a booster seat if the child is secured with a lap belt if the vehicle is not equipped with combination lap and shoulder belt for booster seat installation.
A violation of the child passenger restraint/booster provisions is an infraction and the fine is $50 plus court costs. The fine for violating the safety belt provision of the act is $10. Charges for violating the child passenger restraint and booster seat provisions shall be dismissed or withdrawn if the driver provides evidence that he or she acquired a child passenger restraint system or booster seat prior to or at his or her hearing. The act does not apply to public carriers for hire or students 4 years of age or older who are passengers on a school bus (Sections 307.178 and 307.182).
The act provides that if there are more persons than there are seat belts in the enclosed area of a motor vehicle, then the passengers who are unable to wear seat belts shall sit in the area behind the front seat unless the vehicle is designed only for a front-seated area. This provision does not apply to passengers who are accompanying an intermediate driver's license holder. Under current law, all passengers accompanying a intermediate driver's license holder must be properly restrained. (Subsection 7 of Section 307.178). The act also modifies Subsection 6 of Section 307.178 to apply the $10 fine to persons rather than just drivers.
The child seat provisions of the act are substantially similar to HB 1165 (2006), SS/SCS/HCS/HB 518 (2005), SCS/SB 221 et al (2005), SB 710 (2004), SB 9 (2003), SB 647 (2002) and SB 549 (2001).


• HIGHWAY WORK ZONE SAFETY - This act increases various penalties for offenses occurring within highway work zones or construction zones. Under this act, any person convicted of a second or subsequent moving violation within a work zone shall be assessed a fine of $75. The act provides that a person who is convicted of speeding or passing a vehicle within a work zone when a highway worker is present a second or subsequent time shall be assessed a fine of $300 in addition to any other fine authorized by law (Section 304.582). The act also creates the crime of "endangerment of a highway worker". The act provides that if a person commits the offense of endangerment of a highway worker in which no injury or death results the person shall be subject to a fine of not more than $1,000 and shall have 8 points assessed to their driver's license. The person shall be guilty of aggravated endangerment of a highway worker if a death or injury results. If an a highway worker is injured or killed in a workzone, the offender shall be subject to a fine of not more than $5,000 for an injury and not more than $10,000 if death resulted.

Under the act, a person commits the offense of endangerment of a highway worker if the motorist:

1. Exceeds the posted speed limit by 15 mph or more;
2. Passes another vehicle in a work zone and such offense results in the death or injury of a highway worker;
3. Fails to stop for a work zone flagman or fails to obey traffic control signals erected in the work zone;
4. Drives through or around a work zone by any lane not clearly designated to motorists for the flow of traffic through or around the work zone;
5. Physically assaults or attempts to assault a highway worker with a motor vehicle or other instrument;
6. Intentionally strikes or moves barrels, barriers, signs or other devices erected to control the flow of traffic for a reason other than avoidance of an obstacle, an emergency or to protect the health and safety of another person; or
7. Commits various offenses in which points may be assessed under Section 302.302 (Section 304.585).

The act provides for the assessment of 8 points for an endangerment of a highway worker violation and 12 points for an aggravated endangerment of a highway worker violation (Section 302.302).


• STREETCAR - The act repeals the duty of streetcar motorman to stop or yield such streetcar to passing emergency vehicles (Section 304.022).


• MOVE-OVER LAW - This act increases the penalty on motorists who fail to move over when approached by an oncoming emergency vehicle and motorists who fail to move over when approaching a stationary emergency vehicle from a Class B misdemeanor to a Class A misdemeanor (Section 304.022).


• SCHOOL BUS - This act enhances the penalties for those who fail to stop for school buses that are loading or unloading children. Under the act, any person who fails to properly yield for a school bus and the failure to yield results in the injury of any child shall be guilty of a Class D felony. Any person who fails to properly yield for a school bus where such violation causes the death of any child shall be guilty of a Class C felony. This provision is contained in SB 1079 (2006)(Section 304.070).


• CLUTCH'S LAW (FAILURE TO YIELD) - This act imposes an additional penalty and driver's license suspension on any person failing to yield the right-of-way when the violation results in physical injury, serious physical injury, or death to a person (Section 304.351). This act is commonly known as "Clutch's Law". This section has an effective date of January 1, 2007.

House Professional Registration Omnibus Bill Finds New Life in New Vehicle

The House Professional Registration and Licensing Committee this week passed out of committee its new omnibus bill, House Committee Substitute for Senate Bill 1124. The committee attached many of the provisions of its previous omnibus bill (House Committee Substitute for House Bill 1660 & 1269) to this new bill. House Committee Substitute for House Bill 1660 & 1269 sits idle on the House Informal Perfection Calendar and is now considered dead.

The new omnibus bill would accomplish the following if passed:

• revamps procedures and standards governing the state's suspension of occupational and professional licenses for failure to pay required state taxes
• authorizes the State Board of Nursing to pursue expedited licensure actions against a nurse who poses a clear danger to the public
• directs the Missouri State Board of Nursing to expunge complaints against a nurse if the board's investigation concludes the matter is not grounds for disciplinary action against the nurse's license. This would give nurses the same rights as physicians and dentists to have unsubstantiated complaints removed from their records.
• authorizes pharmacists to be involved in designing, implementing, and monitoring a medication therapeutic plan under a physician's prescription order and to administer vaccines under a written protocol
• requires long-term care facilities, home health agencies, nursing staffing agencies and subcontractors, and employers of nurses in general to report final disciplinary actions against a physician, dentist, podiatrist, psychologist, pharmacist or nurse to the appropriate licensure board. Currently, only hospitals and ambulatory surgical centers are required to file such reports. The appropriate licensure board also would be notified of the termination of contracted staff services because of complaints or reports.
• expands the authority of physician assistants to practice outside of the direct supervision of a physician

House Advances Tax Deduction for Coverage

The House gave first-round approval to legislation creating a state income tax deduction for health insurance premiums taxpayers pay to insure themselves and their spouses and dependents. The bill is the House Committee Substitute for House Bill 1677. The projected state cost of the measure is $28 million in the first year of implementation, growing to $84 million in state fiscal year 2009.

Budget

As of this writing, the House and Senate members of the conference committee had not yet been named.

The 5 House and 5 Senate members are divided with 3 Republicans and 2 Democrats serving for each side.

Difference between the House and Senate will be resolved by the conferees and sent back for approval by each chamber.

Physician Supervision

The Senate gave first-round approval yesterday to a bill that would modify physician supervision requirements for physician assistants. The Senate Committee Substitute for Senate Bill 1032 would allow physician assistants to practice outside of the direct supervision of a physician. It sets a number of standards governing the process, such as a maximum distance between the supervising physician and physician assistant and the percentage of time the two should practice in the same facility.

Background Check

The Senate also gave first-round approval to Senate Bill 838, which would raise the Missouri Highway Patrol's fee for criminal background checks performed on prospective employees. Such checks currently are required for health care workers involved in patient care. The fee increase for the Missouri record checks would be phased in over several years, while the fee for a fingerprint based national search would decrease by $5.

Senate Passes Budget Bills

The Senate completed its debate of the appropriations bills that comprise the state's operating budget for the fiscal year beginning July 1. The bills return to the House, setting the stage for late-session negotiations to resolve differences between the House and Senate versions of the bills.

There are few differences between the House and Senate regarding Medicaid funding affecting hospitals. Where there are differences, the final negotiated amount will be set within the parameters of the House and Senate positions.

• The Senate plan would spend $159 million more than the current year's budget to fund the higher cost of continuing current Medicaid programs. Another $93 million would fund expected growth in Medicaid caseloads.
• The Senate allocated $25 million in state funds to promote the use of information technology in health care; the House would spend $1.7 million for that purpose.
• The Senate earmarked $300,000 in general revenue to modify the premium schedule for State Children's Health Insurance Program participants.
• The Senate and the House concur on funding a restoration of Medicaid coverage for about 3200 disabled, employed Missourians. In 2005, legislators eliminated a more expansive program of this type that covered about 17,000 disabled Missourians. They also agree on restoring coverage of wheelchair batteries and accessories and eyeglasses, which were eliminated in last year's cuts.

The House had added $5 million in state funds to improve Medicaid payment rates for physicians. The Senate deleted the money, setting the stage for conference committee negotiations.

Committee Resurrects Defeated Mandatory Overtime Bill

This week, the House Health Care Policy Committee voted to reconsider its defeat last week of House Bill 1106. The committee then approved the bill. The legislation creates standards for mandatory overtime for health care workers.

Hospitals and the Missouri Nurses Association had testified in opposition to the bill, arguing that new hospital licensure regulations on this topic make the bill unnecessary. The new regulations were developed by the Technical Advisory Committee on the Quality of Patient Care and Nursing Practices. 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 bill's primary proponent is Nurses United, a nursing labor union.

The bill is not expected to advance in the legislative process.

Committee Reviews Association Health Plan Proposal

House Bill 1827 was reviewed by a Senate committee this week. It revises group health insurance laws to promote policies of coverage that can be sold to associations or other groups of affiliated purchasers.

Committee Reviews Bill on Women's Health Care Services

This week, a Senate committee held a hearing on Senate Bill 943. It would require hospitals to furnish each sexual assault victim with medically and factually accurate information about emergency contraception and immediately provide the complete regimen of emergency contraception to the victim who requests it. Violations would incur fines by the Department of Health and Senior Services.

The bill also prohibits governmental entities from restricting access to birth control and creates a women's health services program. Also, it mandates that licensed pharmacies have a duty to properly fill the valid and lawful prescriptions of customers. Pharmacy employees and prospective employees would be required to notify in writing of categories or types of prescriptions that he or she would decline to fill due to sincerely held religious beliefs. The pharmacy may attempt to accommodate the employee's beliefs so long as such accommodation can be made without causing undue hardship to the pharmacy or its clients.

Committee Reviews Medicaid Reform Commission Proposals

A House committee reviewed two bills that were recommendations of the Missouri Medicaid Reform Commission. Senate Bill 901 would create a legislative Joint Committee on Health. The committee would broaden the purview and continue the work of the Medicaid Reform Commission that met during the latter half of 2005.

The Senate Committee Substitute for Senate Bills 858 & 868 would create a new state fund to support initiatives to expand the use of health information technology. The bill creates the new fund and places restrictions on its use; appropriating the money will be considered separately. Legislators have revised the bill to preclude public officials from receiving a financial benefit from health information technology spending. Also, 25 percent of annual spending from the fund will be targeted for medically underserved populations and communities. The fund would be administered by the Department of Social Services.

Next Week

14 working days remain in the 2006 legislative session as lawmakers rush to have their priorities approved for this year.

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