April 25, 2008

Only three weeks remain in the 2008 legislative session and the House and Senate operated in a slow and causal manner this week. Committees in both chambers are still conducting hearing on bills originating in their respective chambers. The House and Senate calendars reflect few bills from the opposite chamber poised for floor debate.

The House and Senate named the conferees for the budget bills and began their conferees to negotiate differences in recommendations between the House and Senate.

News this week includes:

Senate Insure Missouri Proposal Receives Initial Approval
This week, the Missouri Senate completed initial debate on Senate Substitute for Senate Committee Substitute for Senate Bill 1283.  The bill now needs only a final vote from the Senate (expected Monday) before moving to the Missouri House for debate.  The bill contains several provisions including Insure Missouri, health care quality data transparency and adverse events reporting. 

Successful amendments included:

• Language that would permit advance practice nurses to prescribe certain controlled substances under the auspices of a collaborative practice arrangement with a physician
  
  
• Language increasing the membership of the MO HealthNet Oversight Committee from 18 to 29.  Additional members would include two more physicians, and one representative for each of the following:  optometrists, nurses, mental health professionals, rural heath clinics, rural not-for-profit health networks, long-term care facilities, federally qualified health centers, durable medical equipment industry, physical therapists, and a MO HealthNet managed care organization.  This amendment also included language requiring that any physician member must be “board certified” in their specialty.
  
  
• Mandates insurers reimburse services provided through telehealth in the same manner they would reimburse a standard office visit or consultation by the provider or specialist.
  
  
• Requires 25 percent of the monies in the tobacco use prevention and cessation trust fund be used for youth smoking prevention programs
  
  
• Adds regulation of marketing of Medicare Advantage Plans
  
  
• Requires parents of sixth grade girls be informed of issues concerning the human papillomavirus and available vaccine
  
  
• Requires the Department of Health and Senior Services to establish an influenza vaccination pilot program for Missouri public schools
  
  
• Requires the MO HealthNet program not to require prior authorization, step therapy, generic substitution or quantity limits for immunosuppressive drugs without express written or oral notification and the documented consent of the health care professional and the patient
  
  
• Requires that 93 percent of the funds for Insure MO be used to fund payments for health care services.

In its main provisions, 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.
  
  
• Make some changes to state laws governing the state high-risk pool.
  
  
• 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. 
  
  
• 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.
  
  
• Includes health care quality data standardization language. 
  
  
• This language creates new standards on disclosing health care quality data.  It reflects the 19 quality of care data requirements found in a recent agreement between physicians, insurance companies and business groups titled “The Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs.” 
  
  
• promotes telehealth and free clinic services
  
  
• creates a tobacco use, prevention and cessation fund

House Local Government
House Bill 2544 by Chair Schneider was not heard on Wednesday.

This bizarre bill prohibits a political subdivision from imposing a service charge or fee upon another political subdivision except as otherwise specifically authorized by statute.

In visits with Representative Schneider I attempted to let her know of intergovernmental agreement and she revised the bill to only prohibit charges for water and sewer hook-ups which is still ridiculous.

Immigration
Senate Bill 858 was heard Wednesday in the House Immigration Committee.

This is an election year and the Republican leadership is pushing to have an immigration bill passed this year.

SB 858 modifies the law relating to illegal immigrants.

SANCTUARY Municipalities are barred from adopting policies designed to give aliens sanctuary when they are present in violation of federal immigration laws. Those municipalities that adopt sanctuary policies shall be ineligible for any grants provided by the state.

Law enforcement officers shall report arrested individuals to the United States Citizenship and Immigration Services if the officer has probable cause to believe the individual is not legally present in the United States. Those arrested for domestic violence shall not be reported until the person is convicted of domestic violence. (Section 67.307)
TAX WITHHOLDING EXEMPTIONS Under current law, an employee is entitled to the same number of personal and dependency withholding exemptions as are allowed for federal income tax purposes. This act limits the number of personal and dependency withholding exemptions, for state income tax purposes, to not more than ten. (Section 143.191)

PUBLIC EDUCATION Illegal aliens are barred from attending all public universities in the state with the exception of those born on or before August 28, 2008, that have completed three full semesters in a Missouri high school immediately before applying to the university. (Sections 172.360, 174.130, 175.025, 178.635, 178,780, and 178.785)

PUBLIC BENEFITS Under federal law, unlawfully present aliens are not eligible for state or local public benefits with certain exceptions. This act reiterates federal law stating that such aliens are ineligible and the exceptions.
Applicants for benefits shall provide proof of citizenship, residency, or lawful presence in order to receive benefits. If applicants cannot provide such proof they can sign an affidavit attesting to their status and shall be eligible to receive temporary benefits until their status can be determined.

If an applicant is an alien, the applicant shall not receive benefits until lawful presence is verified by the federal government. (Section 208.009)

EMPLOYEE MISCLASSIFICATION This act bars employers with 5 or more employees from knowingly misclassifying employees. Employers must submit federal IRS 1099-MISC forms to the Department of Revenue and penalties for failing to do so are provided. The Attorney General has the power to investigate alleged misclassifications and enforce the section. A process is established by which the Department of Labor may receive complaints and forward them to the Attorney General if they decide the complaint has merit.

The state carries the burden of proving that the employer misclassified the worker and there is a rebuttable presumption that an unauthorized alien is an employee under the act and shall be treated so if the employer cannot produce an I-9 form verifying the legal status of the worker or other forms verifying the individual is an independent contractor. Injunctions may be sought and employers shall be charged $50 per day per misclassified worker up to a maximum of $50,000 for violations. Penalties are increased for repeat offenders in an amount of $100 per day per misclassified worker up to $100,000. (Sections 285.309, 285.500, 285.503, 285.506, 285.509, 285.512, 285.515, and 285.518)

EMPLOYMENT Employers are barred from employing unauthorized aliens. Violators are subject to the suspension of their business permits and licenses or exemptions. In order to correct the violation and have permits and licenses reinstated, the employer shall terminate the employment of the alien or request a second verification from the federal government, sign a sworn affidavit stating that the violation has ended, and submit documentation confirming the entity is enrolled in a federal work authorization program.

Violators under contract with the state shall have their contracts voided and shall be barred form contracting with the state for three years. Subsequent violations shall result in a void contract and a permanent bar from contracting with the state.

Business entities shall participate in a federal work authorization program in order to be eligible for state contracts. Public employers shall also participate in such a program.

Contractors are not liable for unauthorized aliens hired by their subcontractors if the contract binding the two parties affirmatively states that the subcontractor does not knowingly hire unauthorized aliens.

(Sections 285.525, 285.530, 285.535, and 285.540 shall become effective January 1, 2009)

OSHA TRAINING Contractors and subcontractors who contract to work on public works projects shall provide a 10 hour Occupational Safety and Health instruction and safety program, or similar program approved by the department of labor, for their employees. All employees working on projects must have completed the course within 60 days of beginning work and shall keep evidence of completion on the worksite.

Contractors and subcontractors in violation will forfeit $2,500 plus $100 for each worker employed for each day the worker is employed without training to the public body awarding the contract.

Public bodies and contractors may withhold assessed penalties from contractors and subcontractors respectively.
This section becomes effective on August 28, 2009.

(Section 292.675)

DRIVER'S LICENSES The Department of Revenue shall not issue any driver's license to illegal aliens nor to persons who cannot prove lawful presence. A driver's license issued to an illegal alien in another state shall not be honored by the state of Missouri and the Department of Revenue for any purpose. The state of Missouri hereby declares that granting drivers licenses to illegal aliens is repugnant to the public policy of Missouri and therefore Missouri shall not extend full faith and credit to out-of-state drivers licenses issued to illegal aliens. (Section 302.063)

BAIL There shall be a presumption that releasing a person under any conditions set by the court, pending trial, appeal, or other proceeding, shall not reasonably assure the person's appearance if the judge reasonably believes the person is an illegal alien. If such presumption exists, the person shall be jailed until he or she provides verification of his or her lawful presence in the United States to rebut such presumption. If the person adequately proves his or her lawful presence, the judge shall review the issue of release again. However, if the person cannot prove his or her lawful presence, the person shall continue to be jailed until discharged in accordance with the law. (Section 544.470)

HARBORING Individuals are barred from transporting or harboring any alien knowing or in reckless disregard of the fact that the alien has come to, entered, or remained in the U.S. in violation of the law.

Individuals are not liable for delivering the alien to a medical facility, soup kitchen, institution for crisis counseling and intervention, or short-term shelter, or for sheltering such an alien who has been the victim of abuse.(Section 577.722)

COMMUNICATIONS WITH THE FEDERAL GOVERNMENT The act bars government entities, political subdivisions, and government officials from interfering with any communication with the federal government regarding the citizenship or immigration status of any individual. The state shall not fund government entities, agencies, or political subdivisions that have policies that would interfere with such communications. (Section 650.681)

Sections relating to employee misclassification are subject to an emergency clause.

This act is similar to SB 1250 (2006), SB 348 (2007), SB 626 (2007), HB 1346 (2008), HB 1463 (2008), HB 1395 (2008), HB 1736 (2008), HB 2320 (2008), SB 750 (2008), SB 751 (2008), SB 1268 (2008), SB 1269 (2008), SB 929 (2008), and SB 1138 (2008).

Forensic Exam Bill Approved by House Committee
Legislation modifying provisions on forensic examinations of sexual assault victims was approved by a House Committee this week. The bill has already been approved by the Senate.  The House Judiciary Committee included Senate Bill 1159’s language in the 214 page judiciary omnibus bill now known as House Committee Substitute for Senate Bill 976.  The omnibus bill contains several bills and will now be the primary legislative vehicle for any judiciary bill.  An electronic version of the new House Committee Substitute omnibus bill is not yet available.  The bill now moves to the full House for debate.

The forensic examination and sexual assault victim language codifies an executive order from Gov. Matt Blunt by moving payment to medical providers for forensic exams of sexual assault victims from the Missouri Department of Health and Senior Services to the Missouri Department of Public Safety. Medical providers are reimbursed for the exam’s cost with money from the newly created Sexual Offense Forensic Examination Compensation Fund. The fund consists of money from the crime victims’ compensation fund, general revenue and federal funds.

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.

House Advances Abortion Bill- FYI!
The House advanced a proposal this week regulating abortion. House Committee Substitute for House Bill 1831 would require that abortions cannot be performed or induced without the voluntary, informed and uncoerced consent of the patient at least 24 hours before the abortion. The bill also revises the definition of "abortion" and requires an obstetric ultrasound to be conducted prior to the 24-hour waiting period for an abortion.  The bill now moves to the Senate for debate.

The bill would also create the crime of knowingly coercing a woman to seek or obtain an abortion. Such coercion includes committing or threatening to do the following:

• abusing or stalking the woman
• committing an offense against the woman or her family
• filing for divorce
• refusing to pay child support or provide financial support
• taking the unborn child once born or the mother’s other children
• changing the woman’s house or existing residence
• discharging the woman from her employment
• revoking a scholarship awarded to the woman

House Committee Advances Smoking Prevention Proposal
House Bill 1709 would create the Tobacco Use Prevention, Cessation, and Enforcement Trust Fund to be used by the Missouri Department of Health and Senior Services for a comprehensive tobacco control program. Beginning July 1, certain payments to the state under the Master Settlement Agreement of 1998, the agreement between several states and leading tobacco manufacturers, would be deposited into the fund.  The bill now advances to the full House for debate.

House Advances Proposal Prohibiting Public Assistance For Illegal Immigrants
House Committee Substitute for House Bill 1626 was advanced this week by the Missouri House. The bill now moves to the Senate for debate.  If passed, this bill would prohibit individuals who are not citizens or permanent U.S. residents or who do not possess lawful immigration status from receiving state or local public assistance, unless it is mandated under federal law. Documented evidence accepted by the Department of Revenue for obtaining a driver’s license would suffice as proof of citizenship, permanent residency or lawful immigration status when applying for benefits. Individuals could temporarily receive public assistance for a maximum of 90 days while obtaining the necessary documentation or indefinitely if the applicant provides a copy of a completed birth certificate application that is pending.

Midwife legislation still stalled in Senate
A dispute about what state agency would regulate midwives keeps the issue stalled in the state senate.

Supporters say midwives need to be licensed by the state as independent practitioners to help women who want to have their babies at home. The law now says they must have collaborative practices with doctors.

Senator John Loudon's original plan to let midwives regulate themselves has run aground. Senator Chuck Graham wants them under the State Board of Registration for the Healing Arts. But Loudon says that board is controlled by doctors who don't want to give any business to midwives. He proposes having the Department of Insurance regulate them.

Graham says the board regulates medical professionals and midwives are in that category. Loudon maintains that might not be correct, noting, "There is a certain amount of debate...that delivering a baby is not an illness. It's not a medical procedure."
Graham says Loudon's bill does more than let midwives catch babies, though, because it also allows the midwives to inject medicines--putting midwives clearly into the medical practitioner area. Loudon says the midwives could not inject a woman with anything not approved by a doctor.

The two have thrown charges of hypocrisy and of circulating misleading information at each other. Time is getting to be too short in this session for these two to find any middle ground.

Next Week
Only three weeks remain in the 2008 legislative session. The Budget must be completed by May 9th before the May 16th adjournment date.

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