April 27, 2007

The General Assembly is now down to only 14 working days over the next three weeks for the 2007 session of the Missouri legislature.

Remarkably Representative David Pearce informed us that thus far only 7 bills have made it through to the Governor's desk. Last year very few bills passed, approximately 100, and the majority of those pieces of legislation were non-controversial "consent" bills. This was due to a filibuster in the Senate that killed most legislation.

This year as a result of the Senate using a parliamentary motion (the P.Q. or previous question) Senator Bray knocked all the consent bills off the consent calendar clogging the regular debate agenda.

Major issues the budget, Medicaid Reform and MOHELA have yet to be dealt with at this time.

Consequently, a major stoppage will probably occur due to partisanship.

News this week includes:

Emergency Volunteer Immunity

House Bill 579 was passed out of Senate Judiciary this week as a committee substitute.

This priority bill allows for the deployment of any health care professional licensed, registered, or certified in this or any other state who volunteers during an emergency declared by the Governor and grants them immunity from civil damages for their services. Currently, only workers licensed, registered, or certified in this state are allowed to be deployed.

The bill contains an emergency clause.

FISCAL NOTE: No impact on state funds in FY 2008, FY 2009, and FY 2010.

Bill Allowing Do−Not−Resuscitate Orders Outside the Hospital Advances

House Committee Substitute for House Bill 182, sponsored by Rep. Mark Bruns, R-Jefferson City, was advanced this week by the Senate Seniors, Families and Public Health Committee. This bill would establish the Outside the Hospital Do-Not-Resuscitate Act and permit the execution of do-not-resuscitate orders for use by emergency medical providers for patients receiving treatment outside a hospital. This is a companion bill to Senate Bill 658.

Bill Would Expand Health Premium Deductibility

The House Committee Substitute for House Bill 364 would authorize a state income tax deduction for health insurance premiums paid for coverage of the taxpayer and his or her spouse and/or dependents. The deduction would not be available if the expense was otherwise deductible under the federal income tax code. The Senate Health and Mental Health Committee gave the bill a hearing this week.

Health Insurance Reform Bill Heard

The House Committee Substitute for House Bill 818, sponsored by Rep. Doug Ervin, R-Kearney, was heard in the Senate Health and Mental Health Committee this week. If passed, the bill would revise state laws governing health insurance underwriting. It also would expand the ability of associations to purchase health coverage for association members and their dependents. The bill also would modify 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. An initial version of this bill generated strong insurer opposition. It was modified so that no insurers opposed the bill in this week's hearing. Representatives of small businesses and business groups did testify in favor of the bill. The Senate committee is expected to revise the bill yet again in the form of a Senate Committee Substitute.

House Gives Final Approval to Bill Regulating Abortion and Sexual Education

House Committee Substitute for House Bill 1055 was given final approval by the Missouri House of Representatives this week. The bill now advances to the Missouri Senate for debate. If passed, the bill would establish the Missouri Alternatives to Abortion Services Program, revise current law on sexual education, adds "medical emergency" defense language for those who violate Missouri's abortion law, and adds abortion providers to the "ambulatory surgical center" definition. The new Alternatives to Abortion Program would provide services or counseling to pregnant women and assistance to women in caring for their children or placing them up for adoption. Counseling and services are available to a woman during her pregnancy and for one year after the birth of her child. The department or departments administering the programs may contract with public or private agencies to provide services or counseling. This bill is a companion bill to Senate Committee Substitute for Senate Bills 370, 345 and 432.

House Medicaid Fraud Bill Heard in Senate Committee

House Bill 353, sponsored by Rep. Rob Schaaf, R-St. Joseph, is designed to reduce provider fraud in the Medicaid program. The bill was passed by a margin of 156-2 in the Missouri House of Representatives before being sent to the Senate. The bill is more favorable to provider interests than other Medicaid fraud bills that have been considered this session. Identical language was added by the Senate during debate of the MO HealthNet Medicaid reform bill, Senate Substitute for Senate Committee Substitute for Senate Bill 577.

House Committee Hears Medicaid Reform Bill

This week, the House Special Committee on Healthcare Facilities held its second hearing on the Medicaid reform bill, Senate Substitute for Senate Committee Substitute for Senate Bill 577 (also called Missouri HealthNet), sponsored by Senator Charlie Shields, R-St. Joseph. Two more hearings are planned for next week. The bill would rename Medicaid as MO HealthNet and create a MO HealthNet Division in the Department of Social Services to replace the current Division of Medical Services. The bill already has been approved by the Missouri Senate by a margin of 26-7.

Prior to hearing the bill, the House committee held approximately 35 hours of hearings over the past four weeks to educate themselves regarding Medicaid. The House committee is expected to substantially revise the bill in the form of a House Committee Substitute before sending it on to the full House of Representatives for final approval.

Major components of the legislation currently focus on the following:

• Expands the use of managed care and case management and the promotion of healthy behaviors among MO HealthNet enrollees. The bill also authorizes a new premium offset program that would use state and federal funds to help leverage the cost of providing affordable private sector coverage for the uninsured.
• Creates a committee of health care providers, consumers and the Attorney General to craft guidelines for a pay-for-performance payment incentive system.
• Safeguards hospital payments when a health care provider makes a reasonable effort to collect a patient co-payment and is unable to do so. In these cases the state will make full payment to health care providers for services rendered and will not reduce payment as if a co-payment had been collected.
• Enacts a Medicaid fraud provision that is less stringent and more responsive to provider concerns than the civil false claims proposal.
• Extends coverage of family planning and women's health services to uninsured women with incomes up to 185 percent of the federal poverty level.
• Reworks current state laws governing a Missouri Long-term Care Partnership to allow those applying for MO HealthNet coverage of nursing home care to exempt assets equal to the value of benefits paid under a private long-term care insurance policy.

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