May 4 , 2007

Only eleven days remain in the 2007 legislative session. As reported last week major issues still remain to be discussed including the Medicaid reform package−MO HealthNet, the state budget, sale of MOHELA and others.

The Senate and House seem to be at odds (not unusual) on the progress of legislation. As of this writing only 17 bills have actually been sent to the Governor.

The focus of activity is on floor action as committee hearings have declined. News this week includes:

Seat Belts

The proposed primary seat belt law was dead in the House on Tuesday. However, it was revived and added to HB 744 in the Senate of Wednesday evening.

The House will have another shot at the legislation when HB 744 returns from the Senate.

Bill Would Raise Employee Background Check Fees

In debating and amending Senate Bill 84, the House of Representatives opted to authorize increases in the Highway Patrol’s fees charged for conducting criminal background checks. The proposal would affect the Missouri criminal background checks required by law for newly-hired health care employees who will have contact with patients. The fee increase amendment mirrors a separate bill sponsored by Senate President Pro Tem Michael Gibbons.

The current $5 fee for state background checks that are required by law would be raised to $9, with authorization for increases of not more than $1 per year beginning in 2010, to a maximum of $15. The fee for a national criminal background check would increase to $20 from $14, with the $14 fee maintained for foster parent licensing applications and applicants for permits to carry concealed weapons.

Collections Proposal Added to Insurance Underwriting Reform Bill

A Senate committee approved a Senate Committee Substitute for House Bill 818 this week. The legislation, dubbed the "Missouri Health Insurance Portability and Accountability Act," would revamp state laws governing health insurance underwriting. Topics addressed include pre-existing condition exclusions, transfers of coverage between plans, the use of health status information in underwriting, policy renewal and cancellation standards, and premium restrictions. It also would expand the ability of associations to purchase health coverage for association members and their dependents. The bill also would modify standards to expand access to the Missouri Health Insurance Pool, which is designed to provide a source of coverage for those with high−risk medical conditions. Employers that fund health insurance coverage for their employees must create a premium−only Section 125 cafeteria plan for their use.

The revised bill includes a new process for hospitals and other health care providers to garnish state income tax refunds or lottery winnings of uninsured patients in order to repay their unpaid debts for health care services. After the provider documents to the Department of Health and Senior Services that the debt is more than 90 days old and meets the other standards, the department would certify the debt for recovery by the Department of Revenue using its current authority to recover state debts from tax refunds or lottery winnings. The Department of Health and Senior Services would then settle with the health care provider for the recovered funds, minus an administrative fee not to exceed 3 percent.

Committee Advances Bill on Newborn Genetic Testing and Treatment

A Senate committee approved the House Committee Substitute for House Bill 948 this week. The bill would revise standards governing the Department of Health and Senior Services' retention of laboratory specimens and their use in public health research. Also, the results of genetic screening tests on newborns could be released by the department to the child's health care provider. Also, the bill specifies how appropriated funds may be used by the state to subsidize the purchase of costly dietary formula needed to treat those with various metabolic disorders, such as PKU.

Bill Regulating Abortion and Sexual Education Advances

House Committee Substitute for House Bill 1055 was advanced this week by the Senate Judiciary and Civil and Criminal Jurisprudence Committee. This bill already has been passed by the Missouri House of Representatives and 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.

General Assembly Enacts New Law on Physician Assistant Supervision

The General Assembly has completed its work enacting new standards governing the standards for the supervision of physician assistants. The House Committee Substitute for House Bill 497 now goes to the governor for review and approval.

The legislation represents a negotiated accord between several physician organizations, the Missouri Academy of Physician Assistants and MHA. The compromise was forged in response to actions taken late last year by the State Board of Registration for the Healing Arts, which licenses both physicians and physician assistants. Facing questions regarding its legal authority, the board decided that as of August 28, 2007, it would require that physician assistants be supervised at all times by a physician practicing in the same office facility, with exceptions only as specifically authorized by law for a physician assistant's follow−up visits in hospitals, nursing homes and jails.

The new law sets a default standard that a physician assistant must be supervised by a physician working in the same facility 66 percent of the time the physician assistant is providing patient care, with exemptions for follow-up visits in hospitals, nursing homes, jails and patient homes. It also creates a process for waiving the 66 percent standard that involves review and recommendation by the state Advisory Committee on Physician Assistants and a final decision on the waiver application by the State Board of Registration for the Healing Arts. The board’s waiver decisions are to be based on uniformly applied criteria regarding the adequacy of supervision, distance between the physician and physician assistant, and the potential for reduced access to services without a waiver. Waivers would be limited to practice settings that at the time of application were included in a designated health professional shortage area. The bill also sets various standards for physician assistant training and contracts and agreements for physician assistant supervision.

Committee Consolidates Crime-Related Bills

A House committee this week held a hearing on Senate Bill 429 and approved a much larger House Committee Substitute for the bill. The original bill would revise standards for forensic evidence-gathering examinations of victims of sexual assault. It would require that these exams be done using an evidence collection kit provided without charge by the state. The victim could not be billed for the cost of the forensic examination. Instead, the cost of the forensic examination would be billed to and paid by the Department of Health and Senior Services. Other medical treatment costs would be billed to the patient or insurer. If the patient was uninsured, the medical treatment costs could be billed to the state Crime Victims' Compensation Fund.

Among the many amendments added to the bill were several affecting health care. One would authorize increases in the Highway Patrol's fees charged for conducting criminal background checks. The proposal would affect the Missouri criminal background checks required by law for newly−hired health care employees who will have contact with patients. The current $5 fee for state background checks that are required by law would be raised to $9, with authorization for increases of not more than $1 per year beginning in 2010, to a maximum of $15. The fee for a national criminal background check would increase to $20 from $14, with the $14 fee maintained for foster parent licensing applications and applicants for permits to carry concealed weapons.

The bill would create a state system for electronically tracking prescriptions for controlled substances. It would authorize federal grant funding for a data initiative designed to identify those seeking controlled substances from multiple providers and those accumulating large quantities in small increments of the pharmaceutical products used in manufacturing methamphetamine. As amended, the tracking system does not apply to hospital inpatient use of controlled substances or to prescriptions issued upon discharge from the hospital.

Conferees Make Budget Recommendations Conference committees appointed to negotiate differences between the House and Senate versions of the state budget for the fiscal year being July 1 have completed their work. Their recommendations now will be put before the House and Senate for ratification. Legislative work on the budget must be completed by 6 p.m. on Friday, May 11.

$16 million would be allocated to increase Medicaid physician fees, with another $12 million designated for payments to physicians for doing patient risk appraisals. The Senate had proposed $20 million for physician payment increases, the House of Representatives, $32 million.

The recommended Medicaid budget includes the more favorable House position on funding for State Children's Health Insurance Plan coverage. An additional $7 million in state and federal funds would be used to relax the current "affordability" standard used to qualify for SCHIP coverage. The standard refers to the amount of premium the enrollee would be expected to pay for private insurance coverage.

The conferees recommended the Senate position of $5 million in General Revenue, $8.25 million in federal funds and additional FRA funds to support a "premium offset" program designed to expand access to coverage using both public and private funds. The intent of the committee is to budget this amount for a six−month period in fiscal year 2008. The Department of Social Services expects the federal waiver application process to take several months to complete.

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