May 8, 2006

Legislature Sends State Budget to Governor
What a difference a year makes. State lawmakers have approved a $20.8 billion state budget two days prior to the deadline, readily agreeing to a budget a bit more than 8.5% larger than the current state budget. Last year's budget debate featured harsh clashes between Republicans who called for deep budget cuts, especially to Medicaid, and Democrats who resisted them. This year's debate gave way to minor skirmishes between the two parties as lawmakers argued about where best to spend the increased revenue an improved state economy produced. Lawmakers added $20 million to the Medicaid budget, restoring such services as wheelchair accessories and adding eyeglass coverage. Providers also will receive better reimbursement rates. Democrats, though, argue that the budget should have done more to restore the 90,000 Missourians cut from Medicaid rolls last year. Education gets a boost in this budget. Public schools will receive a $128 million increase in their basic funding formula in an education budget that tops $5 billion for the first time. Colleges and universities will receive two percent more next year, but still will fall short of their highest appropriations, made in Fiscal Year 2002. The Missouri Department of Transportation receives a record $2.6 billion, benefitting from a growth in both state and federal road construction funds. State employees will receive a 4% raise, with employees in specialty fields, such as medical, law enforcement and corrections receiving even larger pay hikes. The budget now heads to Governor Blunt who praises it as a budget based on sound fiscal management. The governor says the gains the state has made this year would not have been made without the responsible and in some cases difficult decisions made last year.The operating budget is contained in HB 1001 through HB 1013.

MOHELA
With the operating budget finished, legislators are turning their attention to a bill that would allocate $475 million from a potential sale of part of the loan portfolio held by the Missouri Higher Education Loan Authority. The bill would allocate much of the money for capital improvements at Missouri’s public colleges and universities. However, some legislators are linking passage of the MOHELA funding bill to enactment of a controversial bill that would, among other things, cap state funding for higher education.

If it passes, the MOHELA funding bill also would allocate $1 million for area health education centers, $2.4 million for Primary Care Resource Initiative of Missouri (PRIMO) scholarships during the next fiscal year, $21 million to provide ongoing funding of an account to provide scholarships for training health practitioners for underserved areas and $51.4 million to various state colleges and universities that would be passed through to support construction, renovation and new equipment at federally-qualified health centers across the state.

Medical Malpractice Insurance Reform Bills Advance
House and Senate committees each approved a version of legislation to expand the state’s regulation of medical malpractice insurers. They now will advance to floor debate in their respective chambers. The bills would limit premiums and provide for expanded collection of data on claims and underwriting standards from insurers and self-insured medical liability plans. The bills are the House Committee Substitute for Senate Bill 905 and the Senate Committee Substitute for House Bill 1837.

Medicaid Provider Fraud Bill Advances
After several hearings this week, a House committee approved its own version of legislation to reduce provider fraud in the Medicaid program. In doing so, the committee chair, Rep. Rob Schaaf, R‑St. Joseph, suggested that the differences between the House and Senate positions on Senate Bill 1210 likely will be resolved by conference committee negotiations.

Earlier, the Senate had passed a version of the bill that would create a Missouri Civil False Claims Act that mirrors a federal antifraud law of the same name. Congress recently enacted financial incentives for states to adopt such laws that allow private citizens with information about alleged fraud to join in the government’s recovery lawsuit and receive a share of any award of settlement. The Senate’s version also creates stiffer penalties for fraudulent providers and new whistleblower protections for individuals assisting in a Medicaid fraud action or investigation.

The new House version does not attempt to create a civil false claims law that might qualify for the federal incentive. Instead, whistleblowers would be able to share in 10 percent of the proceeds recovered from the Attorney General’s actions under current anti-fraud laws. In addition, those who report their own or their organization’s fraudulent activity would not be subject to criminal prosecution. A number of the other provisions in the House committee’s bill mirror the Senate language.

Medicaid Reform Continuation Advances
This week, a House Committee endorsed Senate Bill 901. The bill would establish a legislative Joint Committee on Health, which would broaden the purview and continue the work of the Medicaid Reform Commission that met during the latter half of 2005. Statutory authorization for the Medicaid Reform Commission expired December 31, 2005.

Legislators Enact Uncontroversial Bills
Legislators completed their enactment this week of a number of health-related bills that qualified for expedited review as uncontroversial proposals with little or no state cost. The bills now go to the governor for review. They include:

Senate Bill 1155 which would extend the expiration date of the Technical Advisory Committee on the Quality of Patient Care and Nursing Practices in the Missouri Dept. of Health and Senior Services. 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. To date, the group has developed recommendations regarding unlicensed assistive personnel and mandatory overtime for nurses and is working on standards for nursing temporary staffing agencies.

Senate Bill 1177 which would allow city health department employees to be appointed as local registrars for processing vital records information for the DHSS.

House Bill 1732 requires public school districts to allow affected students to carry epinephrine dosage devices or inhalers at school to offset an asthma or anaphylactic attack. House Bill 1245 allows public schools to procure a supply of the epinephrine syringe devices for use by school nurses.

Committee Revises Criminal Background Check Fee
A House committee held a hearing this week on Senate Bill 873 and then approved a modified version of the bill. Among other changes, it would increase the Missouri State Highway Patrol’s fee for conducting criminal background checks. Various health care providers are mandated by law to conduct criminal background checks when hiring employees who have contact with patients. The fee increase for a Missouri criminal record check would be phased in over six years, while the fee for a fingerprint‑based national search would decrease in August 2006 by $5, from $20 to $15.

Proponents of the measure argue that the MSHP’s current $5 fee for a Missouri criminal background check is one of the lowest in the nation and has not been raised for many years. Sen. Pres. Pro Tem Michael Gibbons, R-Kirkwood, who is sponsoring the legislation, said the MSHP has seen a large increase in demand for background checks and needs the funds to upgrade its system.

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