May 11, 2007

As of this writing the House and Senate are still in session on Friday. Major items are still in a state of "flux" as House and Senate conferees meet to hammer out details.

The Medicaid rewrite "MO HealthNet" has yet to be debated on the House floor with only five days remaining in the session. The rumor is that the Governor will call a special session to follow the current session to address MO HealthNet.

In addition, the Speaker of the House Jetton has chosen not to pass HB 19, the capitol improvements bill, for a variety of reasons.

Among the cited reasons are the lack of passage of the Quality Jobs bill, problems with the Conservation Department and the stalling of the Speakers tax cut package.

House Bill 19 contains $44 million for the conservation department and funds for ports, the Highway Patrol, universities, crime labs and state communications. The Speaker has refused to yield to pressure from the Governor, state representatives, lobbyists and interest groups.

News this week includes:

Senate Endorses Emergency Responder Liability Protections

The Senate approved House Bill 579 this week and returned the bill to the House for consideration of the Senate changes. The legislation is designed to enhance the availability of health care workers to respond to major emergencies and natural disasters. It would grant immunity from medical liability to health care practitioners who volunteer to be deployed by the governor or a state agency to respond to an emergency declared by the governor. Its protections would apply to practitioners from Missouri and other states but would not extend to damages caused by willful or wanton acts or omissions.

The bill also would authorize the governor to waive statutory or regulatory requirements when strict compliance would hinder the Missouri Department of Health and Senior Services’ response to a declared emergency or increased health threat to the population. Finally, it would permit the department to suspend laws governing the dispensing of medications in a declared emergency. The department would be authorized to recruit and train volunteers to dispense medications in such an emergency, with state coverage of their liability expenses if they did not otherwise qualify for immunity from liability.

Omnibus Transportation Bill Created in the Senate with Seatbelts

The Senate debated HB 744, sponsored by Rep. Neal St. Onge (R-Ballwin). This bill originally pertained to only outdoor advertising and commercial drivers' licenses, but Sen. Bill Stouffer (R-Napton) offered a Senate substitute which made this an omnibus transportation bill.

Sen. Charlie Shields (R-St. Joseph) offered an amendment that repeals the motor vehicle safety inspection and adds primary seat belt enforcement to the bill. Sen. Chuck Graham (D-Columbia) asked for a division of the question on each subject. The seat belt portion of the bill was adopted by a voice vote. The repeal of the safety inspection portion was adopted by a vote of 20-12.

MO HealthNet

On Tuesday the Special Committee on Health Care Facilities, chaired by Representative Rob Schaaf, R-St. Joseph, approved the 178-page House Committee Substitute Number Two for Senate Substitute for Senate Committee Substitute for Senate Bill 577 (also called MO HealthNet). Several of the changes the House Committee Substitute makes to the Senate version of the bill were reported in previous versions of Legislative Update. 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.

Several of the Medicaid optional services also were restored by the bill, including dental, optometric, podiatry, durable medical equipment, prosthetics and physical, speech and occupational therapy, but continue to be subject to appropriation. The bill still is considered a work in progress, with most of the writing of the final bill projected to be done next week between House and Senate Conference Committee members if time does not run out.

Bill on Newborn Genetic Testing and Treatment Passes

Yesterday, House Committee Substitute for House Bill 948, sponsored by Representative Rob Schaaf, R-St. Joseph, was given final approval by the Missouri Senate. If signed by the governor, the bill will revise standards governing the Department of Health and Senior Services’ retention of laboratory specimens and their use in public health research. It specifies that the results of genetic screening tests on newborns may be released by the department to the child’s health care provider. Also, the bill states 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.

House Members Prepare for Medicaid Reform Debate

At press time, the House Committee Substitute for Senate Bill 577 is slated for House floor debate on Friday, May 11. The bill is Medicaid reform legislation. It would rename Medicaid as "MO HealthNet" and substantially revise the program's structure.

Before its approval this week by the House of Representatives' Special Committee on Healthcare Facilities, the legislation was revamped yet again. Many of the 26 amendments considered by the committee members made relatively technical changes to the version of the bill described last week.

The latest version of the bill does not include specific authorization for a "premium offset" program that would use state and federal funds to help leverage the cost of providing affordable private sector coverage for the uninsured. If the House retains that position, it will become a negotiation item in conference committee discussions between the House and Senate.

The new version also revamps standards relating to the collection of copayments from Medicaid providers. Enrollee copayments will be regarded as payments in addition to and not in lieu of regular provider payments.

The projected cost of the bill going before the House of Representatives is substantially higher than that of the bill passed by the Senate. House floor amendments likely will be offered to trim a number of recently-added benefit and coverage expansions to ease budgetary concerns.

If the House of Representatives approves its version of Senate Bill 577 on May 11, legislators will spend the first part of next week negotiating the many differences between the House and Senate versions. If Senate Bill 577 falters, many of its Medicaid reform components likely will be amended to other bills for debate during the final week of the legislative session.

Senate Endorses Proposal on Insurance Underwriting Reform and Provider Collections

The Senate amended and approved the Senate Substitute #2 for House Bill 818 and returned the measure to the House for consideration of the Senate changes. The bill would revamp state laws governing health insurance underwriting. It addresses the following topics:

• pre-existing condition exclusions
• transfers of coverage between plans
• the use of health status information in underwriting
• policy renewal and cancellation standards
• premium restrictions

The measure also would:

• xpand the ability of associations to purchase health coverage for association members and their dependents.
• modify standards to expand access to the Missouri Health Insurance Pool, which is designed to provide a source of coverage for individuals with high-risk medical conditions. The pool's board of directors is to conduct a study of potential financing mechanisms for the pool.
• direct the Missouri Consolidated Health Care Plan, which provides health insurance coverage to many state employees and retirees, to offer the option of a high deductible plan of coverage coupled with a health savings account meeting federal standards.
• create a system of regulation for discount medical plans.
• authorize state income tax credits for self-employed workers ineligible for a federal health insurance deduction. Also, it grants state income tax deductions for contributions to a "health care sharing ministry," as well as health insurance premiums paid for coverage of taxpayers, their spouses and dependents if those premiums are not otherwise deductible under the federal income tax code.
• require HMOs and health insurers to continue to cover dependent children who reach the limiting age for dependent coverage if the child is incapable of employment because of physical or mental handicap and is dependent upon the enrollee for support and maintenance. Coverage would end at age 25.
• direct the Department of Health and Senior Services to establish a clearinghouse of educational and referral information for those whose unborn infant is diagnosed with an adverse condition by prenatal genetic testing or screening. It will include telephone hotlines specific to Down’s syndrome and other prenatally diagnosed conditions. If a prenatal test result indicates Down's syndrome or other condition, practitioners will provide specified information and resources to the patient.
• includes a new process for health care providers to garnish state income tax refunds or lottery winnings of uninsured patients to repay their unpaid debts for health services. After the provider documents to the Missouri Department of Health and Senior Services that the debt is more than 90 days old and meets the other standards, the DHSS would certify the debt for recovery by the Missouri Department of Revenue using its current authority to recover state debts from tax refunds or lottery winnings. The DHSS would then settle with the health care provider for the recovered funds, minus an administrative fee not to exceed 3 percent.

Newborn Genetic Testing and Treatment Bill Receives Final Approval

House Bill 948 was given final approval from the General Assembly this week and now goes to the governor for review. 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.

Legislators Wrap Up Final Budget

At press time, legislators were finalizing their enactment of the state operating budget for the fiscal year that begins July 1, 2007. Under the Missouri constitution, the budget must be finished by 6 p.m. on Friday, May 11 — one week before the end of the 2007 state legislative session.

Senate Advances Changes to Nursing Licensure Standards

This week, the Senate debated and amended a bill dealing with a variety of occupational and professional licensure topics. House Bill 780 has been returned to the House of Representatives for consideration of the Senate changes. A conference committee is expected to be created to negotiate a resolution to the differences between the House and Senate versions.

The large bill addresses several topics related to nursing and health care delivery.

• The State Board of Nursing would be authorized to use an expedited process to take licensure disciplinary action against a nurse believed to pose a danger to the public. Also, nursing board records of an investigation would be sealed if the board's investigation finds a complaint or allegation is unsubstantiated. The board may create a program for nurses impaired by illness, substance abuse or mental conditions and may require participation as a condition of licensure. Finally, a temporary nursing staffing agency would be required to report disciplinary action taken against one of its nurses to the State Board of Nursing.
• The standards for a state loan forgiveness program for nursing education are revised slightly. If a nurse agrees to work in certain settings for a period of time, a portion of the educational loan will be forgiven. Current law allows nurses to receive loan forgiveness credit for employment in any hospital or in a public or not-for-profit agency or institution that is located in an area of defined need. The proposed legislation would allow employment in a for-profit agency or institution in an area defined to qualify as well.
• Advanced practice nurses would be authorized to prescribe Schedule V controlled substances under a collaborative practice arrangement if they complete additional training.
• Licensure standards for various types of social workers are revised.
• A Chronic Kidney Disease Task Force is created.

Next Week

The General Assembly will have a hectic last week as they attempt to pass additional legislation before the 6:00pm deadline on Friday for adjournment.

There will not be a Friday report as final developments will still be occurring. An end of session report will be sent early in the next week.

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