May 18, 2005

The Missouri General Assembly completed the 2005 legislative session officially on Friday at 6pm.

The session was marked by unprecedented cuts in the state budget. The Department of Social Services “bore the brunt” of reductions. These cuts led to a very austere attitude not only in budget matters but also in any costs affiliated with legislation.

The Governor has until Thursday, July 14, to approve or veto enacted bills.

Highlights of the session include:

The General Assembly has completed its work to enact the House Committee Substitute for Senate Bills 74 & 49. The measure restricts the use of mercury as a preservative in childhood immunizations. It also includes revisions to laws governing newborn metabolic and genetic screening programs and creates an electronic system for processing vital records such as birth and death certificates.

The Senate has given first-round approval to Senate Concurrent Resolution 19, which creates a legislative committee to study other states’ experiences with Health Care Stabilization Funds. The funds provide medical malpractice liability insurance coverage. Legislation discussed during the 2005 session would create a Missouri version of the Kansas Stabilization Fund.

Safety Laws
Highway legislation containing seat belt legislation and child safety restraints did not meet approval this year.

The no-helmet provision which was also contained in the highway bill also was not passed this session.

Lead Abatement
Senator Maida Coleman SB 95 was given approval. It modifies the laws regarding lead abatement and lead poisoning.

Tobacco & Insurance
House Bill 596 did receive approval on the last day.

This legislation allows employers to provide or contract for health insurance at reduced rates for employees who do not use tobacco products.

Umbilical Cord Blood Banks
SB 323 was given final approval.

SB 323 establishes the eligibility criteria for awarding grants to umbilical cord blood banks. The Life Sciences Research Board shall award grants based on:

1. The ability of the applicant
2. The experience of the applicant
3. The applicant's commitment after the expiration of the contract.

The grants will expand existing umbilical cord blood banks and establish new ones for the state of Missouri. The grants shall be awarded subject to appropriation of funds for that purpose.

Emergency Personnel
Provisions of HB 85 were amended to HB 58 and SB 420 .

HB 85 creates immunity from certain civil liabilities for health care professionals who are deployed to provide care during a state of emergency. It also requires the Department of Health and Senior Services and the Division of Professional Registration

to release contact information and licensure or certification information relating to health care professionals to state, local, and private agencies to facilitate their deployment.

Veterans Death Certificates
HB 581 was not passed this year and would have had costly implications for local health departments.

HB 581 prohibits a person from charging a veteran's immediate family a fee for copying the veteran's death certificate if the copies are to be used by the family to file for benefits.

The family member must provide a written notarized statement specifying the exact number of copies needed and indicating how many will be used to file for benefits.

Jam/ Jellies
Senator Klindt successfully attached his jams/ jellies amendment to the omnibus agriculture bill SB 355 .

Klindt had a “vendetta” against his local public health agency.

In discussions with the Department of Health they maintain they still have control over the definition of “hazardous foods” which should water down the provisions Klindt attached to HB 355.

Solid Waste
The omnibus solid waste bill, SB 225, was given approval this year.

The waste tire fee provisions for clean up were passed after several years of failing in the legislature.

The bill pertains to hazardous waste.

SECTION 260.200 - Changes "waste tire" references to "scrap tire".

SECTION 260.262 - Directs a fee of fifty cents to be collected for each lead-acid battery sold. The fee, less six percent to be retained by the seller as collection costs, shall be paid to the Department of Revenue along with the number of batteries sold during the preceding month. Of the monies kept by the Department of Revenue, four percent shall be retained by the department, the rest shall be deposited in the hazardous waste fund.

SECTION 260.270 - Changes "waste tire" references to "scrap tire".

SECTION 260.272 - Changes "waste tire" references to "scrap tire".

SECTION 260.273 - Reinstates the tire fee at fifty cents. The act reinstates the fee beginning the first day of the month no more than sixty days following the effective date of the act; the fee is set to terminate January 2010.

The act directs the Department of Natural Resources to report by January 1, 2009, a complete accounting of tire cleanups - this includes those completed or in progress, the costs associated with these cleanups, number of tires remaining at that time, balance of the fund and enforcement actions initiated to address scrap tires.

SECTION 260.274 - Repeals entire section.

SECTION 260.275 - Changes "waste tire" references to "scrap tire".

SECTION 260.276 - Changes "waste tire" references to "scrap tire".

SECTION 260.278 - Changes "waste tire" references to "scrap tire".

SECTION 260.279 - The act provides preference to Missouri vendors bidding on contracts by the department for the removal or clean up of scrap tires. A five percent preference and ten bonus points shall be given to any vendor that meets one or more of the following factors:

• Vendors residing in Missouri for two years preceding the bid;
  
• Non - resident vendors that employ at least twenty Missouri residents and have maintained their principal
  place of business in the state for two years preceding the bid;
  
• Vendors that reside in Missouri that employ at least seventy-five percent of their workers from Missouri for the entire term of the project;
  
• Non - resident vendors that employ at least twenty Missouri residents and have maintained their principal place of business in the state for two years preceding the bid; for the entire term of the project, these vendors shall employ at least seventy-five percent of their workers from Missouri;
  
• Vendors that provide written certification that the end use of the tires will be for fuel purposes or for the manufacture of a useable good or product; landfilling of tires, tire chips, or tire shreds shall not permit a vendor a preference.

SECTION 260.325 - Solid waste management district boards shall arrange for independent financial audits of the district's operations. Districts receiving two hundred thousand dollars or more shall undergo annual audits, those districts receiving less than two hundred thousand dollars of financial assistance shall undergo the audits at least once every two years. The contents of these audits shall be open to the State Auditor and the option to audit the districts by the state auditor is provided for in the act. The department shall perform audits of district grants, provided the resources are there, at least once every three years.

SECTION 260.330 - The fees for solid waste landfills are modified in the act. No annual adjustment to the current fee is to be made from October 2005 to October 2009, except that which is needed for operating costs and any increase in the total amount of solid waste accepted at landfills and that to be transferred out of the state. No annual increase made during the time frame of October 2005 to October 2009 shall exceed the percentage increase measured by the consumer price index, and shall be made at the discretion of the director of the Department of Natural Resources.

The fees for transfer stations have been modified in the act. No annual adjustment to the current fee is to be made from October 2005 to October 2009, except that which is needed for operating costs and any increase in the total amount of solid waste accepted at landfills and that to be transferred out of the state. No annual increase made during the time frame of October 2005 to October 2009 shall exceed the percentage increase measured by the consumer price index, and shall be made at the discretion of the director of the Department of Natural Resources.

SECTION 260.335 - Each fiscal year, eight hundred thousand dollars from the solid waste management fund shall be made available to the department and the environmental improvement and energy resources authority for the development of markets for recovered materials; this is a change from the current appropriation of one million dollars. Each fiscal year, up to two hundred thousand dollars from the solid waste management fund shall be used by the department for grants to solid waste management districts. District eligibility is laid out in the act as is the calculation for fund disbursement.

Remaining moneys in the fund shall be allocated as follows:

• Thirty-nine percent of the moneys shall go towards the elimination of illegal solid waste disposal;
  
• Sixty-one percent of the moneys shall go towards grants - the breakdown of these moneys are, forty percent shall be allocated based on the population of each district and sixty percent shall be allocated based on the amount of revenue generated within each district.
  
• No more than fifty percent of the allocable revenue may be used for the implementation of a solid waste management plan and at least fifty percent of the allocable revenue shall be allocated for waste reduction, recycling and related services.

Each district shall receive a minimum of ninety-five thousand dollars for district grants and operations.

SECTION 260.342 - Repeals entire section.

SECTION 260.345 - The act changes the membership of the solid waste advisory board, two members shall represent the solid waste management industry, and one member may represent the solid waste composting or recycling industry. The authority to terminate any member based on the failure to attend at least fifty percent of the board meetings has been removed in the act.

SECTION 260.375 - Removes requirement for out of state generators to file a registration report with the commission, as well as removing the allowance for in state generators to submit such registration for these out of state generators.

SECTION 260.380 - New language clarifies that requirements set forth by the commission apply only to those generators located in Missouri. Removes references to out of state generators and the requirements set forth by the department. Removes requirement for in state generators that are receiving hazardous waste from out of state generators pay an annual fee.

There has been a change to the fee paid for by generators - new language clarifies that the fee for in state generators shall be five dollars per ton or portion thereof of waste registered with the department; a change from current law that provided the commission the discretion to establish the fee annually. New language states that the fee shall not exceed fifty-two thousand dollars per generator site per year nor be less than one hundred fifty dollars per site per year.

New language has been added that directs Missouri treatment, storage and disposal facilities to pay an annual fee equal to two dollars per ton or portion thereof for all hazardous waste received from outside the state. Failure to pay such a fee shall result in the imposition of a penalty equal to fifteen percent of the original fee. The fee shall expire December 2011.

SECTION 260.391 - Adds circumstances to the list by which the hazardous waste fund receives funds - new language includes taxes, penalties or interest assessed on those fees or taxes. New language also adds to the list of circumstances to which the hazardous waste fund is responsible - including, prevention of leaks from underground storage tanks and response to petroleum releases from both underground and above ground tanks, and for any other expenditures that are not covered under the federal Comprehensive Environmental Response, Compensation and Liability Act of 1980. Included in these "other expenditures" are:

• Administrative services as necessary for the identification, assessment and cleanup of abandoned sites;
  
• Payments to other state agencies for services consistent with section 260.435 to 260.550;
  
• Acquisition of property as provided in section 260.420;
  
• A development study of a hazardous waste facility in Missouri;
  
• Financing the non-federal share associated with the cost of clean up and site remediation
  
• Reimbursement of owners or operators who accept waste pursuant to department orders

Language clarifies that any funds remaining in the hazardous waste remedial fund shall be transferred to the hazardous waste fund. No monies from the fund shall be available for abandoned site clean up unless the director has made all reasonable efforts to secure voluntary payment from the owners or operators of such site. The director shall make all reasonable efforts to recover expended funds through litigation or cooperative agreements with responsible persons. All recovered monies shall be deposited in the hazardous waste fund. In addition to the revenue specified in the section, the department shall request an annual appropriation from general revenue equal to any state match obligation to the EPA for cleanup performed pursuant to the Comprehensive Environmental Response, Compensation and Liability Act of 1980.

SECTION 260.420 - All references to the hazardous waste remedial fund have been removed.

SECTION 260.446 - Repeals entire section.

SECTION 260.475 - All references to the hazardous waste remedial fund have been removed, along with the deposit breakdown between said fund and the hazardous waste fund - the act forwards all monies to be deposited in the hazardous waste fund. The fee authorized in this section shall expire December 2011.

SECTION 260.479 - Section repealed.

SECTION 260.480 - Repeals current section - added language that clarifies any funds remaining in the hazardous waste remedial fund shall be transferred to the hazardous waste fund.

SECTION 260.481 - All references to the hazardous waste remedial fund have been removed.

SECTION 260.546 - All references to the hazardous waste remedial fund have been removed.

SECTION 260.569 - All references to the hazardous waste remedial fund have been removed.

SECTION 260.900 - Changes the definition "dry cleaning solvent" to include dry-cleaners who use chlorinated solvents and exclude those who use petroleum-based solvents.

SECTION 260.905 - Provides an extension to the hazardous waste management commission to promulgate rules for dy cleaning facility environmental remediation until 2007.

SECTION 260.925 - Modifies circumstances where moneys from the Dry Cleaning Emergency Response Trust Fund (DERT) cannot be used; for corrective action at sites that have been taken out of operation prior to July 1, 2009 and not documented to the department prior to that date.

SECTION 260.935 - Removes facilities that use petroleum, nonchlorinated solvents from the requirement to pay an annual dry-cleaning facility registration surcharge.

SECTION 260.940 - Removes the solvent factor for any nonchlorinated dry-cleaning solvent.

SECTION 260.960 - Clarifies that any rule promulgated after the effective date of this section shall be invalid.

SECTION 260.965 - Sets an expiration date of August 28, 2012 for the operation of the DERT Fund.

SECTION 304.184 - Any truck or tractor-trailer engaged in transporting solid waste may operate with a weight not to exceed twenty-two thousand four hundred pounds on one axle or not to exceed forty-four thousand eight hundred pounds on any tandem axle. The act does not permit the operation of any motor vehicle on the highways in excess of the weight limits imposed by federal statutes.

The sections pertaining to dry cleaning facilities have an emergency clause.

Concentrated Animal Feeding Operations
In a huge victory, the CAFO legislation was defeated in the House on Thursday on a 74-85 vote.

The legislation denied local control by taking away the ability of local county health department to enact ordinances prohibiting CAFO’s.

There was a move to take the legislation up again on Friday. However, the House members voting against the bill stood firm and the bill was not reconsidered.

Appropriations
The Department of Health Budget was completed with $1.25 million included for women/ minority health.

The core public health functions budget was maintained at $9.27 million.

Underage Drinking Bill
SB 402 passed. This bill creates stricter penalties, including loss of driver’s license, for minors who have or drink alcohol. It also requires schools to penalize students for alcohol-related offenses even if not related to school grounds or activities. (Update per Scott Marrs, May 23, 2005).

Thimerosal
A watered down version of SB 74 was passed by the General Assembly. The legislation contains language regarding the mercury preservatives, Hepatitis C and electronic signatures.

The Governor’s Office and DOH officials negotiated the wording on the thimerosal portions of the bill.

SB 74 modifies and creates new provisions with respect to the Department of Health and Senior Services.

MERCURY IMMUNIZATIONS - Under the act, after April 1, 2007, any immunizations administered to knowingly pregnant women or children under three years of age or pregnant women shall not contain more than 1 microgram of mercury per 0.5-milliliter dose.

Beginning April 1, 2007, insurers, health service corporations, or health maintenance organizations who provide coverage for immunizations on a fee schedule or a percentage reimbursement basis shall reimburse at the same rate for immunizations not containing mercury.

The Director of the Department of Health and Senior Services shall exempt the use of a vaccine from compliance with this act if the director finds, and the governor concurs, that an actual or potential public health emergency exists, including an epidemic, outbreak or shortage for which there does not exist a sufficient supply of vaccine that complies this act that would prevent knowingly pregnant or children less than three years of age from receiving the vaccine. The director shall determine the duration of such exemption.

NEWBORN SCREENING - This act provides that newborn screening requirements are not limited to disorders and conditions specified in current law.

HEPATITIS C INFORMATION - This act requires healthcare employers to make certain information available to their employees on the risk of exposure to hepatitis C, including availability of testing, cost, and protocol for accidental exposure.

The department shall maintain a "Missouri Hepatitis C" Internet website and provide information on the disease and on support groups in Missouri. The website must also contain links providing information on the disease.

DEPARTMENT OF HEALTH AND SENIOR SERVICES FUNDS - This also act creates the Department of Health and Senior Services Administrative and Cost Allocation Fund and the Department of Health and Senior Services Disaster Fund.

The act specifies that the administrative and cost allocation fund will receive funding by appropriations, deposits, and moneys transferred or paid to the department in return for goods and services provided.

The disaster fund will be used during a state of emergency at the direction of the Governor to furnish immediate aid and relief.

As to both funds, the State Treasurer will serve as custodian and the department director will serve as administrator. Also, moneys in these funds will not lapse to general revenue at the end of the biennium, and all interest earned will be deposited into the funds.

This act also provides that any interest earned on the Missouri Public Health Services Fund shall accrue to the fund.

BIRTH AND DEATH CERTIFICATES - This act also modifies the birth and death certificate provisions. This act provides that a birth certificate shall be filed within five days of birth and certify the place, time, and date of the live birth by a signature or an electronic process approved by the Department of Health and Senior Services. Current law provides that the certificate be filed within seven days of birth. Also, when a medical certification is filed in order to obtain a death certificate, it must be attested to by either a signature or an electronic process approved by the department.

Status of Selected Health Care Legislation 2005 Session of the missouri general assembly

LEGISLATION ENACTED

HB 11 enacts a Medicaid budget that includes more restrictive eligibility standards. The number of Medicaid enrollees is expected to decline by 9 percent, or 90,000 people, by July 1, 2006. Also, some types of services no longer will be available to some categories of Medicaid recipients.

SB 539 creates a Medicaid Reform Commission of legislators and state agency officials to develop recommendations for redesigning the Medicaid program. Current laws authorizing the Medicaid program will expire July 1, 2008.

SCR 15 authorizes the General Assembly to create a Medicaid Reform Commission immediately so the commission can begin its work before August 28, 2005, the effective date of SB 539.

SCR 19 authorizes a legislative committee to study other states’ use of health care stabilization funds to provide medical malpractice liability insurance coverage.

SB 74 gives the Missouri Department of Health and Senior Services flexibility in determining which genetic and metabolic diseases will be included in newborn screening tests.

SB 420 revises laws allowing a parent to relinquish an unwanted infant to hospital personnel or first responders without incurring child abandonment criminal charges. Current law applies to infants between 6 and 30 days old; the new law covers infants less than 12 months.

SB 74 creates a system for distributing information about hepatitis C to health care employees.

SB 420 and HB 58 authorize state licensure and health department officials to disclose otherwise confidential information for use in verifying licensure and credentialing standards of health care practitioners deployed to respond to a state-declared emergency.

SB 74 creates a state account to fund programs for responding to state-declared emergencies.

LEGISLATION NOT ENACTED

HB 394 would have established new regulatory standards for medical malpractice liability insurers, including some state control over premiums charged.

SB 433 and HB 733 would have created a Health Care Stabilization Fund modeled after a Kansas program.

HB 36 would have repealed the current prohibition against lay midwives overseeing childbirths.

HB 835 would have created an Office of Missouri Surgeon General.

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