May 18, 2006

The 2006 session of the General Assembly was a little more contentious than was the 2005 session. And, the bickering extended beyond party lines as sharp differences arose between Republicans in the House and those in the Senate. Senate Leader Michael Gibbons of Kirkwood acknowledges Republicans in the two chambers didn’t always see eye to eye, but he attributes that to the fact there was so many new issues that hadn’t been in the hopper for years. One of the Republicans’ major accomplishments of the 2005 session was passage of litigation reform. They had tried for a number of sessions to move this issue, but could not get it signed into law until a Republican Governor - Matt Blunt - was elected. Gibbons and other Senate Republicans express disappointment with the failure, this year, of the Legislature to push through the Governor’s plan to sell assets of MOHELA - the Missouri Higher Education Loan Authority. House and Senate Republicans held separate end of session news conferences, while House and Senate Democrats held a joint event. That prompted Coleman to suggest she and House Democratic Leader Jeff Harris get along, while House Speaker Rod Jetton might not get along with some Senate Republicans.

Although the legislature did not pass MOHELA enacting legislation the Senate passed a resolution supporting the Governor’s actions. This gives Governor Blunt the legal backing to go ahead with the sale. This has infuriated House leadership.

The Senate Republicans cut off debate in a rare move late Thursday night. The Senate historically does not limit debate. The Senate Democrats “killed” virtually all legislation that had not been dealt with prior to Friday.

Usually on the last day up to one third of legislation for the session is passed. Numerous proposals did not receive attention and will be back next year.

A recap of the year includes:

Status of Selected Health Care Legislation 2006 Session of the Missouri General Assembly

Legislation Not Enacted

 Health Data Disclosure

• direct the Department of Health and Senior Services to post on the Internet comparative cost and quality data online for use by health care consumers by 2010 (SB 1005)
• create a state Web site to compare pharmacies’ prices for the 50 most common pharmaceuticals (SB 1239)

• revise supervision requirements for physician assistants (SB 1032 and others)
• authorize a system of occupational licensure for midwives (HB 974 and others)
• authorize a system of occupational licensure for surgical technologists (HB 1278 and others)
• create a system of occupational licensure for clinical laboratory personnel (SB 1099 and others)
• authorize Missouri to join an interstate compact for reciprocal recognition of nursing licenses (SB 664 and others)
• direct the nursing licensure board to expunge records of unsubstantiated complaints against nurses (SB 710 and others)
• expand requirements for health care facilities and employers to report disciplinary action against health practitioners to the appropriate licensure board (HB 1665 and others)
• authorize expedited licensure action against a nurse who poses a clear danger to the public (HB 1665)
• expand the scope of practice of pharmacists to allow them to implement pharmaceutical management services approved by a physician (HB 1700 and others)

Government’s Official Pandemic Flu Plan Released
According to the federal government’s official pandemic flu plan, released by the White House May 3, the U.S. health care system will not be able to meet all of the country’s needs in the event of a flu pandemic. The 227-page document, divided into nine chapters, provides a list of actions federal departments must complete as a pandemic spreads; makes predictions about the effect of a pandemic; and makes recommendations for state and local governments, as well as businesses. The plan suggests that Americans plan for the possible reduction or loss of income if you are unable to work or your place of employment is closed and stock a supply of water and food. The plan is available at www.whitehouse.gov/homeland/nspi_implementation.pdf.

More Doctors Are Shunning Managed Care Contracts
After remaining stable since the mid-1990s, the proportion of U.S. physicians with no managed care contracts has grown in recent years, from 9.2 percent in 2000-2001 to 11.5 percent in 2004-2005, according to a study released May 4 by the Washington, D.C.-based Center for Studying Health System Change. Physicians with no managed care contracts either see only patients covered by insurance products that do not include provider networks (i.e., fee-for-service Medicare), make patients pay cash or serve managed care patients as an out-of-network provider billing patients charges for which the physicians are not reimbursed. The study, “No Exodus: Physicians and Managed Care Networks” is available at www.hschange.com/CONTENT/838/

Fewer Eligible Employees Enroll In Employer-Sponsored Health Insurance
In 2003, 80.3 percent of U.S. employees eligible for employer-sponsored health insurance made the decision to enroll. That is down from the 85.3 percent who decided to enroll in 1998, according to a report released May 4 by the Robert Wood Johnson Foundation. Employers paid about 82 percent of the cost in both 1998 and 2003. But three million fewer employees enrolled in optional employer-sponsored health insurance in 2003 than in 1998, in part because of the 42 percent increase in the cost of premiums, the report finds. The report, “Shifting Ground: Changes in Employer-Sponsored Health Insurance,” is available at www.rwjf.org/newsroom/CTUWFinalResearchReport2006.pdf /

However, language added by Representative Susan Phillips obligating a portion of these funds for women’s health services (alternatives to abortion program) was deleted after numerous MOALPHA contacts.

Helmet Law
House Bill 994 the motorcycle helmet law requiring riders younger than 21 years of age to wear helmets did not receive approval.

The Senate chose not to take this bill up on the last day after threats of filibuster by the Senate.

 Schools/ Sexual Instruction
House Bill 1075 , Representative Davis did not receive approval.

The bill’s controversial nature would have incited a filibuster and Senator Charlie Shields, Majority Leader, was not willing to give the bill floor time.

Thanks for your contacts.

The bill changes the official rating agency for the enforcement of standards relating to milk production from the Department of Health to the State Milk Board. The act requires that the board make an official rating survey at least biannually, a change from the current law, which requires such a survey be made annually.

Veterans Certificate
Representative Kevin Wilson’s HB 1470 prohibiting local public health agencies from charging a fee on veterans’ death certificates did not pass.

After a conversation earlier in the session Representative Wilson agreed not to push the legislation or amend it to a bill without visiting with us first.

The bill This bill changes the laws regarding the regulation of water. In its main provisions, the bill:

1. Authorizes the Board of Fund Commissioners, in addition to the amounts authorized prior to August 28, 2007, to issue bonds for grants and loans under Article III of the Missouri Constitution. The additional amounts authorized are $10 million for water pollution control, improvement of drinking water systems, and storm water control; $10 million for rural water and sewer; and $20 million for storm water control in first classification counties and St. Louis City;
   
2. Increases the maximum amount of fees that can be charged by the Department of Natural Resources in order to comply with the federal Safe Drinking Water Act. The department may charge lower fee amounts at its discretion. The authorization to impose fees is extended until September 1, 2012;
   
3. Authorizes public water supply districts, sewer districts, and municipalities to install and maintain sewer and water lines in public highways, roads, and streets subject to the reasonable rules of the jurisdictional governing body. The Highways and Transportation Commission retains ultimate authority to monitor construction in the right-of-way of any state highway;
   
4. Authorizes the Missouri Public Service Commission to provide listings required by Section 303(d) of the federal Clean Water Act to the federal Environmental Protection Agency. Procedures are specified in the bill and include public notice and judicial review requirements;
   
5. Allows the director or the commission to require a bond for the construction of innovative, but unproven, wastewater treatment facilities that are not approved by the federal government or another state's environmental regulatory agency;
   
6. Extends the authorization for certain permit fees under Sections 644.053 and 644.053, RSMo, until December 31, 2009;
   
7. Revises the definition of "point source" in Section 644.016 to exclude agricultural storm water discharges and flows from irrigated agriculture; and
   
8. Exempts the new St. Louis baseball stadium from the equal number of men and women's restroom requirement until one year after its completion.

The bill abolishes the Advisory Committee on Poison Control and transfers its powers and certain duties to the Department of Health and Senior Services. The department in conjunction with local health agencies and health care providers will determine

the region to be served by the Missouri Regional Poison Information Center, and the requirement that an annual report be submitted to the presiding officers of the General Assembly and the department is removed.

The Committee on Radiation Control, a subcommittee of the Missouri Atomic Energy Commission is also abolished.

HB 1118 if enacted would have any health care professional licensed, registered, or certified in this state may be deployed to provide care in the event of a declared emergency, subject to approval by the state emergency management agency. This act provides that any health care professional licensed, registered, or certified in any state who volunteers may be deployed to provide emergency care. This act also provides that health care professionals deployed by the Governor shall be immune from civil liability in the delivery of health care necessitated by the emergency, except for willful or wanton acts or omissions.

This act is similar to SCS/SB 889 (2006).

The bill allows the Department of Health and Senior Services to develop rules and regulations changing the manner and frequency of certain immunizations for children. However, the department cannot require immunizations for diseases other than those allowed by statute.

Thank you for your contacts.

The legislation enacts various provisions relating to the safe operation of motor vehicles to ensure the safety of highway workers, emergency workers and other motorists.

CHILD PASSENGER RESTRAINT LAW - This act modifies the law with respect how motorist must restrain children in motor vehicles.

This act modifies the law with respect to the use of child passenger safety restraint systems and booster seats. The act requires children of certain ages, weights and heights to be restrained by either a child passenger restraint system, booster seat or safety belt.

AGE/WEIGHT/HEIGHT CLASSIFICATION -

1. LESS THAN 4 YEARS OLD - This act requires children less than four years old, regardless of weight, to use an appropriate child passenger restraint system.
2. LESS THAN 40 POUNDS - The act requires children weighing less than 40 pounds, regardless of age, to be secured in a child passenger restraint system appropriate for the child.
3. LESS THAN 8 YEARS OLD/80 POUNDS OR UNDER 4'9" - Children (ages 4-7) and who weigh at least 40 pounds but less than 80 pounds, and are less than 4'9" tall must be secured in a child passenger restraint system or booster seat appropriate for that child.
4. GREATER THAN 80 POUNDS OR TALLER THAN 4'9" - Children who are at least 80 pounds or children taller than 4'9" shall be secured by a vehicle safety belt or booster seat appropriate for that child.

The act allows a child to be transported in back seat without a booster seat if the child is secured with a lap belt if the vehicle is not equipped with combination lap and shoulder belt for booster seat installation.

A violation of the child passenger restraint/booster provisions is an infraction and the fine is $50 plus court costs. The fine for violating the safety belt provision of the act is $10. Charges for violating the child passenger restraint and booster seat provisions shall be dismissed or withdrawn if the driver provides evidence that he or she acquired a child passenger restraint system or booster seat prior to or at his or her hearing. The act does not apply to public carriers for hire or students 4 years of age or older who are passengers on a school bus (Sections 307.178 and 307.182).

The act provides that if there are more persons than there are seat belts in the enclosed area of a motor vehicle, then the passengers who are unable to wear seat belts shall sit in the area behind the front seat unless the vehicle is designed only for a front-seated area. This provision does not apply to passengers who are accompanying an intermediate driver’s license holder. Under current law, all passengers accompanying a intermediate driver's license holder must be properly restrained. (Subsection 7 of Section 307.178). The act also modifies Subsection 6 of Section 307.178 to apply the $10 fine to persons rather than just drivers.

The child seat provisions of the act are substantially similar to HB 1165 (2006), SS/SCS/HCS/HB 518 (2005), SCS/SB 221 et al (2005), SB 710 (2004), SB 9 (2003), SB 647 (2002) and SB 549 (2001).

HIGHWAY WORK ZONE SAFETY - This act increases various penalties for offenses occurring within highway work zones or construction zones. Under this act, any person convicted of a second or subsequent moving violation within a work zone shall be assessed a fine of $75. The act provides that a person who is convicted of speeding or passing a vehicle within a work zone when a highway worker is present a second or subsequent time shall be assessed a fine of $300 in addition to any other fine authorized by law (Section 304.582). The act also creates the crime of "endangerment of a highway worker." The act provides that if a person commits the offense of endangerment of a highway worker in which no injury or death results the person shall be subject to a fine of not more than $1,000 and shall have 8 points assessed to their driver's license. The person shall be guilty of aggravated endangerment of a highway worker if a death or injury results. If an a highway worker is injured or killed in a workzone, the offender shall be subject to a fine of not more than $5,000 for an injury and not more than $10,000 if death resulted.

Under the act, a person commits the offense of endangerment of a highway worker if the motorist:

1. Exceeds the posted speed limit by 15 mph or more;
2. Passes another vehicle in a work zone and such offense results in the death or injury of a highway worker;
3. Fails to stop for a work zone flagman or fails to obey traffic control signals erected in the work zone;
4. Drives through or around a work zone by any lane not clearly designated to motorists for the flow of traffic through or around the work zone;
5. Physically assaults or attempts to assault a highway worker with a motor vehicle or other instrument;
6. Intentionally strikes or moves barrels, barriers, signs or other devices erected to control the flow of traffic for a reason other than avoidance of an obstacle, an emergency or to protect the health and safety of another person; or
7. Commits various offenses in which points may be assessed under section 302.302 (Section 304.585).

The act provides for the assessment of 8 points for an endangerment of a highway worker violation and 12 points for an aggravated endangerment of a highway worker violation (Section 302.302).

STREETCAR - The act repeals the duty of streetcar motorman to stop or yield such streetcar to passing emergency vehicles (section 304.022).

MOVE-OVER LAW - This act increases the penalty on motorists who fail to move over when approached by an oncoming emergency vehicle and motorists who fail to move over when approaching a stationary emergency vehicle from a Class B misdemeanor to a Class A misdemeanor (Section 304.022).

SCHOOL BUS - This act enhances the penalties for those who fail to stop for school buses that are loading or unloading children. Under the act, any person who fails to properly yield for a school bus and the failure to yield results in the injury of any child shall be guilty of a Class D felony. Any person who fails to properly yield for a school bus where such violation causes the death of any child shall be guilty of a Class C felony. This provision is contained in SB 1079 (2006)(Section 304.070).

CLUTCH'S LAW (FAILURE TO YIELD) - This act imposes an additional penalty and driver's license suspension on any person failing to yield the right-of-way when the violation results in physical injury, serious physical injury, or death to a person (section 304.351). This act is commonly known as "Clutch's Law". This section has an effective date of January 1, 2007.

The bill repeals a provision that was to sunset on August 28, 2006, which authorizes dental hygienists to provide certain dental treatments to children on Medicaid without the supervision of a dentist.

Local Registrar
Senator Callahan’s SB 1177 also received approval.

Currently, the State Registrar of Vital Statistics may appoint local registrars, each of whom must be person employed by a county health agency. This act allows local registrars to be an employee of either a county or city health agency.

This act is identical to HB 1707 (2006).

his proposed constitutional amendment establishing limits on total state revenue appropriations may return next year. This is a “watered down” version of Colorado’s TABOR amendments, which may eventually be on Missouri’s ballot in a much harsher form.

The 2006 Missouri General Assembly may be known more for what did not pass in the legislative session.

 As Will Rogers once commented something to the effect of:

“I always feel better when the politicians are at home where they can do less damage”!

 You can catch the humor and agree with that simulation.

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