September 12, 2005

Special Session Report
This report will provide details of activities in Jefferson City this week as the Missouri General Assembly completed its first week of work. The highlights of the week were the passage of two bills by the Senate dealing with abortions for minors and workers’ compensation corrective language. The General Assembly will re-convene next week to finish its deliberations. Other issues that will be considered next week relate to the posting of personal information of public officials on the Internet and very specific revisions to the omnibus crime bills passed during regular session.

Bills Introduced

• HB 1 – Cunningham - Relating to abortion regulations and services for minors
• HB 2 – Lipke - Makes technical corrections to various criminal statutes
• HB 3 - Pratt - Limits the restrictions on posting certain personal information on the Internet.
• HB 4 - Harris - Changes various provisions regarding abortion regulations and services for minors.
• HB 5 - Portwood - Defines "next friend" as used in the laws regarding consent to an abortion by a minor.
• HB 6 Wright-Jones - Establishes the Birth Control Protection Act, changes the laws regarding human sexuality curriculum in schools and emergency care for rape victims, and implements a family planning program.
• SB 1 - Loudon - Modifies laws relating to abortion
• SB 2 - Callahan - Relating to the applicability of workers' compensation law
• SB 3 - Bray - Relating to reducing the number of abortions in the state
• SB 4 - Crowell - Relating to the applicability of workers' compensation law

Note : HB’s 4, 5 & 6 and SB’s 2 & 3 have not been voted out of committee and are not likely to be considered.

 COMMITTEE ACTION

 Special Session House Bills Ready for Debate
HB 1, HB 2 and HB 3 were all voted out of committee “do pass.” HB 1, sponsored by Rep. Jane Cunningham (R-Chesterfield), changes various provisions regarding abortion regulations and services for minors. HB 2, sponsored by Rep. Scott Lipke (R-Jackson), makes technical corrections to various criminal statutes. HB 3, sponsored by Rep. Bryan Pratt (R-Blue Springs), prohibits the posting of certain personal information on the Internet. The bills were then referred to the House Committee on Rules.

On Thursday, September 8 th the House Committee on Rules heard the bills and voted them out “do pass with no time limit for debate.”

The bills are on the perfection calendar and debate is anticipated on these issues next week.

 Abortion Bill Passes Senate and Heads for the House
The Senate debated SB 1, sponsored by Sen. John Loudon (R-Ballwin). This bill seeks to discourage Missouri teens from obtaining abortions in states such as Illinois, where no parental consent is required. It imposes civil liability on anyone who helps a minor get an abortion without permission from a parent or judge and imposes criminal penalties on physicians who don’t have clinical privileges at a hospital within 30 miles of where they perform abortions.

Democrats didn’t give in easily and offered a substitute bill and several amendments that were ultimately defeated. The substitute bill would have promoted sex education and offer access to contraceptives. Attempted amendments included: 1) an attempt to protect the rights of clergy members; 2) allowing surgeons to only have to serve a one-month rotation at hospitals within 30 miles of an abortion clinic; 3) protection for cab drivers; and 4) exempting rape and incest victims from the restrictions.

The senate third read and passed the bill, as introduced, by a vote of 26-6. The bill now goes to the House, which is scheduled to take up the bill next week.

State Reorganization Task Force Issues Recommendations
In January, Gov. Matt Blunt created a Missouri State Government Review Commission. It was to review each executive branch agency and develop recommendations to improve efficiency and effectiveness by restructuring, consolidating or eliminating state agency functions.

The commission created six task forces, each focusing on several state departments. This week, the task force reviewing the state departments of Health and Senior Services, Social Services, and Mental Health issued 22 recommendations. The full commission will discuss the following recommendations Thursday, Sept. 15, in Columbia.

• The Missouri Department of Social Services’ Division of Medical Services, which administers Medicaid, would be transferred to the Missouri Department of Health and Senior Services and renamed the Division of Medicaid. The Medicaid eligibility determination, currently assigned to a different division in the DSS, also would move to the DHSS.
• The certificate of need program would be eliminated. In its report, the task force stated the program “provides little value for the time and costs incurred by the industry and the state to receive CON approvals. Also, it is an impediment to competition in the private sector.”
• Medicaid’s formula for establishing nursing home payments would be reassessed, with emphasis on eliminating state payments for real estate debt amortization.
• State law should require a Medicaid patient be served by home and community-based programs before being admitted to a nursing home, unless a physician certifies the patient’s medical needs cannot be met at home.
• Responsibility for licensing emergency medical technicians would be transferred from the DHSS to the Missouri Department of Economic Development’s Division of Professional Registration. The division now includes most of the state’s professional and occupational licensure boards.
• The DHSS’ Bureau of Narcotics and Dangerous Drugs would be moved to the Missouri Department of Public Safety, which would improve coordination with the federal Drug Enforcement Administration.
• The Veteran’s Commission, which oversees the state veterans’ homes and cemeteries, would be transferred from the DPS to the DHSS’ new Division of Senior and Disability Services.

• The First Steps program of the Missouri Department of Elementary and Secondary Education would move to the DHSS. The program is designed to identify and respond to developmental delays in children younger than 3.
• Disability programs in four state departments, including the Medicaid disability determination process, would be consolidated in the DHSS.
• The Missouri Department of Mental Health would coordinate all mental health services, including those provided in conjunction with corrections, foster care, school and children’s programs.
• Various health and social services telephone hot lines and telephone assistance lines in the DHSS, DMH and DSS would be consolidated in the DHSS.
• Funding for the Centers for Independent Living would be eliminated, and the savings would be transferred to the Home and Community-Based Services program in the DHSS.
• Medicaid payments for personal care services in residential care facilities would end, and the formula for making per diem cash payments to residential care facilities would be adjusted accordingly.

Many of the recommendations mirror the testimony offered to the Medicaid Reform Commission last week by Steve Bradford, co-chair of the Missouri State Government Review Commission. Bradford is president and chief executive officer of The Pyramid Group Inc., a skilled nursing and in-home services provider.

Several of the task force’s proposed changes, including the elimination of the CON program, would require legislators to enact new laws. MHA is contacting commission members about the CON measure, informing them of the implications of this change in promoting the development of specialty hospitals in Missouri.

 Medicaid Commission Submits Recommendations To Congress
The Medicaid Commission responsible for recommending short-term and long-term reforms to the program has submitted its first list of proposals to Congress. The following recommendations from the commission would reduce Medicaid spending $11 billion throughout the next five years.

• restricting beneficiaries’ transfer of assets to qualify for long-term care under Medicaid — $1.4 billion
• permitting states to use the average manufacturer price instead of the average wholesale price to determine payments to drug companies — $4.3 billion
• allowing Medicaid managed care plans to participate in the drug manufacturer rebate program — $2 billion
• expanding the number of beneficiaries who are permitted to be charged copayments and the amount of copayments for prescription drugs, physician visits and other services — $2 billion
• increasing the Medicaid eligibility “look back” period from three to five years — $100 million throughout five years
• reforming the Medicaid Managed Care Organization provider tax requirement — $1.2 billion
•  

Commission members must submit a second report outlining long-term solutions to stabilize Medicaid to Congress by Dec. 31, 2006.

Risk Pools May Help Small Firms Expand Health Insurance Options
Allowing small businesses to pool together to buy employees’ health insurance may encourage them to offer various insurance plans to their workers, according to a report from the Small Business Administration.

In 2002, fewer than 40 percent of the employees of the smallest companies were eligible to enroll in a company health insurance plan. To expand the number of workers at small businesses with health coverage, researchers found giving incentives to employers to offer health coverage isn’t enough. In addition, employees must be able and willing to bear their share of the cost of the coverage. Allowing small business to join together to purchase insurance in risk pools may encourage a wider offering of health benefits.

Although the availability of health insurance benefits in small firms increased during the 1990s, small companies experienced a faster increase in health insurance premiums than their larger counterparts from the mid-1990s through 2002. Businesses with fewer than 100 employees spent an estimated $64.5 billion on health insurance premiums in 2002. That was a 38 percent increase from 1997, despite a decline in the share of total employment among firms with fewer than 100 workers.

In 2002, the average annual premium for health coverage per employee at private, non-farm firms was:

• $4,495 for firms with fewer than 10 workers
• $4,068 for firms with 10-24 workers
• $3,781 for firms with 25-99 workers
• $4,072 for firms with 100-999 workers
• $4,608 for firms with more than 1,000 workers

Among these companies, the percent of employees with health coverage was:

• 31.5 percent for firms with fewer than 10 workers
• 44 percent for firms with 10-24 workers
• 50.4 percent for firms with 25-99 workers
• 58 percent for firms with 100-999 workers
• 64.3 percent for firms with more than 1,000 workers

Officials from the Small Business Administration said younger firms of all sizes are less likely to offer health insurance to employees. In 2002, fewer than 60 percent of employees at firms less than five years old worked for a company offering health insurance. For firms that were more than 20 years old, 93 percent of employees worked for firms that offered health insurance.

The report, “Cost of Employee Benefits in Small and Large Businesses,” is available online at www.sba.gov/advo/research/rs262tot.pdf.

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