WEEKLY OVERVIEW: LOTS OF ACTION AT THE CAPITOL ON HEALTHCARE ISSUES AND INSURANCE

Activity in the Senate this week revolved around getting the budget bills passed on the floor.  Senator Gary Romine (R-Farmington) shook the process by successfully amending the K-12 education bill to fully fund the state foundation formula.  His amendment, which was opposed by Budget Chairman Dan Brown, received the necessary 18 votes and added an additional $45 million to the formula funding.  Because the House version also recommended full funding, this issue is not subject to conference committee proceedings. The $27 billion budget now will go to conference committee to reconcile the versions passed by the House and Senate.  Major differences involve funding for higher education, funding for in-home and nursing home care, state funding for DWI checkpoints, and tax credits for elderly citizens who rent homes.

In yeoman fashion, the House this week continued to pass both House and Senate bills. In a show of frustration on Thursday, the House spent several hours loading up a Senate bill with dozens of amendments before laying the bill over on to the informal calendar.  The trend in the House appears to be to amend Senate bills with House bills that are stalled in the Senate.  There is no lack of grousing by House members regarding the lack of activity in the Senate.

With just two weeks remaining in the session (and now that the budget bills have passed in the Senate), all eyes are on State Senator Rob Schaaf who said this week that he would slow down passage of legislation until the Senate moves ethics reform bills.  Schaaf has sponsored legislation relating to a ban on lobbying gifts and disclosure of “dark money” contributors.

Finally, we have reached the point in session where very few additional bills will be heard by committees.

BUDGET UPDATE: This week the Senate, working under a shortened timeline than has been used in sessions past, completed designing their version of the FY2018 $27.8 billion budget.  There are only five legislative days left before the General Assembly must submit a balanced budget to the Governor for the constitutional deadline of May 5th at 6:00pm.  Committee members are expected to begin meeting on Monday evening, as Senate Conferees have not yet been announced.  If the House and Senate fail to meet the Constitutional deadline of Friday, May 5thto pass a balanced budget, a special session of the legislature will be required. 

Traditionally Senators do not offer amendments on the Senate floor out of respect for the Chairman of the Appropriations Committee and the members who have invested a great deal of time designing a budget.  In a surprising move this week, numerous members ignored tradition by offering amendments on the floor.  The largest of which was offered by Sen. Gary Romine (R-Farmington) which fully funds the Foundation Formula.  This amendment was adopted, against the express wishes of the Chairman, which adds $45 million to the formula.  The concern now is the committee had used this money to fund various programs throughout other departments. 

Unsurprisingly, Sen. Rob Schaaf (R-St. Joseph) offered an amendment which would have removed the funding allocated to the expansion of Medicaid managed care.  After a lengthy debate, this amendment was defeated with 10 ayes and 22 noes. Sen. Scott Sifton (D-Affton) offered an amendment, which was adopted, which restored an additional $1.5 million to the Secretary of State’s Office for the purposes of educating voters on the new provisions of voter identification requirements.

In statements to the media the House Budget Committee Chairman, Rep. Fitzpatrick (R – Shell Knob) stated the budget conference committee members that have been appointed to negotiate the differences will have a tough time balancing the budget.  However, some capitol observers believe there is room to lower the amount the House set-aside for projected Medicaid growth spending for next year in order to forego withholds and or a large supplemental budget request.  Currently, the House version of the budget set aside $98.5 million over and above the $100 million that Governor Greitens recommended to set-aside for projected increase in Medicaid spending.  The $198.5 million set aside will likely be lowered during budget conference negotiations. 

PROFESSIONAL REGISTRATION:  On Thursday, the Senate Committee on Professional Registration met in executive session and voted “do pass 5-2” SCS/HB 815.  Provisions of this substitute include:

  • Dental Cone Beam CT machines;
  • The submission of required professional registration documents electronically;
  • Provisions relating to land surveyors;
  • Provisions relating to suicide training;
  • Dental franchisor and dental service organization language;
  • Provisions relating to hospital employed dentists;
  • Dental school faculty permit language;
  • Provisions relating to out-of-state team physicians;
  • APRN and collaborative agreements mileage change to 75 miles;
  • Removal of the authority for physician assistants to dispense drugs;
  • Language relating to the Missouri State Board of Nursing makeup;
  • Language relating to LPNs personal care visits without the direction of an RN in residential care and assisted living facilities;
  • Optometric continuing education requirements;
  • Continuing education for audiologists.

EMERGENCY COMMUNICATIONS SERVICE: This week the Senate Commerce, Consumer Protection, Energy and Environment Committee held a hearing on HB 334, sponsored by Representative Jeanie Lauer (R-Blue Springs). The bill changes laws regarding funding for emergency 911 services, administration of 911 funding, Missouri 911 Service Board, and the cooperation and contracting between emergency services providers.

Testifying in support of the measure were representatives from MO Chapter of Association of Public Safety, MO Chapter of Emergency Number, MO Municipal League, American Heart Association, MO Nurses Association, Association of Counties provided. No opposing testimony was provided and the committee took no further action.

Later in the week the committee met in executive session and voted SCS HB 334 “do pass” by a vote of 10-1. The SCS states that a statewide study must be done before any municipality may place a 911 tax before the voters.

MEDICAL NEGLIGENCE:  On April 24, the Senate Government Reform Committee held an executive session on SCS SB 524 sponsored by Sen. Koenig (R) and voted the “do pass”.  This bill requires a defendant served after the statute of limitations for wrongful death or medical negligence claims has expired to be served in within one hundred eighty days after a petition has been filed. 

STATE INNOVATION WAIVER TASK FORCE:  On April 25, the Senate Rules, Joint Rules, Ethics and Resolutions Committee held a hearing on SCR 25 sponsored by Sen. Cunningham (R).  This Senate Concurrent Resolution establishes the State Innovation Waiver Task Force.  The sponsor noted that this task force will examine a health care reform plan.  The task force is composed of 25 members.

Testifying in support was United Healthcare, Missouri Insurance Coalition and Blue Cross Blue Shield of Kansas City.

Supporters noted the uncertainty in the marketplace and stated that this task force will help keep our market stable and will be ready to respond to any changes that occur in Washington.

No one testified in opposition.

On April 26, the committee voted SCS SCR 25 “Do Pass”.

OMNIBUS HEALTH AND INSURANCE BILL:  On April 25, the House Insurance Policy Committee held a hearing on SCS SB 334 sponsored by Sen. Sater (R). This bill requires assisted living facilities to provide residents with educational information on influenza.

Testifying in support was Missouri Assisted Living Association and Sanofi Pasteur.

Supporters believed that influenza primarily affects seniors and that the provision of information is an important step in helping to combat the disease.  The Missouri Assisted Living Association wanted the mandatory provision changed.

No one testified in opposition.

The committee then went into executive session. And adopted the following amendments: 

HCA 1 – Wiemann – regarding posting of vaccine information – adopted on a voice vote

HCA 2 – Wiemann – Removes brackets in current statute that eliminates exclusive provider organization plans  if the ACA is repealed – adopted on a voice vote

HCA 3 – Wiemann – adds language regarding notification to local authority on sexual assault of a residence – adopted on a voice vote

HCA 4 – Wiemann – adds HCB 10 which contains the following bills (without the short term medical bill):

HB 341 – Rep. Shull (R) – Suicide Exclusion

HB 345 – Rep. Shull (R) – Insurance Interest

HB 741 – Rep. Engler (R) – Commercial Insurance Forms Exemptions

HB 829 – Rep. Matthiesen (R) – Long Term Care Riders

HB 863 – Rep. McGaugh (R) – Festival Liability Insurance

HB 611 – Rep. Carpenter (D) – Long Term Care Insurance

HB 958 – Rep. Wiemann (R) – Property Insurance

The amendment was adopted on a voice vote.

The committee rolled the amendments into a substitute and voted the bill “do pass” by a vote of 9 to 0.

PHYSICAL THERAPY REIMBURSEMENT:  On April 25, the House Insurance Policy Committee held an executive session on HB 298 sponsored by Rep. Lichtenegger (R).  This bill specifies the minimum reimbursement amount for covered physical therapy services delivered under health benefit plans.

HCA 1 – Wiemann – excludes supplemental insurance policies – adopted on a voice vote

The committee rolled the amendment into a committee substitute and voted the bill “do pass” by a vote of 9 to 0.

SENIOR SERVICES FUNDING:  On April 25, the House Insurance Policy Committee held an executive session on HB 540 sponsored by Rep. Lichtenegger (R). This bill establishes the “Senior Services Growth and Development Program” within the Department of Health and Senior Services to provide additional funding for senior services through area agencies on aging. Beginning January 1, 2018, the Director of the Department of Revenue must deposit 10% of the premium tax collected from certain insurance companies and associations, excluding any moneys statutorily-mandated to be transferred to the State School Moneys Fund and excluding the cost of collection, in the “Senior Services Growth and Development Program Fund.” The moneys collected must be placed in a special fund in the State Treasury and the Department of Health and Senior Services must disburse the funds to the area agencies on aging. The bill requires all area agencies to report annually to the Department of Health and Senior Services, the Department of Insurance, Financial Institutions, and Professional Registration, and the General Assembly on the distribution and use of the funds.

HCA 1 cuts the percentage of funding in the original bill from 10% to 5% was adopted on a voice vote. The committee rolled the amendment into a substitute and voted the bill “do pass” by a vote of 9 to 0. 

PHARMACY CLAIMS:  On April 25, the House Insurance Policy Committee held a hearing on HB 1073 sponsored by Rep. Morris (R).  This bill changes the law regarding insurance claims filed by a pharmacy.  The sponsor noted that this bill is extremely important to the pharmacy industry. He noted that under Direct Indirect Remuneration the PBM months later can take money away that has already been paid on a claim.

Testifying in support was the Missouri Pharmacy Association. Supporters asserted that more information needs to be provided relating to which prescriptions are affected on the claw back on Medicare Part D.

Testifying in opposition was CVS Health and Express Scripts. Opponents believed that they bill interferes with private contracts.

The committee then went into executive session and voted the bill “do pass” by a vote of 9 to 0.

OMNIBUS HEALTH CARE BILL:  On April 26, the House Health and Mental Health Policy Committee held an executive session on HCS SB 501 sponsored by Sen. Sater (R) and voted the bill “do pass” by a vote of 8 to 0.  The original bill requires pharmacists to administer vaccines by protocol in accordance with treatment guidelines established by the Centers for Disease Control.  The substitute in part contains provisions regarding: opioid addiction and treatment; low cost cash prescription maintenance medications; medical record fees; assistant physicians; drug courts; LPNs residential care documenting daily care; and speech pathologists continuing education and licensing.  The title of the bill was changed to “relating to healthcare”.

HEALTH INSURANCE TASK FORCE:  On April 26, the Senate Health and Pensions Committee held a hearing on HCS HB 780 sponsored by Rep.  Hill (R).  This bill establishes the State Innovation Waiver Task Force.  The sponsor noted that the waiver would allow states to come up with a plan to deliver health care.  He noted that 244,000 Missourians were enrolled in the ACA last year.  He also said that they received $853 million in tax credits. 

Testifying in support was United Healthcare and the Missouri Hospital Association. Supporters said that this will give the State the ability to react and respond to what is transpiring at the Federal level and stabilize the health insurance marketplace.

No one testified in opposition and the committee took no action on the bill.

TEXTING WHILE DRIVING: On Thursday, the Senate Transportation Committee conducted a hearing on SB 510, sponsored by Senator Bob Dixon (R-Springfield). This act repeals the existing texting while driving statute, and modifies another statute requiring motorists to exercise the highest degree of care to expressly prohibit operation of a motor vehicle while using a cell phone or certain other devices, and while eating, performing grooming or hygiene tasks, or reading.

The committee took no action on the bill.

CHILD ABUSE AND NEGLECT REPORTS:  On Wednesday, the Senate Committee on Seniors, Families and Children voted “do pass” HB 1158, sponsored by Rep. Diane Franklin (R-Camdenton). The bill specifies that information contained in certain child abuse and neglect investigative reports shall be retained by the Children’s Division of the Department of Social Services. In instances where the division has been unable to determine the identity of the perpetrator, the child’s parents and legal guardian must be notified that the division shall retain, utilize, and disclose all information and findings as provided in family assessment and services cases. The bill also allows the division to reopen a case for review if new, specific, and credible evidence is obtained.

Governor’s Senior Advisor Called to Task in Senate

Sen Denny Hoskins addressed the Senate on a Point of Personal Privilege to call out Austin Chambers, Senior Advisor to the Governor, for threatening Senators in his comments to media, “This isn’t about just something against the Senator from Buchanan, if there are others who are standing in the way than we will engage with them too.” Hoskins expressed his anger over Chambers dirty politics, such as sending out Senators personal cell phone number, “In my heart, I know my colleagues here, whether their Republican, Democrat, Liberal, Conservative are not corrupt.” “I know that we have a job to do here in the Senate and by God I am not going to let some 21-year-old, immature, senior advisor to the Governor derail what the voters put me here to do.” https://clyp.it/njtfnqmc