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January Legislative Update

The Missouri legislature has wrapped up its first full week of the 2016 legislative session, and several issues impacting rural health clinics are moving forward. It is essential that rural health clinics’ needs be represented in these discussions so we can maximize opportunities to serve patients and secure fair reimbursement.

In the FY 2016 budget, the General Assembly passed language directing the Department of Social Services to expand the use of managed care for non-ABD Medicaid patients statewide. According to the department’s timeline, the RFP will be released at the end of April, bids will be due in July, contracts will be awarded in October, and services will begin in May 2017.

Rep. Jay Barnes (R-Jefferson City) is working on a healthcare reform bill to define the state’s expectations for any entity that delivers healthcare to Medicaid patients. His legislation will place a greater emphasis on quality and accountability by raising the minimum medical loss ratio to 90%, instituting performance withholds of at least 5%, and instituting greater enforcement of network adequacy standards.

Another issue that will impact rural health clinics is telehealth reform. Rep. Barnes has filed HB 1923, which is similar to the telehealth bill MARHC supported last year but with some important updates.

HB 1923 authorizes healthcare providers to practice telehealth within their scopes of practice as long as the same standard of care is used. It would also end the existing rule prohibiting rural health clinics from serving as distant sites in a telehealth encounter. Modifying the state’s telehealth regulations will increase patient access to providers and specialists, which is especially critical in rural areas.

A wide range of bills regarding advanced practice nurse practitioners’ scopes of practice have been filed, including legislation that would:

  • Allow a physician to enter into collaborative practice agreements with up to five APRNs

  • Give APRNs prescriptive privileges for Schedule II narcotics

  • Eliminate collaborative practice agreements and license APRNs

MARHC has supported the establishment of a prescription drug monitoring program for years, but this effort has continued to be halted in the Senate. Rep Holly Rehder (R-Sikeston) filed HB 1892 to create a PDMP, and Rep. Barnes filed HB 1922 to establish a prescription abuse registry. With new leadership in place, it is possible that that the Senate will move forward with a PDMP bill in spite of opposition. Any legislation passed, however, is likely to be a compromise version.

Finally, Rep. Diane Franklin (R-Camdenton) has filed HB 1850 to allow various state boards to collaborate with the Department of Health and Senior Services to collect and analyze data on Missouri’s healthcare workforce. This study could help the state assess the availability of various types of providers and identify areas with shortages. Rep. Franklin’s bill will be heard by the Health and Mental Health Policy Committee this week.


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