Legislative Session Review
The Missouri General Assembly's 2017 Legislative Session adjourned May 12. Of the 1,966 bills and resolutions filed, only 76 passed. This is a very low number historically; more than 140 were approved in 2016 and 2015. Members received MARHC's full end-of-session report in the May newsletter. It details the major issues addressed in the Legislature this year as well as bills of interest to rural health clinics. Healthcare issues MARHC monitored include:
After-Hours Care: HB 544, sponsored by Rep. Jay Barnes (R-Jefferson City), directs Mo HealthNet to pay additional reimbursement to providers who care for Medicaid patients after business hours. This is meant to encourage providers to remain open later to give patients options for care beyond the ER. The bill was heard in Health and Mental Health Policy, but it was not voted on due to concerns about the cost.
Collaborative Practice: A wide range of APRN bills were filed this year. HB 244, sponsored by Rep. Lyle Rowland (R-Ava), allows mileage requirements to be waived and increases the number of APRNs a physician can supervise from three to five. HB 165, sponsored by Rep. Tila Hubrecht (R-Dexter), removes most of the collaborative practice agreement requirements and creates licensure for APRNs. No APRN bills moved beyond their Chamber of origin. The House amended several Senate bills with language extending mileage requirements to 75 miles and increasing the supervisory ratio. These sections were removed in conference committee.
Community Paramedics: The budget includes $500,000 general revenue and the corresponding federal match for a Medicaid code to reimburse paramedics for providing services to patients that prevent them from being transported to the ER. The language requires the reimbursement to be lower than payment for transportation to the ER, so the code's cost will be offset by diverted ER trips. This funding was appropriated but withheld last year.
Dental: HB 762, sponsored by Rep. Jay Barnes (R-Jefferson City), and SB 410, sponsored by Sen. Dave Schatz (R-Sullivan), allow hospitals to employ dentists, oral and maxillofacial surgeons, and maxillofacial prosthodontists to perform certain services. This language allows hospitals to own part of a dental practice or employ dentists to provide services, such as extractions, to patients who present in the ED for oral health issues. Hospitals would also be permitted to employ oral and maxillofacial surgeons or maxillofacial prosthodontists whose services may be needed as part of treatment for patients with severe illnesses, such as head and neck cancer. This language was sent to the Governor on SB 50.
Global Waiver: Three bills, SB 28, HB 290, and HB 402, direct the Department of Social Services to apply for a Medicaid global waiver requesting maximum flexibility in administering the program. The bills specifically reference granting the state authority to implement reforms like work requirements or co-pays for Medicaid patients. They also require the department to propose or accept new federal funding mechanisms, such as block grants. SB 28 was debated on the floor but laid over. The other bills were referred to the House Budget Committee but not heard.
Opioid Overdose Prevention: SB 501, which was passed, allows opioid antagonists, such as naloxone, to be dispensed under a statewide order from the Department of Health and Senior Services Director. This is meant to make medications that block the effects of overdoses more widely available. The bill also provides protections for individuals who call for help during an alcohol or drug overdose. The individual in need of assistance and the one who obtained help would not be prosecuted, with exceptions for drug distribution charges.
Prescription Drug Monitoring Program: Proposals to establish a PDMP, which would allow physicians to view patients' prescriptions records, have been blocked in the Senate for years due to privacy concerns. In the absence of legislative action, counties have created their own programs. HB 90, sponsored by Rep. Holly Rehder (R-Sikeston), and SB 231, sponsored by Sen. Dave Schatz (R-Sullivan), would create a comprehensive statewide PDMP mirroring county programs. An alternative, more limited PDMP was proposed by Sen. Rob Schaaf (R-St. Joseph). In a surprise press release, Sen. Schaaf said he would not filibuster HB 90 if it required providers to use the system and held them liable for failing to do so. In the Senate, HB 90 was amended to require providers to use the PDMP except in certain instances. Senators also restricted the PDMP's scope and data so if passed, HB 90 would create a program weaker than counties' existing PDMPs. A conference committee report that compromised between the House and Senate versions was not voted on. This is the furthest PDMP has ever gone in the process.
require individuals performing radiologic imaging or radiation therapy to be certified by the Board of Healing Arts. The bills create different certifications based on the type of procedures done. For example, a limited X-ray machine operator certificate would be available for those only doing x-rays, not MRIs or other procedures. The legislation also outlines the certification and continuing education requirements. MARHC members expressed concerns about the burden these requirements would place on clinics. The bills did not move forward this year. If they are filed next year, MARHC will continue working on protections for clinics, such as allowing educational requirements to be completed virtually and creating a grace period for newly hired employees.
Vaccines: HB 331, sponsored by Rep. Lynn Morris (R-Nixa), bans vaccines containing mercury or other preservative metals from being administrated in Missouri public health clinics. His HB 332 bans vaccines for shingles and chicken pox that contain human DNA from being administered in public health clinics. SB 538, sponsored by Rep. Maria Chappelle-Nadal, bans all vaccines with mercury. Rep. Morris' bills were not heard in Committee, and SB 538 was voted down by the Senate Health and Pensions Committee.