Summer 2012: From MoCEP Executive Director Jorgen Schlemeier

POSTED: September 5th, 2013
POSTED IN: Summer 2012,

Missouri Legislature – Past, Present and Future

The Missouri legislative session has concluded and the Governor has begun signing or in some instances, vetoing legislation. The governor has until July 14th to act, otherwise legislation passed will automatically go into effect. That is rare however and in fact I believe the Governor has only taken that path once during his term.

A quick recap will really serve as an outline of where we start for 2013 session. Here it is:

Prescription Drug Monitoring –

didn’t pass in 2012, leaves Missouri as the last state (Ihave heard that before) to implement a drug monitoring program. Several senators opposed to the bill have since either retreated or termed out, and the primary opposition is down to Senator Rob Schaaf (physician from Buchanan and Platte County). A coalition, to which we will belong, will begin a grassroots campaign, and some paid media, to promote this issue over the summer months. You will receive updates on activity of the group. This of course will culminate in a bill being introduced next session.

Budget –

passed on time, something the feds have a difficult time accomplishing, and the Governor signed it without many restrictions or vetoes. I do not see the Medicaid budget, as it relates to you, changing from past practices. One note however is that new Medicaid Managed Care vendors are enrolling providers now and will go live in July. Since there are some new insurers administering the Medicaid program, be sure to share positive or negative experiences about them, since your issue is likely NOT an isolated one and will want to detect trends.

Two additional notes on the Budget: First, I believe that State’s budget will improve each year if the trends remain steady. This will allow us to request a Medicaid rate increase with a straight face. It is tough to ask for a rate increase when other programs are being whacked. Second, the new Medicaid enrollee eligibility due to the federal health care law will increase total enrollment in the program by 35%.

Medicaid Expansion –

A massive expansion of the Medicaid program under PPACA was struck down by the Supreme Court last week. Missouri would have increased their Medicaid enrollment by 35% had this provision stood. See the following assessment by the NY Times I found informative on this topic, “Very quietly, the Affordable Care Act introduced a revolutionary change: All poor people in America would get Medicaid.” The new law would have extended Medicaid to everyone with incomes up to 133 percent of the federal poverty line ($23,050 a year for a family of four). Aren’t the poor already covered? That depends on where they live. In New York, most adults up to 150 percent of the poverty line are covered; in Texas [and Missouri], Medicaid reaches only to 26 percent of the poverty line — a family of four is not eligible if they earn, say, $9,000 a year. The court ruled that Congress may not require states to expand Medicaid. States can stick to their old Medicaid programs. Stingy states may choose to stay stingy. That part of the decision flew under the media radar. But it is a significant blow to liberals who had a simple way to grow benefits by expanding programs.

Most Favored Nations –

will be introduced next session – this is to ensure an insurance carrier cannot tie your reimbursement to are imbursement schedule you have with another carrier. The Blues have actually taken this one step further and in some cases that
have been reported to me, they require your rate with them be at least 5% less than your lowest contracted amount you have with any other carrier.

Credentialing –

This bill narrowly failed, after passing the Senate and House Committee. The bill would have required insurers to complete the credentialing procedure within 60 days. This primarily affects providers practicing in institutions. The “institution” (hospital, rural health clinic, FQHC) is a provider, but a carrier cannot reimburse a recently hired health care practitioner of such institution until the carrier’s credentialing process is completed. This leaves the institution and provider in a tough spot. Patients expect services, but the carrier will not reimburse for the services. This will be a high priority of provider groups again next year. As issues begin to develop, I will distribute a short summary of which legislators are involved and what issue they are promoting.