Holidays are here which means the session is near. Pre-filing of legislation began on December 1, although the session does not actually convene until January 6. This year, as you know, is not an election year, therefore the beginning of session will have a quick start with little fanfare.
This session may bring the most diverse number of issues that actually have a chance of passing. Many years – really most years, nearly two thousand bills are filed, but only 10% will make it across the finish line. That is a good thing when we are opposed to legislation like repealing the helmet law, but bad with respect to passing priority bills. Below is a flavor of what I see being filed AND having a realistic chance of passing in some form.
First, since 2016 is an election year, we will have to have the normal guns, abortion (likely in the form of regulations on Planned Parenthood) smaller government and lower taxes. One additional item, due to the tragic events over the past weeks, will be resistance to accepting Syrian refugees. The legislature, like all of us, wants to do something to make the nation and our communities safer, but how that manifests itself into a piece of legislation is not yet clear.
This year I won’t be surprised if the legislature passes an Ethics bill. I believe past efforts have fallen short because the outcry from the public has risen only to the level of frustration, but now voters are showing their sentiment for traditional politicians by pushing Trump and Carson to the top of the polls, as well as Missouri experiencing its own set of embarrassing events last session resulting in abrupt resignations.
Your participation in the process is vital. The MOCEP Board represents its members very well by remaining very pro active on issues affecting EM physicians. Here is your mission if you choose to accept it (if you guessed Mission Impossible, you are correct), you need to turn your weapons on the Capitol (if you guessed Mocking J Part II, you are right again). MOCEP will send out a weekly update as well as post it on our web site, www.mocep.org, and your advocacy can be up to date AND timely.
Ok, on to the issues (Jeopardy) that will affect the health care community. Tort reform, Medicaid, private insurance and practice expansions of APRN’s.
A group of business and health care providers have been working over the interim to keep badly needed tort reform bills moving forward. The group, which has no formal coalition name, has identified several issues that need passing but also know that more than two changes per year is unrealistic for the legislature to accomplish. Collateral Source change seems to be the bubbling to the top as a priority for the coalition. This will directly impact health care providers as well as businesses. This bill would allow a plaintiff to only collect the medical costs they actually paid, not all of billed charges if such charges are not due. The difference is what a provider/hospital charges versus what they accept for payment from an insurer (i.e Anthem, United etc.). There are other liability revisions but they apply more to product litigation and not medical malpractice.
There has not been a recent year in which Medicaid has not been a big topic of conversation during the session. Provider Rates continue to be a priority for the legislature, but funding sources have been difficult to identify. Last session a provider rate increase was funded with Tax Amnesty Program receipts, which was predicted at approximately $50M. The program ends at the end of the month, and we will know the amount of revenue available to fund the increases. The Governor has already reduced the rate increase from 3% to 1% anticipating a shortage of revenue. There are a dozen scenarios that can happen between now and the end of the year, and instead of explaining them all, I will simply state that there will be no resolution until mid to late January.
New Care Management for Medicaid?
That is the question a legislative task force is attempting to answer. The committee is comprised of legislators and public members including Dr. Randy Jotte, an Emergency Medicine Physician. Dr. Jotte has been instrumental in successfully advocating a Regional Care Coordination system so area hospitals can quickly access patient data to know what other services and prescriptions the patient has recently received, thereby cutting down on duplicative tests and prescriptions. While the funding was included in the budget the Governor recently withheld the funding for the same reason as provider rates were reduced.
The MoHealthNet Division (Medicaid) solicited ideas from the health care community on delivery systems for Medicaid. The incumbent insurance companies, which currently administer the benefit for a portion of the population in a central corridor of the state, continually attempt to expand their delivery model to a larger portion of the population (elderly and disabled) and throughout the entire state. That plan has thus far backfired as the state appears to be poised to move in a different direction, BUT that direction is not yet known.
The nurses have teamed up with various chain pharmacies to loosen restrictions on collaborative practice arrangements allowing easier administration of a clinic located in a chain pharmacy. The nurses and physician community do not share the same solution and therefore expect this to be a contentious issue once again.
Two issues are surfacing, but I suspect there will be many others. First, the insurance industry would like the authority to sell HMO plans with a higher out of pocket cost to plan members so the premiums can be lower and fit within the ACA requirements for a Platinum, Gold, Silver or Bronze plan. HMO plans are not sold now due to the $50 copay limitation in Missouri law, therefore PPO plans are sold since they allow the ACA max out of pocket cost which currently is approx. $6,500 per year. The problem is most provider protections in the law apply only to HMO plans, so there are discussions between insurers and providers to pass a bill allowing a higher out of pocket cost so insurers can begin to sell HMO plans instead of PPO plans. This could be beneficial to EM physicians, as the HMO laws contain several protections for Emergency Department visits including the “prudent layperson” standard and not retroactive denial of prior authorizations.
Your Task, if you choose to accept it (if you guess Mission Impossible).