The legislature has been adjourned since May 15th but it would be hard to tell by assessing the high activity level of the MOCEP legislative committee.
First, veto session convened on September 14, and the legislature voted on issues the governor vetoed this summer. There were several issues in which MOCP has interest.
- SB608 was overridden by the legislature and will go into effect. This bill requires mandatory ER copayments for Medicaid enrollees. If you recall, we opposed this bill initially however, the sponsor added a provision at our request stating the copayment was to supplement the state payment to the physician and not to supplant such payment.
- This bill also addressed transparency of facility costs. The bill requires providers and facilities to disclose to certain patients under certain conditions, which I could describe, but instead will tell you that we added an amendment that exempted Emergency Departments from these provisions.
- SB656, the infamous gun bill, was overridden and will go into effect. This bill modifies the procedure to carry a concealed weapon and expands the “Stand Your Ground” doctrine. Currently, a person has the right to defend their ground when on their own property, otherwise has a duty to retreat. This bill allows the person to defend their position.
- SB847, received enough votes to override the Governor’s veto in the Senate, but did not get taken up in the house, so the Governor’s veto will stand. This legislation modifies the Collateral Source rule in torts, would limit recovery of medical costs to those costs paid and owed, not charges billed if those were never paid nor owed
Second, the division of Medicaid (MO HealthNet) is developing a payment mechanism to reduce ED facility payments if the patient did not present a health care condition that meets the emergency definition. So what is an “emergency definition?” The state would like to retrospectively reduce the facility payment only (not physician payment) if the condition treated was not an emergency. Drs. Heidt and Char are serving on a task force with the state to develop the litmus test the state will use when making a determination of what level of payment will be made to the hospital. We are advocating for the department to use the prudent layperson standard when retrospectively assessing if care was delivered to a person presenting an emergent condition.
Finally, we have been working on changing the CE required for Emergency Physicians to qualify their facility for Time Critical Diagnosis (TCD) designations. The legislature passed a bill overriding the Dept. of Health’s interpretation of required CE for Emergency Physicians. The legislation transfers the power to establish CE requirements to the Board of Healing Arts. Drs. Heidt and Char, Sarah and I met with the Board’s executive director, general counsel and medical director about what we believed were reasonable CE requirements. They were very open to a reasonable solution. They will gather additional information before meeting with us again to discuss the CE requirement.