Newsletters

POSTED: May 31st, 2017
POSTED IN: EM Pulse - The Official Newsletter of MOCEP, May/June 2017,

Written by Jorgen Schlemeier

Session was over, however the Governor gave the legislature an incomplete grade and called them back for a special session regarding an economic development opportunity in the Boot heel. A St. Louis Post article backed up his assessment: “By sheer numbers, the 2017 session wasn’t that bountiful. Lawmakers passed 55 non-budget bills, which is far fewer than the roughly 120 non-budget-related laws approved in 2008 when the Republicans last held the governor’s seat and the General Assembly.”

The Senate became the bottleneck as Republicans could not contain the infighting despite attempts by leadership to get everyone back on the same page by bringing caucus legislation to the floor.

The Governor said it will be a busy summer for the legislature, however his resolve may fade after assessing the results of the first special session.

Budget

The Budget is complete, and on the Governor’s desk.  While many providers received a rate decrease, we did escape, not without threat, maintaining our current level of funding/rates.

MOCEP worked collaboratively with the Missouri Hospital Association to implement a new Emergency Department payment criterion. Last year, Medicaid (MO HealthNet) attempted to impose a LANE program, which would have resulted in a retrospective denial of payment process.  We opposed the implementation of that program, even though the reduction of payment would have only affected the facility payment and not the physician payment.

The budget committee also attempted to adjust eligibility for seniors and disabled persons receiving care in a facility or in their home (in home services).  The new standard would have made it more difficult for this population to qualify, which would have dropped nearly 70,000 people from care, including kicking them out of a facility. While this budget item does not affect your rate, we are relatively confident that seniors and disabled will immediately enter the emergency department, as they will still be Medicaid eligible. The legislature passed a separate funding bill to address this issue, however the Governor is not yet clear on his position, as it is a bit unique.

PDMP – Failed, but is it on the list for Special Session??  We will see.

The PDMP bill became the roller coaster in the final week of Session. The House sponsor attempted to pass a bill with the senate amendments.  That would have clearly degraded the established county programs. After strong pushback from the coalition members, the conference bill was still too punitive toward prescribers (physicians, dentists, nurses and pharmacists-dispenser), which I believe was the goal of Sen. Rob Schaaf. 

The bottom line is that the bill would have assumed the county programs, and made those conform to the new law, which also contained a sunset clause.  Sen. Schatz and Rep. Holly Rehder continued their advocacy until the final day, and did a great job on this issue. A big “Thank You” to them.

Stemi And Trauma Center Designations

Senate Bill 50, currently on the Governor’s desk, requires the Department of Health and Senior Services (DHSS) to promulgate rules for the designation of a trauma center and a STEMI center without site review if such hospital is certified by a national body. This bill also contains changes to the data requirements, interpretation of specific provisions, and improved communication practices. The bill removes the requirement that the department generate quarterly regional and state outcome data reports for trauma, stroke, and STEMI centers, the State Advisory Council on EMS, and  regional EMS committees (Sections 190.241 and 190.242, RSMo).

Line of Duty Death Benefit

The Line of Duty Death benefit legislation passed. This ensures the decedents family of an emergency first responder can apply for the state benefit in the same manner as the federal benefit.

EMS Legislation

Several bills were filed related to EMS, however only a fraction of the provisions crossed the finish line.

Senate Bill 503 modifies the designations and duties of state and regional EMS medical directors, allows regional medical directors to provide medical direction by telecommunication, and contains provisions allowing regional medical directors to promulgate treatment protocols for patients with special needs and requiring EMS agencies to follow those protocols.

This bill also:

• Addresses liability of EMTs;
• Requires Department of Public Safety to address 911 answering points issues;
• Changes the Advisory Committee for 911 Service Oversight to the Missouri 911 Service Board, reduces the number of board members, and alters the responsibilities of the Board, and requires them to designate a coordinator who shall be responsible for overseeing state 911 operations.

Omnibus Health Legislation

Senate Bill 501 passed and modifies several provisions relating to health care, including: (1) health care records; (2) a health care directives registry; (3) drug or alcohol overdoses; (4) epinephrine auto-injectors; (5) hospital licensure; (6) immunization education; (7) sports medicine; (8) assistant physicians; (9) physician assistants; (10) psychologist internships; (11) vaccine protocols; (12) speech-language pathologists and audiologists; (13) medication-assisted treatment; and (14) a drug take-back program.

Tort Reform 

The Jefferson fix passed- This bill passed in 2005, but the court overturned in the Jefferson case, expanding the definition of when a physician qualifies as a hospital employee. The legislation more clearly defined when a physician could be considered an employee of a hospital.

Expert Witness was signed by the Governor.  This bill, also known as the Daubert Standard, was needed, as the trial bar was bringing “junk science” into the state and suing businesses due to the low bar Missouri has to qualify as an “expert” in a field (not necessarily the same for a med mal claim) or on a matter. 

Dentists in Hospitals

This legislation, sponsored by Rep Jay Barnes, modifies the dental practice act to allow a hospital to employ a dentist for services that are presented by a patient to the hospital. The language passed on SB50.  

 

Bills that did not pass include:

• Opioid Antagonist – HB1137  
• Super Waiver on Debate Calendar – SB 28
• Helmet Bill Fails – Would have repealed Missouri’s current motorcycle helmet laws.
• Powdered Alcohol – HB 29 passed the House and was well received in the Senate Committee, however it did not pass for a good reason, which is odd to admit. The Senate said they did not want to pass the bill because it did not go far enough, and wants to pass a stronger ban next year. They were genuine about their sentiment, and believe the support next year will be stronger for a flat out ban, at least via the internet, and then access only in retail for those 21 and older.
• Nurses Bill Voted Down – The House version of the Nurse bill was defeated in committee this week by a 5-5 vote. We worked against the bill, as it was too expansive for the APRN’s.  They will be back next year with the full menu of practice expansion, and continue to wear down their advocates in the legislature by not taking the proverbial slice at a time.   
• Maintenance of Board Certification – HB 529
• Medicaid Eligibility – HB 961,
• Right Shop Act/AWP – HB 123
• Insurance Bills Fail
• Several bills were filed in anticipation of the ACA repeal, but that did not happen and neither did the bills filed in Missouri. This will be a big topic of discussion during the interim. The Governor’s office is searching for answers to make policies more affordable without making them meaningless to the purchaser.