Legislative Session Didn’t End!

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POSTED IN: EPIC - The Official Newsletter of MOCEP, July/August 2017,

Written by Jorgen Schlemeier

Editorial note Correction: My last column I gleefully announced “Session has ended”; that was an error. 

The Governor has called the legislature back twice since the “regular” session ended, first to allow the state to offer a special incentive to attract a steel plant in southeast Missouri, as well as re-open an aluminum plant in the same part of the state.

After completing that task, abortion became the next topic of discussion and the House and Senate are attempting to reconcile their differences between their versions of regulating abortion facilities. This rose to meet the standard required to be considered in a Special Session, because a judge knocked down the law that required facilities that perform abortions to be licensed as Ambulatory Surgical Centers. With the judges ruling, so went any regulation on abortion facilities, and therefore a regulatory vacuum was created.

The first special session did not affect you unless your 401K is in a steel mill hedge fund.  If so, stop reading this and pick up the Wall Street Journal.

The second special session however does impact you to some degree. The few number of abortions that may need to occur in order to save the life of the mother that come through the ED and any emergency transfers your ED receives from abortion facilities (state statute label, not mine) would rope you into some potential onerous laws.

Potential?  I use that term because the House version of the legislation leaves too much of the details with respect to forms, and complication plans, and transfer plans and physician reporting to the Department of Health Rule and Regulation authority, and then grants new prosecutorial powers to the Attorney General to enforce such rules.

My issue with the bill is not the policy of abortion, but when setting health care practice requirements and documentation, then leave that to the physician and hold them to the “best practice” standard, not a new rule or regulation that can not apply to all conditions for all patients.  In one part of the bill, a physician would have to file a complication plan, which would have to be approved by the Department.  Does the department have the expertise to approve such a clinical plan for complications? We continue to work to either exempt ALL ED services, or leave the physicians to the peer group, such as BOHA, to determine if discipline needs to be imposed on any practice issues.

As you may have seen from Dr. Jonathan Heidt’s updates, insurance continues to be a big issue for all practitioners. Anthem’s recent growing denial of ED services is alarming.  I will not re-review his information. 

The provider groups will be meeting this summer to discuss changes to insurance law in anticipation of changes the insurance industry will propose due to marketplace changes including a federal direction shift either by congressional action, we will see, or by CMS or Presidential Executive order. 

At the end of the regular session, some insurance companies needed state law adjustments anticipating ACA becoming Swiss cheese. These are all unknowns, but certainly want to be prepared when the insurance industry lays out their agenda and coordinated with other providers so we can present a comprehensive plan as well.

Tort – The governor signed all of the tort bills the legislature passed on which I reported in my legislative wrap up in the previous newsletter. While I know you archive those for future reference, here is a refresher. Collateral Source, Expert Witness and Employment Discrimination were the three big bills passed. Collateral Source is the one which will likely most affect your insurance rates, by ensuring awards are based on “actual health care costs that were paid or are owed” and not the “value” of the health care service, which is an amount that was not paid nor owed.

Finally, the State of the State appears to continue to struggle from a state’s fiscal standpoint. Most providers, but not Emergency Physicians, were cut between 3% and 3.5% as well as increasing the standard a senior or disabled person must meet in order to receive in home services or remain in an assisted living facility or nursing home.  The new standard requires them to be sicker, and score 24 points instead of 21 points on a health care acuity scale before being eligible for Medicaid services. This could cause an increase in ED services, at least as an entry point, for many of these seniors and disabled. This cut coupled with eliminating the MoRX program has really put seniors in a tough spot. During the past 15 years, the MoRx law helped seniors who make too much to qualify for Medicaid (above 85% of FPL) and below 185% to assist with their copays in Part D, and also while they were in the doughnut hole.

As more special sessions evolve, I will keep you current of the impact it may have on you, otherwise have a great summer!