Newsletters

POSTED: June 16th, 2023
POSTED IN: 2023 Quarter 2, EM Pulse - The Official Newsletter of MOCEP,

The 2023 Legislative session concluded on May 12 at 6:00 PM – kind of. The Senate and House shipped a record $50B state budget to the Governor (mostly due to passing Federal stimulus money through) along with a few key priorities that were noted in the start-of-session speeches of the chambers leaders, as well as the Governor’s State of the State address in mid-January. The Governor has until June 30 to sign the budget and July 14 to sign the legislation passed.

Unfortunately, with the good comes the not so good as well. For a second year in a row, the Senate halted business a day and a half early due to the same group of senators that ended session early for the Senate in 2022. Senators Eigel (St. Charles) and Moon (SW Missouri) both stood on the Senate floor and blocked numerous bills (some good and some bad) from being passed. This included votes on property tax cuts, energy rate reductions, child care assistance for parents, a crime bill to aid St. Louis City, food sales tax reduction, education reform, initiative petition revisions, and sports betting, along with many other bills, leaving the House of Representatives few bills to send to the Governor. The Senate normally will pass 30 plus House bills each year, but this session it was only seven. Frustration boiled over in the Chamber as level-headed senators rebuked Senators Eigel and Moon, who were seeking the spotlight for notoriety and hoping to boost Senator Eigel’s gubernatorial campaign. 

Health care issues were prominent during session debate. Key topics passed were adjustments in APRN and PA collaborative practice oversight (see below); state funding for additional residency slots to produce additional primary care providers in the state; and increased flexibility for the nursing loan forgiveness funds. Pharmacy Benefit Managers were under attack from multiple angles this session, and the renewed interest to reform their treatment of patients remains high, but it is a complicated subject, and more education will be needed before it can pass.

The Legislature is done unless the Governor calls for a special session – not likely – on his marquis priority (childcare assistance) and will not reconvene until September for a veto session.

BILLS OF INTEREST

Non-Compete Prohibition Fails

HB1394, states that no “facility” in this state shall require any “health care professional,” as both are defined in Section 376.1350, RSMo, who is working in a non-research role to sign any covenant not to compete as a condition of employment.

This bill received heavy opposition and little support; in fact only one physician group testified in support. The Committee failed to take action on the bill during the hearing; however it was amended onto SB3. It too failed to make progress.

APRN/PA Revisions Pass

A piece of legislation allowing APRN and PAs more flexibility to practice passed and is now on the Governor’s desk. Another bill, SB157, was passed and contains identical language, in addition to many other subjects. The bill contains “elimination of mileage under certain conditions (either via waiver or use of telehealth); modified chart reviews, license for APRNs, Schedule II drugs for hospice providers, and flexibility with the 30-day on-site supervision. What it does not include is a path to independent practice and additional Schedule II authority. It also requires Assistant Physicians who are licensed and seeking to match with a residency program to have graduated from a recognized accredited program. It has one provision the other professional registration bills do not contain, allowing other physicians listed on a collaborative agreement with a PA to also do administrative oversight duties, such as chart reviews.

Post-Partum Coverage Passes

Coverage for women postpartum for 12 months, extended from the current 60 days, passed, and is on the Governor’s desk. It was revised by extracting an amendment regarding abortion meant to block implementation of the bill, giving women additional health care after the birth of their baby. The bill was very well received by Republicans and Democrats. 

Medical Licensure Compact

HB 348 has been attached to a licensing bill that has passed. It establishes the interstate medical licensure compact. The hospital systems were in support as was the MHA; however the docs initially opposed it – BUT it was a soft opposition. After conversations with the Chairman that opposition was reversed, giving it a clear path to pass.

The Board of Healing Arts can waive any examination, educational requirements, or experience requirements for the licensure if the Board determines that the applicant met the minimum education and work experience in another state, a branch or unit of the military, a territory of the United States, or the District of Columbia, and has been licensed for at least one year.

Rural Hospital Designation Passed

HB402 was passed and is on the Governor’s desk, in three different bills. The Senate added several provisions, including a provision on surgical smoke regulations, APRN practice act revisions that are identical to the provisions noted above (APRN), medical student debt assistance, Physician Assistant clean-up language, and an assortment of other items. Nothing controversial that we have found.

The original provisions of the bill modified the definition of “hospital” to include facilities designated as rural emergency hospitals by the Centers for Medicare and Medicaid Services for the purposes of hospital licensing law. This bill removes the need for certain number of inpatient beds to keep a rural emergency hospital license in good standing. 

COVID-19 Vaccine Laws Fail

As you know, COVID is not gone, nor is legislation telling everyone what they should think and do about it. Several bills were debated on the House floor. HB700 actually received first-round approval from the House, but was never brought up for a final vote. Proposals to increase liability on employers that require the vaccine all failed; however, one bill did pass precluding school districts from requiring certain vaccines in the end.

The Senate dealt with two vaccine bills, both being punitive to employers and health care workers, as well as patients in one instance. Both of those amendments have been sidelined for the time being; however, one other bill just took an amendment that states that no DHSS mandate can require kids prior to attending school to get the C19 or mRNA-based vaccine.

Hospital Transparency Fails

A bill was filed to impose strong hospital pricing transparency. The bill was never heard and received no discussion. I am not certain of the genesis of the bill. The insurance companies like to propose these bills to divert the attention away from them and to hospital unknown costs, and then blame increased health care premiums on hospitals’ increased charges. 

Upskill Training Fund

HB417, sponsored by Rep Henderson, passed and headed to the Governor’s desk. The bill allows the Department of Economic Development (DED) to disburse grants to qualifying employers for each employee or prospective employee who obtains upskill credentials, and who is trained by the employer for a higher skill and paid a higher wage. 

Temporary Hold Proposal

The legislature added this additional measure of protection for hospitals and emergency departments to HB402 (on the Governor’s desk), as well as attempting to balance patient rights. This bill adds another condition under which you can hold a patient, although it is written in a manner that I am not certain does much differently than current law other than granting the provider another layer of liability protection, kind of.

IMPORTANT DATES FOR 2023

June 30: Last Day to sign Budget bills

July 14: Last Day to Sign Bills

September 13: Veto Session