Newsletters

POSTED: June 25th, 2024
POSTED IN: 2024 Quarter 2, EM Pulse - The Official Newsletter of MOCEP,

2024 Legislative Update

from Gamble & Schlemeier Governmental Consultants

The Missouri Legislative session concluded passing only 28 non budget bills, a record low number.  The Senate dysfunction was the prevailing theme, which resulted in many Senators and Representatives priorities simply dying on the debate calendars from pure gridlock in the Senate. In fact, the Senate during the final week of session – which normally processes the about 80% of the bills passed in a year – conducted no business at all. The Senate Freedom Caucus members caused major disruptions, and showed they had a clear agenda, which began on opening day of session in January, setting the tone that unless they did not approve of a bill or amendment, the issue would struggle to make progress.  In most cases, the issues they deemed not necessary were never even be debated on the Senate floor. That caused a bottleneck that became unfixable. In many instances, more hours were spent reading books on the Senate floor than debating the topic before them, and for the first time in our time at the state capitol, no legislation was sent to a conference committee.

The House of Representatives processed all the bills they could without needing the Senate concurrence.  They too had controversy throughout the session but their rules and processes allow them to work around those issues and remain functional. The House remained working even throughout the final day of session to pass key legislation, but ran out of things to do once the senate concluded their day and session that morning. 

Legislation that navigated its way through the narrow passage way and to the Governor’s desk included:

• $50 billion state balanced budget – many doubted it would pass prior to the deadline, but as history repeats itself once again – they met their constitutional duty
• Funding bill, (FRA) renewing a mechanism to draw down federal money to help pay for health care for Missourians, which alleviated the need to cut $4.2B from the budget. 
• Education bill, granting both public and private education greater abilities to educate students. This bill expanded from $25M to $50M a quasi-privately funded scholarship for students to attend a private school as well as over $500M of additional funding for public school programs, including a minimum teacher pay of $40,000 per year. 
• Planned Parenthood defunding legislation, precludes state money from going to Planned Parenthood – a law that codified the current budget practice in Missouri.
• Discounted Prescription Drugs, expanding access to discounted prescription drugs – allowed more pharmacies to provide prescriptions under the 340b program
• Public Safety Bill – included juvenile court changes, ban on shooting your weapon in the air and allows firefighters to enroll in a critical incident stress management program. The bill also precludes an arrest of a person who misses their court date due to a traffic violation. 
• Video Service protection – precludes a city from taxing a streaming service, such as Netflix Hulu Disney and the dozens of others. 

BILLS OF INTEREST

ED Staffing by Physician– Failed

HB2548 – filed by Rep Brad Christ and SB1406 – sponsored by Sen Karla Eslinger were heard in the House Professional Registration Committee and received good support but also had opponents voice concern what this would do to rural critical access hospitals. Drs. Bausano, Poirer, Kroll and Char testified in support – and really enlightened the committee.  Once we realized that the opposition was too great to get a bill passed this session, we reduced the bill to a few key components, outlined below. The measure actually lost some of the support we originally had because we deleted the mandatory physician coverage in an ED. We will need to file the bill as we began this year to restore our original intent. The bill stated (after our amendment that removed the mandatory physician coverage) that;

• to ensure consumers/patients are notified when a physician is not on-site in the ED,
• requires notification to in-coming EMS services, and
• hospitals with ED physician coverage less than 50% have to report to the Department on an annual basis.  

APRN Legislation – Failed

APRN’s were back for “clarification” in their law, expanding it beyond the agreement last year. This stirred up controversy immediately since the physician community believed an agreement had been reached the previous session. The bill would have eliminated the need for an APRN to enter into a collaborative agreement with a physician in order to see patients.  The Committee was not enthralled with the idea, and it made no real progress. This proposal will be back next session.

FRA Renewal – Passed

This bill renews a program that brings $4.2B of funding to the state for the Medicaid program, and without it Missouri would have to cut provider rates drastically or cut other major programs like funding to education.

CRNA Legislation –Failed

The CRNA’s want to cut their required ties with their physician – this proposal has many legislators spooked that no physician will be overseeing a CRNA who can have a nearly parallel scope of practice to an Anesthesiologist. This bill was heard in the House and Senate, but never gained support.  I suspect they will attempt to renew legislators interest next session.

Human Trafficking – Failed

Another attempt to address human trafficking was passed out of the House Crime Prevention Committee.  It was amended to address some of the committee members concerns on mandating 5 hours of anti-human trafficking CE for EMS every re-licensure period.  The sponsor changed the bill to no more than 4 hours each licensure period based on an annual curriculum a committee – formed in the bill – establishes. My guess is the committee does not update their curriculum each year, and therefore a full 4 hours will never be required. We ensured this bill did NOT apply to you, after our lesson with the mandated CE’s in the Stroke and STEMI legislation many years ago. 

Prior Authorization – Failed

Rep Melanie Stinnett presented HB1976 regarding prior authorization of health care services to the House Healthcare Reform Committee. The bill states prior authorization shall not be required unless a determination is made that less than 90% of prior authorization requests submitted by the health care provider in the previous evaluation period, as defined in the bill, were or would have been approved. The providers supported it and health insurance companies believe it will be the end of the world.  

Farm Bureau Health Insurance – Failed

Rep Kurtis Gregory filed HB2082, passed the House and was ready for Senate floor debate, however the end of session melt down precluded many of these bills from moving forward. This bill allows Farm Bureau to offer a stripped down health insurance product to their members. I worked with the FB to ensure that emergency services is a covered benefit, otherwise you will be stuck with “insured patients” having no ability to pay. They agreed. The insurance companies do not like this bill – shocking!

Non-Compete Clauses– Failed – This will be a topic that will resurface next session.

MSMA is now fully motivated to pass language to include not for profits into the non-compete ban, similar to what the FTC is imposing on for-profits.

• 191.265. Any noncompete clause of an employment contract between an employer and a physician licensed under chapter 334 that restricts the right of the physician to practice medicine in any geographic area for any period of time after the termination of such employment relationship shall be void and forceable, provided that nothing in this section shall render void or unenforceable the remaining provisions of any such employment contract.

SB1396 was filed in the Senate would ban non-competes for not-for-profit health care entities with physicians they employ, and restrict for profit entities to non competes that are no longer than 1 year and no further than 50 miles. This will be promoted by the physician groups, but the Senate is moving so slowly that I don’t see it as an immediate threat. A House version (Hb2754) was filed.

HB2787 – Establishes the “Uniform Restrictive Employment Agreement Act” is a more comprehensive non-compete bill.  It was filed and is already assigned to committee and , received a speedy committee assignment and was heard.  The bill is very complex and the committee was lost in that complexity.

Truth in Advertising– Failed

Senator Justin Brown filed a bill and Rep Benny Cook filed a bill adding EMS workers to the Peer Review Committee protection and process. It was supported broadly by the EMS community and opposed by the trial attorneys, as we expected. They want the work product of the Peer Review Committee to be discoverable. That is a non-starter for us. This bill allows EMS to join all other health practitioners in the peer review process, which allows peers to assist others in improving their health care delivery quality.  This closes no information that is available today, it simply closes the reports of the peer review committee, which will not exist if this bill does not pass.  The House and Senate bills were voted out of their respective Committees. The Senate bill was voted out with a committee substitute this week.

Truth in Advertising– Failed

HB2534, sponsored by Rep Lisa Thomas – this bill specifies that advertisements for the services of a health care practitioner must include the health care practitioner’s full name and title.  Furthermore, any advertisement that refers to board certification of a health care practitioner must include the entire name of the board that issued the certification. This is to ensure misrepresentations of a person’s licensure status does not occur, such as someone referring to themselves as a “doctor” because they have a PhD but not licensed as a doctor.  This was heard before the House Health and Mental Health Committee.

SAC Revision–Failed

HB 1953 – This bill modifies provisions relating to the State Advisory Council on Emergency Medical Services. These bills were heard and voted out of both the house and senate committees.  This is moving but the Senate is sooooo slow right now, and I suspect will get slower over the next couple weeks, I am not certain of the path of even non-controversial items.

Violence in HC Facilities– Failed

HB 2556 – Rep Hicks and Sen Schroer have each sponsored a bill granting liability protection, as well as personal protection for health care workers. The bill states that; -No employee or contractor of a licensed or registered health care facility shall be required to physically engage with a person exhibiting violent tendencies if there is a reasonable fear that such engagement may result in bodily harm to the employee or contractor. This bill was heard and after further studying of the bill, it is not a good bill.

• No licensed or registered health care facility shall require an employee or contractor to become certified, or otherwise to participate, in training that limits physical control or restraint of violent patients to specific holds or positions.
• No licensed or registered health care facility, or any employee or contractor of such health care facility, shall, if acting in good faith and without gross negligence, be held liable for damages arising out of an incident in which a violent patient who poses a risk of bodily harm to employees, contractors, or bystanders escapes or otherwise flees.

View all bills tracked for Missouri College of Emergency Physicians here.