The state passed funding for a regional care coordination project to better manage super users of ER services. the state realized that a duplication of services, tests and prescriptions were so prevalent among this small population (less than 5%) that they were consuming over 40% of the medicaid $$. We are working with the division of MoHealthNet to begin implementation.
So the legislative session has come to an end in Missouri. Here is what passed and what didn’t.
- Caps. A two-tiered cap system passed with a 1.7% annual inflator. Bill was signed by the Governor.
- Board of Healing Arts. Bill allows the Board and other boards to issue non-binding opinions. What this means is when a physician calls with a simple question about licensing, the Board can now answer it.
- Medicaid managed care expansion. Some and children under fee-for-service will be moved to managed cared.
- Nurse and PA can now prescribe hydrocodone. They could always prescribe it when it was a schedule III but lost this ability when it was moved to a schedule II.
What Didn’t Pass
- Prescription drug monitoring. Same hold up as before. The Senator that is against this tried to pass his own version which was a bad bill which also did not pass.
- Epipens. Would have allowed restaurants and amusement parks to stock them.
- Expert witness. Would have changed the standard to align with federal standards
- Cannabidiol. Would have expanded who could prescribe it and for what disorders. Other medical marijuana bills also did not pass.
- Helmet repeal. Passed the House but died in the Senate.
- Car safety bills. Bill to increase seat belt fine failed as did bill to extend no texting and driving to people over 21
Good Article on ER Google Glass utilizing new technology to to bring virtual docs into the ER
A 2013 report by the federal Substance Abuse and Mental Health Services Administration found that emergency room visits related to nonmedical use of prescription stimulants among adults 18 to 34 tripled from 2005 to 2011, to almost 23,000
This is just another piece of evidence an effective PDMP should be passed in Missouri
By Jorgen Schlemeier
Download to read the in-depth report.
The Senate and House have all the ingredients for a melt down over the budget, but I predict it will be short lived and the budget will pass on time.
The dispute continues over the lump sum budgeting, aka “pooling,” which gives the governor tremendous flexibility on how to spend the money in the budget; the conversion of the portion of the state in a fee for service Medicaid system to Medicaid Managed Care; and finally the 6% reductions in Medicaid and 4% in Health and Senior Services. This may remind you a bit of the federal issue we are experiencing with Medicare where Congress is attempting to balance the program’s costs on the backs of providers.
While the Senate Appropriations Chairman’s intention is not to cut provider rates, and in fact has concurred with the House on a rate increase, the budget as passed by the Senate likely produces a different result.
The House has dug in against the Senate’s position and interest groups and providers are calling anyone they can find to block the Senate proposal and restore line item budgeting and restoring the money reduced by the Senate.
The Senate’s version of the budget includes the Regional Coordination Super User project and granted a 3% rate increase for ED Physicians beginning January 1, 2016 (half way into the new fiscal year), both of which are good.
The Governor added some relief late last week when he announced an upgrade to the States fiscal picture by increasing anticipated revenues by $80M. That will be enough to backfill most of the reductions made by the Senate, which many believe will be felt primarily by providers receiving lower rates. The legislature is not too eager at this point to use that money.
Senators Needing Contact – [Contact Information] -ask them to reinstate line item budgeting for each service/provider (i.e dental or pharmacy or in home etc.) and reverse the “pooling” idea.
Dan Brown – Camden, Crawford, Dent, Phelps and Pulaski –
Mike Kehoe – Counties of Cole, Gasconade, Maries, Miller, Moniteau, Morgan and Osage –
Talking Points – Rates for ED Physicians are already unbelievably low (approx. $25) AND the 6% cut in Medicaid and 4% cut in Mental Health approved will impact provider rates. ED Physicians HAVE TO TREAT ALL patients that come to the ED, unlike other providers who can simply choose not to take Medicaid. We do not have that option. We would ask that you vote to reverse the cuts in conference.
Go to the documents section of the Legislative Affairs – Health Policy Committee for archived reports.
This week through bipartisan legislation, congress voted to overturn the SGR. Included in this, CHIP was reauthorized for another 2 years. The legislation also outlines:
- Medicare’s current quality reporting programs will be streamlined and simplified into one merit-based incentive payment system, referred to as “MIPS.” This consolidation will reduce the aggregate level of financial penalties physicians otherwise could have faced.
- Protections are included so that medical liability cases cannot use Medicare quality program standards and measures as a standard or duty of care.
- Incentive payments will be available for physicians who participate in alternative payment models and meet certain thresholds.
- Technical support will be provided to help smaller practices participate in alternative payment models or the new fee-for-service incentive program.
Please go to the following link for more information.
New this year for the MOCEP annual meeting is a social networking event on Friday evening, April 17:
Friday, April 17
6:30 – 8:30 pm
1610 Main Street
Kansas City, Missouri 64108
MOCEP Education and General Membership Meeting
Saturday, April 18, 2015
The Westin Kansas City at Crown Center
Roanoke Room – Ballroom Level
1 East Pershing Road
Kansas City, MO 64108
8:00 am – 12:00 pm Educational Components
- 8-8:50 am – LLSA Session 1: Dr. Kevin O’Rourke, UMKC-Truman Medical Center
- 8:50-9:40 am – LLSA Session 2: Dr. Tim Koboldt, University of Missouri Hospitals & Clinics
- 10-11:30 am – Culturally & Linguistically Appropriate Services within the Emergency Department: Dr. Michael L. Weaver, Luke’s Hospital of Kansas City
- 11:30 am – 12 pm: MOCEP Grants – review of activity and accomplishments To Be Finalized
12:00 – 1:15 pm General Membership Meeting (Working Lunch)
- Election of Board Members (nominations from the floor are allowed)
- Election of ACEP Councillors
- State Legislative Update
1:30 – 3:00 pm Board of Directors Meeting
Hope to see everyone in Kansas City!
The MOCEP meeting will be held in conjunction with the Missouri State Medical Association’s Convention.
Go to http://www.msma.org/mx/hm.asp?id=ConventionRegis#.VPDYddrna71 to register for the MSMA convention.
Committee: Health and Mental Health Policy
Chair: Frederick, Keith – (Rep-121)
Date: Wednesday, March 11, 2015
Time: Upon Conclusion of Morning Session
Location: House Hearing Room 5
Public Hearings will be conducted for the following bills:
HB 660 — MO HEALTHNET
Sponsor: Ross, Robert (Rep-142)
Requires MO HealthNet participants to pay a co-payment of eight dollars for the use of emergency room services for the treatment of nonemergency conditions
The Medical Malpractice Non Economic Damage ($350,000) was passed out of the House Thursday with 101 votes. 82 votes were needed and 109 votes would be needed in the event the bill passes and the Governor vetoes the bill.
The Senate will have “Tort Week(s)” for the next two weeks and the senate version of the Med Mal bill will be debated. This is a different version than the House version, in that it established a two tier cap. A higher cap for wrongful death and other catastrophic events ($700,000) and a lower cap for all other med mal cases at $400,000.
The logical question is; why not pass the House version containing the $350,000 cap. The reason is unfortunately simple, we can not get that version to a vote in the Senate.
The APRN proposal to include Schedule II prescribing in their scope of practice was heard, but will likely not make it out of committee, unless it is limited to only hydrocodone products, which they prescribed prior to its reclassification.
Finally, the “Observational Status” legislation, which requires the hospital to notify patients of their inpatient or observational status on a timely basis was heard in the Senate. We have language drafted to attach to this bill which would alleviate the ED Physician from this duty, and place that responsibility with the hospital admission staff.