• The General Assembly enacted Senate Bill 577, which revamps laws governing the Medicaid program and renames the program as “MO HealthNet.” Broadly, it modifies who will be eligible for coverage, the services they will receive, the delivery models through which health care services will be provided and paid for, and administrative and program accountability issues.

• The bill also addresses other health care topics, some of which are included in this overview.

MHA has prepared a separate summary of Senate Bill 577.

• revise underwriting standards used in selling large group, small group and individual insurance policies (HB 818)

• limit premiums that may be charged for coverage under the state’s insurance pool for high-risk or medically uninsurable individuals and revamp the pool’s eligibility standards to meet federal standards (HB 818)

• require employers who contribute to an employee health plan to provide a premium-only cafeteria plan (HB 818)

• authorize a state income tax credit to offset a federal income tax levied on income used by a self-employed taxpayer to buy health insurance. Also, health insurance premiums of taxpayers and their spouses or dependents will be deductible under the state income tax law if they are considered taxable under the federal tax code. (HB 818)

• require health insurers to continue providing coverage to dependents beyond the normal age limit if they are unmarried, incapable of holding self-sustaining employment because of physical or mental handicap, and reliant on the enrollee for maintenance and support. The coverage requirement will expire at age 25. (HB 818)

• require health insurers to give claims experience data upon request to employers who buy group coverage for more than 50 covered lives. The data will include number and dollar value of claims for the employer but will not identify individual enrollees. (HB 791)

• allow those reporting allegations of suspected Medicaid provider fraud to receive 10 percent of amounts recovered by the state attorney general under current Medicaid fraud statutes (SB 577)

• prohibit retaliatory actions taken against those reporting allegations of Medicaid fraud (SB 577)

• revise standards defining fraudulent activities in the Medicaid program and increase some penalties for violating Medicaid fraud statutes. The fraud standards will apply to state employees, representatives and subcontractors. (SB 577)

• reauthorize the hospital Federal Reimbursement Allowance for an additional two years to September 30, 2009. The provider taxes for pharmacies and Medicaid managed care plans also are extended by two years to June 30, 2009. The nursing home FRA is extended by four years to September 30, 2011. (SB 4)

• establish new standards governing supervision of physician assistants. The standards represent a compromise agreement forged in response to the prospect of a very restrictive interpretation of physician assistant supervision standards beginning August 2007. (HB 497)

• set various standards for physician assistant training and contracts or agreements for physician assistant supervision (HB 497)

• authorize an “Out-of-Hospital Do-Not-Resuscitate” form and establish standards for its use. The DHSS will develop standardized forms and identifiers. (HB 182)

• include as a criterion for receipt of state “Quality Jobs” tax credits that an employer must offer full-time employees health insurance and pay at least half of the premium (HB 327)

• codify an existing executive order calling for the state to report on the employers who have 50 or more employees or their spouses or dependents who are MO HealthNet enrollees (SB 577)

• create an expedited process for restricting or suspending the license of a nurse believed to pose a danger to the public (HB 780, SB 308)

• require nurse staffing agencies to report disciplinary actions taken against a nurse employee to the Missouri State Board of Nursing (HB 780, SB 308)

• create a program to identify and treat nurses impaired by illness, substance abuse or mental conditions and permit the state nursing board to require participation as a condition of licensure (HB 780, SB 308)

• seal the records of the board’s investigation of a complaint if the investigation concludes the complaint or allegation is unsubstantiated or is not grounds for licensure action (HB 780, SB 308)

• increase the criminal penalty for violating nursing licensure laws to a class D felony. Currently, the penalty is a class A misdemeanor. (HB 780)

• authorize the State Legal Expense Fund, which covers the liability costs of state employees and some medical practitioners working in certain settings, to cover additional providers. Among other changes, the legislation extends coverage to specialist physicians providing free care based on referrals from various clinic settings. (SB 577)

• allow private contributions to a state account to generate state matching funds if the proceeds are used to improve or maintain access to primary health care services in designated shortage areas (SB 577)

• grant a maximum of $1 million in state income tax credits for donations of money or medical or office equipment made to help improve access to primary health care services in a health professional shortage area designated by federal and state officials (SB 577)

• expand the settings in which a nurse may receive credit toward a state nursing education loan forgiveness program to include for-profit, nonhospital agencies in an underserved area (SB 513, HB 780)

• authorize appropriations of Health Access Incentives Fund monies to enhance MO HealthNet payments to psychologists, psychiatrists and other mental health providers in shortage areas. Also, psychiatrists and psychologists are specifically made eligible for a program of state incentives to encourage practice in underserved areas. (SB 577)

• permit hospitals and other providers to request that the state intercept patients’ state income tax refunds or lottery winnings to pay unpaid medical debts. The state would retain a maximum of 20 percent of the funds recovered. (HB 818)

• revise standards for forensic examinations to collect evidence in cases involving sexual assault. The state will provide evidence collection kits without charge, and the cost of the forensic examination will be billed to the state and not to the patient. Other medical treatment costs would be billed to the patient or insurer. If the patient is uninsured, costs of treating the patient other than for the forensic examination may be submitted to the state’s Crime Victim’s Compensation Fund. Providers must file reports of the forensic examination with the prosecuting attorney within three business days of completion. (HB 583)

• repeal a law requiring the use of nonalcoholic antiseptic swabs before drawing blood for a blood/alcohol test (HB 574)

• raise the fees for state criminal background checks on employees. The current $5 fee for state background checks that are required by law would be raised to $9, with authorization for increases of not more than $1 per year beginning in 2010, to a maximum of $15. The fee for a national criminal background check would increase to $20 from $14. (SB 84, HB 41)

• allow schools of medicine, nursing and other health professions to check whether students are listed on the state’s Employee Disqualification List before placing them in clinical training rotations in health care facilities. Those on the list have been found to have perpetrated abuse or neglect and are precluded from health care employment under current law. (SB 308)

• establish new standards to define, report, investigate and prosecute abuse or neglect occurring in facilities licensed, operated or funded by the Missouri Department of Mental Health (SB 3)

• create a state review board to investigate deaths of those in the care and custody of the DMH (SB 3)

• direct the DMH to develop rules, guidelines and protocols to help physicians and hospitals to identify suspicious deaths of those in the care and custody of the department (SB 3)

• require health care facilities and practitioners to disclose records sought by the state review board in investigating the death of a person who was in the care and custody of the DMH (SB 3)

• repeal deadlines for investigating child abuse and neglect allegations if the child dies during the investigation (SB 25)

• exempt those with ministerial or “tocological” (a synonym for childbirth or midwifery) certification by a private accreditation group from other state laws governing obstetrical care, including the current prohibition on the practice of midwifery (HB 818)

• create a system of state regulation for discount medical plans (HB 818, SB 66)

• exempt “health care sharing ministries” from regulation as health insurers and provide an income tax deduction for amounts contributed to these arrangements (HB 818)

• establish new standards for captive insurance companies (SB 66)

• revise state laws governing insurer investments and state regulators’ enforcement powers and procedures over insurers (SB 66)

• require physicians to provide specified information to patients in disclosing the results of prenatal tests for Down’s Syndrome or other prenatal diagnoses (HB 818)

• grant immunity from medical liability to health care practitioners who volunteer to be deployed by the governor or state agency to respond to an emergency declared by the governor. Its protections would apply to practitioners from Missouri and other states but would not extend to damages caused by willful or wanton acts or omissions. (HB 579)

• authorize the governor to waive statutory or regulatory standards that would hinder the state’s ability to respond to a declared emergency (HB 579)

• permit the DHSS to train volunteers to dispense medications in the event of a declared emergency. Liability coverage for such volunteers would be provided by the State Legal Expense Fund. (HB 579)

• direct the Missouri Consolidated Health Care Plan, which covers most state employees and some local government workers, to offer its enrollees a high-deductible plan of coverage coupled with a health savings account meeting federal standards. The requirement takes effect for the open enrollment period for the 2009 plan year. (HB 818, SB 406)

• require settings in which more than a specified number of abortions are performed to be licensed as ambulatory surgical centers (HB 1055)

• include a definition of “medical emergency” in the abortion law and make a medical emergency an affirmative defense against an allegation of performing an unlawful abortion (HB 1055)

• revise content standards for public schools’ sex education programs to reference federal abstinence education laws. Those with any tie to abortion services may not be involved in such programs. (HB 1055)

• codify in state law an “Alternatives to Abortion” counseling and support services program that has been implemented by appropriation for several years (HB 1055)

• authorize pharmacists to design and implement medication therapeutic plans under a specific prescription order from a physician. The physician and pharmacist licensure boards will develop regulations governing these orders and plans. (HB 195)

• create a program to identify and treat pharmacists impaired by physical or mental illness or substance abuse and permit the Missouri Board of Pharmacy to require participation in the program to avoid licensure sanction or revocation (SB 195)

• require a health insurer to notify its enrollees who are taking a prescription drug at least 30 days before deleting the drug from the insurer’s formulary. The requirement will not apply to generic substitutions. (HB 818)

• prohibit a person from accepting a prescription drug that is dispensed if he or she is not the patient or an authorized representative of the patient unless the person is on the premises of a licensed pharmacy (HB 195)

• modify standards governing the DHSS’ retention and use of newborn blood test samples and results. The legislation also specifies how appropriated funds may be used by the state to subsidize dietary formula for patients with PKU and related metabolic disorders. (HB 948)

• authorize project labor agreements and create new labor relations standards governing governmental construction projects (SB 339)

• change the process of electing hospital district directors for Iron County Hospital District in Pilot Knob. Each voter would vote for one hospital district director from the hospital election district in which the voter resides. Currently, each voter chooses six directors, with one from each of the six hospital election districts. (SB 22, SB 298)

• prohibit bond counsel or advisors from being involved in the issuance of bonds if they have made direct or indirect contributions to a campaign to promote the bond issue (SB 22)

• require that certain information be provided to taxpayers before a public hearing on setting local property tax rates (SB 22)

• repeal the requirement that county governments advertise contracts and purchases for less than $6,000 (SB 22)

• prohibit employers from disciplining crime victims, witnesses or victims’ immediate families for attending a legal proceeding to prosecute the crime. Also, employers may not require them to use vacation time or personal leave to attend, participate in preparations or honor a subpoena to testify at a criminal proceeding. (HB 583)

• require the Missouri Department of Social Services to designate regional liaisons to interact with faith-based community services organizations (SB 46)

• authorize state funding to support the programs for volunteers to transport the elderly to health-care related appointments (HB 98)

• revise licensure standards for physical therapists (SB 272)

• revise state licensure standards for chiropractors, optometrists, nursing home administrators, marital and family therapists and social workers (HB 780, SB 308)

• allow graduates of foreign medical schools to serve on the Missouri State Board of Registration for the Healing Arts, which regulates physicians, physician assistants and various other health practitioners (HB 780)

• create new standards for fire alarm and fire sprinkler systems in nursing homes and other long-term care facilities, with state loan assistance available to retrofit existing facilities with fire sprinklers (HB 952)

• increase the monthly allowance for personal expenses for low-income elderly, blind and disabled residents of nursing homes and residential care facilities. The current allowance is $25; the new payment would be $30. (SB 418)

• expand on current law creating criminal penalties for those who assume responsibility for managing the funds of an elderly or disabled person who is a nursing home resident and fails to pay the facility (SB 577)

• call for school children to be given a vision screening examination at certain ages (SB 16)

• prohibit state and local government agencies from discriminating between licensed professional counselors (HB 554)

• revise standards for complaints by inmates against licensed professional counselors or social workers (HB 555)

• establish a Chronic Kidney Disease Task Force, to function until August 2008 (HB 780, SB 577, SB 308)

• repeal certificate of need review for construction of a new hospital (HB 466)

• eliminate CON review of acquisition of medical equipment costing more than $1 million and revise CON review standards for long-term care projects (SB 579)

• create a state Civil False Claims Act modeled after a federal law that allows those making fraud allegations to sue providers and collect a portion of any proceeds recovered (SB 465 and others)

• permanently ban a provider from Medicaid based on a single Medicaid fraud conviction (amendment removed from SB 577)

• require hospitals and ambulatory surgical centers to implement an acuity-based patient classification system, with specific staffing ratios required (HB 588)

• require hospitals to compile and post daily staffing information in patient care areas of each hospital unit (HB 799)

• authorize HMOs to sell high‑deductible policies of coverage (SB 63)

• require health insurers to include in their networks any physician or other practitioner willing to meet the contractual terms (HB 432)

• require hospitals to report certain adverse events to a patient safety organization (SB 333 and others)

• authorize patient safety organizations in state law and establish legal protections for their data and findings (SB 333 and others)

• prohibit a hospital from charging an uninsured patient more than the Medicare reimbursement rate for the same service (HB 817)

• reinstate federal standards for overtime wages that were omitted by a November 2006 state ballot initiative on minimum wage rates (SB 255)

• create a health care quality report card for hospitals and other providers (SB 704)

• require any public or private entity receiving a complaint about care delivered in a hospital licensed in this state to forward the complaint to the Missouri Department of Health and Senior Services (HB 508)

• require hospitals and other health care facilities to conduct employee criminal background checks on all current employees to check for new types of criminal violations (SB 333 and others)

• revamp standards for reporting and prosecuting abuse and neglect in health care settings (HB 796 and others)

• authorize advanced practice nurses to prescribe controlled substances under a collaborative practice arrangement with a physician (HB 190 and others)

• create the Missouri Health Profession Shortage Planning Commission (HB 450)

• prohibit physicians from billing for anatomic pathology services not personally rendered (HB 1156 and others)

• revise the Uniform Anatomical Gift Act governing standards and procedures for organ donation and procurement (SB 496 and HB 723)

• revise the uniform anatomical gift act (HB 723 and others)

• revise reporting requirements for ventilator-associated pneumonia (SB 333)

• lower the standard for violations of the open meetings and records laws by state and local governments (HB 648)

• measure limits of tort liability for public entities at the time of the occurrence giving rise to the claim (SB 533)

• authorize medical expense liens in wrongful death cases (HB 599)

• create a licensure system for persons administering medical imaging or radiation therapy procedures (HB 208 and others)

• establish a system of licensure for clinical laboratory scientists and technicians (HB 314)

• register surgical technologists and protect their use of the title (HB 378)

• create a system of occupational licensure for naturopathic physicians (HB 640 and others)

• create the classification of licensed prescribing psychologist (HB 350 and others)

• include emergency medical practitioners under the state’s peer review law (HB 278 and others)

• require pharmacists to fill all lawful prescriptions for contraceptives (HB 156)

• create a system of data collection regarding prescriptions for controlled substance (SB 25 and others)

• provide immunity from liability to pharmacies that refuse to prescribe abortifacient drugs or devices (HB 412)

• require health insurers to provide coverage for human papilloma virus inoculations and require female students to be inoculated before enrolling in grade six (HB 541)

• create an Office of Missouri Surgeon General (HB 321)

• require rape victims to be informed of their right to request a drug test for the presence of a date rape drug (HB 917 and others)

• require hospitals to provide emergency contraception (HB 1018)

• require hospitals to make a reasonable attempt to notify the patient’s primary physician of emergency treatment upon the patient’s request (SB 357)

• allow state residents to participate in the Missouri Consolidated Health Care Plan for an additional premium (HB 976 and others)

• increase copying fees for patient medical records requests (HB 569)

• expand conscience clause protections of providers, insurers and facilities that refuse to provide services because of moral objections (HB 434)

• eliminate helmet requirement for operators or riders of a motorcycle ages 21 or older (HB 155 and others)

• revise seat belt usage laws to allow traffic stops solely for seat belt violations (HB 443 and others)

• require all insurance premium rate changes in excess of 15 percent to be approved by the state insurance agency after a public hearing (HB 1125)

• earmark a portion of tobacco settlement funds for youth smoking prevention (SB 109)

• include the owner and medical management entities in the immunity from liability for use of an automated external defibrillator (HB 1067)

• create a collective bargaining process for public employees (SB 641)

• require insurers to cover emergency room treatment and subsequent inpatient hospitalization at a non-network facility on the same basis as a network hospital if the patient’s transfer to a network facility is medically contraindicated (HB 420)

• establish a priority among family members for the release of any information, records or documents regarding a person who has died (HB 705)

• create standards for expert witnesses in legal proceedings, including medical malpractice lawsuits (HB 597)

• require screening and assessment of a child before admission for Medicaid inpatient psychiatric treatment (HB 451)

• establish a single-payer health system based on the Canadian model (SB 484 and others)

• prohibit illegal aliens from receiving any public assistance, except as mandated by federal law (HB 889 and others)

• restore Medicaid cuts made in the 2005 legislative session to be no more restrictive than before January 1, 2005 (SB 581 and others)

• prohibit health carriers from changing any diagnostic or current procedural terminology code submitted by a health care provider without the written permission of the health care provider (HB 729)

• require that an arrestee be treated at his or her own expense for injuries or intoxication before being incarcerated (HB 770)

• automatically redirect deposits to all state statutory and administrative funds into the general revenue fund beginning January 1 through June 13 if the immediate state fiscal year’s general revenue collections did not grow by at least 2 percent (SB 222)

• provide increased reimbursement (up to 120 percent of Medicare) for certain physician services under the state medical assistance program if the physician also provides “health care home” services (HB 728)

• require reasonable cost reimbursement from Medicaid to providers for services provided (HB 447)

• limit growth in general revenue appropriations and expands budget reserve funds (HJR 20)