Government Relations

UM Legislative Update Newsletter

May 16, 2006

Health care legislation approved by the General Assembly:

Links to individual bills can be found at /ums/gr/reports/UM_006.htm

SBs 567 and 792  –  Clinical Trials and Other Health Insurance Coverage: This act modifies health insurance coverage provisions. Currently, an employer may provide or contract for health insurance at a reduced premium rate for employees who do not smoke or use tobacco products. This act allows the employer to also provide or contract for health insurance at a reduced deductible level for employees who do not smoke or use tobacco products. Insurers or small-employer carriers offering these policies will not be in violation of any unfair trade practice. These provisions are similar to HB1101 (2006).
This act requires health insurance companies to provide coverage for routine patient care costs incurred as the result of phase II clinical trials undertaken to treat cancer. Currently, Section 376.429, RSMo, requires coverage for phases III or IV only. In addition, health benefit plans may limit coverage for the routine patient care costs of patients in phase II of a clinical trial to those treating facilities within the health benefit plans' provider network; except that, this provision shall not be construed as relieving a health benefit plan of the sufficiency of network requirements under state statute. Routine patient care costs coverage for phase II clinical trials shall apply if the trial is sanctioned by the National Institutes of Health (NIH) or National Cancer Institute (NCI) and conducted at an academic or National Cancer Institute Center; and the person covered under this section is enrolled in the clinical trial and not merely following the protocol of phase II clinical trials.

Finally, this act provides that health insurers will be required to charge only one co-payment on a prescription if the required single dosage is not available and a combination of dosage amounts must be dispensed to fill the prescription. This provision does not apply to prescriptions in excess of a one-month supply. If technology does not permit adjudication, the health carrier or health benefit plan will provide reimbursement forms for the patients. These provisions are similar to HB1904 (2006).

SB 614 – Residential Treatment Agency Tax Credit: This act creates an income tax credit in an amount equal to 50 percent of the amount of an eligible monetary donation made, on or after Jan. 1, 2007, to a qualifying residential treatment agency. The tax credit may not be applied against withholding taxes. The tax credit is non-refundable, but may be carried forward four years. The tax credit is fully transferable. An agency may apply to the Department of Revenue for the tax credits in an aggregate amount that does not exceed forty percent of the payments made by the Department of Social Services to the agency in the preceding twelve months. The provisions of this act shall automatically sunset six years after the effective date of the act unless reauthorized.

SB 616 -  Assisted Living Facilities: This act modifies provisions related to assisted living facilities. It repeals the terms "residential care facility I" and "residential care facility II" and replaces them with "residential care facility" and the newly created term “assisted living facility," respectively. This act provides for a grandfather clause regarding the new licensing requirements for existing residential care facility II entities. Further, this act prohibits any facility from naming or advertising itself as an assisted living facility without obtaining a license from the Department of Health and Senior Services. There also is a grandfather clause for supplemental welfare assistance payments for those facilities licensed as a residential care facility II prior to the effective date of this act allowing such facilities to continue to receive such payments as long as eligibility requirements are met and until such time as the department of health and senior services has effected rules to ensure compliance with this act.

Assisted living facilities contain services consisting of social models based on the premise that the resident's unit is his or her home. There are new definitions for "activities of daily living" which include eating, dressing, bathing, toileting, transferring, and walking and for "instrumental activities of daily living" which consist of preparing meals, shopping for personal items, medication management, managing money, using the telephone, housework, and transportation ability. There are also new definitions for "appropriately trained and qualified individuals," "community based assessment" and "social model of care."

This act prescribes requirements for assisted living facilities in order to accept or retain individuals. An individual in a facility must not require hospitalization or skilled nursing. The facility must employ a staff large enough and skilled enough to handle twenty-four hour care. The facility must also have a written plan for the protection of all residents in the event of a disaster. The signatures of an authorized representative of the facility and the resident or legal representative shall be contained in the individualized service plan. The facility must implement self-care and leisure activity programs.

The facility must complete pre move-in screening and resident assessments for community based services. This assessment will be used by the facility to implement an individualized service plan to be reviewed at least annually by the resident or legal representative. The residence must ensure that it does not accept or retain a resident who has exhibited behaviors that present a reasonable likelihood of serious harm to himself or herself. The resident must not require skilled nursing services or more than one person to physically assist the resident with any activity of daily living, except bathing. The resident must not be bed-bound or similarly immobilized due to a debilitating or chronic condition. The facility must also develop a plan to protect the rights, privacy, and safety of all residents.

The act repeals the requirement that residential care facilities can only admit persons who are capable mentally and physically of negotiating a normal path to safety under certain conditions. This acts now allows for an assisted living facility to accept or retain an individual with a physical, cognitive, or other impairment that prevents the resident from safely evacuating the residence with minimal assistance so long as the facility has sufficient staff present twenty-four hours a day to assist in evacuations and contains an individualized evacuation plan for such a resident. The facility shall also be equipped with an automatic sprinkler system, an automated fire door system and smoke alarms compliant with national fire codes. This act also provides a licensed hospice exception to the pathway to safety provisions.

The facility must take measures to allow residents the opportunity to explore the facility and grounds and use personal electronic monitoring device for any resident whose physician recommends the use of the device.  Licensed facilities must also disclose to a prospective resident information regarding the services the facility is able to provide, costs of such services to the resident, and the conditions that will require discharge or transfer from the facility.

SB 756 – Professional Registration: This act modifies provisions regarding the licensing of certain professions. (This summary includes an overview of health-related modifications only.)

PRESCRIPTIVE AUTHORITY –  This act authorizes advance practice nurses to prescribe certain substances containing pseudoephedrine while engaged in a collaborative agreement with a physician.

DENTAL RECORDS - The act requires dentists to retain patient records in a form reviewable by the board for at least 7 years from the date of last service or from the age of majority. Laboratory work orders must be retained for 7 years. Changes to patient records made after 48 hours from the final entry shall be documented as an addendum.

AUTOMATIC REVOCATION OF LICENSES - The act expands the grounds for automatic revocation currently reserved only for physicians to cover all licensees covered under Chapter 334, RSMo (physicians, physical therapists, athletic trainers, physician assistants, anesthesiologist assistants).

COLLABORATIVE PRACTICE AGREEMENTS/PHYSICIAN ASSISTANT AGREEMENTS - This act requires physicians to report to the State Board of Registration for the Healing Arts any collaborative practice or physician assistant agreement entered into within 30 days.  Physicians are also required to provide the board with all collaborative practice agreements when renewing their licenses. This information will be available to the public. The board is authorized to conduct random review of such agreements to determine whether licensees are in compliance with this act.

PROFESSIONAL COUNSELORS – Professional counselors licensed in other states are allowed to apply for licensure in Missouri without examination if the applicant has had no disciplinary action taken against his or her license in the past five years or has met all eligibility criteria established by the professional organization.

CLINICAL SOCIAL WORKERS – Such professionals are allowed to obtain a Missouri license if they have had no disciplinary actions taken against their license in the preceding five years and their current state license has substantially the same licensing requirements as the state of Missouri.

ADMINISTRATIVE HEARING COMMISSION - The act allows notice of service of a complaint to be published if service cannot be accomplished in person or by certified mail.

SB 765 – Emergency Medical Treatment: Under this act, informed consent for an experimental medical treatment is not required if the patient is subject to a life-threatening emergency and the institutional review board responsible for the review, approval, and continuing review of the research activity has approved both the research activity and a waiver of informed consent and has both found and documented that the requirements for an exception from informed consent requirements for emergency research, as approved under federal regulations have been satisfied. This act contains an emergency clause. This act is identical to HB1601.

SB 822 – Health Care Provider Tax: This act extends the expiration date for the state’s Medicaid Managed Care organization reimbursement allowance and the pharmacy tax from June 30, 2006, to June 30, 2007. The expiration date for the hospital federal reimbursement allowance and the nursing facility reimbursement allowance is extended from Sept. 30, 2006, to Sept. 30, 2007. The bill contains an emergency clause.

SB 828 – Dental Hygiene Services: This act repeals a provision that was to sunset on August 28, 2006 which authorizes dental hygienists to provide certain dental treatments to children on Medicaid without the supervision of a dentist.

SB 974 – Mental Health Services: This act extends the date for the Department of Mental Health to complete a mental health service plan for persons on waitlists from Nov.1, 2003, to Nov. 1 of each year beginning Nov. 1, 2007.

SB 1057 – Health Care Professional Liens: This act adds physical therapists to the definition of “health care practitioner” for the purpose of liens for patients whose sickness or injury was caused by a tortfeasor.

SB 1084 – Health Care for Uninsured Children: This act extends the expiration date of the Children’s Health Insurance Program (CHIP) established by the Department of Social Services to pay for health care for uninsured children from July 1, 2007 to June 30, 2008.  The expiration date of the financial assistance for the Consumer-Directed Personal Care Services Program is also extended from June 30, 2006 to June 30, 2008.  This act contains an emergency clause.

SB 1117 – Missouri Rx Plan Advisory Commission: This act modifies the provisions relating to the Missouri Rx Plan Advisory Commission to reflect that the Missouri Rx Plan is no longer housed in the Department of Health and Senior Services but in the Department of Social Services. This act removes the provision in the Missouri Rx statute denying eligibility to individuals enrolled in Medicare Advantage Plans.

SB 1155 – Technical Advisory Committee on the Quality of Patient Care and Nursing Practices: This act modifies provisions relating to the technical advisory committee on the quality of patient care and nursing practices. This act extends the sunset provision from Dec. 31, 2006, to Dec. 31, 2011.

SB 1197 – Blood Donation: This act allows any person who is 16 years of age or older to donate blood if written permission or authorization is obtained from his or her parent or guardian.

HB 1222 – Special Deputy Coroners:  This bill allows a coroner or medical examiner to appoint a special deputy coroner or special deputy medical examiner in the event of a natural disaster, mass casualties, or other emergency. All appointees will be directly supervised by the coroner or medical examiner, will not serve more than 30 days, and will not receive compensation for services rendered. However, any necessary expenses incurred in the performance of official duties will be reimbursed. The coroner or medical examiner making this appointment must file a record of the appointee's full name, address, date of birth, date of appointment, and date of termination with the county clerk.

HB 1234 – Nursing  Student Loan Repayment Program: This bill changes the laws regarding the Nursing Student Loan Repayment Program. "Eligible student" is defined as a person who has been accepted as a full-time nursing student, rather than a person who has applied for admission. Currently, 25 percent of the loan is forgiven for each year of employment. The bill revises the repayment provision to allow forgiveness through employment without a specific schedule.

HB 1245 – School Nurses: This bill allows school nurses, upon authorization by the school board, to keep on hand and administer pre-filled syringes of epinephrine in two dosage strengths. The nurse may administer the medication when, based on training, he or she believes a student is having an acute anaphylactic episode. The prescription must be written by a licensed physician listing the school district as the patient, include the nurse's name, and be filled at a licensed pharmacy.

HB 1491 – Medical Assistance: This bill requires the Family Support Division within the Department of Social Services to determine whether an individual who is applying for Missouri Medicaid Program benefits is eligible for federal medical services from the Missouri Veterans Commission. If an applicant or recipient is eligible for the federal medical services, the division must urge the person to utilize these benefits. The division will consult with the commission regarding a method that can be used to determine whether an individual who receives state medical assistance is eligible for the federal benefits. The bill does not require an individual to exhaust any federal veterans' benefits prior to receiving state medical assistance.

HB 1515 – Collaborative Practice Reporting: This bill requires physicians to report to the State Board of Registration for the Healing Arts any collaborative practice or physician assistant agreement entered into within 30 days. Physicians are also required to provide the board with all their collaborative practice agreements when renewing their license. This information will be available to the public. The board is authorized to conduct random reviews of these agreements to determine whether licensees are in compliance with the provisions of the bill.

HB 1601 – Emergency Medical Treatment: This act specifies that informed consent is not required for research programs or experimental medical procedures for certain patients subject to a life-threatening emergency when conducted in accordance with certain federal regulations and when the institutional review board has approved the research activity. This act contains an emergency clause and is identical to SB765.

HB 1687 – Donation of Prescription Drugs:  This act allows drugs donated to the Prescription Drug Repository Program that are not used or accepted by any pharmacy, hospital, or non-profit clinic in this state to be distributed to out-of-state charitable repositories.

HB 1732 – Self-Administered Medications by Students: Currently, the self-administration of an asthma medication inhaler by students is permissible under certain conditions. This bill changes the laws to include auto-injectible epinephrine for anaphylactic shock as a permissible self-administered medication. The bill specifies the necessary conditions for self-administration including a written treatment plan, proof that a student has demonstrated the skill required, and a signed liability release for the school.

HB 1837 – Medical Malpractice Insurance and Health Care Stabilization Board: This bill changes the laws regarding medical malpractice insurance and the enforcement powers of the Department of Insurance.

MEDICAL MALPRACTICE INSURANCE:

  1. Allows limited liability companies, corporations, limited liability partnerships, partnerships, and other entities formed for the practice of law or medicine to become members of an association providing malpractice insurance to its members;
  2. Requires the malpractice association's articles of association and bylaws to specify and define the types of assessments its members and former members might have to pay to cover losses and expenses incurred by the association;
  3. Makes associations writing malpractice insurance subject to reporting, notification, and rating requirements;
  4. Requires the Director of the Department of Insurance to establish risk reporting categories and reporting standards for insurers to annually report medical malpractice insurance premiums, losses, exposures, and other information the director may require.  The director will compile this information in a manner appropriate for assisting medical malpractice insurers in developing future base rates, schedule rating, or individual risk rating factors and other aspects of their rating plans;
  5. Requires the director to annually establish and publish a market rate reflecting the mean of the actual rates charged for each risk reporting category and publish comparisons of the base rates charged by each insurer;
  6. Allows the director to issue administrative orders and seek other remedies specified in the bill to assure compliance for violations of the provisions relating to reporting medical malpractice information;
  7. Prohibits medical malpractice insurers from charging rates that are excessive, inadequate, or unfairly discriminatory. Rates will be based upon Missouri loss experience if available, not experience from other states unless the failure to do so will jeopardize the financial stability of the insurer; and
  8. Prohibits an insurer from increasing malpractice insurance rates by more than 15% or refusing to renew a policy without at least 60 days' written notification unless requested by the insured or due to changes in the insured's practice or risk characteristics.  Insurers cannot cease issuing policies in this state without 180 days' written notice to the insured and the director.  If an insurer fails to give notice, the policyholder has the right to continue coverage under the policy.

ENFORCEMENT OF VIOLATIONS OF THE STATE INSURANCE CODE:

  1. Allows the director, upon determining that a person has violated or attempted to violate provisions of the insurance laws, to order certain forms of relief.
  2. Authorizes fines of up to $100,000 and imprisonment of up to10 years if a person violates a cease and desist order. Currently, a person may be punished by a maximum $1,000 fine and up to one year in jail;
  3. Allows the director to suspend or revoke a corporation's or insurer's certificate of authority for violating insurance laws or for a felony or misdemeanor conviction.  The director must provide 30 days' notice and a hearing, if requested, before revocation;
  4. Allows the director to seek redress in county circuit courts.  The court can issue injunctions, freeze assets, or take other action as specified.  A consumer restitution fund is created for preserving and distributing disgorgement or restitution funds obtained through enforcement procedures to aggrieved consumers;
  5. Classifies various violations of insurance laws into five categories from level one through level five.  Maximum fines are established at each level with level one being the least and level five the highest.  All fines collected will go to fund public schools as required by the Constitution.

HEALTH CARE STABILIZATION FUND FEASIBILITY BOARD - The bill creates the Health Care Stabilization Fund Feasibility Board within the Department of Insurance to analyze medical malpractice data to determine whether a health care stabilization fund should be established in Missouri.  As part of its duties, the board will conduct a comprehensive study on whether a health care stabilization fund is feasible within Missouri, or specified geographic regions thereof, or for specific medical specialties. If a health care stabilization fund is feasible within Missouri, the report will also recommend to the General Assembly on its structure, design, and funding. The board will consist of 10 members.  The board will meet at least quarterly and submit its final report and recommendations regarding the feasibility of a health care stabilization fund to the Governor and the General Assembly by Dec. 31, 2010.  The board is also required to submit annual reports on its progress, and the board will expire Dec. 31, 2010.

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