Missouri Academy of Family Physicians (MAFP) Legislative Update - January 18, 2015 By Pat Strader, Legislative Consultant for MAFP

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Missouri Academy of Family Physicians (MAFP) Legislative Update - January 18, 2015 By Pat Strader, Legislative Consultant for MAFP Legislature Returns to Jefferson City for 2015 Session MAFP Agenda,

1 Missouri Academy of Family Physicians (MAFP) Legislative Update - January 18, 2015 By Pat Strader, Legislative Consultant for MAFP Legislature Returns to Jefferson City for 2015 Session MAFP Agenda, Bill Review and Tracking The Missouri Legislature returned Wednesday, January 7th for the First Regular Session of the 98 th General Assembly. Over 800 bills and resolutions have already been filed in the House and Senate. MAFP monitors and tracks bills that are of direct interest to MAFP and other miscellaneous bills that could be potential vehicles for legislation or amendments. Bills found to be of interest are tracked in three categories: Tier I, Tier II and Tier III. The first two tiers are accessible on the MAFP website and the list is updated frequently as additional bills are introduced. You can access the bill summary, bill text and other information about a bill, by clicking on the "bill number" which takes you directly to the House or Senate website. As session progresses, bills may be moved into different categories or deleted if they are found to not be of interest. The Legislature is off Monday, January 19 in honor of Martin Luther King Day Session Overview The Republicans hold super majorities in both the House and Senate. The House has a large number of freshmen legislators who are new to the process. There are 117 Republicans and 45 Democrats; with a vacancy in House District 29 where Republican Representative Noel Torpey recently resigned. The Senate has a number of new Senators as well, but all five of them previously served in the House of Representatives at some point in time. The Republicans hold a 25-9 majority in the Senate. State of the State/State of the Judiciary Governor Jay Nixon will deliver his State of the State Address to a joint session of the general assembly at 7:00 p.m. on Wednesday, January 21. The State of the Judiciary will be delivered by Chief Justice Mary R. Russell at 10:30 a.m. on Thursday, January 22. House Revamps Committee Structure Speaker John Diehl (R-Town and Country) has revamped the House committee structure. "Select Standing Committees" will each have smaller standing committees reporting to them. Some of the key committees for health care include: Appropriations-Health, Mental Health and Social Services; Children and Families; Government Accountability and Oversight; Health and Mental Health Policy; Health Insurance; and Professional Registration and Licensing. Committee Chairs. Co-Chairs and Republican Committee members have been appointed but the Democrat members have not as of this writing. In the House, Dr. Keith Frederick (R-Rolla) will chair the Health and Mental Health Policy Committee and serve as a member on Select Committee on Social Services; Appropriations-Health, Mental Health and Social Services; and Professional Registration and Licensing. Dr. Jim Neeley (R-Cameron) will serve as Vice Chair of Children and Families and be on Appropriations-Health, Mental Health and Social Services. The Children and Families Committee will be chaired by Rep. Diane Franklin (R-Camdenton) (who chaired in the interim committee on health care workforce). The Health Insurance Committee will be chaired by Rep. Jim Hansen (R- Frankford). Senate Committees Announced Committees of importance for health care issues and policy include: Committee on Financial, Governmental Organizations and Elections; Committee on Seniors, Families and Children; Committee on Small Business, Insurance and Industry; Committee on General Laws and Pensions; Committee on Veterans and Health; and Committee on Appropriations. Committee chairs and assignments were announced last week. The Senate will begin hearing bills next week.

There are two physicians in the Missouri Senate. Dr. Rob Schaaf (R-St. Joseph) will chair General Laws and Pensions and serve as Vice-Chair of Veterans' Affairs and Health. Newly-elected Senator, Dr.

2 There are two physicians in the Missouri Senate. Dr. Rob Schaaf (R-St. Joseph) will chair General Laws and Pensions and serve as Vice-Chair of Veterans' Affairs and Health. Newly-elected Senator, Dr. Bob Onder (R- Lake St. Louis) will serve on both of these committees. Senator David Sater (R-Cassville) will chair the Seniors, Families and Children Committee. Senator Sater is a pharmacist. Senator Jay Wasson (R-Nixa) will again chair the Financial, Governmental Organizations and Elections Committee where most scope of practice bills are referred. Tort Reform MAFP continues to work with a large coalition whose goal is to reestablish a cap on non-economic damages in medical malpractice cases. HB 118 (Burlison) and SB 239 (Brown) establishes a statutory cause of action, replacing the common law action and reestablishes the $350,000 cap on non-economic damages. Tort reform "white coat day" is set for Tuesday, February 24 th -- which is the same day as MAFP's Advocacy Day at the Capitol. Please consider signing up for your Advocacy Day at the MAFP website and attend both of these important events. A number of other bills and joint resolutions have been filed regarding various areas of tort law. Direct Primary Care (DPC) MAFP will be advocating this session for legislation that adds provisions in the statutes for physicians providing direct primary care through a medical retainer agreement between the physician and patient. Importantly this legislation clarifies that DPC is NOT insurance. MAFP developed draft legislation based on provisions from other states that have already adopted statutes (Washington, Oregon, Louisiana, Utah, West Virginia, and Arizona). Dr. Keith Frederick (R-Rolla) filed HB 261 which was based on the Michigan law but "withdrew" the bill so that MAFP and others could have more input into the legislation. A new version will be filed soon in the House and we will be pursuing a Senate sponsor for a companion bill to be filed in that body. Prescription Drug Monitoring Program (PDMP) Three bills have been filed that would establish a prescription drug monitoring program act - HB 130, sponsored by Rep. Holly Rehder (R-Sikeston) and SB 63, sponsored by Senator David Sater (R-Cassville). MAFP is a member of the PDMP NOW Coalition that is supporting passage of legislation this session. I have included as an attachment an article relating to the PDMP Launch. Dr. Rob Schaaf has filed his version which requires the Department of Health and Senior Services to establish and maintain a program to monitor the dispensing of all Schedule II through IV controlled substances using an existing data aggregation platform through the State Data Center within the Office of Administration. Dr. Schaaf feels that SB 111 would utilize the State BNDD (Board of Narcotics and Dangerous Drugs) to track the prescriptions and that they already have access to the data. He would still prefer that voters vote on the issue of whether or not Missouri should adopt a PDMP. Medicaid Transformation/Expansion/Reform While there are a number of legislators who desire to reform and/or expand Medicaid, there has not yet been enough conversation to predict if anything will occur this session. House Speaker John Diehl has said that Medicaid Expansion is unlikely because he does not see an appetite for it, while House Minority Leader Jake Hummel says he will continue to push for expansion despite the small Democratic numbers. Several bills have been filed in the Senate that would expand Medicaid - SB 90 introduced by Senator Paul LeVota (D- Independence) and SB 186 introduced by Senator Kiki Curls (D-Kansas City). A number of other bills have been filed: HB 386 (Barnes) Requires the Department of Social Services to implement rules to allow primary care providers who provide services to MO HealthNet participants between the hours of 5:00 p.m. and 7:00 a.m. to receive additional reimbursement; HB 466 (Engler) Changes the asset limits to qualify for MO HealthNet benefits to $2,000 for a single person and $4,000 for a married couple; 2

HB 474 (Webber) Changes the laws regarding eligibility for MO HealthNet benefits; SB 118 (Brown) Requires MO HealthNet participants to pay an $8 dollar copay for the use of the emergency room

3 HB 474 (Webber) Changes the laws regarding eligibility for MO HealthNet benefits; SB 118 (Brown) Requires MO HealthNet participants to pay an $8 dollar copay for the use of the emergency room services for the treatment of a nonemergency condition; SB 243 (Schmitt) Modifies provisions relating to MO HealthNet managed care organizations rate setting; SB 230 (Romine) This is an extensive Medicaid Transformation bill, similar to the one he filed last session. It modifies numerous provisions relating Medicaid, such as extending managed care statewide; developing incentive programs to encourage construction of urgent care clinics that would operate outside of normal business hours and be located adjacent to emergency room facilities; move current fee-for-service population to ACO's; and implement the Health Care Homes Program (primary care clinics) as a provider-directed care coordination program to transition the fee-for-service program to a coordinated care organization. In the House, Representative Jay Barnes (R-Jefferson City) filed a number of bills last session that were not expansion but moved some Medicaid populations into managed care and private insurance plans. Senator Ryan Silvey (R-North Kansas City) offered an amendment at the very end of the 2014 session that included expansion provisions and we expect him to continue to work on the issue. He believes there has not been sufficient conversation about Medicaid expansion by the legislature. Nurses While we haven't yet seen legislation filed relating to Advanced Practice Registered Nurses, we certainly expect some bills to be filed. We assume there will be an effort to increase and/or do away with the mileage requirement and the requirement for a collaborative practice agreement. It's certainly possible that Missouri Nurses Association (MONA) will again pursue "independent practice". Another party that entered into the conversations last year was the retail clinics. In fact, last year Walgreens filed a request with the Board of Healing Arts to amend the rules and regulations to change provisions on these requirements, in addition to the two-week rule. Midwives Rep. Kurt Bahr (R-St. Charles) has again filed legislation to license midwives. HB 521 is very similar to last year's legislation. It would create a six-member Board of Midwifery within the Division of Professional Registration comprised of one public member and five midwives who attend births in homes or other out-ofhospital settings. The initial midwife members appointed would not need to be licensed at the time of appointment if they are certified professional midwives currently certified by the North American Registry of Midwives. The bill spells out the board's duties, and includes definitions of "Professional midwife", and the "Practice of midwifery". The applicant must present evidence of current certification by NARM as a certified professional midwife (CPM) and the measure includes a section on "continuing education". The midwife must provide clients with written disclosure statements to be signed by the clients to include a description of their education and related training and a number of other requirements (Section ). They must give the client a statement concerning the licensed midwife's malpractice or liability insurance coverage but doesn't seem to require any coverage. HB 521 provides for reimbursement for pregnancy, childbirth and newborn services under MO HealthNet. Other Key Bills of Interest: HB 320 (Barnes) School-Based Health Clinics - Requires the Department of Social Services to assist certain public schools with establishing on-site health clinics to permit rural health clinics, federally qualified health centers, or other primary care practices to co-locate on the property of public elementary and secondary schools with 50% or more students who are eligible for free or reduced price lunch. Provisions of the bill are null and 3

4 void unless and until waivers are granted by the federal government. The bill also provides that DHSS shall assist with identifying a telehealth clinic implemental model, assist with identifying and securing funding for equipment, staff and other telehealth clinic expenses; and assist with creating linkages with primary care practices, rural health clinics and FQHCs. http ://www. house.mo. gov/billtracking/bill s151/billpdf/intro/hb 0320I. PDF HB 181 (Haahr) Medical Records of Deceased Patients - Changes the laws regarding medical records of deceased patients. This bill expands on the medical records statutes and should make it easier for an adult child of the deceased patient; a parent of the deceased patient; an adult brother or sister of the deceased patient; and a guardian or conservator of the deceased patient at the time of the patient's death to access records. There are limitations included as well. Review the summary at this link: HB 319 (Barnes) Telehealth Services - This bill requires specified individuals who are licensed in Missouri to be considered eligible health care providers for the provision of telehealth services in the MO HealthNet program. Eligible individuals must include: (1) Physicians (5) Pharmacists (2) ARPNs (6) Speech, occupational and physical therapists (3) Dentists and oral surgeons (7) Clinical social workers; and (4) Psychologists and provisional licenses (8) Health care providers practicing in rural areas "Originating site" is defined as a telehealth site where the MO HealthNet participant receiving the telehealth service is located for the encounter. The originating site must ensure immediate availability of clinical staff during a telehealth encounter if a participant requires assistance. An originating site must be one of the following locations: (1) Office of a physician or health care provider; (2) Hospital; (3) Critical access hospital; (4) Rural health clinic; FQHC; Nursing Home; Dialysis center; Missouri state habilitation center or regional office; Community mental health center; Missouri state mental health facility; Missouri state facility; Missouri residential treatment facility licensed by and under contract with the Children's Division within DHSS. Facilities must have multiple campuses and have the ability to adhere to technology requirements. Missouri licensed psychiatrists, licensed psychologists, or provisionally licensed psychologists, and advanced registered nurse practitioners who are (13) (14) (15) enrolled MO HealthNet providers must be the only consulting providers at these locations; Comprehensive substance treatment and rehabilitation program (CSTAR); School; or The MO HealthNet recipient's home. house.mo.gov/billtracking/bills151/billpdf/intro/hbo3 19I.PDF 4

5 HB 340 (Kendrick) Originating Sites for Telehealth Defines an "originating site" for telehealth services and includes school-based health centers in the definition. Originating sites include all of those listed above in HB 319 except it does not include the "MO HealthNet recipient's home". Health and Safety A variety of bills have already been filed relating to the repeal of the motorcycle helmet law and prohibition on texting while driving. ********* Please let me know if you have any questions or comments Pat Strader plstrader@embarqmail.com (573)

KYNA IMAN, LLC 124 East High Street P.O. Box 1483 Jefferson City, MO fax

KYNA IMAN, LLC 124 East High Street P.O. Box 1483 Jefferson City, MO 65102 314-651-1185 573-635-2858-fax kynaiman@earthlink.net TO: MISSOURI NURSES ASSOCIATION FROM: Kyna Iman and Tricia Workman DATE: