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MASCA Legislative Report 4/23

Top News of the Week

Key Updates

  1. Statewide Managed Care: The Missouri Constitution requires the legislature to pass a balanced budget by May 5th. The budget bills are currently in the Senate Appropriations Committee, but it’s uncertain how much Senator Rob Schaaf, MD (R-St. Joseph) will filibuster the budget on the Senate floor due to a controversial 7-4 committee vote to keep the statewide managed care contracts for Medicaid services in-tact. Schaaf has been the chief opponent of statewide managed care, a payment model that includes contracts with private insurance providers who cover Medicaid enrollees on a fixed dollar amount per member per month. This is an alternative to the fee-for-service payment model, in which the government sets the reimbursement rate for each provider. Managed care has been used for several years along the I-70 corridor, but the state passed legislation in 2016 to expand the program statewide, which is set to go into effect in the coming months. Opponents of managed care are concerned that control may be shifted from providers to insurance companies, while supporters suggest that privatizing the delivery of Medicaid services will result in cost savings through increased efficiencies.

  2. Schaaf Effect: Senator Rob Schaaf, MD (R-St. Joseph) has been the main obstacle to operational efficiency in the state senate this year, as he has formed various allies on different issues and leveraged the power of the Senate rulebook to filibuster the upper chamber’s process and procedures. As a result, Schaaf has in many ways secured more control over the flow of the Senate than Senate leadership, as nothing can move to a vote until he and his allies sit down. He has blocked legislation relating to a Prescription Drug Monitoring Program (PDMP), statewide managed care for Medicaid enrollees, tort reform and a mixture of high profile and low profile issues. Given that Schaaf has no incentive to pass legislation, he has recruited allies within the Republican and Democrat party by committing to them that he will help them filibuster legislation that is important to them. Last week, freshman Senator Caleb Rowden (R-Columbia) stood up to Schaaf and confronted him on a few issues relating to ethics. Rowden’s inquiry was viewed by many as “standing up to the bully,” as the debate prompted Schaaf to throw down his microphone. The Senate abruptly adjourned until Mondayafternoon when legislators had planned on staying Thursday evening and Friday to work on high priority issues. If Schaaf prevents the Senate from advancing the budget, which is the one thing they are constitutionally required to pass, it signals that the fate of all other pending legislation is up in the air. This week’s actions even prompted the Governor to launch attack ads against Schaaf, a fellow Republican, which urged people to call Schaaf’s personal cell phone.

  3. PDMP: The House rejected the Senate’s changes to PDMP this week and sent the bill to conference committee. It is unlikely the bill will advance; however, the county program is expected to launch next month (see below).

Rowden-Schaaf Debate


Hearings this week

MONDAY - 04/24/17

Senate-Professional Registration MONDAY - 04/24/17

2:00 PM, SCR 1

HB 815

Basye, Chuck

Provides ways a professional licensee or holder of a permit certificate, or registration may submit payment and information to a board.

HB 480

Ross, Robert

Establishes guidelines for the regulation of occupations and professions not regulated by the Division of Professional Registration.

Committee Members: Riddle, Jeanie (R) / Rowden, Caleb (R) / Cunningham, Mike (R) / Eigel, Bill (R) / Schupp, Jill (D) / Sifton, Scott (D) / Wieland, Paul (R)

TUESDAY - 04/25/17

House-Insurance Policy (POSTING CHANGE) TUESDAY - 04/25/17 12:00 PM or upon morning adj., whichever is later, HR 4 Executive Session:

HB 298

Lichtenegger, Donna

Specifies the minimum reimbursement amount for covered physical therapy services delivered under health benefit plans.

Committee Members: Engler, Kevin (R) / Wiemann, John D. (R) / Ellebracht, Mark (D) / Burnett, Ingrid (D) / Burns, Bob (D) / Messenger, Jeff (R) / Morris, Lynn (R) / Muntzel, Dave (R) / Pfautsch, Donna (R) / Shull, Noel (R) / Stephens, Mike (R)

WEDNESDAY - 04/26/17

Senate-Health and Pensions WEDNESDAY - 04/26/17 10:00 AM, SCR 1

HB 780

Hill, Justin

Establishes a state innovation waiver task force to develop a health care reform plan.

Committee Members: Schaaf, Rob (R) / Koenig, Andrew (R) / Chappelle-Nadal, Maria (D) / Onder, Bob (R) / Sater, David (R) / Schupp, Jill (D) / Silvey, Ryan (R)

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