MASCA Legislative Update: 4/15/2018

Priority Bill Status:

Designated Caregiver Act: An act that would require all hospitals and ASCs to offer patients the option to disclose a designated caregiver who would have permission to view their medical information and any post-release care instructions. MASCA has lobbied in opposition of this bill based on the fact that ASCs already do this through a patient privacy form that every patient has the option to sign. It is our goal to amend this to exempt ASCs who are using existing patient privacy forms.

Status: The Senate is scheduled for a hearing on this bill next week; however, the sponsor confirmed he is not dug in on the issue and is happy to exempt ASCs. The House Health Committee is also scheduled for a vote this week, but we have an amendment prepared to exempt ASCs.

Surprise Billing: We expect debate on the Senate floor this week on SB 982, a health insurance bill that will include surprise billing, which occurs when a patient receives a bill from an out-of-network provider at an in-network facility. The potential compromise will be limited to emergency services (opposed to elective/planned procedures) and will be a hybrid of laws passed in Minnesota and Arizona. Under this proposal, a health insurance carrier would have to pay the physician a reasonable rate with no specific metrics in statute. If the provider does not think the rate is fair, the provider and carrier have 90 days to negotiate a fair rate. If the provider is still unsatisfied, they can take the issue to arbitration through the Department of Insurance. The arbitration panel can refer to a variety of metrics, including the physician’s skill, training, experience, etc. and must determine a fair rate between 120% of Medicare and 70th percentile of usual and customary rates (UCR) for that procedure in the same geographical area.

Status: Senate Bill 982 is on the Senate Informal Calendar – we expect debate on the Senate floor next week (high probability of this issue passing in some format)

Scope of Practice Expansion for Nurses: HB 1574 (Rowland) has passed the House and was referred to the Senate Professional Registration Committee this week. This bill allows a physician to enter into collaborative practice arrangements or supervision agreements with a total of six fulltime equivalent advanced practice registered nurses (APRN), assistant physicians, or physician assistants, in any combination thereof. Currently, a doctor can work with up to three APRNs and three Physician Assistants at one time. At this point, there is no other legislation moving that would expand scope of practice for APRNs.

Status: Passed House and has been referred to Senate Professional Registration Committee (compromise that does not expand scope of practice, high probability of this passing)

Assistant Physicians: Expands scope of practice for assistant physicians, a new professional created in Missouri a few years ago that allows physicians who have not matched for a residency to provide services through a collaborative practice arrangement. Under current law, an assistant physician can only provide primary care services in underserved areas. This bill would allow an assistant physician to provide other services outside of primary care and would allow them to provide these services in health care facilities with internship or residency training programs. This issue has split the provider community, as it is sponsored by Rep. Keith Frederick, DO (R-Rolla) and supported by the MO State Medical Association. However, opponents include the MO Academy of Family Physicians, Washington University Medical School, MO Academy of Physician Assistants and the MO Insurance Coalition, all of whom testified that medical school was not designed to produce practitioners without residency.

Status: House Bill 2127 has passed the House and is posted for a hearing on Tuesday in the Senate Professional Registration & Licensing Committee

7 Day Opioid Limit: Restricts initial opioid prescription to seven-day supply limit, unless designated in the medical record the reason for additional supply. This was amended onto another Senate pharmacy bill that has been approved by the full Senate and House Professional Registration Committee.

Status: Senate Bill 826 (Sater) passed the House Rules Committee last week and is headed to the House floor (high probability of passage).

Opioid Omnibus Bill: Rep. Keith Frederick, DO (R-Rolla) was successful in passing a bill out of the House that contains several provisions relating to opioids, including:

Drug Take-Back Program – public collection process for unused controlled substances
Prescription Abuse Registry – Anyone over 18 can volunteer to be listed in this registry, which providers can monitor to see if they are prescribing to someone who has a history of abuse. A person can petition to be removed after five years. In other words, this is a self-imposed rehab concept for those individuals who want to put in place barriers to access.
Patient Satisfaction Scores – Specifies that a patient scoring of pain control shall not be required when defining data standards for quality of care and patient satisfaction.
IATOA – An initiative designed for assistant physicians to address overdose situations in the emergency room and creates a path for assistant physicians to obtain prescriptive authority.

Drug Trafficking – Fentanyl: Legislation that would make it a crime to distribute, deliver, produce or attempt to purchase more than 10 grams of fentanyl. Anything more than 60 grams would be considered a felony. The MO State Troopers Association, MO Prosecuting Attorneys Association and other law enforcement groups testified in support of the bill.

Status: House Bill 1254 was passed out of the House Rules Committee last week (no opposition in committee – potential amendment on other bills moving in the House).

3D – Mammography: Requires insurance carriers to cover 3D mammography screenings.