Q3: Possible candidates in the 2018 General Election for United States Senate are the Republican Josh Hawley and the Democrat Claire McCaskill. If the election were held today, for whom would you vote?

Josh Hawley: 44%

Claire McCaskill: 48%

Undecided: 8%

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: We were successful in amending this in the House Health Policy Committee to exempt ASCs, provided your ASC is compliant with existing CMS regulations regarding patient privacy

Surprise Billing: We were successful in passing a bill through the Senate last week that reflects a compromise between the providers and insurance companies on Surprise Billing, which occurs when a patient is treated by an out-of-network provider at an in-network facility. While the bill originally impacted all health care services, this version that passed the Senate is 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.

Another amendment was added by Sen. Wayne Wallingford (R-Cape Girardeau) that holds insurance companies accountable for inaccurate information listed on their provider directory. They would be required to update their directory every 30 days, and they would be required to treat a service as in-network if a patient relied on outdated/inaccurate information on a directory that listed a provider as being in-network.

Status: Senate Bill 982 was given first round approval by the Senate last week and must receive a final roll call vote this week prior to moving to the House.

Scope of Practice Expansion for NursesHB 1574 (Rowland) 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 was heard in the Senate Professional Registration & Licensing Committee last week.

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) is on the House Calendar and two votes away from the Governor’s desk.

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.

Status: House Bill 2105 is scheduled for a hearing this week in the Senate Seniors & Families Committee.

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, but is too far behind to pass as a stand-alone bill. However, we will monitor for any amendments to other legislation.

“Pain Capable Unborn Child Protection Act”A bill that would restrict abortions after 22 weeks, which is defined as the “pain capable gestational age.” This mirrors a bill ACOG has opposed at the federal level.

Status: House Bill 1266 was heard last week in the Senate Seniors & Families Committee.

Consent for Minors Obtaining Abortion: Requires a parent/guardian of a minor consenting to an abortion to notify any other custodial parent/guardian in writing prior to issuing written consent for the abortion.

Status: House Bill 1383 passed the House 113-27 and passed out of the Senate committee, but has not been reported to the Senate Calendar.

Long Acting Reversible Contraceptives: Allows a health care provider to transfer a long-acting reversible contraceptive to a patient other than the patient to whom it was initially prescribed in certain circumstances.

Status: House Bill 1499 was approved 133-10 in the House and is scheduled for a public hearing next week in the Senate Seniors & Families Committee.

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

Status: House Bill 1252 passed out of the House 145-2 and was heard last week in the Senate Insurance Committee, which should vote on the measure this week.

Upcoming Public Hearings:

MONDAY - 04/23/18

Senate-Professional Registration MONDAY - 04/23/18 2:00 PM, SCR 1

HB 1419

Haefner, Marsha

Requires certain health care professionals to complete two hours of suicide prevention training as a condition of licensure.

Senate-Fiscal Oversight MONDAY - 04/23/18 2:45 PM, Pershing Conference Room

SB 982

Wieland, Paul

Enacts provisions relating to payments for health care services

House-Rules-Administrative Oversight (POSTING CHANGE) MONDAY - 04/23/18 5:00 PM or Upon Adj., whichever is later, HR 6 Executive Session:

HB 2209