MASCA Legislative Update: 4/29/2018
KC Star's Allison Kite: Missouri senators wrong to oppose opioid drug tracking; Comments from Schaaf, Sen. Jamilah Nasheed (D-St. Louis County [sic]) The Missouri Times: SD 17 special election: Lauren Arthur outraises Kevin Corlew in April quarterly filings
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. The Senate also passed this out of committee last week, but both the House/Senate bills are too late to pass on their own. We will be monitoring amendments in both chambers.
Surprise Billing: This 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.
Details of bill:
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their directory every 30 days, and they would be required to treat a service as in-network if a patient relied on outdated/inaccurate information on a directory that listed a provider as being in-network.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 referred this week to the House Children & Families Committee and is expected to have a public hearing next week.
Scope of Practice Expansion for Nurses: HB 1574 (Rowland) allows a physician to enter into collaborative practice arrangements or supervision agreements with a total of six full-time 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: Scheduled for a public hearing in Senate Professional Registration on Monday
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 passed out of committee last week, but has not yet been reported to the Senate Calendar.
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) was passed by the House last week with a variety of additional amendments. The bill is now in conference committee between the House & Senate to negotiate final changes.
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 was heard last week in the Senate Seniors & Families Committee and could be voted on this week in 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. The language was also amended onto HCB 15, which has been approved by the House, but still is unlikely to pass before the end of the session on May 18th.
3D – Mammography: Requires insurance carriers to cover 3D mammography screenings.
Status: House Bill 1252 passed out of the House 145-2 and was passed unanimously out of the Senate Insurance Committee last week. It should be added to the Senate Calendar this week.
Upcoming Public Hearings:
MONDAY - 04/30/18
Senate-Professional Registration MONDAY - 04/30/18 2:00 PM, SCR 1
Modifies provisions relating to advanced practice registered nurses in collaborative practice arrangements
House-Rules-Administrative Oversight (POSTING CHANGE) MONDAY - 04/30/18 5:00 PM or Upon Adj., whichever is later, HR 6
Prohibits covenants not to compete.
Modifies the composition, duties or repeals outright certain administrative boards, commissions, and councils