Journal of the House


First Regular Session, 94th General Assembly




SEVENTY-THIRD DAY, Friday, May 11, 2007

The House met pursuant to adjournment.

 

            Speaker Jetton in the Chair.

 

            Prayer by Ralph Robinett, Sergeant-at-Arms.

 

              When Every Day is Special

 

              O Lord, today is truly special, for it comes as a gift from You to us.

 

              We are surrounded by the marvelous things You have made: babies are born, leaves bud on the trees, bodies heal after illness, people build friendships.

 

              Help us to always see Your hand in our world, even on what seems like the most ordinary of days. Open our eyes to see Your love in countless little things, and in that way become aware of the grand scale of Your grace.

 

              Make our hearts sing with Your praise today and every day.

 

              Today is truly special for it is a gift from You to us. Thank You for this day. Amen.

 

            The Pledge of Allegiance to the flag was recited.

 

            The Speaker appointed the following to act as Honorary Pages for the Day, to serve without compensation: Tyler Matthew Loveall, Judith Svetanics, Neil Svetanics and Laura Ransin.

 

            The Journal of the seventy-second day was approved as printed.

 

            Representative Pratt assumed the Chair.

 

HOUSE COURTESY RESOLUTIONS OFFERED AND ISSUED

 

            House Resolution No. 3561 through House Resolution No. 3609

 

COMMITTEE REPORT

 

            Committee on Fiscal Review, Chairman Guest reporting:

 

            Mr. Speaker: Your Committee on Fiscal Review, to which was referred HCS SS SCS SB 577 (Fiscal Note), begs leave to report it has examined the same and recommends that it Do Pass.

HOUSE BILL WITH SENATE AMENDMENT

 

            SS#2 SCS HCS HBs 444, 217, 225, 239, 243, 297, 402 & 172, relating to a deduction for social security, was taken up by Representative Jetton.

            Representative Nieves assumed the Chair.

 

            Representative Pratt resumed the Chair.

 

            On motion of Representative Jetton, SS#2 SCS HCS HBs 444, 217, 225, 239, 243, 297, 402 & 172 was adopted by the following vote:

 

AYES: 135

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 123

Bearden

Bivins

Brandom

Bringer

Brown 30

Burnett

Casey

Chappelle-Nadal

Cooper 120

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Darrough

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Emery

Ervin

Faith

Fallert

Fares

Fisher

Flook

Frame

Franz

Funderburk

George

Grill

Grisamore

Guest

Harris 23

Hobbs

Hodges

Holsman

Hoskins

Hubbard

Hunter

Icet

Jones 89

Kelly

Komo

Kraus

Lampe

Lembke

LeVota

Liese

Lipke

Loehner

Marsh

May

McClanahan

McGhee

Meadows

Meiners

Moore

Munzlinger

Muschany

Nance

Nieves

Nolte

Norr

Onder

Page

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Robinson

Roorda

Rucker

Ruestman

Ruzicka

Salva

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schieffer

Schlottach

Schneider

Schoeller

Schoemehl

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Spreng

Stevenson

St. Onge

Storch

Stream

Sutherland

Swinger

Thomson

Threlkeld

Tilley

Todd

Viebrock

Wallace

Walsh

Wasson

Wells

Weter

Whorton

Wilson 119

Wilson 130

Witte

Wood

Wright 159

Yaeger

Yates

Zimmerman

Mr Speaker

 

 

 

 

 

NOES: 011

 

 

 

 

 

 

 

 

 

Baker 25

Corcoran

Daus

Harris 110

Low 39

Nasheed

Oxford

Talboy

Villa

Vogt

Zweifel

 

 

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 017

 

 

 

 

 

 

Bland

Bowman

Brown 50

Bruns

Curls

Haywood

Hughes

Johnson

Jones 117

Kingery

Kratky

Kuessner

Lowe 44

Walton

Wildberger

Wright-Jones

Young

 

 

 

 

 


            On motion of Representative Jetton, SS#2 SCS HCS HBs 444, 217, 225, 239, 243, 297, 402 & 172 was truly agreed to and finally passed by the following vote:

 

AYES: 133

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 123

Bearden

Bivins

Brandom

Bringer

Brown 30

Burnett

Casey

Chappelle-Nadal

Cooper 120

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Darrough

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Emery

Ervin

Faith

Fallert

Fares

Fisher

Flook

Frame

Franz

Funderburk

George

Grill

Grisamore

Guest

Harris 23

Hobbs

Hodges

Holsman

Hoskins

Hubbard

Hunter

Icet

Jones 89

Kelly

Komo

Kraus

Lampe

Lembke

LeVota

Liese

Lipke

Loehner

Marsh

May

McClanahan

McGhee

Meadows

Meiners

Moore

Munzlinger

Muschany

Nance

Nieves

Nolte

Norr

Onder

Page

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Robinson

Roorda

Rucker

Ruestman

Ruzicka

Salva

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schieffer

Schneider

Schoeller

Schoemehl

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Spreng

Stevenson

St. Onge

Storch

Stream

Sutherland

Swinger

Thomson

Threlkeld

Tilley

Todd

Wallace

Walsh

Wasson

Wells

Weter

Whorton

Wilson 119

Wilson 130

Witte

Wood

Wright 159

Yaeger

Yates

Zimmerman

Mr Speaker

 

 

 

 

 

 

 

NOES: 011

 

 

 

 

 

 

 

 

 

Baker 25

Corcoran

Daus

Harris 110

Low 39

Nasheed

Oxford

Talboy

Villa

Vogt

Zweifel

 

 

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 019

 

 

 

 

 

 

Bland

Bowman

Brown 50

Bruns

Curls

Haywood

Hughes

Johnson

Jones 117

Kingery

Kratky

Kuessner

Lowe 44

Schlottach

Viebrock

Walton

Wildberger

Wright-Jones

Young

 

 

            Representative Pratt declared the bill passed.

 

RECESS

 

            On motion of Representative Dempsey, the House recessed until 11:45 a.m.

 

            The hour of recess having expired, the House was called to order by Representative Cooper (120).

 

MESSAGES FROM THE SENATE

 

             Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on SCS HCS HB 10, and has taken up and passed CCS SCS HCS HB 10.

 

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on SCS HCS HB 11, as amended, and has taken up and passed CCS SCS HCS HB 11.

 

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on SCS HCS HB 12, and has taken up and passed CCS SCS HCS HB 12.

 

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on SCS HCS HB 13, and has taken up and passed CCS SCS HCS HB 13.

 

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the President Pro Tem has appointed the following Conference Committee to act with a like Committee from the House on SS SCS HB 255, as amended: Senators Vogel, Scott, Ridgeway, Green and Shoemyer.

 

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and passed SS#2 SCS HCS HB 818, entitled:

 

            An act to repeal sections 103.085, 143.121, 143.782, 313.321, 376.426, 376.776, 376.960, 376.961, 376.964, 376.966, 376.986, 376.989, 379.930, 379.936, 379.938, 379.940, 379.942, 379.943, 379.944, and 379.952, RSMo, and to enact in lieu thereof forty-nine new sections relating to health insurance, with an effective date for certain sections.

 

            With Senate Amendment No. 2.

 

Senate Amendment No. 2

 

AMEND Senate Substitute No. 2 for Senate Committee Substitute for House Committee Substitute for House Bill No. 818, Page 70, Section 376.990, Line 20 of said page, by inserting before the word “third” the following:

 

              licensed”.

 

            In which the concurrence of the House is respectfully requested.

 

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on HCS SB 81, as amended, and has taken up and passed CCS HCS SB 81.

 

            Emergency clause adopted.

 

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate refuses to concur in HCS SCS SB 86, as amended, and requests the House to recede from its position and, failing to do so, grant the Senate a conference thereon.

 

 


HOUSE BILL WITH SENATE AMENDMENTS

 

            SS#2 SCS HCS HB 818, as amended, relating to health insurance portability, was taken up by Representative Ervin.

 

            Representative Ervin moved that the SS#2 SCS HCS HB 818, as amended, be adopted.

 

            Representative Donnelly made a substitute motion that the House refuse to adopt SS#2 SCS HCS HB 818, as amended, and request the Senate to recede from its position and, failing to do so, grant the House a conference.

 

            Which motion was defeated by the following vote:

 

AYES: 056

 

 

 

 

 

 

 

 

 

Aull

Baker 25

Bringer

Burnett

Casey

Chappelle-Nadal

Corcoran

Darrough

Daus

Donnelly

Dougherty

El-Amin

Fallert

Frame

George

Grill

Harris 23

Harris 110

Hodges

Holsman

Hubbard

Komo

Lampe

LeVota

Liese

Low 39

McClanahan

Meadows

Meiners

Nasheed

Norr

Oxford

Page

Quinn 9

Robinson

Roorda

Rucker

Salva

Scavuzzo

Schieffer

Schoemehl

Shively

Skaggs

Spreng

Storch

Swinger

Talboy

Todd

Villa

Vogt

Walsh

Whorton

Witte

Yaeger

Zimmerman

Zweifel

 

 

 

 

 

 

 

 

 

NOES: 091

 

 

 

 

 

 

 

 

 

Avery

Baker 123

Bearden

Bivins

Brandom

Brown 30

Bruns

Cooper 120

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Dusenberg

Emery

Ervin

Faith

Fares

Fisher

Flook

Franz

Funderburk

Grisamore

Guest

Hobbs

Hoskins

Hunter

Icet

Jones 89

Jones 117

Kelly

Kraus

Lembke

Lipke

Loehner

Marsh

May

McGhee

Moore

Munzlinger

Muschany

Nance

Nieves

Nolte

Onder

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Richard

Robb

Ruestman

Ruzicka

Sander

Sater

Schaaf

Schad

Scharnhorst

Schlottach

Schneider

Schoeller

Self

Silvey

Smith 14

Smith 150

Stevenson

St. Onge

Stream

Sutherland

Thomson

Threlkeld

Tilley

Wallace

Wasson

Wells

Weter

Wilson 119

Wilson 130

Wood

Wright 159

Yates

Mr Speaker

 

 

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 016

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Viebrock

Walton

Wildberger

Wright-Jones

Young

 

 

 

 

 

            On motion of Representative Ervin, SS#2 SCS HCS HB 818, as amended, was adopted by the following vote:

 

AYES: 104

 

 

 

 

 

 

 

 

 

Avery

Baker 123

Bearden

Bivins

Brandom

Brown 30

Bruns

Cooper 120

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Dougherty

Dusenberg

El-Amin

Emery

Ervin

Faith

Fares

Fisher

Flook

Franz

Funderburk

Grill

Grisamore

Guest

Hobbs

Holsman

Hubbard

Hunter

Icet

Jones 89

Jones 117

Kelly

Komo

Kraus

Lembke

Liese

Lipke

Loehner

Marsh

May

McGhee

Meiners

Moore

Munzlinger

Muschany

Nance

Nieves

Nolte

Onder

Page

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Ruestman

Ruzicka

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schlottach

Schneider

Schoeller

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Stevenson

St. Onge

Stream

Sutherland

Thomson

Threlkeld

Tilley

Viebrock

Wallace

Wasson

Wells

Weter

Wilson 119

Wilson 130

Wood

Wright 159

Yates

Mr Speaker

 

 

 

 

 

 

NOES: 043

 

 

 

 

 

 

 

 

 

Aull

Baker 25

Bringer

Burnett

Casey

Chappelle-Nadal

Corcoran

Darrough

Daus

Donnelly

Fallert

Frame

George

Harris 23

Harris 110

Hodges

Hoskins

Lampe

LeVota

Low 39

McClanahan

Meadows

Norr

Oxford

Robinson

Roorda

Rucker

Salva

Schieffer

Schoemehl

Spreng

Storch

Swinger

Talboy

Todd

Villa

Vogt

Walsh

Whorton

Witte

Yaeger

Zimmerman

Zweifel

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 016

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Nasheed

Walton

Wildberger

Wright-Jones

Young

 

 

 

 

 

 


            On motion of Representative Ervin, SS#2 SCS HCS HB 818, as amended, was truly agreed to and finally passed by the following vote:

 

AYES: 106

 

 

 

 

 

 

 

 

 

Avery

Baker 123

Bearden

Bivins

Brandom

Brown 30

Bruns

Cooper 120

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Dougherty

Dusenberg

El-Amin

Emery

Ervin

Faith

Fallert

Fares

Fisher

Flook

Franz

Funderburk

Grill

Grisamore

Guest

Hobbs

Holsman

Hoskins

Hubbard

Hunter

Icet

Jones 89

Jones 117

Kelly

Komo

Kraus

Lembke

Liese

Lipke

Loehner

Marsh

May

McGhee

Meiners

Moore

Munzlinger

Muschany

Nance

Nieves

Nolte

Onder

Page

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Ruestman

Ruzicka

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schlottach

Schneider

Schoeller

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Stevenson

St. Onge

Stream

Sutherland

Thomson

Threlkeld

Tilley

Viebrock

Wallace

Wasson

Wells

Weter

Wilson 119

Wilson 130

Wood

Wright 159

Yates

Mr Speaker

 

 

 

 

 

 

 

 

 

NOES: 041

 

 

 

 

 

 

 

 

 

Aull

Baker 25

Bringer

Burnett

Casey

Chappelle-Nadal

Corcoran

Darrough

Daus

Donnelly

Frame

George

Harris 23

Harris 110

Hodges

Lampe

LeVota

Low 39

McClanahan

Meadows

Nasheed

Norr

Oxford

Robinson

Roorda

Rucker

Schieffer

Schoemehl

Spreng

Storch

Swinger

Talboy

Todd

Villa

Vogt

Walsh

Whorton

Witte

Yaeger

Zimmerman

Zweifel

 

 

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 016

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Salva

Walton

Wildberger

Wright-Jones

Young

 

 

 

 

 

            Representative Cooper (120) declared the bill passed.

 

            Speaker Jetton resumed the Chair.

 

THIRD READING OF SENATE BILLS

 

            SB 513, relating to the Professional and Practical Nursing Student Loan Program, was taken up by Representative Wasson.

 

            On motion of Representative Wasson, SB 513 was truly agreed to and finally passed by the following vote:

 

AYES: 148

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Baker 123

Bearden

Bivins

Brandom

Bringer

Brown 30

Bruns

Burnett

Casey

Chappelle-Nadal

Cooper 120

Cooper 155

Cooper 158

Corcoran

Cox

Cunningham 145

Cunningham 86

Darrough

Daus

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Emery

Ervin

Faith

Fallert

Fares

Fisher

Flook

Frame

Franz

Funderburk

George

Grill

Grisamore

Guest

Harris 23

Harris 110

Hobbs

Hodges

Holsman

Hoskins

Hubbard

Hunter

Icet

Jones 89

Jones 117

Kelly

Komo

Kraus

Lampe

Lembke

LeVota

Liese

Lipke

Loehner

Low 39

Marsh

May

McClanahan

McGhee

Meadows

Meiners

Moore

Munzlinger

Muschany

Nance

Nasheed

Nieves

Nolte

Norr

Onder

Oxford

Page

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Robinson

Roorda

Rucker

Ruestman

Ruzicka

Salva

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schieffer

Schlottach

Schneider

Schoeller

Schoemehl

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Spreng

Stevenson

St. Onge

Storch

Stream

Sutherland

Swinger

Talboy

Thomson

Threlkeld

Tilley

Todd

Viebrock

Villa

Vogt

Wallace

Walsh

Wasson

Wells

Weter

Whorton

Wilson 119

Wilson 130

Witte

Wood

Wright 159

Yaeger

Yates

Zimmerman

Zweifel

Mr Speaker

 

 

 

 

 

 

 

NOES: 000

 

 

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 015

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Walton

Wildberger

Wright-Jones

Young

 

            Speaker Jetton declared the bill passed.

 

            HCS SS SCS SB 577, relating to the Missouri HealthNet Program, was taken up by Representative Schaaf.

 

            Representative Schaaf offered House Amendment No 1.

 

 


House Amendment No. 1

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 25, Section 208.001, Subsection 1, Lines 1 through 4, by deleting all of said lines and inserting in lieu thereof the following:

 

              "208.001. 1. Sections 105.711, 135.096, 135.575, 191.411, 191.900, 191.905, 191.907, 191.908, 191.909, 191.910, 191.914, 191.1050, 191.1053, 191.1056, 192.632, 198.069, 198.097, 208.001, 208.146, 208.151, 208.152, 208.153, 208.197, 208.201, 208.212, 208.213, 208.215, 208.217, 208.225, 208.230, 208.612, 208.631, 208.640, 208.659, 208.670, 208.690, 208.692, 208.694, 208.696, 208.698, 208.750, 208.930, 208.950, 208.952, 208.954, 208.956, 208.960, 208.962, 208.964, 208.968, 208.975, 208.978, 375.020, 375.143, 473.398, and 620.510 RSMo, may be known as and may be cited as the "Missouri Continuing Health Improvement Act" "; and

 

              Further amend said bill, Page 44, Section 208.153, Line 30, by deleting the word "any" and inserting in lieu thereof the words "all or part of a"; and

 

              Further amend said bill, page and section, Line 31, by inserting after the word "pass" the words "the pertinent portion, as defined by departmental regulation, of"; and

 

              Further amend said bill, Page 45, Section 208.197, Subsection 2, Line 16, by deleting the word "encourage" and inserting in lieu thereof "discourage"; and

 

              Further amend said bill, Page 70, Section 208.950, Subsection 1, Subdivision (12), Line 58, by inserting before the word "the", the words "if the participant has a PCP, the office or clinic of a participant's PCP or PCP extender, and any team of individuals associated with that office or clinic, or if the participant has no PCP,"; and

 

              Further amend said bill, Page 70, Section 208.950, Line 61, by deleting the words "The home is led by a clinically appropriate provider, who"; and

 

              Further amend said bill, Pages 70 to 71, Section 208.950, Lines 62 through 69, by deleting said lines; and

 

              Further amend said bill, Page 71, Section 208.950, Subsection 1, Subdivision (14), Line 75, by inserting after "208.152" the words "and other budgeted services"; and

 

              Further amend said bill, Page 71, Section 208.950, Subsection 1, Subdivision (19), Line 93, by deleting the word "select" and inserting in lieu thereof "selected"; and

 

              Further amend said bill, Page 73, Section 208.950, Subsection 1, Subdivision (25), Line 146, by deleting the word "existing"; and

 

              Further amend said bill, Page 80, Section 208.954, Subsection 1, Subdivision (1), Paragraph (a), Line 4, by inserting after the word "and" the word "of"; and

 

              Further amend said bill, Page 81, Section 208.954, Subsection 2, Line 50, by inserting after the word "all" the word "primary"; and

 

              Further amend said bill, Page 83, Section 208.956, Subsection 1, Subdivision (6), Line 15, by inserting after the word "professionals" the words "of which, one shall be a dentist,"; and

 

              Further amend said bill, Page 92, Section 208.964, Subdivision (6), Lines 87 through 88, by deleting the words "not included as part of an ASO plan, managed care plan, or component state plan for such population." and inserting in lieu thereof the following:

 

              "may include services of a component state plan upon approval of the department of mental health, but said ABD participants shall not be included as part of an ASO plan or a managed care plan."; and

 

              Further amend said bill, Page 95, Section 208.975, Subsection 7, Lines 54 and 55, by deleting the words "seven hundred fifty thousand dollars within any three-year span." and inserting in lieu thereof the following:

 

              "two million dollars per fiscal year."; and

 

              Further amend said bill, Page 101, Section 620.510, Subsection 3, Subdivision (5), Line 18, by inserting after the word "services," and words "and the director of the department of mental health,"; and

 

              Further amend said bill, Page 103, Section 4, by deleting the said section; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            Representative Tilley offered House Amendment No. 1 to House Amendment No. 1.

 

House Amendment No. 1

to

House Amendment No. 1

 

AMEND House Amendment No. 1 to House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 1, Line 1, by inserting before the word "AMEND" the words 'AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 15, Line 40, by inserting before the word "A" the words "The person so referred shall be subject to the penalties provided for under 42 U.S.C. Chapter 7, Subchapter XI, Section 1320a-7." '.

 

            On motion of Representative Tilley, House Amendment No. 1 to House Amendment No. 1 was adopted.

 

            On motion of Representative Schaaf, House Amendment No. 1, as amended, was adopted.

 

            Representative Hobbs offered House Amendment No. 2.

 

House Amendment No. 2

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 22, Section 191.1050, Lines 9 and 10, by deleting all of said lines and inserting in lieu thereof the following:

 

              "section 632.005, RSMo, rural health clinic, or any group of licensed health care professionals in an area of defined need that is designated by the department as"; and

 

              Further amend said bill, Page 22, Section 191.1053, Line 15, by inserting after all of said lines the following:

 

              "4. The department may promulgate rules to implement the provisions of sections 191.1050 to 191.1056. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2007, shall be invalid and void."; and

 

              Further amend said bill, Page 22, Section 191.1056, Line 3, by inserting after the second appearance of the word "fund" on said line the following:

 

              ", with the approval of the oversight committee created in section 208.956, RSMo,"; and

 

              Further amend said title, enacting clause and intersectional references accordingly.

 

            On motion of Representative Hobbs, House Amendment No. 2 was adopted.

 

            Representative Portwood offered House Amendment No. 3.

 

House Amendment No. 3

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 2, Section A., by inserting after all of said section the following:

 

              “103.003. As used in sections 103.003 to 103.175, the following terms mean:

              (1) "Actuarial reserves", the necessary funding required to pay all the medical expenses for services provided to members of the plan but for which the claims have not yet been received by the claims administrator;

              (2) "Actuary", a member of the American Academy of Actuaries or who is an enrolled actuary under the Employee Retirement Income Security Act of 1974;

              (3) "Agency", a state-sponsored institution of higher learning, political subdivision or governmental entity or instrumentality;

              (4) "Alternative delivery health care program", a plan of covered benefits that pays medical expenses through an alternate mechanism rather than on a fee-for-service basis. This includes, but is not limited to, health maintenance organizations and preferred provider organizations, all of which shall include chiropractic physicians licensed under chapter 331, RSMo, in the provider networks or organizations;

              (5) "Board", the board of trustees of the Missouri consolidated health care plan;

              (6) "Claims administrator", an agency contracted to process medical claims submitted from providers or members of the plan and their dependents;

              (7) "Coordination of benefits", to work with another group-sponsored health care plan which also covers a member of the plan to ensure that both plans pay their appropriate amount of the health care expenses incurred by the member;

              (8) "Covered benefits", a schedule of covered services, including chiropractic services, which are payable under the plan;

              (9) "Dental plan", any contractual arrangement to provide, either directly or through arrangement with others, specified dental benefits to members on a fixed prepayment basis or as a benefit of such subscribers' participation or membership in any other contract, agreement, or group or any corporation, partnership, or other entity which undertakes to provide or arrange specified dental benefits on a prepayment or other basis or to indemnify for specified dental benefits;

              [(9)] (10) "Employee", any person employed full time by the state or a participating member agency, or a person eligible for coverage by a state-sponsored retirement system or a retirement system sponsored by a participating member agency of the plan;

              [(10)] (11) "Evidence of good health", medical information supplied by a potential member of the plan that is reviewed to determine the financial risk the person represents to the plan and the corresponding determination of whether or not he or she should be accepted into the plan;

              [(11)] (12) "Health care plan", any group medical benefit plan providing coverage on an expense-incurred basis, any HMO, any group service or indemnity contract issued by a health plan of any type or description;

              [(12)] (13) "Medical benefits coverages" shall include services provided by chiropractic physicians as well as physicians licensed under chapter 334, RSMo;

              [(13)] (14) "Medical expenses", costs for services performed by a provider and covered under the plan;

              (15) "Member", any person who is a participant in the Missouri consolidated health care plan, including eligible subscribers and subscribers' spouses and unemancipated children;

              [(14)] (16) "Missouri consolidated health care plan benefit fund account", the benefit trust fund account containing all payroll deductions, payments, and income from all sources for the plan;

              [(15)] (17) "Officer", an elected official of the state of Missouri;

              [(16)] (18) "Participating member agency", a state-sponsored institution of higher learning, political subdivision or governmental entity that has elected to join the plan and has been accepted by the board;

              [(17)] (19) "Plan year", a twelve-month period designated by the board which is used to calculate the annual rate categories and the appropriate coverage;

              [(18)] (20) "Provider", a physician, hospital, pharmacist, psychologist, chiropractic physician or other licensed practitioner who or which provides health care services within the respective scope of practice of such practitioner pursuant to state law and regulation;

              [(19)] (21) "Retiree", a person who is not an employee and is receiving or is entitled to receive an annuity benefit from a state-sponsored retirement system or a retirement system of a participating member agency of the plan or becomes eligible for retirement benefits because of service with a participating member agency;

              (22) "Subscriber", a person who is either:

              (a) An eligible employee of the state or a participating member agency;

              (b) An eligible retiree of the state or a participating member agency;

              (c) An eligible surviving spouse or dependent of a deceased employee or deceased employee or deceased retiree of the state or a participating member agency;

              (d) A former employee of the state or a participating member agency who is eligible for coverage under the federal Consolidated Omnibus Budget Reconciliation Act; or

              (e) A person eligible for medical assistance under section 208.146, RSMo, and not otherwise eligible for coverage under the Missouri consolidated health care plan and who elects dental or vision coverage or both through the Missouri consolidated health care plan;

              (23) "Vision plan", any contractual arrangement to provide, either directly or through arrangement with others, specified vision benefits to members on a fixed prepayment basis or as a benefit of such subscribers' participation or membership in any other contract, agreement, or group or any corporation, partnership, or other entity which undertakes to provide or arrange specified vision benefits on a prepayment or other basis or to indemnify for specified vision benefits.

 

              103.005. For the purpose of covering medical, dental, and vision expenses of the officers, employees and retirees, the eligible dependents of officers, employees and retirees and to the surviving spouses and children of deceased officers, employees and retirees of the state and participating member agencies of the state, and providing dental and vision benefits to eligible participants of medical assistance under section 208.146, RSMo, there is hereby created and established a health care plan which shall be a body corporate, which shall be under the management of the board of trustees herein described, and shall be known as the "Missouri Consolidated Health Care Plan". Notwithstanding any provision of law to the contrary, such plan may sue and be sued, transact business, contract, invest funds and hold cash, securities and other property and shall be vested with such other powers as may be necessary or proper to enable it, its officers, employees, and agents to carry out fully and effectively all the purposes of sections 103.003 to 103.175.

 

              103.087. For purposes of this section, the terms "medical assistance subscriber" or "medical assistance participant" shall mean a person receiving medical assistance under section 208.146, RSMo. Except as otherwise provided by sections 103.003 to 103.175, dental and vision benefits coverage as provided by sections 103.003 to 103.175 shall be made available to persons receiving medical assistance under section 208.146, RSMo. Spouses or unemancipated children under the age of twenty-three of such persons shall also be eligible to receive such dental and vision benefits.

              (1) Dental and vision plans shall be available for enrollment by medical assistance eligible participants no earlier than January 1, 2008, and no later than July 1, 2008;

              (2) The cost of providing dental and vision benefits to medical assistance eligible subscribers and subscribers' dependents not otherwise eligible for coverage through the Missouri consolidated health care plan shall not be allowed to adversely affect the state's or participating member agencies' rates or benefits;

              (3) An initial thirty-day enrollment period shall be available for persons eligible for medical assistance not otherwise eligible for coverage under the Missouri consolidated health care plan to enroll in the dental or vision benefits or both under the Missouri consolidated health care plan. This initial thirty-day enrollment period shall begin from such person's initial date of approval under medical assistance under section 208.146, RSMo;

              (4) There shall be an annual thirty-day enrollment period, at a time designated by the board, during which persons eligible for medical assistance not otherwise eligible for coverage under the Missouri consolidated health care plan shall be able to enroll in the dental or vision plans or both;

              (5) Medical assistance participants not otherwise eligible for coverage under the Missouri consolidated health care plan shall also be eligible to enroll in the dental or vision plans or both as a medical assistance participant within sixty days of a loss of other group dental or vision coverage, or both, provided that such coverage was in place for at least twelve consecutive months immediately prior to the loss and that such loss was due to:

              (a) The subscriber's or the subscriber's spouse's termination of employment; or

              (b) Termination of group dental or vision coverage, or both, by the employer;

              (6) Coverage for such dental and vision benefits to medical assistance subscribers and subscribers' dependents shall terminate when the medical assistance participant ceases to be eligible for medical assistance;

              (7) Monthly, in accordance with a schedule developed by the board, or its designee, the medical assistance subscriber shall promptly pay to the executive director an amount equal to the amount of the premium due based upon the participation in the dental or vision plans, or both, as billed by the Missouri consolidated health care plan. Such premium shall be set by the board and shall cover all associated costs, including administrative costs, of the plan for providing such services to medical assistance participants. The executive director shall promptly deposit such amounts to the benefit trust fund account;

              (8) The plan shall not assume responsibility for any liabilities incurred by the medical assistance program or its eligible participants or its participants' spouses or unemancipated dependents prior to the group's effective date;

              (9) If so determined by the board, the department of social services shall reimburse the plan for any initial start-up costs incurred by the plan solely on behalf of the medical assistance participants and necessary in order for the medical assistance participants to be included in the plan;

              (10) If a medical assistance subscriber fails to make any payment due the plan, the board may immediately terminate the medical assistance subscriber's and associated members' enrollment in the plan and stop paying claims accrued during the period of nonpayment. Any subscriber terminated for non-payment of premiums shall not be eligible for coverage until the next annual enrollment period as provided in subdivision (4) of this section.”; and

 

              Further amend said bill, Page 26, Section 208.146, Lines 1 to 62, by deleting all of said lines and inserting in lieu thereof the following:

 

              208.146. 1. The program established under this section shall be known as the "Ticket to Work Health Assurance Program". Subject to appropriations and in accordance with the federal Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA), Public Law 106-170, the medical assistance provided for in section 208.151 may be paid for a person who is employed and who:

              (1) Except for earnings, meets the definition of disabled under the Supplemental Security Income Program or meets the definition of an employed individual with a medically improved disability under TWWIIA;

              (2) Has earned income, as defined in subsection 2 of this section;

              (3) Meets the asset limits in subsection 3 of this section;

              (4) Has net income, as defined in subsection 3 of this section, that does not exceed the limit for permanent and totally disabled individuals to receive nonspenddown MO HealthNet under subdivision (24) of subsection 1 of section 208.151; and

              (5) Has a gross income of two hundred fifty percent or less of the federal poverty level, excluding any earned income of the worker with a disability between two hundred fifty and three hundred fifty percent of the federal poverty level. For purposes of this subdivision, "gross income" includes all income of the person and the person's spouse that would be considered in determining MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151. Individuals with gross incomes in excess of one hundred percent of the federal poverty level shall pay a premium for participation in accordance with subsection 4 of this section.

              2. For income to be considered earned income for purposes of this section, the department of social services shall document that Medicare and Social Security taxes are withheld from such income. Self-employed persons shall provide proof of payment of Medicare and Social Security taxes for income to be considered earned.

              3. (1) For purposes of determining eligibility under this section, the available asset limit and the definition of available assets shall be the same as those used to determine MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151 except for:

              (a) Medical savings accounts limited to deposits of earned income and earnings on such income while a participant in the program created under this section with a value not to exceed five thousand dollars per year; and

              (b) Independent living accounts limited to deposits of earned income and earnings on such income while a participant in the program created under this section with a value not to exceed five thousand dollars per year. For purposes of this section, an "independent living account" means an account established and maintained to provide savings for transportation, housing, home modification, and personal care services and assistive devices associated with such person's disability.

              (2) To determine net income, the following shall be disregarded:

              (a) All earned income of the disabled worker;

              (b) The first sixty-five dollars and one-half of the remaining earned income of a nondisabled spouse's earned income;

              (c) A twenty-dollar standard deduction;

              (d) Health insurance premiums;

              (e) A seventy-five dollar a month standard deduction for the disabled worker's dental and optical insurance when the total dental and optical insurance premiums are less than seventy-five dollars;

              (f) All Supplemental Security Income payments, and the first fifty dollars of SSDI payments;

              (g) A standard deduction for impairment-related employment expenses equal to one-half of the disabled worker's earned income.

              4. Any person whose gross income exceeds one hundred percent of the federal poverty level shall pay a premium for participation in the medical assistance provided in this section. Such premium shall be:

              (1) For a person whose gross income is more than one hundred percent but less than one hundred fifty percent of the federal poverty level, four percent of income at one hundred percent of the federal poverty level;

              (2) For a person whose gross income equals or exceeds one hundred fifty percent but is less than two hundred percent of the federal poverty level, four percent of income at one hundred fifty percent of the federal poverty level;

              (3) For a person whose gross income equals or exceeds two hundred percent but less than two hundred fifty percent of the federal poverty level, five percent of income at two hundred percent of the federal poverty level;

              (4) For a person whose gross income equals or exceeds two hundred fifty percent but less than three hundred percent of the federal poverty level, six percent of income at two hundred fifty percent of the federal poverty level;

              (5) For a person whose gross income equals or exceeds three hundred percent but less than three hundred fifty percent of the federal poverty level, seven percent of income at three hundred percent of the federal poverty level.

              5. Recipients of services through this program shall report any change in income or household size within ten days of the occurrence of such change. An increase in premiums resulting from a reported change in income or household size shall be effective with the next premium invoice that is mailed to a person after due process requirements have been met. A decrease in premiums shall be effective the first day of the month immediately following the month in which the change is reported.

              6. If an eligible person's employer offers employer-sponsored health insurance and the department of social services determines that it is more cost effective, such person shall participate in the employer-sponsored insurance. The department shall pay such person's portion of the premiums, co-payments, and any other costs associated with participation in the employer-sponsored health insurance.

              7. Those persons found eligible for medical assistance through this section shall have the right to purchase dental or optical insurance or both through the Missouri Consolidated Health Care Plan.”; and

 

              Further amend said bill, Pages 60 and 61, Section 208.640, Lines 1 to 41, by deleting all of said lines and inserting in lieu thereof the following:

 

              “208.640. 1. Parents and guardians of uninsured children with incomes [between] above one hundred [fifty-one and] fifty percent and below three hundred percent of the federal poverty level who do not have access to affordable employer-sponsored health care insurance or other affordable health care coverage may obtain coverage pursuant to this section.

              2. For families with gross income above one hundred fifty percent to one hundred eighty-five percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of three percent of one hundred fifty percent of the federal poverty level for a family of three [less than or equal to one hundred thirty-three percent of the monthly average premium required in the state's current Missouri consolidated health care plan]. For families with gross income above one hundred eighty-five percent to two hundred twenty-five percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of four percent of one hundred eighty-five percent of the federal poverty level for a family of three. For families with gross income above two hundred twenty-five percent and below three hundred percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of five percent of two hundred twenty-five percent of the federal poverty level for a family of three. Health insurance plans that do not cover an eligible child's pre-existing condition shall not be considered "affordable employer-sponsored health care insurance or other affordable health care coverage" for purposes of sections 208.631 to 208.657.

              3. The parents and guardians of eligible uninsured children pursuant to this section are responsible for a monthly premium [equal to the average premium required for the Missouri consolidated health care plan] as required by annual state appropriation; provided that the total aggregate cost sharing for a family covered by these sections shall not exceed five percent of such family's income for the years involved. No co-payments or other cost sharing is permitted with respect to benefits for well-baby and well-child care including age-appropriate immunizations. Cost-sharing provisions pursuant to sections 208.631 to 208.657 shall not exceed the limits established by 42 U.S.C. Section 1397cc(e).

 

              208.658. Up to one percent of any federal funds received under the provisions of Title XXI of the Social Security Act, as amended, and up to one percent of any state funds used to match those federal funds may be used for outreach through the MO HealthNet division for children's health program established under sections 208.631 to 208.657. The MO HealthNet division may contract with local public health agencies for purposes of this section. The provisions of this section shall be subject to appropriation.”; and

 

              Further amend said bill, Page 64, Section 208.696, Line 19, by deleting the word “and”; and

 

              Further amend said bill, Page 64, Section 208.696, Line 20, by inserting immediately following the word “care”; the following “partnership approved”; and

 

              Further amend said bill, Page 65, Section 208.696, Lines 23 to 24, by deleting all of said lines and inserting in lieu thereof the following:

 

              eligibility;

              (7) Develop requirements that all long-term care policies sold in the state of Missouri shall include coverage for all home and community based services, including but not limited to consumer-directed services, in-home, home health, and assisted living services;

              (8) Develop requirements that all long-term care insurance policies sold in the state of Missouri shall disallow exclusions based on pre-existing conditions;

              (9) Develop requirements that vendors of long-term care policies shall not charge a higher fee for premiums for individuals with pre-existing conditions or disabilities; and

              (10) Develop requirements that all vendors of long-term care insurance shall provide each potential purchaser with accurate and verifiable information on the rates, expressed as a percentage of all claims for long-term care services which the vendor has denied in the past twelve months”; and

 

              Further amend said bill, Page 103, Section 4, by inserting after all of said section the following:

 

              Section 5. The provisions in section 103.005, RSMo, relating to dental and vision benefits for medical assistance participants under section 208.146, RSMo, section 103.087, RSMo, section 208.146, RSMo, and subsection 7 of section 208.151, RSMo, shall expire six years after the effective date of this act.”; and

 

              Further amend said bill, Page 107, Section B., by inserting after all of said section the following:

 

              “Section C. The repeal and reenactment of sections 103.003, 103.005, and 208.151, and the enactment of sections 103.087 and 208.146, shall be effective upon notice to the revisor of statutes that a waiver or approval of a state plan amendment has been obtained from the Secretary of the Department of Health and Human Services by the director of the department of social services.”; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            Representative Page requested a division of the question on House Amendment No. 3.

 

House Amendment No. 3

PART I

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 2, Section A., by inserting after all of said section the following:

 

              “103.003. As used in sections 103.003 to 103.175, the following terms mean:

              (1) "Actuarial reserves", the necessary funding required to pay all the medical expenses for services provided to members of the plan but for which the claims have not yet been received by the claims administrator;

              (2) "Actuary", a member of the American Academy of Actuaries or who is an enrolled actuary under the Employee Retirement Income Security Act of 1974;

              (3) "Agency", a state-sponsored institution of higher learning, political subdivision or governmental entity or instrumentality;

              (4) "Alternative delivery health care program", a plan of covered benefits that pays medical expenses through an alternate mechanism rather than on a fee-for-service basis. This includes, but is not limited to, health maintenance organizations and preferred provider organizations, all of which shall include chiropractic physicians licensed under chapter 331, RSMo, in the provider networks or organizations;

              (5) "Board", the board of trustees of the Missouri consolidated health care plan;

              (6) "Claims administrator", an agency contracted to process medical claims submitted from providers or members of the plan and their dependents;

              (7) "Coordination of benefits", to work with another group-sponsored health care plan which also covers a member of the plan to ensure that both plans pay their appropriate amount of the health care expenses incurred by the member;

              (8) "Covered benefits", a schedule of covered services, including chiropractic services, which are payable under the plan;

              (9) "Dental plan", any contractual arrangement to provide, either directly or through arrangement with others, specified dental benefits to members on a fixed prepayment basis or as a benefit of such subscribers' participation or membership in any other contract, agreement, or group or any corporation, partnership, or other entity which undertakes to provide or arrange specified dental benefits on a prepayment or other basis or to indemnify for specified dental benefits;

              [(9)] (10) "Employee", any person employed full time by the state or a participating member agency, or a person eligible for coverage by a state-sponsored retirement system or a retirement system sponsored by a participating member agency of the plan;

              [(10)] (11) "Evidence of good health", medical information supplied by a potential member of the plan that is reviewed to determine the financial risk the person represents to the plan and the corresponding determination of whether or not he or she should be accepted into the plan;

              [(11)] (12) "Health care plan", any group medical benefit plan providing coverage on an expense-incurred basis, any HMO, any group service or indemnity contract issued by a health plan of any type or description;

              [(12)] (13) "Medical benefits coverages" shall include services provided by chiropractic physicians as well as physicians licensed under chapter 334, RSMo;

              [(13)] (14) "Medical expenses", costs for services performed by a provider and covered under the plan;

              (15) "Member", any person who is a participant in the Missouri consolidated health care plan, including eligible subscribers and subscribers' spouses and unemancipated children;

              [(14)] (16) "Missouri consolidated health care plan benefit fund account", the benefit trust fund account containing all payroll deductions, payments, and income from all sources for the plan;

              [(15)] (17) "Officer", an elected official of the state of Missouri;

              [(16)] (18) "Participating member agency", a state-sponsored institution of higher learning, political subdivision or governmental entity that has elected to join the plan and has been accepted by the board;

              [(17)] (19) "Plan year", a twelve-month period designated by the board which is used to calculate the annual rate categories and the appropriate coverage;

              [(18)] (20) "Provider", a physician, hospital, pharmacist, psychologist, chiropractic physician or other licensed practitioner who or which provides health care services within the respective scope of practice of such practitioner pursuant to state law and regulation;

              [(19)] (21) "Retiree", a person who is not an employee and is receiving or is entitled to receive an annuity benefit from a state-sponsored retirement system or a retirement system of a participating member agency of the plan or becomes eligible for retirement benefits because of service with a participating member agency;

              (22) "Subscriber", a person who is either:

              (a) An eligible employee of the state or a participating member agency;

              (b) An eligible retiree of the state or a participating member agency;

              (c) An eligible surviving spouse or dependent of a deceased employee or deceased employee or deceased retiree of the state or a participating member agency;

              (d) A former employee of the state or a participating member agency who is eligible for coverage under the federal Consolidated Omnibus Budget Reconciliation Act; or

              (e) A person eligible for medical assistance under section 208.146, RSMo, and not otherwise eligible for coverage under the Missouri consolidated health care plan and who elects dental or vision coverage or both through the Missouri consolidated health care plan;

              (23) "Vision plan", any contractual arrangement to provide, either directly or through arrangement with others, specified vision benefits to members on a fixed prepayment basis or as a benefit of such subscribers' participation or membership in any other contract, agreement, or group or any corporation, partnership, or other entity which undertakes to provide or arrange specified vision benefits on a prepayment or other basis or to indemnify for specified vision benefits.

 

              103.005. For the purpose of covering medical, dental, and vision expenses of the officers, employees and retirees, the eligible dependents of officers, employees and retirees and to the surviving spouses and children of deceased officers, employees and retirees of the state and participating member agencies of the state, and providing dental and vision benefits to eligible participants of medical assistance under section 208.146, RSMo, there is hereby created and established a health care plan which shall be a body corporate, which shall be under the management of the board of trustees herein described, and shall be known as the "Missouri Consolidated Health Care Plan". Notwithstanding any provision of law to the contrary, such plan may sue and be sued, transact business, contract, invest funds and hold cash, securities and other property and shall be vested with such other powers as may be necessary or proper to enable it, its officers, employees, and agents to carry out fully and effectively all the purposes of sections 103.003 to 103.175.

 

              103.087. For purposes of this section, the terms "medical assistance subscriber" or "medical assistance participant" shall mean a person receiving medical assistance under section 208.146, RSMo. Except as otherwise provided by sections 103.003 to 103.175, dental and vision benefits coverage as provided by sections 103.003 to 103.175 shall be made available to persons receiving medical assistance under section 208.146, RSMo. Spouses or unemancipated children under the age of twenty-three of such persons shall also be eligible to receive such dental and vision benefits.

              (1) Dental and vision plans shall be available for enrollment by medical assistance eligible participants no earlier than January 1, 2008, and no later than July 1, 2008;

              (2) The cost of providing dental and vision benefits to medical assistance eligible subscribers and subscribers' dependents not otherwise eligible for coverage through the Missouri consolidated health care plan shall not be allowed to adversely affect the state's or participating member agencies' rates or benefits;

              (3) An initial thirty-day enrollment period shall be available for persons eligible for medical assistance not otherwise eligible for coverage under the Missouri consolidated health care plan to enroll in the dental or vision benefits or both under the Missouri consolidated health care plan. This initial thirty-day enrollment period shall begin from such person's initial date of approval under medical assistance under section 208.146, RSMo;

              (4) There shall be an annual thirty-day enrollment period, at a time designated by the board, during which persons eligible for medical assistance not otherwise eligible for coverage under the Missouri consolidated health care plan shall be able to enroll in the dental or vision plans or both;

              (5) Medical assistance participants not otherwise eligible for coverage under the Missouri consolidated health care plan shall also be eligible to enroll in the dental or vision plans or both as a medical assistance participant within sixty days of a loss of other group dental or vision coverage, or both, provided that such coverage was in place for at least twelve consecutive months immediately prior to the loss and that such loss was due to:

              (a) The subscriber's or the subscriber's spouse's termination of employment; or

              (b) Termination of group dental or vision coverage, or both, by the employer;

              (6) Coverage for such dental and vision benefits to medical assistance subscribers and subscribers' dependents shall terminate when the medical assistance participant ceases to be eligible for medical assistance;

              (7) Monthly, in accordance with a schedule developed by the board, or its designee, the medical assistance subscriber shall promptly pay to the executive director an amount equal to the amount of the premium due based upon the participation in the dental or vision plans, or both, as billed by the Missouri consolidated health care plan. Such premium shall be set by the board and shall cover all associated costs, including administrative costs, of the plan for providing such services to medical assistance participants. The executive director shall promptly deposit such amounts to the benefit trust fund account;

              (8) The plan shall not assume responsibility for any liabilities incurred by the medical assistance program or its eligible participants or its participants' spouses or unemancipated dependents prior to the group's effective date;

              (9) If so determined by the board, the department of social services shall reimburse the plan for any initial start-up costs incurred by the plan solely on behalf of the medical assistance participants and necessary in order for the medical assistance participants to be included in the plan;

              (10) If a medical assistance subscriber fails to make any payment due the plan, the board may immediately terminate the medical assistance subscriber's and associated members' enrollment in the plan and stop paying claims accrued during the period of nonpayment. Any subscriber terminated for non-payment of premiums shall not be eligible for coverage until the next annual enrollment period as provided in subdivision (4) of this section.”; and

 

              Further amend said bill, Page 26, Section 208.146, Lines 1 to 62, by deleting all of said lines and inserting in lieu thereof the following:

 

              208.146. 1. The program established under this section shall be known as the "Ticket to Work Health Assurance Program". Subject to appropriations and in accordance with the federal Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA), Public Law 106-170, the medical assistance provided for in section 208.151 may be paid for a person who is employed and who:

              (1) Except for earnings, meets the definition of disabled under the Supplemental Security Income Program or meets the definition of an employed individual with a medically improved disability under TWWIIA;

              (2) Has earned income, as defined in subsection 2 of this section;

              (3) Meets the asset limits in subsection 3 of this section;

              (4) Has net income, as defined in subsection 3 of this section, that does not exceed the limit for permanent and totally disabled individuals to receive nonspenddown MO HealthNet under subdivision (24) of subsection 1 of section 208.151; and

              (5) Has a gross income of two hundred fifty percent or less of the federal poverty level, excluding any earned income of the worker with a disability between two hundred fifty and three hundred fifty percent of the federal poverty level. For purposes of this subdivision, "gross income" includes all income of the person and the person's spouse that would be considered in determining MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151. Individuals with gross incomes in excess of one hundred percent of the federal poverty level shall pay a premium for participation in accordance with subsection 4 of this section.

              2. For income to be considered earned income for purposes of this section, the department of social services shall document that Medicare and Social Security taxes are withheld from such income. Self-employed persons shall provide proof of payment of Medicare and Social Security taxes for income to be considered earned.

              3. (1) For purposes of determining eligibility under this section, the available asset limit and the definition of available assets shall be the same as those used to determine MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151 except for:

              (a) Medical savings accounts limited to deposits of earned income and earnings on such income while a participant in the program created under this section with a value not to exceed five thousand dollars per year; and

              (b) Independent living accounts limited to deposits of earned income and earnings on such income while a participant in the program created under this section with a value not to exceed five thousand dollars per year. For purposes of this section, an "independent living account" means an account established and maintained to provide savings for transportation, housing, home modification, and personal care services and assistive devices associated with such person's disability.

              (2) To determine net income, the following shall be disregarded:

              (a) All earned income of the disabled worker;

              (b) The first sixty-five dollars and one-half of the remaining earned income of a nondisabled spouse's earned income;

              (c) A twenty-dollar standard deduction;

              (d) Health insurance premiums;

              (e) A seventy-five dollar a month standard deduction for the disabled worker's dental and optical insurance when the total dental and optical insurance premiums are less than seventy-five dollars;

              (f) All Supplemental Security Income payments, and the first fifty dollars of SSDI payments;

              (g) A standard deduction for impairment-related employment expenses equal to one-half of the disabled worker's earned income.

              4. Any person whose gross income exceeds one hundred percent of the federal poverty level shall pay a premium for participation in the medical assistance provided in this section. Such premium shall be:

              (1) For a person whose gross income is more than one hundred percent but less than one hundred fifty percent of the federal poverty level, four percent of income at one hundred percent of the federal poverty level;

              (2) For a person whose gross income equals or exceeds one hundred fifty percent but is less than two hundred percent of the federal poverty level, four percent of income at one hundred fifty percent of the federal poverty level;

              (3) For a person whose gross income equals or exceeds two hundred percent but less than two hundred fifty percent of the federal poverty level, five percent of income at two hundred percent of the federal poverty level;

              (4) For a person whose gross income equals or exceeds two hundred fifty percent but less than three hundred percent of the federal poverty level, six percent of income at two hundred fifty percent of the federal poverty level;

              (5) For a person whose gross income equals or exceeds three hundred percent but less than three hundred fifty percent of the federal poverty level, seven percent of income at three hundred percent of the federal poverty level.

              5. Recipients of services through this program shall report any change in income or household size within ten days of the occurrence of such change. An increase in premiums resulting from a reported change in income or household size shall be effective with the next premium invoice that is mailed to a person after due process requirements have been met. A decrease in premiums shall be effective the first day of the month immediately following the month in which the change is reported.

              6. If an eligible person's employer offers employer-sponsored health insurance and the department of social services determines that it is more cost effective, such person shall participate in the employer-sponsored insurance. The department shall pay such person's portion of the premiums, co-payments, and any other costs associated with participation in the employer-sponsored health insurance.

              7. Those persons found eligible for medical assistance through this section shall have the right to purchase dental or optical insurance or both through the Missouri Consolidated Health Care Plan.”; and

 

            On motion of Representative Portwood, Part I of House Amendment No. 3 was adopted by the following vote:

 

AYES: 145

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Baker 123

Bearden

Bivins

Brandom

Bringer

Brown 30

Bruns

Burnett

Casey

Chappelle-Nadal

Cooper 120

Cooper 155

Cooper 158

Corcoran

Cox

Cunningham 145

Cunningham 86

Darrough

Daus

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Faith

Fallert

Fares

Fisher

Flook

Frame

Franz

Funderburk

George

Grill

Grisamore

Guest

Harris 23

Harris 110

Hobbs

Hodges

Holsman

Hubbard

Hunter

Icet

Jones 89

Jones 117

Kelly

Komo

Kraus

Lampe

Lembke

LeVota

Liese

Lipke

Loehner

Low 39

Marsh

May

McClanahan

McGhee

Meadows

Meiners

Moore

Munzlinger

Muschany

Nance

Nasheed

Nieves

Nolte

Norr

Onder

Oxford

Page

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Robinson

Roorda

Rucker

Ruestman

Ruzicka

Salva

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schieffer

Schlottach

Schneider

Schoeller

Schoemehl

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Spreng

Stevenson

St. Onge

Storch

Stream

Sutherland

Swinger

Talboy

Thomson

Threlkeld

Tilley

Todd

Viebrock

Villa

Vogt

Wallace

Walsh

Wasson

Wells

Weter

Whorton

Wilson 119

Wilson 130

Witte

Wood

Wright 159

Yaeger

Yates

Zimmerman

Zweifel

Mr Speaker

 

 

 

 

 

NOES: 003

 

 

 

 

 

 

 

 

 

Emery

Ervin

Hoskins

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 015

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Walton

Wildberger

Wright-Jones

Young

 

House Amendment No. 3

 

PART II

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Pages 60 and 61, Section 208.640, Lines 1 to 41, by deleting all of said lines and inserting in lieu thereof the following:

 

              “208.640. 1. Parents and guardians of uninsured children with incomes [between] above one hundred [fifty-one and] fifty percent and below three hundred percent of the federal poverty level who do not have access to affordable employer-sponsored health care insurance or other affordable health care coverage may obtain coverage pursuant to this section.

              2. For families with gross income above one hundred fifty percent to one hundred eighty-five percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of three percent of one hundred fifty percent of the federal poverty level for a family of three [less than or equal to one hundred thirty-three percent of the monthly average premium required in the state's current Missouri consolidated health care plan]. For families with gross income above one hundred eighty-five percent to two hundred twenty-five percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of four percent of one hundred eighty-five percent of the federal poverty level for a family of three. For families with gross income above two hundred twenty-five percent and below three hundred percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of five percent of two hundred twenty-five percent of the federal poverty level for a family of three. Health insurance plans that do not cover an eligible child's pre-existing condition shall not be considered "affordable employer-sponsored health care insurance or other affordable health care coverage" for purposes of sections 208.631 to 208.657.

              3. The parents and guardians of eligible uninsured children pursuant to this section are responsible for a monthly premium [equal to the average premium required for the Missouri consolidated health care plan] as required by annual state appropriation; provided that the total aggregate cost sharing for a family covered by these sections shall not exceed five percent of such family's income for the years involved. No co-payments or other cost sharing is permitted with respect to benefits for well-baby and well-child care including age-appropriate immunizations. Cost-sharing provisions pursuant to sections 208.631 to 208.657 shall not exceed the limits established by 42 U.S.C. Section 1397cc(e).

 

              208.658. Up to one percent of any federal funds received under the provisions of Title XXI of the Social

Security Act, as amended, and up to one percent of any state funds used to match those federal funds may be used for outreach through the MO HealthNet division for children's health program established under sections 208.631 to 208.657. The MO HealthNet division may contract with local public health agencies for purposes of this section. The provisions of this section shall be subject to appropriation.”; and

 

            Representative Portwood moved that Part II of House Amendment No. 3 be adopted.

 

            Which motion was defeated by the following vote:

 

AYES: 001

 

 

 

 

 

 

 

 

 

Whorton

 

 

 

 

 

 

 

 

 

NOES: 145

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Baker 123

Bearden

Bivins

Brandom

Bringer

Brown 30

Bruns

Burnett

Casey

Chappelle-Nadal

Cooper 120

Cooper 155

Cooper 158

Corcoran

Cox

Cunningham 145

Cunningham 86

Darrough

Daus

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Emery

Ervin

Faith

Fallert

Fares

Fisher

Flook

Frame

Franz

Funderburk

George

Grill

Grisamore

Guest

Harris 23

Harris 110

Hobbs

Hodges

Holsman

Hoskins

Hubbard

Hunter

Icet

Jones 89

Jones 117

Komo

Kraus

Lampe

Lembke

LeVota

Liese

Lipke

Loehner

Low 39

Marsh

May

McClanahan

McGhee

Meadows

Meiners

Moore

Munzlinger

Muschany

Nance

Nasheed

Nieves

Nolte

Norr

Onder

Oxford

Page

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Robinson

Roorda

Ruestman

Ruzicka

Salva

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schieffer

Schlottach

Schneider

Schoeller

Schoemehl

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Spreng

Stevenson

St. Onge

Storch

Stream

Sutherland

Swinger

Talboy

Thomson

Threlkeld

Tilley

Todd

Viebrock

Villa

Vogt

Wallace

Walsh

Wasson

Wells

Weter

Wilson 119

Wilson 130

Witte

Wood

Wright 159

Yaeger

Yates

Zimmerman

Zweifel

Mr Speaker

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 017

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kelly

Kingery

Kratky

Kuessner

Lowe 44

Rucker

Walton

Wildberger

Wright-Jones

Young

 

 

 

 

House Amendment No. 3

 

PART III

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 64, Section 208.696, Line 19, by deleting the word “and”; and

 

              Further amend said bill, Page 64, Section 208.696, Line 20, by inserting immediately following the word “care”; the following “partnership approved”; and

 

              Further amend said bill, Page 65, Section 208.696, Lines 23 to 24, by deleting all of said lines and inserting in lieu thereof the following:

 

              eligibility;

              (7) Develop requirements that all long-term care policies sold in the state of Missouri shall include coverage for all home and community based services, including but not limited to consumer-directed services, in-home, home health, and assisted living services;

              (8) Develop requirements that all long-term care insurance policies sold in the state of Missouri shall disallow exclusions based on pre-existing conditions;

              (9) Develop requirements that vendors of long-term care policies shall not charge a higher fee for premiums for individuals with pre-existing conditions or disabilities; and

              (10) Develop requirements that all vendors of long-term care insurance shall provide each potential purchaser with accurate and verifiable information on the rates, expressed as a percentage of all claims for long-term care services which the vendor has denied in the past twelve months”; and

 

              Further amend said bill, Page 103, Section 4, by inserting after all of said section the following:

 

              Section 5. The provisions in section 103.005, RSMo, relating to dental and vision benefits for medical assistance participants under section 208.146, RSMo, section 103.087, RSMo, section 208.146, RSMo, and subsection 7 of section 208.151, RSMo, shall expire six years after the effective date of this act.”; and

 

              Further amend said bill, Page 107, Section B., by inserting after all of said section the following:

 

              “Section C. The repeal and reenactment of sections 103.003, 103.005, and 208.151, and the enactment of sections 103.087 and 208.146, shall be effective upon notice to the revisor of statutes that a waiver or approval of a state plan amendment has been obtained from the Secretary of the Department of Health and Human Services by the director of the department of social services.”; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Portwood, Part III of House Amendment No. 3 was adopted by the following vote:

 

AYES: 142

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Baker 123

Bearden

Bivins

Brandom

Bringer

Brown 30

Bruns

Burnett

Casey

Chappelle-Nadal

Cooper 120

Cooper 155

Cooper 158

Corcoran

Cox

Cunningham 145

Cunningham 86

Darrough

Daus

Davis

Day

Deeken

Dempsey

Denison

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Emery

Ervin

Faith

Fallert

Fares

Fisher

Flook

Frame

Franz

Funderburk

George

Grill

Grisamore

Guest

Harris 23

Harris 110

Hobbs

Hodges

Holsman

Hubbard

Hunter

Icet

Jones 89

Jones 117

Kelly

Komo

Kraus

Lampe

Lembke

LeVota

Liese

Lipke

Loehner

Low 39

Marsh

May

McClanahan

McGhee

Meadows

Meiners

Moore

Munzlinger

Muschany

Nance

Nasheed

Nieves

Nolte

Norr

Onder

Oxford

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Robinson

Roorda

Ruestman

Ruzicka

Salva

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schieffer

Schlottach

Schneider

Schoeller

Schoemehl

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Spreng

Stevenson

St. Onge

Storch

Stream

Sutherland

Swinger

Talboy

Thomson

Tilley

Todd

Viebrock

Villa

Vogt

Wallace

Walsh

Wells

Weter

Whorton

Wilson 119

Wilson 130

Witte

Wood

Wright 159

Yaeger

Yates

Zimmerman

Zweifel

Mr Speaker

 

 

 

 

 

 

 

 

NOES: 001

 

 

 

 

 

 

 

 

 

Hoskins

 

 

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 020

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Dethrow

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Page

Rucker

Threlkeld

Walton

Wasson

Wildberger

Wright-Jones

Young

 

            Representative Bearden offered House Amendment No. 4.

 

House Amendment No. 4

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 73, Section 208.950, Lines 145-153, by deleting all of said lines and inserting in lieu thereof the following:

 

              "state beginning with the next contract renewal period. The division may promulgate rules to compare different methods for dental management. Such rules shall include but are not limited to methods to compare cost, outcomes, encounter data, network adequacy including availability of specialty providers, timeliness of service delivery, delivery of preventative services and emergency services, and patient satisfaction. Once such rules have been adopted the division may, in the following contract period in one managed care region, negotiate with one managed care organization to have dental services for enrolles provided using the division's technology and internal resources and negotiate with one managed care organization to have dental services for enrollees provided using an administrative services organization to be contracted separately from the managed care organization. Three months prior to the end of at least a twelve-month contract period a comparison of the methods of dental management shall be conducted by the division in accordance with the rules, and the results reported to the oversight committee, who shall"; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            Representative Skaggs raised a point of order that House Amendment No. 4 amends previously amended material.

 

            The Chair ruled the point of order not well taken.

 

            On motion of Representative Bearden, House Amendment No. 4 was adopted.

 

            Representative Bearden offered House Amendment No. 5.

 

House Amendment No. 5

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 36, Section 208.152, Line 89, by inserting after the word “appropriations” the following:

 

              . Until such time as a four-tier level is implemented, each resident of such facility who qualifies for assistance under section 208.030, RSMo shall, at a minimum, if prescribed by a physician, be authorized one hour of personal care services per day. Authorized units of personal care services shall not be reduced or tier level lowered unless an order approving such reduction or lowering is obtained from the resident’s personal physician. Such authorized units of personal care services or tier level shall be transferred with such resident if her or she transfers to another such facility”; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Bearden, House Amendment No. 5 was adopted.

 

            Representative Kraus offered House Amendment No. 6.

 

House Amendment No. 6

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Section 208.152, Page 43, Line 318, by inserting after all of said line the following:

 

              (11) Pursuant to federal law and subject to appropriations, MO HealthNet participants shall submit to random testing for illegal drugs to remain eligible for MO HealthNet services.”; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            Representative Tilley assumed the Chair.

 

            Representative Schaaf offered House Amendment No. 1 to House Amendment No. 6.

 

House Amendment No. 1

to

House Amendment No. 6

 

AMEND House Amendment No. 6 to House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Line 4, by deleting the words "Pursuant to" and inserting in lieu thereof the word "Notwithstanding".

 

            Speaker Jetton resumed the Chair.

 

            On motion of Representative Schaaf, House Amendment No. 1 to House Amendment No. 6 was adopted.

 

            Representative Page offered House Amendment No. 2 to House Amendment No. 6.

 

            Representative Pratt raised a point of order that House Amendment No. 2 to House Amendment No. 6 goes beyond the scope of the bill.

 

            The Chair ruled the point of order well taken.

 

            On motion of Representative Kraus, House Amendment No. 6, as amended, was adopted by the following vote:

 

AYES: 123

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 123

Bearden

Bivins

Brandom

Bringer

Brown 30

Bruns

Casey

Chappelle-Nadal

Cooper 120

Cooper 155

Cooper 158

Corcoran

Cox

Cunningham 145

Cunningham 86

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Donnelly

Dusenberg

Emery

Ervin

Faith

Fallert

Fares

Fisher

Flook

Franz

Funderburk

Grill

Grisamore

Guest

Harris 23

Harris 110

Hobbs

Hodges

Hunter

Icet

Jones 89

Jones 117

Kelly

Komo

Kraus

Lampe

Lembke

Lipke

Loehner

Marsh

May

McClanahan

McGhee

Meiners

Moore

Munzlinger

Muschany

Nance

Nieves

Nolte

Norr

Onder

Page

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Robinson

Ruestman

Ruzicka

Salva

Sander

Sater

Scavuzzo

Schaaf

Schad

Scharnhorst

Schieffer

Schlottach

Schneider

Schoeller

Schoemehl

Self

Silvey

Skaggs

Smith 14

Smith 150

Stevenson

St. Onge

Storch

Stream

Sutherland

Swinger

Thomson

Threlkeld

Tilley

Todd

Viebrock

Wallace

Wasson

Wells

Weter

Whorton

Wilson 119

Wilson 130

Witte

Wood

Wright 159

Yaeger

Yates

Zimmerman

Zweifel

Mr Speaker

 

 

 

 

 

 

 

NOES: 024

 

 

 

 

 

 

 

 

 

Baker 25

Burnett

Darrough

Daus

Dougherty

El-Amin

Frame

George

Holsman

Hoskins

Hubbard

LeVota

Liese

Low 39

Meadows

Nasheed

Oxford

Roorda

Rucker

Spreng

Talboy

Villa

Vogt

Walsh

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 016

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Shively

Walton

Wildberger

Wright-Jones

Young

 

 

 

 

 

            Representative Pratt offered House Amendment No. 7.

 

House Amendment No. 7

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 49, Section 208.215.1, Line 12, by deleting the words "any health benefit plan" on such line; and

 

              Further amend such bill, by deleting the Lines 13-19; and

 

              Further amend such bill, Page 51, Section 208.215.8, by deleting Lines 86-91, and replace in lieu thereof the following:

 

              "and after the time of the service of the notice.".

 

            On motion of Representative Pratt, House Amendment No. 7 was adopted.

 

            Representative Sater offered House Amendment No. 8.

 

House Amendment No. 8

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Section 105.711, Page 4, Line 98, by deleting the word "community"; and

 

              Further amend said bill, Section 208.151, Subsection 1, Subdivision (22), Page 31, Line 141, by deleting the words "By January 1, 2008, the department of social services shall"; and

 

              Further amend said bill and section, Pages 31 and 32, Lines 142 through 164, by deleting said lines; and

 

              Further amend said bill, Section 208.153, Subsection 2, Page 44, Lines 25 through 29, by deleting said lines; and

 

              Further amend said bill, Section 208.952, Subsection 8, Page 77, Lines 47 to 48, by deleting said lines and inserting in lieu thereof the following:

 

              "8. No provisions of any statute shall be construed as to require any aged, blind or disabled person to enroll in a managed care plan."; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional accordingly.

 

            On motion of Representative Sater, House Amendment No. 8 was adopted.

 

            Representative Cooper (158) offered House Amendment No. 9.

 

House Amendment No. 9

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Section 4, Page 103, by inserting after all of said section the following:

 

              "Section 5. Beginning July 1, 2007, a joint interim committee appointed by the speaker of the house of representatives and the president pro tem of the senate shall make a comprehensive study on the effects of asthma on children and adults, including the solicitation of information from appropriate state agencies and the public on the social, economic, educational and health implications of asthma. The committee shall prepare and submit a report including its recommendation for changes to the governor, the house of representatives, and the senate no later than December 31, 2007."; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Cooper (158), House Amendment No. 9 was adopted.

 

            Representative Onder offered House Amendment No. 10.

 

House Amendment No. 10

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Pages 10-12, Section 167.182, by striking all of said section; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Onder, House Amendment No. 10 was adopted by the following vote:

 

AYES: 074

 

 

 

 

 

 

 

 

 

Baker 123

Bearden

Bivins

Brandom

Brown 30

Bruns

Cooper 120

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Emery

Ervin

Faith

Fisher

Flook

Franz

Funderburk

Grisamore

Guest

Hobbs

Hunter

Icet

Jones 89

Jones 117

Kelly

Lembke

Lipke

Loehner

May

Moore

Munzlinger

Nance

Nieves

Nolte

Onder

Pearce

Pollock

Pratt

Quinn 7

Richard

Robb

Ruestman

Ruzicka

Sander

Sater

Schad

Scharnhorst

Schlottach

Schneider

Schoeller

Self

Smith 14

Smith 150

Stevenson

Sutherland

Thomson

Tilley

Viebrock

Wallace

Wasson

Wells

Wilson 119

Wilson 130

Wood

Wright 159

Yates

 

 

 

 

 

 

NOES: 072

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Bringer

Burnett

Casey

Chappelle-Nadal

Corcoran

Darrough

Daus

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Fallert

Fares

Frame

George

Grill

Harris 23

Harris 110

Hodges

Holsman

Hoskins

Hubbard

Komo

Kraus

Lampe

LeVota

Liese

Low 39

Marsh

McClanahan

McGhee

Meadows

Meiners

Muschany

Nasheed

Norr

Oxford

Page

Portwood

Quinn 9

Robinson

Roorda

Rucker

Salva

Scavuzzo

Schaaf

Schieffer

Schoemehl

Shively

Silvey

Skaggs

Spreng

St. Onge

Storch

Stream

Swinger

Talboy

Todd

Villa

Vogt

Walsh

Weter

Whorton

Witte

Yaeger

Zimmerman

Zweifel

Mr Speaker

 

 

 

 

 

 

 

 

PRESENT: 001

 

 

 

 

 

 

 

 

 

Threlkeld

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 016

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Parson

Walton

Wildberger

Wright-Jones

Young

 

 

 

 

 

            Representative Sater offered House Amendment No. 11.

 

House Amendment No. 11

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 61, Section 208.640, Lines 33 to 41, by deleting all of said lines and inserting in lieu thereof the following:

 

              2. The department of social services shall study the expansion of a presumptive eligibility process for children for medical assistance benefits.”; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Sater, House Amendment No. 11 was adopted by the following vote:

 

AYES: 076

 

 

 

 

 

 

 

 

 

Baker 123

Bearden

Bivins

Brandom

Brown 30

Bruns

Cooper 155

Cooper 158

Cox

Cunningham 86

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Dusenberg

Emery

Ervin

Fisher

Flook

Franz

Funderburk

Guest

Hobbs

Hunter

Icet

Jones 89

Jones 117

Kelly

Lembke

Lipke

Loehner

Marsh

May

McGhee

Moore

Munzlinger

Muschany

Nieves

Onder

Parson

Pearce

Pollock

Pratt

Quinn 7

Robb

Ruestman

Ruzicka

Sander

Sater

Schaaf

Schad

Scharnhorst

Schlottach

Schoeller

Self

Smith 14

Stevenson

St. Onge

Sutherland

Thomson

Threlkeld

Tilley

Viebrock

Wallace

Wasson

Wells

Weter

Wilson 119

Wilson 130

Wood

Wright 159

Yates

Mr Speaker

 

 

 

 

 

 

 

 

 

NOES: 069

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Bringer

Burnett

Casey

Chappelle-Nadal

Corcoran

Darrough

Daus

Donnelly

Dougherty

El-Amin

Faith

Fallert

Fares

Frame

George

Grill

Grisamore

Harris 23

Harris 110

Hodges

Holsman

Hoskins

Hubbard

Komo

Kraus

Lampe

LeVota

Liese

Low 39

McClanahan

Meadows

Meiners

Nance

Nasheed

Nolte

Norr

Oxford

Page

Portwood

Quinn 9

Robinson

Roorda

Rucker

Salva

Scavuzzo

Schieffer

Schneider

Schoemehl

Shively

Silvey

Skaggs

Smith 150

Spreng

Storch

Stream

Swinger

Talboy

Todd

Villa

Vogt

Walsh

Whorton

Witte

Yaeger

Zimmerman

Zweifel

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 018

 

 

 

 

 

 

Bland

Bowman

Brown 50

Cooper 120

Cunningham 145

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Richard

Walton

Wildberger

Wright-Jones

Young

 

 

 

            Representative Schaaf offered House Amendment No. 12.

 

House Amendment No. 12

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 61, Section 208.640, Line 30, by deleting all of said line and inserting in lieu thereof the following:

              exceeded the annual coverage limits for all health care services, the child is not”; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Schaaf, House Amendment No. 12 was adopted.

 

            Representative Wilson (130) offered House Amendment No. 13.

 

 


House Amendment No. 13

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Pages 73 and 74, Section 208.950, Lines 167 through 172, by deleting all of said lines and inserting in lieu thereof the following:

 

              (29) "Comprehensive Entry Point", an entity that has staff available to access the web-based/terminal server electronic patient health record, has minimal conflict of interest, has experience in providing federally-funded information and assistance, and utilizes the universal information and assessment system and where a person can seek information and assistance about long-term care services including, but not limited to, hospitals, home care agencies, county developmental disabilities boards, centers for independent living, facilities licensed under chapter 198, RSMo, area agencies on aging, health care providers, transportation providers, home-delivered meal providers, and behavioral health providers;”; and

 

              Further amend said bill, Page 75, Section 208.950, Line 226, by inserting immediately following the first instance of the word “based” the following:

 

              /terminal server”; and

 

              Further amend said bill, Page 77, Section 208.952, Line 41, by inserting immediately following the word “web-based” the following:

 

              /terminal server”; and

 

              Further amend said bill, Pages 85 through 87, Section 208.956, Lines 99 through 185, by deleting all of said lines and inserting in lieu thereof the following:

 

              4. By October 1, 2008, the Department of Health and Senior Services, in conjunction with the commission convened by the Lieutenant Governor, shall develop and implement a comprehensive entry point system for long-term care through a public process that shall:(1) Offer Missourians an array of choices including community-based, in-home, residential and institutional services;(2) Provide information and assistance about the array of long-term care services to Missourians through a complete state-wide information and assistance system that is accessible by phone, in-person, and via the Internet or other appropriate technology;

              (3) Allow consumers to independently choose from a full range of home, community-based, and facility-based health and social services as well as access appropriate services to meet individual needs and preferences from the provider of the consumer’s choice;(4) Create a delivery system that is easy to understand and accessible and which shall include financial presumptive eligibility for home and community based services;(5) Create a delivery system that is efficient, reduces duplication, minimizes conflict of interest, and streamlines access to federal, state and local funding sources and programs;(6) Establishes a long-term care system that seeks to achieve timely access to and payment for care, foster quality and excellence in service delivery, and promote innovative and cost-effective strategies;

              (7) Implements an electronic system utilizing a uniform screening and assessment mechanism establishing consumers’ need for services, availability of informal supports, plan of service, service authorization, and services provided;

              (8) Provides a nursing home pre-admission screening and resident review (PASRR) mechanism for all Missourians seeking nursing home care that will also track community-based unmet needs; and

              (9) Provides a care coordination system to be available as needed for consumers at risk of premature institutionalization, those being discharged from a hospital and those individuals in a crisis.

              5. The duties and functions of the comprehensive entry point shall include but not be limited to:

              (1) Provide a comprehensive and coordinated service system for Missouri’s long-term care population, prioritizing by greatest need of individuals;

              (2) Evaluate programs and services for the the long-term care population, and determine the extent to which those programs and services meet the needs of the consumer;(3) Provide consultation and assistance to communities and groups developing local services;(4) Promote community education regarding the services available through publications, presentations, radio, television, and the press;(5) Cooperate with agencies of the federal, state and local government in studies and conferences designed to examine the needs of the long-term care consumer and prepare programs to address those needs;(6) Establish and maintain information and referral sources throughout Missouri;(7) Initiate, evaluate, and provide assistance for improving programs in cooperation with all other state agencies having concerns or responsibility for long-term care;(8) Screen, assess, authorize, and track services delivered, and identify unmet needs;(9) Provide Missouri’s long-term care consumers and their families with a locally focused, coordinated approach to integrating information and referral for all available services;(10) Provide for easier access to long-term-care services by providing local access to the long-term-care network;

              (11) Develop referral agreements with local community service organizations, such as senior centers, existing service providers, volunteer associations, and other similar organizations, to better assist clients who do not need or do not wish to enroll in programs funded by the state or the comprehensive entry point;

              (12) Develop a referral agreement that includes protocols designed to ensure that consumers and their families are able to access information and services in the most efficient and least cumbersome manner possible;

              (13) Provide an initial screening of all clients who request long-term-care services to determine whether the person would be most appropriately served through any combination of federally funded programs, state-funded programs, locally funded or community volunteer programs, or private funding for services;(14) Determine functional eligibility for the programs and services administered through the comprehensive entry point for long-term care services for persons residing within the geographic area served by the comprehensive entry point and determine a priority ranking for services which is based upon the potential recipient's frailty level, likelihood of pre-mature institutional placement without such services, and abuse or neglect survivors;(15) Manage the availability of financial resources for the programs and services within MO HealthNet for long-term care participants residing within the geographic area served by the comprehensive entry point;

              (16) Refer a client to the most appropriate entity to begin receiving services when financial resources become available;(17) Assist the department in locating services for individuals in need of adult protective services and shall give these individuals primary consideration for receiving services;

              (18) Develop an annual program improvement plan for submission to the department;

              (19) Develop strong community partnerships to maximize the use of community resources for the purpose of assisting to remain in their community settings for as long as it is safely possible and needs are met; and

              (20) Conduct comprehensive assessments as appropriate of clients and develop a service plan consistent with established protocols that ensure that the unique needs of each client are met.

              6. The services to be coordinated through the comprehensive entry point system shall include those funded through MO HealthNet waivers, MO HealthNet state plans, Older Americans Act, and other funding as appropriate.7. The department shall, prior to designation of an comprehensive entry point system , develop by rule operational and quality assurance standards and outcome measures to ensure that clients receiving services through all long-term-care programs administered through a comprehensive entry point are receiving the appropriate care they require and that contractors and subcontractors are adhering to the terms of their contracts and are acting in the best interests of the clients they are serving, consistent with the intent of the Legislature to ensure the most appropriate care in the least restrictive care setting to met the needs of the clients.

              8. The department shall by rule provide operating procedures for a comprehensive entry point system, which shall include:

              (1) Minimum standards for financial operation, including audit procedures.

              (2) Procedures for monitoring and sanctioning.

              (3) Minimum standards for technology utilized by the comprehensive entry point system.

              (4) Minimum staff requirements which shall ensure that the comprehensive entry point system employs sufficient quality and quantity of staff to adequately meet the needs of the consumers residing within the area served by the comprehensive entry point system.

              (5) Minimum accessibility standards, including hours of operation.

              (6) Minimum oversight standards for the governing body of the comprehensive entry point to ensure its continuous involvement in, and accountability for, all matters related to the development, implementation, staffing, administration, and operations of the comprehensive entry point.

              (7) Minimum education and experience requirements for executive directors and other executive staff positions of comprehensive entry point system.

              (8) Minimum requirements regarding any executive staff positions that the comprehensive entry point must employ and minimum requirements that a candidate must meet in order to be eligible for appointment to such positions.

              9. This section shall not be construed to allow the comprehensive entry point to restrict, manage, or impede the local fundraising activities of service providers.

              10. (1) The Lieutenant Governor shall convene a commission to advise in the planning, implementation, and evaluation of the comprehensive entry point system. In addition, the commission shall have an on-going responsibility to review and act upon the recommendations contained in the annual program improvement plans.

              (2) The commission shall be comprised of state-wide representatives of long-term care service providers, housing authorities, social service organizations, advocacy groups, representatives of clients receiving services through the comprehensive entry point, and any other persons or groups as determined by the Lt. Governor.

              11. Starting July 1, 2009, the department shall provide to the Governor, Lieutenant Governor and the general assembly a yearly report that provides an update on the implementation the comprehensive entry point system, successes, roadblocks and recommendations including but not limited to, a transition plan for implementation to the populations currently served by DHSS.

              12. There is hereby created in the state treasury the “Comprehensive Entry Point System Fund”, which shall consist of all moneys deposited in the fund pursuant to this section, and all moneys which may be appropriated to it by the general assembly from federal or other sources.

              13. (1) The state treasurer shall be custodian of the fund and may approve disbursements from the fund pursuant to this section. Notwithstanding the provision of section 44.080 RSMo, to the contrary, any moneys remaining in the fund at the end of the biennium shall not revert to the credit of the general revenue fund. The state treasurer shall invest moneys in the fund in the same manner as other funds are invested. Any interest and moneys earned on such investments shall be credited to the fund.

              (2) All funds collected by or due and payable to the comprehensive entry point system shall remain in and accrue to said fund.”; and

 

              Further amend said bill, Page 90, Section 208.964, Lines 29 through 30, by deleting the words “natural point of entry” and inserting in lieu thereof the following “comprehensive entry point”; and

 

              Further amend said bill, Page 92, Section 208.968, Line 5, by deleting the words “natural points of entry” and inserting in lieu thereof the following “comprehensive entry points”; and

 

              Further amend said bill, Page 92, Section 208.968, Line 11, by deleting the words “natural points of entry” and inserting in lieu thereof the following “comprehensive entry points”; and

 

              Further amend said bill, Page 93, Section 208.968, Line 19, by deleting the words “natural points of entry” and inserting in lieu thereof the following “comprehensive entry points”; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            Representative Schoeller offered House Amendment No. 1 to House Amendment No. 13.

 

 


House Amendment No. 1

to

House Amendment No. 13

 

AMEND House Amendment No. 13 to House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 2, on Line 23, by removing the word "all" and adding "MO Health clients"; and

 

              Further amend on Page 3, Line 25, by removing the word "all" and adding "MO Health".

 

            On motion of Representative Schoeller, House Amendment No. 1 to House Amendment No. 13 was adopted.

 

            Representative Wilson (130) moved that House Amendment No. 13, as amended, be adopted.

 

            Which motion was defeated.

 

            Representative Burnett offered House Amendment No. 14.

 

House Amendment No. 14

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, by deleting the word "MO" as it appears throughout the bill and replacing it with the word "NO".

 

            Representative Burnett moved that House Amendment No. 14 be adopted.

 

            Which motion was defeated by the following vote:

 

AYES: 054

 

 

 

 

 

 

 

 

 

Aull

Baker 25

Bringer

Burnett

Casey

Chappelle-Nadal

Corcoran

Darrough

Daus

Donnelly

Fallert

Frame

George

Grill

Harris 23

Harris 110

Hodges

Holsman

Hubbard

Komo

Lampe

LeVota

Liese

Low 39

McClanahan

Meadows

Meiners

Nasheed

Norr

Oxford

Page

Quinn 9

Robinson

Roorda

Rucker

Salva

Scavuzzo

Schieffer

Schoemehl

Shively

Skaggs

Spreng

Storch

Swinger

Talboy

Todd

Villa

Vogt

Walsh

Whorton

Witte

Yaeger

Zimmerman

Zweifel

 

 

 

 

 

 

NOES: 093

 

 

 

 

 

 

 

 

 

Avery

Baker 123

Bearden

Bivins

Brandom

Brown 30

Bruns

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Dougherty

Dusenberg

El-Amin

Emery

Ervin

Faith

Fares

Fisher

Flook

Franz

Funderburk

Grisamore

Guest

Hobbs

Hoskins

Hunter

Icet

Jones 89

Jones 117

Kelly

Kraus

Lembke

Lipke

Loehner

Marsh

May

McGhee

Moore

Munzlinger

Muschany

Nance

Nieves

Nolte

Onder

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Richard

Robb

Ruestman

Ruzicka

Sander

Sater

Schaaf

Schad

Scharnhorst

Schlottach

Schneider

Schoeller

Self

Silvey

Smith 14

Smith 150

Stevenson

St. Onge

Stream

Sutherland

Thomson

Threlkeld

Tilley

Viebrock

Wallace

Wasson

Wells

Weter

Wilson 119

Wilson 130

Wood

Wright 159

Yates

Mr Speaker

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 016

 

 

 

 

 

 

Bland

Bowman

Brown 50

Cooper 120

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Walton

Wildberger

Wright-Jones

Young

 

 

 

 

 

            Representative McClanahan offered House Amendment No. 15.

 

House Amendment No. 15

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 34, Section 208.151, Line 240, by inserting after said line:

 

              "7. Notwithstanding any other provision of law, eligibility requirements in the state Medicaid program shall be no more restrictive than those in effect on January 1, 2005."; and

 

              Further amend, Page 43, Section 208.152, Line 318, by inserting after said line:

 

              "11. Notwithstanding any other provision of law, state Medicaid services, cost-sharing (including co-payments and premiums), long-term care services criteria, and MC+ for kids affordability standards shall be no more restrictive than the state Medicaid program requirements in effect on January 1, 2005.".

 

            Speaker Pro Tem Bearden assumed the Chair.

 

            Representative Robb offered House Amendment No. 1 to House Amendment No. 15.

 

            House Amendment No. 1 to House Amendment No. 15 was withdrawn.

 

            Representative McClanahan moved that House Amendment No. 15 be adopted.

 

            Which motion was defeated by the following vote:

 

AYES: 068

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Bringer

Burnett

Casey

Chappelle-Nadal

Corcoran

Darrough

Daus

Donnelly

Dougherty

El-Amin

Faith

Fallert

Frame

George

Grill

Grisamore

Harris 23

Harris 110

Hodges

Holsman

Hoskins

Hubbard

Komo

Kraus

Lampe

LeVota

Liese

Low 39

Marsh

McClanahan

Meadows

Meiners

Nance

Nasheed

Nolte

Norr

Oxford

Page

Quinn 9

Robinson

Roorda

Rucker

Scavuzzo

Schieffer

Schneider

Schoemehl

Shively

Silvey

Skaggs

Smith 150

Spreng

Storch

Stream

Swinger

Talboy

Todd

Villa

Vogt

Walsh

Whorton

Witte

Wright 159

Yaeger

Zimmerman

Zweifel

 

 

 

 

 

 

 

NOES: 078

 

 

 

 

 

 

 

 

 

Baker 123

Bearden

Bivins

Brandom

Brown 30

Bruns

Cooper 120

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Davis

Day

Deeken

Dempsey

Denison

Dethrow

Dixon

Dusenberg

Emery

Ervin

Fares

Fisher

Flook

Franz

Funderburk

Guest

Hobbs

Hunter

Icet

Jones 89

Jones 117

Kelly

Lembke

Lipke

Loehner

May

McGhee

Moore

Munzlinger

Muschany

Nieves

Onder

Parson

Pearce

Pollock

Portwood

Pratt

Quinn 7

Richard

Robb

Ruestman

Ruzicka

Sander

Sater

Schaaf

Schad

Scharnhorst

Schlottach

Schoeller

Self

Smith 14

Stevenson

St. Onge

Sutherland

Thomson

Threlkeld

Tilley

Viebrock

Wallace

Wells

Weter

Wilson 119

Wilson 130

Wood

Yates

Mr Speaker

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 017

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Salva

Walton

Wasson

Wildberger

Wright-Jones

Young

 

 

 

 

            Representative Storch offered House Amendment No. 16.

 

House Amendment No. 16

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Section 208.640, Page 61, Line 32, by inserting after all of said line the following:

 

              "In addition, consistent with 42 U.S.C. section 1396cc(e)(3) amd 42 C.F.R. section 457.560, private or employer-sponsored health insurance shall not be considered affordable if the family's total cost-sharing (including premiums, enrollment fees, deductibles, co-payments, co-insurance, or similar cost-sharing) under such insurance would exceed five percent of the family's annual income. The Family Support Division shall promulgate regulations to establish a process for determining whether the total cost of available private or employer-sponsored health insurance exceeds 5% of family income."; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Storch, House Amendment No. 16 was adopted by the following vote:

 

AYES: 128

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Bearden

Brandom

Bringer

Brown 30

Bruns

Burnett

Casey

Chappelle-Nadal

Cooper 120

Corcoran

Cox

Cunningham 145

Cunningham 86

Darrough

Daus

Day

Deeken

Dempsey

Denison

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Faith

Fallert

Fares

Fisher

Flook

Frame

Funderburk

George

Grill

Grisamore

Guest

Harris 23

Harris 110

Hobbs

Hodges

Holsman

Hubbard

Hunter

Icet

Jones 117

Kelly

Komo

Kraus

Lampe

Lembke

LeVota

Liese

Lipke

Loehner

Low 39

Marsh

May

McClanahan

McGhee

Meadows

Meiners

Moore

Munzlinger

Muschany

Nance

Nasheed

Nieves

Nolte

Norr

Onder

Oxford

Page

Parson

Pearce

Portwood

Pratt

Quinn 7

Quinn 9

Richard

Robb

Robinson

Roorda

Rucker

Ruestman

Ruzicka

Sander

Scavuzzo

Schaaf

Scharnhorst

Schieffer

Schneider

Schoeller

Schoemehl

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Spreng

Stevenson

St. Onge

Storch

Stream

Sutherland

Swinger

Talboy

Thomson

Threlkeld

Tilley

Todd

Viebrock

Villa

Vogt

Walsh

Wasson

Wells

Weter

Wilson 130

Witte

Wright 159

Yaeger

Yates

Zimmerman

Zweifel

Mr Speaker

 

 

 

 

 

 

 

NOES: 016

 

 

 

 

 

 

 

 

 

Baker 123

Bivins

Cooper 155

Cooper 158

Davis

Dethrow

Emery

Ervin

Franz

Hoskins

Jones 89

Pollock

Sater

Schad

Wallace

Wood

 

 

 

 

 

 

 

 

 

PRESENT: 001

 

 

 

 

 

 

 

 

 

Wilson 119

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 018

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Salva

Schlottach

Walton

Whorton

Wildberger

Wright-Jones

Young

 

 

 

            Representative Sater offered House Amendment No. 17.

 

House Amendment No. 17

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Section 208.151, Page 34, Line 231, by inserting immediately after the word "state" the following:

 

              ", unless subject to appropriation or directed by statute"; and

 

              Further amend said substitute, said section, said page, Line 235, by inserting immediately after the word "thereof" the following:

 

              ", unless the request for such a waiver is made subject to appropriation or directed by statute"; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Sater, House Amendment No. 17 was adopted.

 

            Representative Zweifel offered House Amendment No. 18.

 

House Amendment No. 18

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 25, Section 208.001, Line 22, by inserting after all of said line the following:

 

              "208.145. 1. For the purposes of the application of section 208.151, individuals shall be deemed to be recipients of aid to families with dependent children and individuals shall be deemed eligible for [such assistance] the medical assistance authorized under section 208.151 if:

              (1) The individual meets eligibility requirements which are no more restrictive than the July 16, 1996, eligibility requirements for aid to families with dependent children, as established by the family support division [of family services]; or

              (2) Each dependent child, and each relative with whom such a child is living including the spouse of such relative as described in 42 U.S.C. 606(b), as in effect on July 16, 1996, who ceases to meet the eligibility criteria set forth in subdivision (1) of this [section] subsection as a result of the collection or increased collection of child or spousal support under part IV-D of the Social Security Act, 42 U.S.C. 651 et seq., and who has received such aid in at least three of the six months immediately preceding the month in which ineligibility begins, shall be deemed eligible for an additional four calendar months beginning with the month in which such ineligibility begins.

              2. For determination of eligibility under subsection 1 of this section, less restrictive income methodologies as authorized in 42 U.S.C. Section 1396 u1(b)(2)(C) shall be used to disregard two-thirds of earned income in place of the disregard of thirty dollars of earned income plus one-third of remaining earned income. Such disregard shall not be time limited and shall be applied on all income eligibility tests except gross income."; and

 

              Further amend said title, enacting clause and intersectional references accordingly.

 

            Representative Zweifel moved that House Amendment No. 18 be adopted.

 

            Which motion was defeated by the following vote:

 

AYES: 067

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Brandom

Bringer

Burnett

Casey

Chappelle-Nadal

Corcoran

Darrough

Daus

Day

Donnelly

El-Amin

Faith

Fallert

Frame

George

Grill

Grisamore

Harris 23

Harris 110

Hodges

Holsman

Hubbard

Komo

Kraus

Lampe

LeVota

Liese

Low 39

Marsh

McClanahan

Meadows

Meiners

Nance

Nasheed

Nolte

Norr

Oxford

Page

Portwood

Quinn 9

Robinson

Roorda

Rucker

Scavuzzo

Schieffer

Schoemehl

Shively

Silvey

Skaggs

Smith 150

Spreng

Storch

Stream

Swinger

Talboy

Todd

Villa

Vogt

Walsh

Witte

Wright 159

Yaeger

Zimmerman

Zweifel

 

 

 

 

 

 

 

 

NOES: 078

 

 

 

 

 

 

 

 

 

Baker 123

Bearden

Bivins

Brown 30

Bruns

Cooper 120

Cooper 155

Cooper 158

Cox

Cunningham 145

Cunningham 86

Davis

Deeken

Dempsey

Denison

Dethrow

Dixon

Dusenberg

Emery

Ervin

Fares

Fisher

Flook

Franz

Funderburk

Guest

Hobbs

Hoskins

Hunter

Icet

Jones 89

Jones 117

Kelly

Lembke

Lipke

Loehner

May

McGhee

Moore

Munzlinger

Muschany

Nieves

Onder

Parson

Pearce

Pollock

Pratt

Quinn 7

Richard

Robb

Ruestman

Ruzicka

Sander

Sater

Schaaf

Schad

Scharnhorst

Schlottach

Schneider

Schoeller

Self

Smith 14

Stevenson

St. Onge

Sutherland

Thomson

Threlkeld

Tilley

Viebrock

Wallace

Wasson

Wells

Weter

Wilson 119

Wilson 130

Wood

Yates

Mr Speaker

 

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 018

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Dougherty

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Salva

Walton

Whorton

Wildberger

Wright-Jones

Young

 

 

 

            Representative Zweifel offered House Amendment No. 19.

 

House Amendment No. 19

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 1, In the Title, Line 5, by inserting after "RSMo," the following:

 

              "and section 208.755 as truly agreed and finally passed in Senate Substitute for Senate Committee Substitute for House Committee Substitute for House Bill No. 327, Ninety-fourth General Assembly, First Regular Session,"; and

 

              Further amend said bill, Page 1, Section A, Line 4, by inserting after "RSMo," the following:

 

              "and section 208.755 as truly agreed and finally passed in Senate Substitute for Senate Committee Substitute for House Committee Substitute for House Bill No. 327, Ninety-fourth General Assembly, First Regular Session,"; and

 

              Further amend said bill, Page 104, Section 208.014, Line 29, by inserting after all of said line the following:

 

"[208.755. 1. There is hereby established within the department of economic development a program to be known as the "Family Development Account Program". The program shall provide eligible families and individuals with an opportunity to establish special savings accounts for moneys which may be used by such families and individuals for education, home ownership or small business capitalization.

2. The department shall solicit proposals from community-based organizations seeking to administer the accounts on a not-for-profit basis. Community-based organization proposals shall include:

(1) A requirement that the individual account holder or the family of an account holder match the contributions of a community-based organization member by contributing cash;

(2) A process for including account holders in decision making regarding the investment of funds in the accounts;

(3) Specifications of the population or populations targeted for priority participation in the program;

(4) A requirement that the individual account holder or the family of an account holder attend economic literacy seminars;

(5) A process for including economic literacy seminars in the family development account program; and

(6) A process for regular evaluation and review of family development accounts to ensure program compliance by account holders.

3. In reviewing the proposals of community-based organizations, the department shall consider the following factors:

(1) The not-for-profit status of such organization;

(2) The fiscal accountability of the community-based organization;

(3) The ability of the community-based organization to provide or raise moneys for matching contributions;

(4) The ability of the community-based organization to establish and administer a reserve fund account which shall receive all contributions from program contributors; and

(5) The significance and quality of proposed auxiliary services, including economic literacy seminars, and their relationship to the goals of the family development account program.

4. No more than [twenty] fifteen percent of all funds in the reserve fund account may be used for administrative costs of the program in each of the first two years of the program, and no more than [fifteen] ten percent of such funds may be used for administrative costs for any subsequent year. Funds deposited by account holders shall not be used for administrative costs.

5. The department shall promulgate rules and regulations to implement and administer the provisions of sections 208.750 to 208.775. No rule or portion of a rule promulgated pursuant to the authority of sections 208.750 to 208.775 shall become effective unless it has been promulgated pursuant to the provisions of chapter 536, RSMo.]"; and

 

              Further amend said title, enacting clause and intersectional references accordingly.

 

            On motion of Representative Zweifel, House Amendment No. 19 was adopted.

 

            Representative Holsman offered House Amendment No. 20.

 

House Amendment No. 20

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 41, Section 208.152, Line 238, by inserting after the number “(27)” the following:

 

              Home nursing visits for newborn infants. Such nursing services shall consist of home visits designed to prevent infant mortality, child abuse and neglect for at-risk infants by providing health care, education, and positive parenting skills and shall be capable of providing follow-up care as needed for up to twenty-four months after the initial visit. For the purposes of this section, “at risk” may include infants born medically fragile, chemically dependent, or deemed by the treating physician as displaying failure to thrive or born to a chemically dependent parent, to a teenage mother, to a mentally or physically challenged mother, to a family where there has been a history of prior premature births, abuse or neglect, or domestic violence.

              (a) This shall be developed as a three-year pilot project, using a maximum of four hundred fifty thousand dollars general revenue, in a county of the first classification with more than eighty thousand but fewer than ninety thousand inhabitants, a county of the third classification with more than nineteen thousand five hundred but less than twenty-one thousand five hundred inhabitants, a county with a charter form of government and with more than one million inhabitants, a city not within a county, and a county with a charter form of government and with more than six hundred thousand but fewer than seven hundred thousand inhabitants.

              (b) The division shall request appropriate waivers or state plan amendments from the Secretary of the federal Department of Health and Human Services to permit the establishment of this pilot project;

              (28)”; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            Representative Page offered House Substitute Amendment No. 1 for House Amendment No. 20.

 

            Representative Pratt raised a point of order that House Substitute Amendment No. 1 for House Amendment No. 20 goes beyond the scope of the bill.

 

            The Chair ruled the point of order well taken.

 

            On motion of Representative Holsman, House Amendment No. 20 was adopted by the following vote:

 

AYES: 101

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Brandom

Bringer

Bruns

Burnett

Casey

Chappelle-Nadal

Cooper 158

Corcoran

Cunningham 145

Daus

Day

Deeken

Dempsey

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Faith

Fallert

Fares

Flook

Frame

Funderburk

George

Grill

Grisamore

Harris 23

Harris 110

Hodges

Holsman

Hubbard

Komo

Kraus

Lampe

Lembke

LeVota

Liese

Lipke

Loehner

Low 39

Marsh

McClanahan

McGhee

Meadows

Meiners

Muschany

Nance

Nasheed

Nieves

Nolte

Norr

Oxford

Page

Pollock

Portwood

Pratt

Quinn 9

Robinson

Roorda

Rucker

Ruzicka

Salva

Sander

Scavuzzo

Schieffer

Schlottach

Schneider

Schoeller

Schoemehl

Self

Shively

Silvey

Skaggs

Smith 14

Smith 150

Spreng

Storch

Stream

Sutherland

Swinger

Talboy

Thomson

Threlkeld

Tilley

Todd

Villa

Vogt

Walsh

Wasson

Wells

Weter

Wilson 130

Witte

Yaeger

Yates

Zimmerman

Zweifel

 

 

 

 

 

 

 

 

 

NOES: 044

 

 

 

 

 

 

 

 

 

Baker 123

Bearden

Bivins

Brown 30

Cooper 120

Cooper 155

Cox

Cunningham 86

Davis

Denison

Dethrow

Emery

Ervin

Fisher

Franz

Guest

Hobbs

Hoskins

Hunter

Icet

Jones 89

Jones 117

Kelly

May

Moore

Munzlinger

Onder

Parson

Pearce

Quinn 7

Richard

Robb

Ruestman

Sater

Schaaf

Schad

Scharnhorst

Stevenson

St. Onge

Viebrock

Wilson 119

Wood

Wright 159

Mr Speaker

 

 

 

 

 

 

PRESENT: 000

 

 

 

 

 

 

 

 

 

ABSENT WITH LEAVE: 018

 

 

 

 

 

 

Bland

Bowman

Brown 50

Curls

Darrough

Haywood

Hughes

Johnson

Kingery

Kratky

Kuessner

Lowe 44

Wallace

Walton

Whorton

Wildberger

Wright-Jones

Young

 

 

 

            Representative Donnelly offered House Amendment No. 21.

 

House Amendment No. 21

 

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 38, Section 208.152, Line 160, by inserting after the word "therapy" the following:

 

              "and any evaluation required to make the determination of medically necessary;"; and

 

              Further amend said section, Line 198, by inserting after the word "wheelchairs" the words "and any evaluation required to make the determination of medically necessary"; and

 

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

 

            On motion of Representative Donnelly, House Amendment No. 21 was adopted by the following vote:

 

AYES: 114

 

 

 

 

 

 

 

 

 

Aull

Avery

Baker 25

Brandom

Bringer

Bruns

Burnett

Casey

Chappelle-Nadal

Cooper 155

Cooper 158

Corcoran

Cunningham 145

Cunningham 86

Darrough

Daus

Day

Deeken

Dempsey

Denison

Dixon

Donnelly

Dougherty

Dusenberg

El-Amin

Faith

Fallert

Fares

Fisher

Frame

Funderburk

George

Grill

Grisamore

Guest