HCS#2 HB 1933, 1375, 1662, 1816, 1940, 1971, 2240, 2313, 2423 &
2435 -- HEALTH CARE

SPONSOR:  Schaaf

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
Healthcare Transformation by a vote of 6 to 1.

This substitute changes the laws regarding health care.

HEALTH CARE WHISTLEBLOWER PROTECTION ACT

The substitute establishes the Health Care Whistleblower
Protection Act which prohibits employers from taking retaliatory
action against employees who disclose or threaten to disclose
alleged prohibited activities or provide information or testify
before any public body regarding violations which the employee
reasonably believes constitutes improper quality of patient care.
Hospitals and surgical centers are required to allow employees
reporting violations to do so anonymously.

Within one year, an employee may bring a civil action against any
employer violating these provisions.  The substitute allows the
court to issue an injunction to stop the employer's illegal
activity; reinstate the employee's position, benefits, and
seniority rights; and order payment of lost wages, reasonable
litigation costs, attorney fees, and punitive damages.  If an
employee brings an action without basis in law or fact, a court
may order the employee to pay reasonable attorney fees and court
costs.  Employers must conspicuously display notices of the
employee protections specified in the substitute.  Employers
violating these provisions may be fined an amount of up to $1,000
for a first offense and up to $5,000 for a subsequent offense.

HOSPITAL PATIENT SAFETY

The substitute:

(1)  Requires each hospital to establish a safe patient handling
committee by January 1, 2009, to design and recommend the process
for implementing a safe patient handling program;

(2)  Requires each hospital to establish a safe patient handling
program by July 1, 2009, to implement a safe handling policy for
all shifts, conduct a patient handling hazzard assessment,
conduct annual performance evaluations of the program, and
consider incorporating patient handling equipment in future
hospital remodels;

(3)  Requires each hospital, by January 1, 2012, to acquire their
choice of a specified minimum of patient lifting equipment and to
train staff on policies, equipment, and devices at least
annually;

(4)  Requires each hospital to develop procedures for employees
to refuse to perform or be involved in patient handling or
movement that will expose the patient or employee to an
unacceptable risk of injury;

(5)  Requires the Division of Workers' Compensation within the
Department of Labor and Industrial Relations to develop rules to
provide a reduced premium for hospitals that implement a safe
patient handling program by January 1, 2010, and to complete an
evaluation and report on the results of the reduced premium to
the appropriate committees of the General Assembly by December 1,
2013, and December 1, 2015; and

(6)  Specifies that hospitals can apply to the Missouri Health
and Educational Falsities Authority for low-cost loans to
purchase their choice of patient handling equipment.

MEDICAL ASSISTANCE PROGRAM PROVIDER REIMBURSEMENT

The substitute specifies that under the MO HealthNet Program, the
successor to the Missouri Medicaid Program, providers can receive
enhanced reimbursement for certain services.  Subject to
appropriations, the enhanced rate will be 100% of the federal
Medicare reimbursement rate for new and established patients.  In
order to qualify for the enhanced reimbursement, the provider
must:

(1)  Become the health care home for a MO HealthNet patient;

(2)  Complete a patient history and consultation for the patient;
and

(3)  File a treatment plan for the patient.

MO HEALTHNET PROGRAM BENEFITS

Subject to appropriations, the substitute adds medically
necessary home telemonitoring and chiropractic services to the
list of covered services under the MO HealthNet Program.  An
electronic web-based prior authorization system using guidelines
consistent with national standards will be used to verify the
medical need.

Subject to appropriations, the substitute also adds home nursing
visits and follow-up care as needed until an infant's second
birthday for certain at-risk newborns to the list of covered
services under the MO HealthNet Program.  The MO HealthNet
Division within the Department of Social Services is required to
request the appropriate waivers or state plan amendments from the
federal Department of Health and Human Services to provide these
services as a three-year pilot in the counties of Buchanan,
Greene, and Jackson.

ACCESS TO PSYCHOTROPIC MEDICATIONS

Currently, under the MO HealthNet Program, fee for service
eligible policies for prescribing psychotropic medications are
prohibited from including any new limits to initial drug access
requirements.  The substitute applies these provisions to any
additional geographic areas or participant populations designated
to receive benefits through a care plan other than a fee for
service plan.

MO HEALTHNET OVERSIGHT COMMITTEE

The number of members on the MO HealthNet Oversight Committee is
increased from 18 to 23 by removing one public member and adding
one podiatrist, one nurse, two mental health professionals, one
representative of federally qualified health centers, and one
representative of rural health clinics.

HEARING INSTRUMENT DISCLOSURE REQUIREMENTS

Audiologists and hearing instrument dealers and fitters are
required to include the total price to be paid for a hearing
instrument in the purchase agreement.

Audiologists and hearing instrument dealers and fitters must, at
the time of initial examination, provide prospective purchasers
information about magnetic coupling options which are available
in hearing instruments, the proper use of magnetic coupling
technologies, and the Telecommunications Equipment Distribution
Program established under Section 209.253, RSMo.

PAYMENT OF INSURANCE CLAIMS

The substitute requires the notice of the status of a claim that
includes a request for additional information from a health
carrier or third-party contractor to specify the information
requested and from whom it is requested, such as the claimant,
the patient, or another health care provider.  If a denied claim
does not include a specific reason for denial, the claim will not
be considered denied.

RECOMMENDATIONS FOR SWITCHING MEDICATIONS

All switch communications must clearly identify the originally
prescribed medication and disclose any financial interest that
the health care insurer, pharmacy benefits manager, or
prescribing physician has in the patient's decision to switch
medications.  Any person who issues or delivers or causes to be
issued or delivered a switch communication that has not been
approved, provides a misrepresentation or false statement in a
switch communication, or commits any other material violation of
these provisions will be subject to a fine of up to $25,000.

PHYSICIAN OVERRIDE OF DRUG RESTRICTIONS

A prescribing physician can override any step therapy or fail
first protocol when the treatment has been ineffective in
treating the patient's disease or medical condition, is expected
to be ineffective, or is likely to cause an adverse reaction.
The duration of any step therapy or fail first protocol cannot
last longer than 14 days.  For medications with no generic
equivalent and for which the prescribing physician feels there is
no appropriate therapeutic alternative, the health carrier or
pharmacy benefit manager is required to provide access to United
States Food and Drug Administration labeled medications without
restriction.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
but Greater than $16,243,644 in FY 2009, Unknown but Greater than
$20,195,315 in FY 2010, and Unknown but Greater than $21,062,324.
Estimated Cost on Other State Funds of $44,718 in FY 2009,
$54,192 in FY 2010, and $55,817 in FY 2011.

PROPONENTS:  Supporters of House Bill 1933 say that the bill can
save money on MO HealthNet Program patients and reduce emergency
room use and the length of hospital stays.  Multiple types of
services can be performed through telemarketing such as blood
pressure checks, blood sugar checks, and weight monitoring.

Supporters of House Bill 1375 say that the bill increases access
to health care, rewards physicians for the time they spend with
patients, and motivates physicians to be engaged in the process.

Supporters of House Bill 1662 say that the bill provides
consumers with information regarding price, features, and
available technology associated with hearing devices.

Supporters of House Bill 1940 say that the bill will benefit
hospitals and nurses, save hospitals money on workers'
compensation claims, and reduce the number of lost work days.

Supporters of House Bill 1971 say that the bill will save the MO
HealthNet Program money because participants can be treated
without requiring any further intervention.

Supporters of House Bill 2240 say that the bill will provide
information to patients when their medication has been switched
from one drug to another.  The bill does not prevent physicians
from prescribing generic or generic alternative medications.

Supporters of House Bill 2313 say that the bill makes an
important addition to the committee.

Supporters of House Bill 2423 say that the bill helps children in
at-risk environments, saves lives, and makes good use of state
funds.

Supporters of House Bill 2435 say that the bill strengthens the
current prompt payment law and helps physicians receive timely
reimbursement for services they have provided.

Testifying for HB 1933 were Representative Schaaf; Roy Holand,
MD; Missouri Hospital Association; and Missouri Nurses
Association.

Testifying for HB 1375 were Representative Portwood; and Missouri
Academy of Family Physicians.

Testifying for HB 1662 were Representative Deeken; Diane Golden,
Missouri Assistive Technology; Angela Graves, Missouri Commission
for Deaf and Hard of Hearing; and Kim Davis.

Testifying for HB 1816 were Representative LeVota; Susan Nye,
Service Employees International Union Nurse Alliance; and Nurses
United.

Testifying for HB 1940 were Representative Page; Patty Cyr,
Service Employees International Union Nurse Alliance; Dana Ming;
Susan Nye, Service Employees International Union Nurse Alliance;
Nurses United; and Missouri Nurses Association.

Testifying for HB 1971 were Representative Portwood; and Missouri
State Chiropractors Association.

Testifying for HB 2240 were Representative Stevenson; Tracey
Joyce; Wal-Mart Stores, Incorporated; Missouri Pharmacy
Association; and Sean Taylor, Epilepsy Foundation.

Testifying for HB 2313 were Representative Schaaf for
Representative Hobbs; and Missouri Association of Rural Health
Clinics.

Testifying for HB 2423 were Representatives Holsman and Storch;
Sharon Rohrbach, Nurses for Newborns; Partnership for Children;
Signature Health Services; and Patrick Dougherty.

Testifying for HB 2435 were Representative Lembke; Signature
Health Services; Karen Reuschle, Metro Heart Group of St. Louis
Incorporated; Jeanne Blumm, Surgery Center of St. Louis; and
Missouri State Medical Association.

OPPONENTS:  Those who oppose House Bill 1816 say that the bill
duplicates investigations and increases costs for hospitals.
Some of the standards are unclear, and reporting would be more
difficult.

Those who oppose House Bill 2240 say that the bill creates a
cumbersome, complex, and contradictory procedure requiring
information that is impossible to obtain.  Medication switching
is only performed when based on recommendations and review.
Insurance plans already have an appeal process for when a
physician feels that a certain drug is necessary for a patient.

Those who oppose House Bill 2435 say that the bill will cause
problems for health care providers, there are already penalties
for unreasonably denying a claim, and the Department of
Insurance, Financial Institutions, and Professional Registration
already fines insurers for prompt pay problems in market conduct
examinations.

Testifying against HB 1816 were Missouri Hospital Association;
and Missouri Pharmacy Association.

Testifying against HB 2240 were Express Scripts; MEDCO Health
Solutions, Incorporated; Missouri Retailers Association; Anthem
Blue Cross Blue Shield; Coventry Health Care of Kansas,
Incorporated; Missouri Insurance Coalition; and CVS/Caremark Rx,
Incorporated.

Testifying against HB 2435 were Coventry Health Care of Kansas,
Incorporated; Blue Cross Blue Shield of Kansas City; State Farm
Insurance Companies; and Missouri Insurance Coalition.

OTHERS:  Others testifying on House Bill 1940 say that many
hospitals have lifting equipment that isn't used and they don't
want hospitals to have to purchase additional equipment that
won't get used.

Others testifying on House Bill 2435 provided information
regarding the accrual of interest and market conduct
examinations.

Testifying on HB 1940 was Missouri Hospital Association.

Testifying on HB 2435 was Department of Insurance, Financial
Institutions, and Professional Registration.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:11 pm