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					               ________________________________
               Governmental & Public Relations Consultants



                            MEMORANDUM



TO:            MPTA

FROM:          John E. Bardgett, Jr.
               John Bardgett & Associates, Inc.

DATE:          March 17, 2006

RE:            Legislative Activity – Week 11
               March 13 – March 16, 2006

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The Missouri Legislature has reached the half-way point of the 2006 legislative
session and has adjourned for their annual spring break. They will reconvene at
approximately 4:00 p.m. on Monday, March 27th. The House of Representatives
worked late into the evening as they debated and passed the state’s $21 billion
operating budget. The Senate Appropriations Committee has already scheduled
mark-up hearings beginning on Tuesday, March 28th at 8:00 a.m.

The Missouri Senate Republican Leadership remains committed to passing a new
election law which would require Missouri voters to produce a government issued
photo ID in order to be allowed to vote in the November 2006 elections.
Democratic members of the Senate skillfully arranged a filibuster which went on
for most of the week. This bill still awaits more Senate debate. The much debated
eminent domain legislation sponsored by Rep. Steve Hobbs (R – Mexico) was
presented to the House Judiciary Committee this past week. HB 1944 was
discussed by the House Judiciary Committee in lengthy hearings that lasted
almost an entire day. Chairman Bryan Pratt stated that the Judiciary Committee
will resume hearings on eminent domain on Tuesday, March 28th and then begin
the daunting task of preparing a House Committee Substitute for HB 1944.
As the legislature is not in session next week, there will be no weekly report on
Friday, March 24th.

HCS / HB 1759 – sponsored by Rep. Wasson (R – Nixa) relates to athletic
trainers. The substitute of this bill is on the House Consent Calendar awaiting
debate by the full House. As a consent bill, it cannot be amended on the floor.
Please review this substitute to ensure that our issues have been dealt with.
http://www.house.mo.gov/bills061/biltxt/commit/HB1759C.HTM.

SCS/SB 841 – sponsored by Sen. Ridgeway (R – Smithville) authorizes peer
review committees for certain emergency services. This bill is on the Senate
Perfection Calendar. We were successful in amending physical therapists to this
bill.

SB 1057 – sponsored by Sen. Loudon (R – St. Louis County) is the legislation
which includes physical therapists in the definition of healthcare practitioners that
are allowed to file a lien for health care services. Physical therapists were omitted
from this definition of healthcare practitioners in 1999 when the legislature gave
other healthcare practitioners the lien right. This bill was voted out “do pass”
consent by the Senate Small Business and Insurance Committee on Wednesday,
March 15th. This bill will now go on the Consent Calendar for consideration by the
full Senate as a non-controversial and unamendable bill.

This week the Senate Appropriations Committee held hearings for the Department
of Social Services to present their budget overview. Director Sherman began the
presentation on Monday by explaining the shift in direction that is currently taking
place in the Division of Family Services (DFS). The goal of the shift within the
Division of Family Services is to make the process more effective in identifying
Missourians who are currently utilizing services for which they may not be eligible.
According to Director Sherman, DFS has decreased the abuse of state programs
by 92%.

The Director noted his outlook for the future of the department is not to just assist
Missourians in paying their medical bills, but to become a healthcare model for
other states. Director Sherman also pointed out that his department is looking to
strengthen their relationships with communities. He feels that the communities
know best what their top issues are and can take a buck much further than the
state.

There were several comments made during the hearing from key legislators that
were of interest. The committee members had questions about the Managed Care
funding line item. The Division Director of Medical Services, Dr. Mike Ditmore,
explained that the division has received a total of 9 bids in response to the RFP
request for the Medicaid Managed Care population. The bids are currently being
reviewed and should have the selection made by the end of this month.
Regardless of the process, the Director noted that the budget request will not be
impacted.
The Senate Appropriations Committee will meet the week following the Legislative
Spring Break to begin mark-up on the House Budget Bills.

SB 1239 – sponsored by Sen. Gibbons (R- St. Louis) would mandate that the 50
most common prescription drugs be posted on the Internet along with the cost of
the drugs. This bill was heard in the Senate Pensions Committee on Wednesday,
March 15th. Sen. Gibbons said this would allow people to compare and provide
more transparency. He also noted that the cost of implementing this bill is
relatively low, an estimated $300,000. A representative from AARP testified in
support of the bill.

Medicaid Fraud
SB 1210 – sponsored by Sen. Koster (R-Harrisonville) allows individuals to sue for
Medicaid fraud and modifies various provisions relating to the reporting and
investigation of such fraud. This bill was heard in the Senate Pensions Committee
on Wednesday, March 15th. Sen. Koster said that the fraud estimates in Missouri
vary dramatically; however, it is estimated that between 3% and 10% of the state’s
$5.5 billion Medicaid program can be attributed to fraud. He said those committing
fraud are taking funds away from Missouri’s neediest citizens and the abuse
should not be tolerated.

Sen. Koster said Texas, Illinois, Florida, New York and California have all made
great strides with Medicaid reform. These states were studied in detail as SB
1210 was prepared. He also stressed that SB 1210 was designed to acknowledge
the seriousness of fraud. Overall, it imposes penalties for abuse that match or
exceed federal penalties.

Main provisions of the bill include the following:

   •   adopts the federal definition of the word “knowing” (in relation to fraud).
   •   changes the penalty from a class “D” felony (1-4 years) to a class “C” felony
       (1-7 years).
   •   implements the “85% rule” which requires that an offender complete at least
       85% of his sentence.
   •   makes the willful obstruction of justice a “D” felony (i.e., the loss or
       destruction of documents)
   •   would permanently ban those convicted of fraud (They would never be
       allowed to participate in the Medicaid program again.)

The bill also encourages “whistleblowing” and provides protection for those who
report fraudulent activity. This is based on a federal statute and its adoption may
be monetarily beneficial to Missouri. Sen. Koster said that currently for every $1 of
fraud money the state is able to recoup, it sends 60 cents to the federal
government. With the adoption of this provision, the state would send only 50
cents.
The Director of Medicaid Fraud for the Missouri Attorney General’s Office testified
in support of the bill. He said that the clandestine and secretive nature of Medicaid
fraud necessitates strong penalties.

Mr. Harvey Tettlebaum testified in opposition to SB 1210. Mr. Tettlebaum is an
attorney who testified on behalf of a number of healthcare providers (including
Missouri Healthcare Association, Missouri Dental Association and Missouri
Pharmacy Association). Mr. Tettlebaum said that several aspects of the bill were
faulty despite the good intentions of the Missouri lawmakers. He said the
penalties in the bill are simply too harsh. He said that no healthcare company
could afford to risk being permanently banned from the Medicaid system –
regardless of how strongly they believe themselves to be innocent. He said
companies could not afford to fight and would rather pay to settle. Hence, it would
be much more lucrative to “go after” providers rather than recipients. Mr.
Tettlebaum also indicated that some of the language used in the bill may be in
violation of federal law. He said Missouri should look at the resources already in
place. He said the Attorney General’s Office may lack manpower, but they already
have the authority to go after those guilty of fraud. He also suggested using Social
Services and contract agencies to help combat fraud.

SB 1244 - sponsored by Sen. Loudon (R - St. Louis) also deals with Medicaid
fraud. This bill was also heard in the Senate Pensions Committee on Wednesday,
March 15th.
This bill is very similar to SB 1210, but Sen. Loudon said that his bill does not
impose a permanent ban for violators from participating in the Medicaid program.
Testimony given for SB 1210 was also considered for SB 1244.

Sen. Jason Crowell (R - Cape Girardeau), Committee Chair, stated that SB 1210
is being considered the “lead bill” for Medicaid Fraud reform. He stated that three
bills were being heard by the committee and he expressed his apologies to Sen.
Graham (D - Columbia), noting that Sen. Graham was sponsoring SB 844 also
dealing with Medicaid Fraud reform. This bill was inadvertently left off the
schedule and will be heard later.

The House of Representatives completed their work on the Fiscal Year 2007
Budget this week until it returns from the Senate. On Tuesday, March 14th, they
began perfecting the budget, which lasted through Wednesday evening. The
budget bills were third read and passed by the House on Thursday, March 16th.
The Senate Appropriations Committee will take up the bills when the legislature
returns from Spring Break. They are scheduled to meet on Monday, 27th at 1:00
p.m. The Budget Chairman, Representative Allen Icet (R – St. Louis County)
opened each of the 13 budget bills for legislators to have the opportunity to offer
decreasing amendments followed by increasing amendments. Several democrats
attempted to further amend the use of the projected MOHELA proceeds; however,
their attempts were unsuccessful. Overall, very few changes were made to any of
the budget bills on the House floor. The most substantive change made to the
budget bills on the floor was by Rep. Cooper (R – Cape Girardeau). The series of
amendments successfully offered by Rep. Cooper would consolidate the functions
of facilities management services in the Office of Administration as opposed to a
function of each separate state department. The amendments that were adopted
to budget bills of interest are as follows:

HB 1002 – sponsored by Rep. Allen Icet (R – St. Louis County) appropriates
money for the expenses, grants, refunds, and distributions of the State Board of
Education and the Department of Elementary and Secondary Education, and the
several divisions.

   •   HA#2 (Decrease) – offered by Rep. Cooper (R – Cape Girardeau) removes
       the facility management and maintenance line items from Department of
       Elementary and Secondary Education.
   •   HA#3 (Increase) – offered by Rep. Cooper (R – Cape Girardeau)
       consolidates the facility management and maintenance line items to the
       Office of Administration.
   •   HA#5 (Increase) – offered by Rep. Moore (R – Fulton) increases funding for
       Blind Skilled Specialists by $140,000.

HB 1010 – sponsored by Rep. Allen Icet (R – St. Louis County) appropriates
money for the expenses, grants, refunds, and distributions of the Department of
Mental Health, the Board of Public Buildings, the Department of Health and Senior
Services.

   •   HA#1 – offered by Rep. Phillips (R – Kansas City) deletes language under
       section 10.650 relating to “voluntary choice of contraceptives” and adds
       “alternatives to abortion services, prenatal health care for purposes of
       carrying an unborn child to term, and health care referrals.”
   •   HA#2 – (Decrease) offered by Rep. Moore (R-Fulton) takes $140,000 from
       in-home personal care.
   •   HA#3 (Decrease) - offered by Rep. Cooper (R – Cape Girardeau) removes
       the facility management and maintenance line item from the Departments of
       Mental Health and Health and Senior Services.
   •   HA#4 (Increase) – offered by Rep. Cooper (R – Cape Girardeau)
       consolidates the facility management and maintenance line items from the
       Departments of Mental Health and Health and Senior Services to the Office
       of Administration.

HB 1011 – sponsored by Rep. Allen Icet (R – St. Louis County) appropriates
money for the expenses, grants, and distributions of the Department of Social
Services and the several divisions and programs.

   •   HA#1 (Increase) – offered by Rep. Donnelly (D – St. Louis City) increased
       funding for Medicaid provider fraud investigations by $650,000.
   •   HA#2 (Decrease) – offered by Rep. Cooper (R – Cape Girardeau) removes
       the facility management and maintenance line items from Department of
       Social Services.
   •   HA#3 (Increase) – offered by Rep. Cooper (R – Cape Girardeau)
       consolidates the facility management and maintenance line items from the
       Department of Social Services to the Office of Administration.
   •   HA#4 – offered by Rep. Sater (R - Cassville) inserts language for the
       Department of Social Services Division of Medical Services to have
       authority for reimbursement of durable medical equipment per the Division’s
       policy.
   •   HA#5 – offered by Rep. Sater (R - Cassville) deletes language under
       section 11.510 that states “30% of the federal poverty level” and inserts
       “TANF level.”
   •   HA#7 (Increase) – offered by Rep. Bearden (R – St. Charles) includes $1
       million of the current appropriation for the Healthcare Technology Fund be
       provided directly to an e-records pilot program in the St. Louis Metropolitan
       region with the contractor to provide $7 million in matching funds.
   •   HA#9 (Increase) – offered by Rep. Donnelly (D – St. Louis) increases
       Medicaid provider fraud investigation funds by $112,000.

HB 1226 – sponsored by Rep. Portwood (R – St. Louis) requires health insurance
coverage for certain chiropractic care services. An Executive Session was held on
Thursday, March 16th, in the House Committee on Health Care Policy and there
was a House Committee Substitute offered and adopted, and the bill was voted
out “do pass.”

HB 1088 – sponsored by Rep. Schaaf (R – St. Joseph) allows enrollees to pay the
lower of the co-payment assigned by the health maintenance organization or
health insurer or the usual and customary retail price of the prescription drug. This
bill was heard in the House Insurance Policy Committee on Wednesday, March
15th. There was no testimony on the bill and, in an executive session, the
committee voted the bill “do pass” consent. As a consent bill, the bill cannot be
amended on the House floor.

HB 1515 – sponsored by Rep. Behnen (R – Kirksville) requires physicians to
report to the State Board of Registration for the Healing Arts any collaborative
practice agreements entered into and authorizes the board to conduct audits for
compliance. This bill is on the House Consent Calendar awaiting debate by the
full House. As a consent bill, it cannot be amended on the House floor.

HB 1792 – sponsored by Rep. Kraus (R – Raytown) requires the evidence of
coverage statement issued on a health maintenance organization policy or
contract to include co-insurance amounts, other cost-sharing features, or the
features which have been requested by the group sponsor or the individual
certificate holder. This bill was voted “do pass” by the House Insurance Policy
Committee on Wednesday, March 15th.

HB 1278 & HB 1188 – co-sponsored by Rep. May (R – Rolla) and Rep. Wildberger
(D – St. Joseph) establishes the Registered Surgical Assistants and Registered
Surgical Technologist Title Protection Act. Both of these bills were jointly
presented to the House Professional Registration and Licensing Committee on
Wednesday, March 15th. Testifying in support of the bills was the Association of
Surgical Technologists and Assistants. Testifying in opposition to the bill was the
Mission Valley Career Academy. No further action was taken on the bill at this
time.

HB 1595 – sponsored by Rep. Portwood (R – Ballwin) changes the Chiropractor
Practice Act. This bill was presented to the House Professional Registration and
Licensing Committee on Wednesday, March 15th. Testifying in support of the bill
were a chiropractor for himself, representatives of the Logan Chiropractic College,
and two chiropractic patients as individuals. Testifying in opposition to the bill was
the Missouri Association of Osteopathic Physicians and Surgeons. No further
action was taken on the bill at this time.

HCS / HB 1660 – sponsored by Rep. Behnen (R – Kirksville) is a 165-page
omnibus professional registration bill which was voted out of the House
Professional Registration Committee this past week 14 - 0. This bill will now move
to the House floor and, according to Chairman Behnen, contains numerous non-
controversial statute changes related to professional licensing. This bill will no
doubt become a perfect vehicle for every amendment dealing with licensed
professionals in our state. It is the intent of Chairman Behnen to attempt to keep
all controversial amendments off this bill. Please let us know if you have any
concerns with the sections of the bill we emailed to you on Thursday morning.

HCS / HB 1767 – sponsored by Rep. Bruns (R – Jefferson City) transfers the
Division of Aging from the Department of Social Services to the Department of
Health and Senior Services. This bill was voted out “do pass” in an Executive
Session of the House Senior Citizen Advocacy Committee on Thursday, March
16th.

HB 1904 - sponsored by Rep. Threlkeld (R – Washington) requires health benefit
plans to only impose one co-payment for a single prescription drug if it requires
dispensing a combination of dosages of the prescription drug. This bill was heard
on Thursday, March 16th in the House Committee on Health Care Policy. No
public testimony was given on this bill. An Executive Session was held and there
was a House Committee Substitute offered and adopted, and the bill was voted
out “do pass.”

HB 1936 – sponsored by Rep. Tilley (R – Perryville) extends sunset for the
committee on the Quality of Patient Care. This bill was presented to the House
Professional Registration and Licensing Committee on Wednesday, March 15th.
Testifying in support of the bill were the Missouri Nurses Association and the
Missouri Hospital Association. There was no opposition testimony given, and the
bill was voted out “do pass” consent by a vote of 14 - 0.

SCS / SB 897 – sponsored by Sen. Kennedy (D – St. Louis City) establishes the
Medical Imaging and Radiation Therapy Quality Assurance Board. This bill was
voted out “do pass” in an Executive Session of the Senate Aging, Families, Mental
and Public Health Committee on Wednesday, March 15th.

SB 1076 – sponsored by Sen. Goodman (R – Mt. Vernon) prohibits healthcare
professionals from billing for anatomic pathology services not personally rendered.
This bill was voted out “do pass” in an Executive Session of the Senate Aging,
Families, Mental and Public Health Committee on Wednesday, March 15th.

SCS / SB 1082 – sponsored by Sen. Shields (R – St. Joseph) relates to workers’
compensation medical fees. Under the act, the determination of customary fees
charged for treatment for the purposes of workers' compensation shall be based
on comparable volume-based discount contracts of the health care provider
delivering the treatment and care. All medical fee disputes shall be filed with the
Division of Workers' Compensation or the Labor and Industrial Relations
Commission in rehabilitation cases, within two years from the date of the rendering
of the most recent medical service for which payment or reimbursement is sought.
In a medical fee dispute hearing, evidence of usual and customary fees may
include charges customarily billed by the provider for the same services rendered
to others and comparable volume-based discount contracts of the health care
provider. The act removes references to the Board of Rehabilitation for the
purposes of regulating fees and charges. A Senate Committee Substitute was
adopted, and the bill was voted out of the Senate Small Business Committee “do
pass” on Wednesday, March 15th. The House version of this bill, HB 1763 –
sponsored by Rep. Yates (R – Jackson County), was also voted out of committee
this week.

SB 1084 – sponsored by Sen. Gibbons (R – St. Louis County) extends the sunset
date for the Healthcare for Uninsured Children Program from July 1, 2007 to June
30, 2008. This date corresponds to the sunset date for the state Medicaid
program. This bill was voted “do pass” as a consent bill by the Senate Pensions
Committee this week. It is now on the Senate Calendar awaiting debate by the full
Senate.

SB 1103 – sponsored by Sen. Goodman (R – Mt. Vernon) requires insurers to
provide notice of coinsurance or other cost sharing features in the evidence of
coverage they issue to enrollees. This bill was heard in the Senate Small
Business Committee on Wednesday, March 15th. Testifying in favor of the bill
were Blue Cross / Blue Shield of Missouri, Blue Cross / Blue Shield of Kansas
City, the Missouri Independent Insurance Agents, the Missouri Insurance
Coalition, the Missouri Chamber of Commerce, Coventry Health Care, America’s
Health Insurance Plans, the Kansas City Chamber of Commerce and the
Associated Industries of Missouri. Testifying in opposition was United HealthCare
of the Midwest, who stated that that it was unfair for HMO’s to offer this insurance
product under HMO regulations and not have to pay the 2% premium tax. No
further action was taken on the bill.
SB 1124 – sponsored by Sen. Shields (R – St. Joseph) changes licensing
standards for physical therapist assistants, professional counselors, and clinical
social workers. This bill was heard in the Senate Financial, Governmental
Organizations and Elections Committee on Monday, March 13th. Testifying in
support of the bill was the Division of Professional Registration. No opposition
testimony was given and the bill was voted out “do pass” consent. The bill is now
on the Senate Consent Calendar awaiting debate by the full Senate.

SB 1155 – sponsored by Sen. Stouffer (R – Napton) modifies provisions on the
technical advisory committee on the quality of patient care and nursing practices.
This bill was heard in the Senate Aging, Families, Mental and Public Health
Committee on Wednesday, March 15th. Testifying in support of the bill were the
Missouri Nurses Association and the Missouri Hospital Association. No opposition
testimony was given. In an Executive Session that followed the hearing, the bill
was voted out “do pass” consent.

HCS / HB 1697 – sponsored by Rep. Brown (D – Kansas City) authorizes a tax
credit for employers who hire qualified high school students for summer jobs. This
bill was voted out “do pass” from the House Job Creation and Economic
Development Committee on Wednesday, March 15th during an Executive Session.

HB 1619 – sponsored by Rep. Sutherland (R – Warrenton) changes the annual
franchise tax rates and income threshold amounts for corporations beginning with
the tax year 2007. By tax year 2011, the tax rate will be zero. This bill is on the
House Perfection Calendar awaiting debate by the full House.

HB 1827 – sponsored by Rep. Wasson (R – Nixa) changes the authorized
categories of business and premium requirements on health insurance policies
issued to an association of small and large employers. This bill is on the House
Perfection Calendar awaiting debate by the full House.

HB 1870 – sponsored by Rep. Kratky (D – St. Louis) authorizes a tax credit for
hiring disabled workers. This bill was heard in the House Job Creation and
Economic Development Committee on Wednesday, March 15th. Testifying in
support of the bill were the Division of Vocational Rehabilitation, the Missouri
Rehabilitation Center, and Kevin Rainwater on behalf of the Missouri Association
of Rehabilitation Facilities. No opposition testimony was presented. The
committee attempted to vote on the bill during Executive Session but, due to the
lack of time and the considerable amount of questions regarding whether or not
the tax credit is only applicable to new or existing hires, no further action was
taken.

SB 735 – sponsored by Sen. Crowell (R – Cape Girardeau) modifies procedures
for filing documents with the Labor and Industrial Relations Commissions. This bill
was taken up from the Senate Consent Calendar on Monday, March 13th and was
third read and finally passed. It now moves to the House of Representatives for a
committee assignment.
SB 779 – sponsored by Sen. Engler (R – Farmington) modifies requirements for
labor posters. This bill was taken up from the Senate Consent Calendar on
Monday, March 13th by the full Senate and was third read and finally passed. It
now moves to the House of Representatives for a committee assignment.

SB 875 – sponsored by Sen. Barnitz (D – Lake Springs) is referred to as the Red
Tape Reduction Act. This bill was heard in the Senate Judiciary Committee on
Monday, March 13th. The bill was brought forward by the Secretary of State’s
Office and is intended to improve efficiency and the speed of government
regulations. The bill specifically allows businesses the option of filing biennial
reports; allows the Secretary of State to create an expedited service option for
filings; and reduces fees for online LLC filings. Ms. Carol Fischer, representing the
Secretary of State’s Office, testified in favor of the bill as did an attorney who
represents small business persons, a small business person, the St. Louis RCGA,
and the Missouri Chamber of Commerce.

SB 1010 – sponsored by Sen. Wheeler (D – Kansas City) also is part of the
Secretary of State’s legislative package. This bill was heard in the Senate
Judiciary Committee on Monday, March 13th. This act defines responsible
persons for limited liability companies for the purposes of withholding and paying
taxes. Under the act, members of a limited liability company shall not be liable for
taxes solely based on such member's membership in the company unless that
member is a responsible person. The act repeals language requiring duplicate
filings for corporations and partnerships for articles of acceptance, resignation of
registered agents, articles of merger, and changes of address for agents and
registered offices. Ms. Carol Fischer also testified in favor of this bill as did the
Missouri Chamber of Commerce.

				
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