Prescription Drug Monitoring, Tort Reform, Insurance, Scope of Practice... the List Goes On
Missouri’s 99th General Assembly will reconvene on January 3, 2018, to begin their second session of legislative work. They will work until May 18, 2018, when the state constitution mandates their adjournment. In between those dates, your MSMA lobbyists will be advancing a pro-physician agenda, while simultaneously heading off attempts to interfere with your profession. Following is a list of some of the issues we anticipate dealing with during the first five months of the new year.
Prescription Drug Monitoring Program
Last year’s effort to establish a statewide Prescription Drug Monitoring Program (PDMP) died in the last days of session when some legislators disapproved of supplanting the St. Louis County PDMP with a lesser state-run version. Since the end of the 2017 session, the St. Louis County program has only strengthened as counties and municipalities have become frustrated at the lack of a comprehensive state PDMP. At the time of this writing, 49 cities and counties have joined the St. Louis County program. This local PDMP now covers almost 80% of the state’s patients and 90% of its prescribers. In July, the Governor issued an executive order that allows that Department of Health and Senior Services to data mine prescription information from Express Scripts in a curious effort to identify over-prescribers. This new government surveillance program has not yet been launched due to push back by the General Assembly. We anticipate the introduction of a comprehensive statewide PDMP bill this year. We will oppose efforts to mandate physician utilization of the PDMP. As things progress, we may come to realize the best way to implement a statewide PDMP is to allow the state to assume the St. Louis County program, thereby giving the state an operational head start.
Tort Reform
The state’s tort reform coalition (of which, MSMA is a member) had a very impressive 2017. Among other tort issues the coalition managed to pass were physician friendly changes to the collateral source rule and expert witness standards. We foresee fewer tort issues this year that would have a direct impact on physicians, but we will continue to pursue some of the coalition’s objectives, including an overhaul of the state’s venue laws. In addition, there are two cases pending before the state Supreme Court which ask the court to either significantly weaken or declare unconstitutional the state’s affidavit of merit law. We will keep a close eye on the Court’s eventual decisions, as well as continue to monitor efforts to assail the noneconomic damages cap in medical malpractice cases.
Insurance
It appears that much of our time during the upcoming session will be dedicated to fighting a growing number of disastrous policies unilaterally implemented by insurance companies in the past year. The most well-documented of these issues is Anthem’s new policy in which they retroactively deny payment for certain emergency room services. We will be introducing legislation to ensure that whether or not the prudent layperson standard is met is ultimately determined by the patient’s symptoms, not the insurance company. We will attempt to limit insurer’s ability to unilaterally amend contracts, especially those which opt physicians into new networks. Redefining “clinical peer,” as it relates to adverse determination appeals, to ensure that they are actively practicing and board certified will be on our agenda. We will also take a close look at changing payment recoupment practices, banning claims payment by virtual credit cards, and some anti-retaliation provisions. It appears that we will have a close working relationship with our insurance industry counterparts this coming spring.
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APRNs
For a number of years we have battled the advance practice registered nurses over their scope of practice and their attempts to desecrate the collaborative practice act. We are anticipating that their advocates will once again introduce legislation to remove collaborative practice and the necessary patient protections that accompany it. Last year, we agreed to make some of the changes the APRNs had pursued for years. Once we had done so, they demanded even more, and their efforts eventually died. We may see a repeat of that compromise language in 2018. In addition, we will likely seek to allow a stand alone APRN license for those accomplished nurses under the authority of the Board of Registration for the Healing Arts. That board already oversees licensure for assistant physicians and PAs, two groups with nearly identical scopes of practice as APRNs. They will likely oppose this effort, but we think it commonsense, and will perhaps open further avenues for compromise in the future.
Tanning Bed Prohibition
Forty-four states have some type of restriction on indoor tanning use by minors. In 2014, MSMA was instrumental in passing a law that required parental consent for minors who utilize tanning beds. Frequent exposure to ultraviolet rays by young people greatly increases their risk of developing melanoma. This year, we will make an effort to completely ban the use of tanning beds by people under 17 years of age. If successful, Missouri will join 16 other states in this prohibition. MSMA will be part of a large coalition of organizations that will lead this effort, including the cancer society, dermatology associations, and children’s hospitals.
Fund Sweep
From time to time, the General Assembly finds itself in a financial pinch so seemingly dire that they try to sweep the professional licensure fees collected by the Board of Registration for the Healing Arts. That was case last year when the legislature sought additional funds to close a gap in expected in-home care funding. With a week remaining in the 2017 session, we found ourselves protecting the Board’s funds. The Board of Healing Arts receives no public funding; its operating expenses are borne entirely from fees. Therefore, any skimming of those funds for other state purposes would, in effect, be a tax on physicians. We will watch for this financial sleight-of-hand as the session progresses.
Grab Bag
As is the case every legislative session, we are sure to contend with some issues we dealt with last year that failed to cross the finish line. Expect to see us contend with the annual effort to repeal the motorcycle helmet law. It is highly likely we will lock horns at some point with the chiropractors, athletic trainers, radiology technicians, physical therapists, and maybe the professional counselors as well. We will keep a watchful eye on the activities of the statewide MO HealthNet managed care companies, and fight for increased physician reimbursement and funding for public health initiatives. It’s bound to be another busy year for organized medicine.
If you wish, there are a number of things you can do to assist us in these endeavors. First, please consider volunteering as the MSMA Physician of the Day in the Capitol. This rewarding program gives participants insight into MSMA’s physician advocacy, and can initiate or further a relationship between MSMA members and their legislators. Plus…it’s a lot of fun. You can find available dates on the MSMA Advocacy webpage. Second, keep in mind that 2018 is an election year. Get to know who is running in your area. See if they’re friendly to our efforts, and share that information with us. This data is incredibly helpful to the Missouri Medical PAC as election day draws near. Speaking of the PAC, there’s no better way for you to support candidates that support organized medicine than through a PAC donation. Please consider giving. Finally, as a member, don’t hesitate to reach out to the MSMA lobbyists when you have a question or concern. Advocacy on your and your patients behalf is one of your many MSMA member benefits.
Follow our adventures during the 2018 legislative session in MSMA’s weekly Legislative Report. The first edition will head out the door on January 4, 2018, and members will continue receiving it each Thursday throughout session.
Biography
Jeff Howell, JD, is MSMA’s General Counsel and Director of Governmental Relations.
Contact: jhowell@msma.org
