KYNA IMAN, LLC 124 East High Street P.O. Box 1483 Jefferson City, MO fax

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1 KYNA IMAN, LLC 124 East High Street P.O. Box 1483 Jefferson City, MO fax TO: MISSOURI NURSES ASSOCIATION FROM: Kyna Iman DATE: May 16, 2015 RE: End of Session Report The 2015 Missouri General Assembly ended its five-month session on Friday, May 15. The session was marked by scandal, tragedy and, in the end, several changes were made to the state s laws. On the final day, lawmakers passed a measure preserving more than $3.5 billion for Medicaid. Republican House Speaker John Diehl resigned on Friday, after admitting to an improper relationship with a state Capitol intern. Representative Todd Richardson, R-Poplar Bluff, was sworn in as the new House Speaker on Friday morning for the last day. In February, Missouri Auditor Tom Schweich took his own life, and a month later, Schweich s longtime spokesman further shook the state s political community by also committing suicide. Typically, the final day in Jefferson City is marked by frantic negotiations and lastminute deals for final passage of legislation. However, Diehl s stunning departure, coupled with Democratic anger over Republican parliamentary tactics in the Senate, ground most legislative work to a halt. Senators adjourned three hours before the 6:00 p.m. deadline. The House closed business at 5:50 p.m. Here are the bills MONA worked hard on that passed and stalled during the 2015 session. PASSED: SCHEDULE II HYDROCODONE PRESCRIPTIVE AUTHORITY: This act allows certain advanced practice registered nurses, physician assistants, and assistant physicians to prescribe Schedule II - hydrocodone. Hydrocodone prescriptions are limited to a one five day supply without refill.

2 Senator Wayne Wallingford and Representative Craig Redmon originally filed legislation on behalf of MONA to allow ALL Schedule II s to be prescribed by APRN s. However, opposition kept us from passing prescriptive authority for all schedule II medications. MONA will continue to make this a main priority for passage. (HB709) DEATH CERTIFICATE PROCEDURE: Lawmakers passed this act that adds advanced practice registered nurses, assistant physicians, and physician assistants to specified phases of the death certification process, including data provision, certification of death, and authorization for the final disposition of the decedent's body. (SB618) OPINIONS ISSUED BY BOARDS UNDER THE DIVISION OF PROFESSIONAL REGISTRATION: Originally this bill was filed to allow the healthcare professional boards to provide opinions on any healthcare profession. MONA had this amended to allow a board or commission to only address topics relating to the qualifications, functions, or duties of the profession they license or regulate. This act provides that certain professional boards and commissions, as specified in the act, which license professions may issue oral or written opinions addressing topics relating to the qualifications, functions, or duties of any profession licensed by such board or commission. The opinions are for educational purposes, are not binding on the licensee, and cannot be used as the basis for discipline against a licensee. (HB709 and SB107) BUDGET: Lawmakers passed a $26 billion state budget, which Nixon has already signed. It included an additional $12 million for higher education institutions, and $300 million in bonding for maintenance and repair projects at colleges and other state-owned buildings, including the Capitol. The State Hospital in Fulton was on approved on the list of projects from last year. The budget also expands Medicaid managed care to 200,000 parents and children, continuing to exempt the elderly and disabled. There is also $499,752 appropriated for the nurse loan program. MALPRACTICE LAW: Lawmakers passed and Nixon signed a bill capping noneconomic damages in medical malpractice cases at $400,000. Catastrophic malpractice injuries, and those that result in death, are capped at $700,000. (SB239) EATING DISORDER COVERAGE: Senator David Pearce passed this act that requires health benefit plans delivered, issued for delivery, continued or renewed on or after January 1, 2017, in accordance with current law requirements for coverage of mental health disorders, to provide coverage for the diagnosis and treatment of eating disorders. The act further requires that the provided coverage include a broad array of specialist services as proscribed as necessary by the patient's treatment team. Coverage under this act is limited to medically necessary treatment and the treatment plan must include all elements necessary for a health benefit plan to pay claims. Under the act medical necessity determinations and care management for the treatment of eating disorders shall consider the overall medical and mental health needs of the individual with the eating disorder and shall not be based solely on weight. Coverage may be subject

3 to other general exclusions and limitations of the contract or benefit plan not in conflict with the act. (SB145) MENTAL HEALTH LIAISON RECORDS: This act requires specified residential facilities, mental health programs, and mental health facilities to disclose information and confidential records to Department of Mental Health-designated community mental health liaisons for the purpose of care and service coordination. Additionally, confidential records and files maintained by any court in civil commitment proceedings shall be made available to community mental health liaisons. The court may impose appropriate restrictions or require a showing of good cause before releasing such records. (SB426) FAILED PASSAGE: COLLABORATIVE PRACTICE ARRANGEMENTS: Rep. Burlison and Senator Wasson filed bills to address CPA s mainly at Retail Clinics such as Walgreens and CVS Pharmacy. The sponsors worked closely with MONA and AANP on the wording. The act states that when a physician reviews pursuant to a collaborative practice arrangement an advanced practice registered nurse's delivery of health care services, which includes chart review, the collaborating physician need not be present at the health care practitioner's site. Current law provides that an advanced practice registered nurse shall practice with the collaborating physician continuously present for one-month before practicing in a setting where the collaborating physician is not continuously present. This act states that this requirement does not apply to collaborative arrangements between a physician and an advanced practice registered nurse if the collaborative physician is new to a patient population to which the collaborating advanced practice registered nurse, assistant physician, or assistant physician is already familiar. HEALTHCARE PROFESSIONALS WORKFORCE DATA: One of the State Board of Nursing s priority pieces of legislation failed to make passage. This act provides that the State Board of Nursing, Board of Pharmacy, Missouri Dental Board, State Committee of Psychologists, and State Board of Registration for the Healing Arts may enter into contractual agreements with the Department of Health and Senior Services, public institutions of higher education, and nonprofit entities in order to collect and analyze workforce data from its licensees for the purpose of future workforce planning and to assess the accessibility and availability of qualified health care services and practitioners in Missouri. MONA supported to show where healthcare provider shortages are in our state.and how nurses are filling those gaps. CRITERIA FOR REGULATING PREVIOUSLY UNREGULATED PROFESSIONS AND OCCUPATIONS: This act provides that the state shall not impose a substantial burden on an individual's pursuit of his or her occupation or profession unless there is an compelling interest for the state to protect the general welfare. If a compelling interest does exist, then the regulation adopted shall be

4 substantially related to the public interest to be protected. This was Rep. Burlison s language that MONA watched. It may have an affect on pursuing a separate license for APRN s. PERINATAL ADVISORY COUNCIL: This bill was brought forward by March of Dimes and MONA monitored it throughout the session. This act establishes the Perinatal Advisory Council, which shall be comprised of representatives from specified community and health organizations and professions. After receiving public input, the Council shall make recommendations for the division of the state into neonatal and maternal care regions. The Council shall establish criteria for levels of birthing center care and base its levels of care designations upon evidence and best practices as identified by the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists. By January 1, 2017, and every year thereafter, hospital license applications shall include the appropriate level of maternal care and neonatal care designations as determined by the Council. By the same date, any hospital operated by a state university shall report to the Department of Health and Senior Services, upon the Department's request, the appropriate level of maternal care designation and neonatal care designation. The Department may partner with appropriate nationally recognized nonprofit organizations with relevant expertise to administer the provisions of this act. MEDICATION SYNCHRONIZATION: This act requires health carriers or managed care plans offering health benefit plans that provide prescription drug coverage to offer medication synchronization services that allows for the alignment of refill dates for an enrollee's prescription drugs that are covered benefits. The health carrier or managed care plan shall not charge an amount in excess of the otherwise applicable co-payment amount under the health benefit plan and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met. Senator Sater and Rep. Lynne Morris were pushing passage of this. TELEHEALTH SERVICES: This act specifies the licensed individuals who shall be considered eligible health care providers for the provision of telehealth services. Additionally, this act specifies the originating sites where a MO HealthNet participant may receive telehealth services, as well as requiring that such originating sites ensure the immediate availability of clinical staff during the telehealth encounter if a participant requires assistance. This act establishes a statewide home telemonitoring program. Home telemonitoring services are health care services that require scheduled remote monitoring of data related to a patient's health. The act specifies the individuals for whom home telemonitoring services may be made available. Additionally, no originating site for home telemonitoring shall be required to maintain immediate availability of on-site clinical staff during the telemonitoring service. If the Department of Social Services determines that home telemonitoring is not cost effective, the Department may discontinue the program and stop providing reimbursement through MO HealthNet for such services.

5 This act addresses the use of asynchronous store-and-forward technology in the practice of telehealth services for MO HealthNet recipients. "Asynchronous store-and-forward" is defined in the act as the transfer of a patient's clinically important digital samples, such as still images, videos, audio, and text files, and relevant data from an originating site through the use of a camera or similar recording device that stores digital samples that are forwarded via telecommunication to a distant site for consultation by a consulting provider without requiring the simultaneous presence of the patient and the patient's treating provider. The Department of Social Services, in consultation with the departments of Mental Health and Health and Senior Services, shall promulgate rules governing the use of asynchronous store-and-forward technology in the practice of telehealth in MO HealthNet. The act also specifies reimbursement for asynchronous store-and-forward services for the treating provider and the consulting provider. This act establishes the "Telehealth Services Advisory Committee" to advise the Department of Social Services and propose rules relating to telehealth services through asynchronous store-and-forward technology. The act specifies the committee members, appointments, and other terms. MONA was successful in changing Rep. Frederick s changes to only allow primary care physicians on the Advisory Committee, to allow all primary care providers. However, the bill still failed passage. This was a priority for Missouri Association of Rural Health Clinics. CRIME VICTIM COMPENSATION FUND: This bill authorizes a board certified psychiatric-mental health clinical nurse specialist and board certified psychiatric-mental health clinical nurse practitioner to be eligible for reimbursement by crime victim compensation when providing crisis counseling. This bill was sponsored by Rep. Jeanne Kirkton and was slated for passage until the early shut down of the Senate caused the amendment to be stripped from SB141. PHYSICAL THERAPISTS: The act adds physical therapists to the list of authorized health care practitioners who may sign statements necessary for a person to receive a windshield placard or special plates for a temporary or permanent physical disability. Rep. Sue Allen amended this bill on every healthcare bill, but it still failed final passage. PHYSICIAN LICENSURE: The act provides that an applicant for licensure as a physician or a surgeon who does not achieve a passing score within three attempts on a licensing exam administered in one or more states may petition the State Board of Registration for the Healing Arts for an exception to such requirement based upon unusual or extenuating circumstances. Likewise, an applicant who does not pass a step of the United States Medical Licensing Examination within three attempts or does not pass all three steps within a seven year period may also petition the Board for an exception. The act states that applicants must provide proof of successful completion of the USMLE or an exam administered by the National Board of Osteopathic Medical Examiners, rather than just proof of completion. Rep. Keith Frederick tried to pass this but it failed.

6 MAINTENANCE OF PHYSICIAN LICENSURE: The act provides that the state shall not require maintenance of licensure, as defined in the act, as a condition of physician licensure or any form of specialty medical board certification to practice medicine within the state. The State Board of Registration for the Healing Arts or any other state agency shall not discriminate against physicians who do not maintain specialty medical board certification. Rep. Andrew Koenig sponsored this legislation for a friend. MONA will further review this and may oppose next session if it is reintroduced. Thank you so much for the opportunity to represent the Missouri Nurses Association during the 2015 legislative session. Please let me know if you have any questions at kynaiman@earthlink.net