Missouri Senate

Senate Substitute

MINIMUM HEALTH PROMOTION STANDARD FOR STATE BUILDINGS

This act requires the Office of Administration, in consultation with the Department of Health and Senior Services to submit a report to the Governor and General Assembly by December 31 2008, detailing the opportunities for the state to implement a minimum health promotion standard for construction or substantial renovation of a state building. The report on minimum health standards shall also include estimates of any additional costs or savings from incorporating new architectural features. The health promotion standards to be developed in the report shall consist of architectural features designed to promote and encourage a healthier workplace and environment for those working and using the resources in a state building. SECTION 8.365

HEALTH CABINET AND HEALTH POLICY COUNCIL

This act creates the Missouri Health Cabinet. The cabinet shall ensure that the public policy of the state relating to health is developed to promote interdepartmental collaboration and program implementation in order that services designed for health are planned, managed, and delivered in a holistic and integrated manner to improve the health of Missourians.

The cabinet is created in the executive office of the Governor and shall meet for its first organizational session no later than October 1, 2008. Thereafter the cabinet shall meet at least six times each year, with two of the meetings in different regions of the state in order to solicit input from the public. The cabinet shall consist of six members, including the Governor, the director of the Departments of Health and Senior Services, mental health, insurance, financial institutions and professional registration and the commissioner of education. The president pro tem of the Senate, the Speaker of the House, the chief justice of the Supreme Court, the Attorney General, and the Commissioner of the Office of Administration, and the director of Agriculture, or their appointed designees shall serve as ex officio members of the cabinet.

The Governor shall appoint a Health Policy Council to assist the cabinet in its tasks. Beginning August 28, 2008, the chairs of the MO HealthNet Oversight Committee and the Comprehensive Entry-Point System Subcommittee, shall be members on the Health Policy Council. The council shall replace the State Boards of Health and Senior Services, which are repealed under the act. The members of the council shall consist of representatives from the health care or health policy field. SECTIONS 26.850 TO 26.856

REPORT ON SHIFTING DEMOGRAPHICS

The Lieutenant Governor, in his or her capacity as the senior advocate for the state, shall coordinate with all the directors of the departments in this state to review their major policies, programs, and structures in light of the state's increasingly older and more diverse population. A policy brief shall be submitted to the Governor and General Assembly by July 1, 2009, and shall highlight critical functions or issue areas that would be affected by shifting demographics and how such issues should be addressed within the next ten years. SECTION 26.900

CAFETERIA PLAN FOR INSURANCE PREMIUMS

This act allows the Commissioner of Administration to deduct cafeteria plan administrative fees and any amount necessary for the participation in the cafeteria plan from the employee's compensation warrant, unless the employee affirmatively elects not to participate in the plan. Vendors are allowed to solicit the selection of products currently allowed to be included in cafeteria plans, on site in state facilities. SECTION 33.103

This provision is similar to SCS/SB 1015 (2008) and HB 1535 (2008).

PREVENTIVE SERVICES

Beginning January 1, 2010, the Missouri consolidated health care plan shall include, as part of its covered benefits, all of the preventive benefits recommended by the federal U.S. Preventive Services Task Force. SECTION 103.185

TAX CREDITS AND DEDUCTIONS

This act increases the amount of tax credits available for taxpayers who modify their home to be accessible for seniors or disabled people who reside with such taxpayer. Under current law, up to one hundred thousand dollars in tax credits remaining unused under the rebuilding communities tax credit program are allocated for use by taxpayers who modify their homes for disabled persons residing with such taxpayers. This act increases the amount of available tax credits by allocating all unused tax credits under the rebuilding communities tax credit program for use by taxpayers who modify their homes for seniors or disabled persons residing with such taxpayers. The rebuilding communities tax credit program is capped at ten million dollars annually. Constructing additional rooms in the dwelling or a new structure on the property for the purpose of accommodating the senior or disabled person is added as a new eligible cost for which the tax credit may be claimed. SECTIONS 135.535 AND 135.562

This provision is substantially similar to SB 717 (2008).

This act provides an income tax deduction in the amount equal to 100% of the premium paid by the taxpayer during the taxable year for high deductible health plans established and used with a health savings account under the applicable provisions of the Internal Revenue Code to the extent the amount is not deducted on the taxpayer's federal income tax return for that taxable year. SECTION 143.116

LOCAL COMMUNITY HEALTH COALITIONS

The Department of Social Services shall administer a grant in the amount of 350,000 dollars to a local government entity or local health department to be used for the establishment of a study to assess the feasibility of pilot projects in the greater St. Charles and southeast bootheel areas of the state. Any grant awarded shall be matched in equal value by the grant recipient. The pilot projects shall have the involvement of the local community health coalition to establish new approaches to expand coverage for the uninsured population in the respective communities and to create healthier populations through a single comprehensive health care plan. The program shall be administered by the Department of Health and Senior Services and shall have a six-year sunset. SECTION 191.845

TRANSPARENCY OF HEALTH CARE SERVICES

This act establishes guidelines for transparency in pricing and quality of health care services. Criteria is established for insurers to use in programs that publicly assess and compare the quality and cost efficiency of health care providers. A provider cannot decline to enter into a provider contract with an insurer solely because the insurer uses quality and cost efficiency of health care data programs.

A person who sells or distributes health care quality and cost efficiency data in a comparative format to the public is required to identify the source used to confirm the validity of the data and its analysis as an objective indicator of health care quality. This provision does not apply to articles or research studies that are published in peer-reviewed academic journals, nonprofit community-based organizations, or by state or local governments. The Department of Health and Senior Services is required to investigate complaints of alleged violations and is authorized to impose a penalty of up to $1,000. Alleged violations by health insurers will be investigated and enforced by the Department of Insurance, Financial Institutions, and Professional Registration. SECTIONS 191.1005 to 191.1010

These provisions are similar to certain provisions in HCS/HBs 2413, 2355 & 2398 (2008).

MISSOURI HEALTHY WORKPLACE RECOGNITION PROGRAM

This act requires the Department of Health and Senior Services to develop the Missouri Healthy Workplace Recognition Program for the purpose of granting official state recognition to employers with more than fifty employees for excellence in promoting health, wellness, and prevention. The criteria for awarding such recognition shall include at a minimum whether the employer offers workplace wellness programs; incentives for healthier lifestyles; opportunities for active community involvement and exercise, and encouragement of well visits with health care providers. SECTION 191.1025

INTERNET WEB-BASED PRIMARY CARE ACCESS PILOT PROJECT

This act requires the general assembly to appropriate 400,000 dollars from the health care technology fund to the department of social services to award a grant to implement an internet web-based primary care access pilot project designed as a collaboration between private and public sectors to connect, where appropriate, a patient with a primary care medical home, and schedule patients into available community-based appointments as an alternative to non-emergency use of the hospital emergency room as consistent with federal law and regulations. The criteria for the grant are specified in the act. SECTION 191.1200

TELEHEALTH

This act expresses the state's recognition of the delivery of health care via telehealth as a safe, practical and necessary practice in the state. By January 1, 2009, the Department of Health and Senior Services shall promulgate quality control rules to be used in removing and improving the service of telehealth practitioners. SECTIONS 191.1250 to 191.1277

COMMUNITY AND FAITH-BASED ORGANIZATIONS

This act requires the Office of Minority Health to solicit proposals from such community programs and organizations to develop solutions regarding health and wellness. SECTION 192.083

MISSOURI FREE CLINICS FUND

This act creates the "Missouri Free Clinics Fund" to be administered by the Department of Social Services for use by clinics in the Missouri free clinics association to increase their infrastructure and bolster their sustainability in order to serve a greater number of people in a more effective manner. For a one-time funding appropriation of 500,000 dollars from the General Assembly, the Department shall disburse funds to the association, to be equitably and evenly distributed to all free clinics in this state, in accordance with applicable guidelines, policies, and requirements established by the department. SECTION 192.990

TOBACCO USE PREVENTION, AND CESSATION FUND

This act creates the tobacco use prevention and cessation fund. Beginning fiscal year 2009, payments received from the strategic contribution fund will be deposited into the newly created fund to be used to fund tobacco prevention and cessation programs. SECTION 196.1200

This provision is substantially similar to SCS/SB 946 (2008).

ADVERSE HEALTH EVENTS

This act requires hospitals to report whenever they have a "serious reportable event in health care," as identified by the National Quality Forum. Such events include wrong-site surgery, retention of a foreign object in a patient after surgery, and death or serious disability associated with medication error.

The initial report of the event shall be reported to the patient safety organization no later than the close of business on the next business day following discovery of the incident. The initial report shall include a description of immediate actions taken by the hospital to minimize the risk of harm to patients and prevent reoccurrence. Within 45 days after the event occurred, the hospital shall submit to the patient safety organization a root cause analysis and a prevention plan.

The patient safety organization shall publish an annual report to the public on reportable incidents. The report shall show the number and rate per patient encounter by region and by category of reportable incident and may identify reportable incidents by type of facility.

Beginning July 1, 2010, any hospital that reports a reportable incident shall not charge for or bill any entity for all services related to the reportable incident. SECTIONS 197.551 TO 197.590

These provisions are substantially similar to SCS/SB 916 (2008).

MO HEALTHNET

Current law as to MO HealthNet eligibility was modified to reflect changes for custodial parents under 100 percent of the federal poverty level and how subject to appropriation certain earned income shall be disregarded for these participants. Individuals eligible due to the disregard provision who are at least 19 years of age and less than 65 years of age shall receive health care coverage under the Insure Missouri plan, unless they are dual Medicare and Medicaid eligible or pregnant. SECTION 208.145

The Professional Services Payment Committee shall be required to review and make recommendations to the MO HealthNet Division regarding standards and policies for denying payment to a health care provider for treatment costs associated with preventable errors. SECTION 208.149

Prescribed medically necessary therapy services, including physical, occupational, and speech therapy, shall be covered under the Mo HealthNet program. SECTION 208.152.

This act requires third party payers to honor MO HealthNet subrogation claims for up three years from the date of service and grants the MO HealthNet Division authority to collect from third party payers through subrogation of claims. SECTION 208.215

This act also establishes the Insure Missouri program to be administered by the Department of Social Services to provide health care coverage. The department shall be required to apply to the United States Department of Health and Human Services for a waiver and/or a state plan amendment to implement the program. SECTIONS 208. 1300 to 208.1345

HEALTH INSURANCE

The Department of Insurance, Financial Institutions and Professional Registration shall administer a grant program to assist the start-up of non-profit broker organizations. Eligible participants shall apply to the department for a grant, using a competitive application process prescribed by the department. The department shall award one grant not to exceed twenty-five thousand dollars. The department shall establish eligibility and give preference to applicants who demonstrate the ability to enhance representation of low-cost health insurance coverage models in the market. This program shall expire in 6 years unless re-authorized by the General Assembly. SECTION 376.025

Under this act, health carriers are allowed to include wellness and health promotion programs, condition or disease management programs, health risk appraisals programs, and similar provisions in high deductible health plans or policies that comport with federal requirements, provided that such wellness and health promotion programs are approved by the department of insurance, financial institutions and professional registration. SECTION 376.685

This act modifies the provisions of Missouri's high risk pool to provide that the twelve-month preexisting condition exclusion period shall not apply for coverage if the person applying for pool coverage has at least three months of uninterrupted prior insurance coverage, so long as the application for pool coverage is made not later than sixty-three days following the loss of such health insurance coverage. SECTION 376.986

Under this act, the director of Insurance, Financial Institutions and Professional Registration is authorized to allow health reimbursement arrangement only plans that encourage employer financial support of health insurance or health related expenses recognized under the rules of the Internal Revenue Service to be approved for sale in connection with or packaged with individual health insurance policies otherwise approved by the director. SECTION 376.1600

The director shall study and recommend to the General Assembly changes to remove any unnecessary application and marketing barriers that limit the entry of new health insurance products into the Missouri market. The director shall examine state statutory and regulatory requirements along with market conditions which create barriers for the entry of new health insurance products and health insurance companies. The director shall also examine proposals adopted in other states that streamline the regulatory environment to make it easier for health insurance companies to market new and existing products. The director shall submit a report of his or her findings and recommendations to each member of the General Assembly no later than January 1, 2009. SECTION 376.1618.

ADRIANE CROUSE