MHPCA Legislative Update 1.20.17
Jane Moore
EXPENDITURE RESTRICTIONS PART DEUX
On Monday Governor Greitens announced the an expected additional round of budgetary withholds. This comes just a week after he has taken office. Higher education institutions around the state bore the brunt of the cuts, $55 million from the four-year institutions and $11.8 million from community colleges. Other programs that took hits were transportation for K-12 education, the state’s biodiesel incentives fund, core cuts to the state’s various humanities and cultural partners and Missouri’s tourism advertising budget.
This round of withholds totaled $146 million, this is in addition to the $200 million already in withholding from actions former Governor Nixon took earlier in the fiscal year. During his announcement video seen here, Governor Greitens said he will need to reduce spending by $700 million over the next 18 months. During a breakfast I attended with the House Budget Chairman’s Chief of Staff Chris Dunn, he said that the Governor most likely arrived at that number by carrying over current withholds, projecting out the state not making the over $70 million transfer to the facilities maintenance fund this fiscal year or next, and very possibly further withholds.
There are some key drivers to how Missouri has found itself in this budget crunch. First is that the state was ended the last fiscal year with $100 million less in carry over than expected, this put us in the hole right off the bat. Furthermore, former Governor Nixon then chose to repay the rainy day fund a month earlier than required last year, which then would later put the state into a further cash flow pinch. Currently, the state has borrowed $450 million from the state’s rainy day fund this fiscal year, which must be paid back in full by May 15th. Then there are pieces of legislation that are having a drag on revenues. One that has been mentioned over and over is SB 19 which allows for corporations to apportion their taxes across several states. This was first estimated to have a fiscal note of $15 million, but now it is estimated to have a negative $200 million impact on revenue collections. While this downturn in revenue may seem as severe as during the financial crisis of FY 10, & FY 11, this time around there is not an influx of federal dollars propping up our revenues.
COMMITTEE HEARINGS OF INTEREST
House Appropriations for Health, Mental Health and Social Services
On Tuesday Representative David Wood’s House Appropriations for Health, Mental Health and Social Services kicked off their season by holding an introductory hearing, going around to the members of the committee hearing from members about their priorities. House Appropriations staff analysts Julie and Glenn gave very brief, high level overviews of HBs 10 & 11.
The committee heard testimony from the Department of Mental Health and public testimony on the department on Wednesday. Director of Mental Health Mark Stringer gave a walk through of the larger programs within the department. They heard from Missouri Kids First, the Missouri Association of Rehabilitation Facilities and the Brain Injury Trust.
Senate-Government Reform
Senator Rowden’s SB 237 that modified various definitions of employee and physician employee in actions against health care providers for personal injury or death. The Senator began that this is a common sense piece of reform. This was originally passed in 2005 stating that healthcare providers can not be held responsible for someone that was not employed by them, in 2014 they replaced this with a broader bill that basically undid the original bill. This legislation is just making sure that the law and liability line up and does not stop anyone from being made whole. The Missouri Hospital Association, BJC, Cox, Missouri Chamber of Commerce, SSM and the Missouri State Medical Association testified in support. The Missouri Association of Trial Attorneys testified in opposition.
House Health Care Policy Committee
Representative Keith Frederick’s committee heard three bills on Wednesday, just following the perfection of Right-to-Work on the House floor , so their window for their hearing was slightly abbreviated this week. They heard Rep. Becky Ruth’s HB 66 which expands newborn screening requirements to include Hunter syndrome. There were several personal stories in support of the legislation and none in opposition. HB 544 sponsored by Rep. Jay Barnes which would allow for additional reimbursement under MO HealthNet for physicians who operate outside normal business hours heard testimony. The sponsor did acknowledge the almost $3 million fiscal note to the bill, but said that it should be less since there would be less ER utilization if people could access their primary care physicians outside normal business hours. The Missouri State Medical Association and the osteopaths testified in support. There was no opposition.
Senate Health and Pensions
Senator Schaaf’s Senate Health and Pensions Committee met on Wednesday to hear three different bills. The first up was Senator Hegeman’s SB 62 which would require employees to begin to contribute 2% into the College and University Retirement Plan. Senator Hegeman
said that in order for the plan to remain solvent, this change would be needed. Missouri Western University testified in support of the legislation along with the Council of Public Higher Education, Missouri National Education Association. TIA Craft the fund
manager for the program also testified in support. Senator Schaaf indicated that he would vote the bill out next week.
Senator Sater’s SB 97 which requires hospitals to adopt and implement evidence-based sepsis protocols. There was no testimony in favor of the legislation. The Missouri Hospital Association spoke in opposition saying that this is a burdensome regulation. The committee also heard Senator Schupp’s SB 117 that would require health care workers to receive the flu vaccine. The Missouri Assisted Living Association, the Missouri Health Care Association, the Missouri Hospital Association all testified in opposition to the bill. All of the testimony in opposition centered around that the focus should be requiring the patient or resident receive the vaccine and that this could create another reason a regulating agency could fault a facility for not keeping proper paperwork and reduce their quality score.
COMING UP…
Wednesday at 8:30am the Senate Appropriations Committee will hear public testimony for ALL departments.
The House Appropriations Committee for Health, Mental Health and Social Services will hear information from DHSS on Tuesday at 2pm along with public testimony related to the department, then on Wednesday at 2pm will hear information from DSS, followed by public testimony related to that department. Bill, I have you signed up for Senate testimony.
Senator Schaaf’s Senate Health and Pensions Committee will hear Senator Koenig’s SB 228 on the MOSERS pension plan, SB 74 by Senator Schaaf and SB 231 by Senator Schatz, both bills are various forms of legislation that would establish a prescription drug monitoring system.
Upcoming Dates of Interest
March 1st - Last day to file Senate bills
March 20th - 24th - Legislative Spring Break
April 1st - Last day to file bills in the House
May 5th - Appropriation bills must be TAFP
May 12th - Final day of session
July 1 - First day of Missouri’s new fiscal year (FY 2018)
Track: Hospice
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Exempts health care entities registered with the department of health and senior services that distribute hypodermic needles or syringes from the crime of unlawful delivery of drug paraphernalia. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Establishes the Narcotics Control Act. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Establishes the "Missouri Right to Shop Act". |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Establishes the "Patients First Medicaid Reform Act". |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Establishes the "Designated Health Care Decision-Maker Act". |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Modifies provisions relating to expert witnesses. |
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Track Name(s): |
Hospice |
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Bill History: |
01-23-17 H Meeting set for 1:00 PM, HR 6 - House-Litigation Reform |
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Establishes a limit on residential property assessment increases for the elderly and disabled who own and live in their principal residence proportional to the increase of their Social Security benefit. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Changes the Uniform Arbitration Act regarding agreements between employers and at-will employees. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Changes provisions relating to advanced practice registered nurses. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Creates the Silver Alert System to aid in identifying and locating a missing endangered person. |
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Track Name(s): |
Hospice |
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Bill History: |
01-24-17 H Meeting set for 8:00 AM, HR 5 - House-Crime Prevention and Public Safety |
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Changes provisions relating to the scope of practice for physical therapists. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Modifies the duration of unemployment compensation, modifies the method to pay federal advances, and raises the fund trigger causing contribution rate reductions. |
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Track Name(s): |
Hospice |
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Bill History: |
01-24-17 H Meeting set for 8:00 AM, HR 6 - House-Special Committee/Employment Security |
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Requires the Department of Social Services to apply for a global waiver for MO HealthNet. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Establishes a pilot program to transfer the authority to inspect nursing homes from the Department of Health and Senior Services to local health departments. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Changes the laws regarding vaccines and disorder monitoring. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Prohibits an employer from taking an adverse employment action based on an employee's reproductive health care decision. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Changes the laws regarding health care records of deceased patients. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Establishes the Missouri Freedom to Choose Health Care Act. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Requires the Department of Social Services to apply for a global waiver for MO HealthNet. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Specifies that the county coroner or medical examiner need not be notified and no investigation is necessary for a death that occurs under hospice care. |
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Track Name(s): |
Hospice |
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Bill History: |
01-05-17 H Read second time |
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Allows persons with certain serious medical conditions to use medical cannabis. |
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Track Name(s): |
Hospice |
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Bill History: |
01-09-17 H Read second time |
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Establishes "Simon's Law", which changes the laws regarding life-sustaining or nonbeneficial treatment policies of health care facilities. |
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Track Name(s): |
Hospice |
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Bill History: |
01-09-17 H Read second time |
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Modifies definitions of 'employee' and 'physician employee' in actions against health care providers for personal injury or death. |
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Track Name(s): |
Hospice |
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Bill History: |
01-09-17 H Read second time |
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Allows structured family caregiving as a covered service under MO HealthNet, subject to the approval of federal waivers. |
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Track Name(s): |
Hospice |
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Bill History: |
01-09-17 H Read second time |
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Changes the laws regarding MO HealthNet services. |
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Track Name(s): |
Hospice |
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Bill History: |
01-10-17 H Read second time |
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Establishes the Death with Dignity Act to allow patients with terminal illnesses to end their life in a humane and dignified manner. |
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Track Name(s): |
Hospice |
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Bill History: |
01-10-17 H Read second time |
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Creates standards for predetermination of health care benefits requests and responses. |
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Track Name(s): |
Hospice |
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Bill History: |
01-11-17 H Read second time |
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Changes the laws regarding the Missouri Human Rights Act and employment discrimination. |
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Track Name(s): |
Hospice |
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Bill History: |
01-11-17 H Read second time |
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Changes the laws regarding dispensations of maintenance medications. |
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Track Name(s): |
Hospice |
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Bill History: |
01-19-17 H Introduced and read first time |
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Appropriates money for the expenses, grants, and distributions of the Department of Social Services. |
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Track Name(s): |
Hospice |
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Bill History: |
01-20-17 H Set on the House Calendar |
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Modifies provisions relating to the collateral source rule and provides that parties may introduce evidence of the actual cost, rather than the value, of the medical care rendered. |
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Track Name(s): |
Hospice |
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Bill History: |
01-23-17 S Set on the Senate Calendar |
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Enacts provisions relating to advanced practice registered nurses. |
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Track Name(s): |
Hospice |
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Bill History: |
01-10-17 S Referred to Senate Committee on Senate-Professional Registration |
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Establishes the Advance Health Care Directive Registry. |
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Track Name(s): |
Hospice |
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Bill History: |
01-10-17 S Referred to Senate Committee on Senate-Health and Pensions |
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Provides for the expansion of MO HealthNet services beginning January 1, 2018. |
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Track Name(s): |
Hospice |
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Bill History: |
01-10-17 S Referred to Senate Committee on Senate-Health and Pensions |
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Establishes a Prescription Drug Monitoring Act. |
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Track Name(s): |
Hospice |
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Bill History: |
01-25-17 S Meeting set for 10:00 AM, SCR 1 - Senate-Health and Pensions |
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Requires elder abuse investigators to provide specified written materials to alleged perpetrators. |
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Track Name(s): |
Hospice |
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Bill History: |
01-10-17 S Referred to Senate Committee on Senate-Seniors/Families and Children |
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Establishes the Senior Services Growth and Development Program. |
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Track Name(s): |
Hospice |
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Bill History: |
01-11-17 S Referred to Senate Committee on Senate-Seniors/Families and Children |
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Modifies provisions relating to expert witnesses. |
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Track Name(s): |
Hospice |
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Bill History: |
01-12-17 S Referred to Senate Committee on Senate-Government Reform |
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Creates the MO HealthNet Buy-In for Workers with Disabilities program. |
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Track Name(s): |
Hospice |
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Bill History: |
01-12-17 S Referred to Senate Committee on Senate-Health and Pensions |
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Establishes the Narcotics Control Act. |
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Track Name(s): |
Hospice |
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Bill History: |
01-25-17 S Meeting set for 10:00 AM, SCR 1 - Senate-Health and Pensions |
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Establishes a workers' compensation claims database. |
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Track Name(s): |
Hospice |
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Bill History: |
01-12-17 S Referred to Senate Committee on Senate-Small Business and Industry |
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Modifies definitions of "employee" and "physician employee" in actions against health care providers for personal injury or death. |
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Track Name(s): |
Hospice |
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Bill History: |
01-25-17 S Meeting set for 8:00 AM, SCR 1 - Senate-Government Reform |
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Requires health carriers and health care providers to establish and participate in shared savings incentive programs. |
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Track Name(s): |
Hospice |
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Bill History: |
01-12-17 S Referred to Senate Committee on Senate-Seniors/Families and Children |
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Establishes the Narcotics Control Act. |
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Track Name(s): |
Hospice |
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Bill History: |
01-19-17 S Referred to Senate Committee on Senate-Trans./Infrastructure/Pub. Safety |
Jane Moore
CEO
Missouri Hospice & Palliative Care Assn.
600 Monroe Street
Suite 300
Jefferson City, MO 65101
Phone 573-634-5514
Fax 573-635-0659
Please save the date for the Midwest Conference October 22- 24, 2017 at Hilton Frontenac!
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