Bill Summary – FastDemocracy

SECOND REGULAR SESSION
                        HOUSE BILL NO. 3255
                               103RD GENERAL ASSEMBLY


                                INTRODUCED BY REPRESENTATIVE TERRY.

     6979H.01I                                                                    JOSEPH ENGLER, Chief Clerk


                                                AN ACT
     To amend chapter 354, RSMo, by adding thereto twenty-one new sections relating to the
           Missouri universal health assurance program, with a contingent effective date for
           certain sections.


     Be it enacted by the General Assembly of the state of Missouri, as follows:

            Section A. Chapter 354, RSMo, is amended by adding thereto twenty-one new
 sections, to be known as sections 354.750, 354.753, 354.756, 354.759, 354.762, 354.765,
 354.768, 354.769, 354.770, 354.771, 354.774, 354.777, 354.780, 354.783, 354.786, 354.789,
 354.792, 354.795, 354.807, 354.810, and 354.813, to read as follows:
            354.750. 1. Sections 354.750 to 354.813 shall be known and may be cited as the
 "Missouri Universal Health Assurance Program".
        2. The Missouri universal health assurance program is hereby created for the
 purpose of providing a publicly financed statewide program to provide comprehensive
 necessary health, mental health, and dental health care services, including preventive
 screenings, for all residents of this state. The program shall have as its goals:
        (1) Timely access to health care services of the highest quality for every resident
 of the state so that all may benefit;
        (2) The provision of adequate funding for health care; and
        (3) Lower health care spending through streamlined administration, a single bill,
 and uniform payments.
        3. As used in sections 354.750 to 354.813, the following terms mean:
        (1) "Board", the board of governors of the Missouri universal health assurance
 program;

     EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
     intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language.
HB 3255                                         2

      (2) "Eligible person", any person who qualifies for benefits under section
354.783;
      (3) "Fund", the Missouri health care trust fund;
      (4) "Participating provider", any person who is authorized to furnish services
under the provisions of sections 354.750 to 354.813 and under rules adopted by the
board of governors of the Missouri universal health assurance program;
      (5) "Program", the Missouri universal health assurance program.
          354.753. The Missouri universal health assurance program shall be a body
corporate and an instrumentality of the state. In the program shall be vested the powers
and duties specified in sections 354.750 to 354.813 and those powers necessary to enable
the program and the program's officers, employees, and agents to carry out the
purposes of sections 354.750 to 354.813.
          354.756. 1. The director of the department of health and senior services shall
divide the population of the state into six regional health planning and policy
development districts of roughly equal population. An advisory council in each district
shall:
      (1) Assist the board in the development of a comprehensive state health care
plan under section 354.765 and in the development of budgetary allocations for health
care services and of operating policies and procedures for the program; and
      (2) Develop a transportation plan to enable indigents, elderly persons, and
persons with disabilities to have access to nonemergency health care services.
      2. Not later than thirty days after the first meeting of the board of governors
appointed under section 354.759, the board shall submit to the governor a list of names
of qualified persons who reside in each of the six regional health planning and policy
development districts. From such list, the governor shall appoint to each district an
advisory council composed of the following nine members:
      (1) Two physicians;
      (2) One registered nurse;
      (3) One licensed health care provider who is neither a physician nor a registered
nurse;
      (4) One dentist;
      (5) One medical director of a mental health facility;
      (6) One municipal or county public health administrator;
      (7) One person with a physical disability; and
      (8) One professional consumer advocate.
      3. The terms of the initial appointees to each of the district advisory councils
shall be as follows: four shall be appointed for a term of four years, three for a term of
HB 3255                                          3

 three years, and two for a term of two years. Thereafter, all terms shall be for four
 years, but any member appointed to fill a vacancy in an unexpired term shall serve only
 for the remainder of that term. No member shall be appointed to serve more than two
 consecutive terms.
              354.759. 1. The Missouri universal health assurance program shall be
 administered by a board of governors composed of twenty-three members:
          (1) Fourteen of whom shall be appointed by the governor with the advice and
 consent of the senate as follows:
          (a) One representative of a hospital;
          (b) Two physicians;
          (c) One registered nurse;
          (d) One epidemiologist;
          (e) One representative of a community health center;
          (f) One mental health care provider;
          (g) One professional consumer advocate;
          (h) Two persons whose annual income does not exceed twice the federal poverty
 level;
          (i) One person sixty-five years of age or older;
          (j) One person who is a licensed health care professional other than a physician
 or a nurse;
          (k) One person trained in bioethics; and
          (l) One dentist;
          (2) Six of whom shall represent the regional health planning and policy
 development districts established under section 354.756, appointed by the director of the
 department of health and senior services; and
          (3) Three of whom shall be the following ex officio members:
          (a) The director of the department of health and senior services;
          (b) The director of the department of social services; and
          (c) The director of the department of mental health.
          2. The terms of the initial members who are appointed under subdivision (1) of
 subsection 1 of this section shall be staggered as follows: five shall be appointed for a
 term of four years, five for a term of three years, and four for a term of two years. The
 initial terms of the members selected under subdivision (2) of subsection 1 of this section
 shall be staggered so that the members selected from even-numbered districts shall
 serve an initial term of three years and those from odd-numbered districts shall serve
 four years. Thereafter, all terms shall be for four years, but a member appointed to fill
HB 3255                                          4

 a vacancy in an unexpired term shall serve only for the remainder of that term. No
 member shall be appointed to serve more than two consecutive terms.
         3. Members of the board shall at all times include:
         (1) Sufficient representatives of racial, ethnic, and gender diversity so that the
 makeup of the board shall accurately reflect the racial, ethnic, and gender diversity of
 the state population; and
         (2) At least two members who are defined as disabled under the Americans with
 Disabilities Act, 42 U.S.C. Section 12101 et seq.
         4. The board shall elect a chair and vice chair.
         5. Meetings shall be called by the chair or by any thirteen members. The board
 shall meet at least six times per year. All meetings of the board shall be announced in
 advance and open to the public, except as provided by chapter 610.
         6. Thirteen members of the board constitute a quorum, and an affirmative vote
 of at least thirteen members shall be necessary for any action to be taken by the board.
         7. The members of the board shall be reimbursed from the Missouri health care
 trust fund for mileage and any necessary and actual expenses incurred while engaged in
 the business of the board.
             354.762. 1. The board of governors of the Missouri universal health assurance
 program shall be responsible for:
         (1) Establishing budget and policy guidelines for the program through the
 development of a comprehensive state health care plan under section 354.765;
         (2) Establishing fee schedules using the last available calendar year as a base
 year;
         (3) Determining aggregate capital expenditures in keeping with the goals
 established under subdivision (2) of subsection 1 of section 354.765;
         (4) Approving additions to services offered by the program;
         (5) Administering and implementing the program and administering the
 Missouri health care trust fund created under section 354.770;
         (6) Adopting rules under chapter 536;
         (7) Monitoring the operation of the program;
         (8) Studying means of incorporating institutional long-term care benefits into
 the program, studying immigration into the state for the purpose of receiving health
 care services under the program, and reporting on the progress of such studies to the
 speaker of the house of representatives, the president pro tempore of the senate, and the
 governor;
         (9) Reporting annually to the speaker of the house of representatives, the
 president pro tempore of the senate, and the governor on the program's activities and
HB 3255                                          5

 recommending any changes to insurance and health care laws to improve access to
 health care for residents of this state;
         (10) Disseminating to providers of services and to the public information
 concerning the program and the persons eligible to receive the benefits of the program;
         (11) Conducting necessary investigations and inquiries and compelling the
 submission of information, documents, and records the board considers necessary to
 carry out its duties under the provisions of sections 354.750 to 354.813;
         (12) Conducting utilization reviews of patients and providers to identify abuses
 of the program and reporting abuses to state agencies;
         (13) Employing and supervising staff;
         (14) Conducting other activities the board considers necessary to carry out the
 purposes of sections 354.750 to 354.813;
         (15) Establishing standards and procedures for negotiating and entering into
 contracts with participating providers; and
         (16) Initiating and responding to lawsuits.
         2. The board, after providing notice to consumers, providers, the director of the
 department of health and senior services, and other interested parties, may hold
 hearings in connection with any action that it proposes to take under subsection 1 of this
 section. Nothing in this section shall be construed as authorizing the board to adopt
 rules under subdivision (6) or (15) of subsection 1 of this section or to conduct
 evaluations or investigations under subdivision (11) of subsection 1 of this section
 without holding public hearings.
             354.765. 1. The board, in cooperation with the district advisory councils
 established under section 354.756, shall annually develop a comprehensive state health
 care plan. The plan shall include the following:
         (1) A comprehensive budget for the program within the limits of funds made
 available through the measures instituted in sections 354.750 to 354.813. The budget
 shall include specific amounts to be allocated respectively to:
         (a) The health services account established under section 354.774;
         (b) The prescribed medications and durable and nondurable medical equipment
 account established under section 354.774;
         (c) The regional capital improvement account established under section 354.774;
         (d) The health professional education and training fund established under
 section 354.777; and
         (e) Administration of the program in an amount not to exceed four percent of
 the total funds available to the program;
HB 3255                                           6

         (2) Specific goals for the total portion of funds in the health services account to
 be expended for the capital needs of providers under section 354.792;
         (3) An evaluation of the health care and mental health needs of the state and of
 each regional health planning and policy development district including, but not limited
 to, assessments of:
         (a) Regional needs and other investments in health care equipment and capital
 improvements;
         (b) The effectiveness of state and local efforts to coordinate the activities of the
 health care delivery system; and
         (c) Any other unmet local health care or mental health needs;
         (4) Goals for geographic distribution of health care providers and personnel,
 with strategies for using the authority over reimbursements under section 354.792 and
 resources from the health professional education and training fund established in
 section 354.777 to achieve such goals;
         (5) Quantitative goals for the use of health and mental health services by eligible
 persons;
         (6) Specific goals for the physical and mental health status of Missourians and
 for quality of care rendered under the program; and
         (7) An evaluation of the adequacy of total funds available to the program.
         2. Prior to promulgation of the comprehensive state health care plan, the board
 shall:
         (1) Appoint a subcommittee of experts in medical and health care ethics to
 advise the board on the ethical issues relating to the allocation of health care resources;
         (2) Appoint a subcommittee of licensed physicians, registered nurses, and
 registered pharmacists to establish an evidence-based system formulary for all
 prescription drugs and durable and nondurable medical equipment used by the
 Missouri health care system;
         (3) Instruct each district advisory council to conduct at least one public hearing
 in at least two areas of its region to gather public comment on the proposed plan. The
 board shall provide the district advisory councils with staff assistance in conducting
 such hearings; and
         (4) Hold at least two public hearings to gather public comment on the proposed
 plan.
         3. The comprehensive state health care plan shall, to the extent practicable, seek
 to assure the most cost-effective delivery of health care by reflecting the following
 priorities:
         (1) Quality of care to be achieved through the following:
HB 3255                                          7

         (a) Primary and preventive services;
         (b) Accountability of providers to payers and consumers for both the outcomes
 and consumer acceptability of the care they render;
         (c) Continuity of care, as embodied in coordination of services to individuals and
 the community; and
         (d) Maintenance of high levels of professional competence and expertise among
 health care providers according to professional practice standards;
         (2) Access to care through the equitable distribution of resources within the
 health care delivery system on the basis of community need; and
         (3) Efficient use of resources through:
         (a) Elimination of unnecessary administrative and overhead expenses;
         (b) Elimination of means testing;
         (c) Establishment of cost-containment pricing for reimbursements to
 manufacturers of pharmaceuticals and manufacturers of durable and nondurable
 medical equipment; and
         (d) Innovative and cost-effective models of care including, but not limited to:
         a. Community, nonmedical, or in-home services that provide alternatives to
 institutional long-term care;
         b. Community health nursing;
         c. Services provided by nurse practitioners; and
         d. Psychiatric and other mental health services provided on an outpatient basis.
             354.768. The board of governors of the Missouri universal health assurance
 program shall appoint the executive director of the program.
             354.769. 1. The executive director of the program shall serve as secretary to the
 board and shall perform such duties in the administration of the program as the board
 may assign.
         2. The board may delegate to the executive director any of the board's functions
 or duties under sections 354.750 to 354.813, except the issuance of rules and the
 determination of the program.
             354.770. The board shall administer the "Missouri Health Care Trust Fund",
 which is hereby created in the state treasury, into which shall be placed all federal
 payments received as a result of any waiver of requirements granted by the United
 States Secretary of Health and Human Services under health care programs established
 under Title XVIII and Title XIX of the Social Security Act, as amended, and all moneys
 appropriated by the general assembly to the program under sections 354.750 to 354.813.
 Moneys in the fund shall be used for comprehensive necessary health care services and
 to support construction, renovation, and equipping of health care institutions based on
HB 3255                                          8

 regional needs in accordance with sections 354.750 to 354.813 and rules established by
 the board of governors of the program and for no other purpose. The board shall have
 power, in the name and on behalf of the program, to purchase, acquire, hold, lend, lease,
 sell, assign, transfer, and dispose of all property and rights, and enter into written
 contracts, all as may be necessary or proper to carry out the purposes of sections
 354.750 to 354.813.
             354.771. 1. All moneys received by or belonging to the program shall be
 deposited in the state treasury to the credit of the Missouri health care trust fund. No
 such moneys shall be deposited in, or be retained by, any bank or trust company that
 does not have on deposit at the time the kind and value of collateral required by sections
 30.240 and 30.270 for depositories of the state treasurer. The executive director shall be
 responsible for all property belonging to the program and shall give such corporate
 surety bonds for the faithful handling of the property as the board shall require.
         2. The board of governors shall administer the fund and shall conduct a
 quarterly review of the expenditures from and revenues received by the fund.
         3. The board shall submit each quarterly review to the state auditor for
 oversight.
         4