Author: Mike Lear

VIDEO: House Endorses Bill to Speed Up Health Care, Limit ‘Prior Authorization’

      The House has voted for the second straight year to decrease wait times for Missourians seeking medical care, while increasing the quality of and access to that care and lowering costs. 

Representative Melanie Stinnett (Photo: Tim Bommel, Missouri House Communications)

      Representatives voted overwhelmingly last week to send to the Senate House Bill 618, dealing with prior authorization. 

      “‘Prior authorization’ is a term used to describe the process for requiring healthcare providers to request approval before providing a healthcare service,” explained bill sponsor Melanie Stinnett (R-Springfield). 

      She said it is a practice that is, “Getting in the way of health care for every day Missourians.”  

“I could go through all the components of prior authorization and all the pieces that are required but ultimately the process requires time, and it includes delays for patients.  We have data from different sources that says that healthcare providers, that physicians are spending sometimes 14 hours of their week doing prior authorization tasks, and that’s time that they could be spending with patients, that’s time that they could be providing care to Missourians.”

      Stinnett’s bill would free healthcare providers from having to seek prior authorization from insurance providers for a given procedure for six months, if at least 90 percent of its previous requests for authorization have been approved.  The bill also lays out how a provider could maintain that exemption status through ongoing evaluations. 

      Stinnett, who is a speech-language pathologist, said the current process is giving power and authority to insurance companies.  She recalled one case in which an insurer was denying care for one of her patients, based on the finding that the patient’s hearing loss was not congenital. 

      “Funny thing is, there’s not a diagnosis code for congenital hearing loss, and so there was no way for me to indicate that readily, and then going through the appeals trying to provide letters from the neonatologist and get that from the hospital and get that information from the ENT, and it was just a fight all along the way. I, as the provider, chose to go ahead and provide care uncompensated until I won that battle but it was months of a battle.”

      Other legislators who work in medical fields joined Stinnett in expressing why her legislation is needed. 

      Springfield Democrat Jeremy Dean worked in several healthcare clinics in his district.  He said legislators hear often that Missourians want more time from their physicians.

Representative Jeremy Dean (Photo: Tim Bommel, Missouri House Communications)

“We go and see our doctor hopefully one time a year if we’re healthy and it seems like we’re in and out, the doctor doesn’t have time to talk to us, and I think that this is one of the prime reasons that has caused doctors to feel like they are so stretched thin for time, is because they’re doing so many other things to please our insurance companies,” Dean told Stinnett during debate in the House. 

“Thank you so much for bringing this bill forward.  It’s absolutely going to help our constituents and the people of Missouri.”

      Representative Gregg Bush (D-Columbia) is a registered nurse.  He said there is a “crisis” in Missouri and the rest of the U.S., of individuals seeking care from medical professionals being impeded by insurance companies.

      “Right now in each one of our districts there is somebody who is sick and injured who’s going into a hospital, who’s going into a clinic, and instead of the clinician or a healthcare provider being able to treat our citizens who are sick and injured, [that provider is] on the phone with someone far away who’s never even laid eyes on the patient, who’s never even been around the person who is sick and injured, and is telling our health care providers what they can and can’t do.  Mr. Speaker I trust our education, being able to treat the patient in front of us, and that’s why I’m urging the whole body to vote ‘yes’ on this bill.”

VIDEO: An exchange between Representatives Gregg Bush (D-Columbia) and Melanie Stinnett (R-Springfield) illustrates why they believe her House Bill 618 should pass:

“Prior authorization is literally red tape in healthcare,” said Rolla Republican Tara Peters.  “When we’re sick and when we are trying to find out what’s wrong with us to try to get treatment we should not be waiting on insurance companies to make those decisions for us.”

      “We recently heard a story about a person under anesthesia that the insurance company would only pay so much, and they were actually under the anesthesia and had to get authorization to get more.  I mean, what kind of absurdity is that?” Peters asked.  “Let’s do away with barriers that are hindering our healthy outcomes for our Missourians and let’s pass House Bill 618.”

      Ozark Republican Jamie Gragg talked about his own experience as a patient with breathing issues related to allergies which used to result in him frequently being hospitalized for days at a time. 

Once he was diagnosed, doctors were able to put him on medication that kept him out of the hospital “however, every year I have to go through a preauthorization, and there are times where I am off the medication for a couple of months because the preauthorization is such a headache.  It’s a pain, because there are times when I’m off the medication for a couple of months that I have issues with breathing again.”

“I’m not unique,” Gragg told his colleagues.  “This is what people go through, and it’s even more detrimental with some other medications they have to wait for, so this is a very much needed bill.”

      Though much of the sentiment expressed during debate suggested that this legislation would benefit patients over insurers, Stinnett said she believes both sides will win if it becomes law.

Representative Gregg Bush (Photo: Tim Bommel, Missouri House Communications)

      “When providers know that their prior auth status is based on a 90 percent approval rating, they’ll be less likely to test the waters and see what they can get approved.  There’ll be streamlining of what services are provided, and the motivating factors mentioned previously will be neutralized.”   

“Ultimately,” Stinnett continued, “what will win out is the best interest of patients, and every Missourian will be positively impacted.”

      The House voted 148-4 to send that proposal to the Senate.  Similar legislation last year was voted out of the House 146-6, but it did not receive a committee hearing in that chamber.

House plan would Accelerate Detection of Child, Animal, and Elderly Abuse by Connecting Investigators

      A House committee advanced this week a plan that could save the lives of children, the elderly, and animals in the State of Missouri simply by having different types of investigators talk to one another.

Representative Holly Jones (Photo: Tim Bommel, Missouri House Communications)

      House Bill 1298 would make those who investigate the abuse of children, the elderly, and other vulnerable persons mandated reporters of animal abuse and visa versa, and require the necessary cross training for those investigators.

      “There’s a direct correlation between child abuse and elderly abuse in most cases, and animal abuse.  In this bill we’re asking for agencies involved in any of the reporting on childhood abuse and animal abuse to cross-report for the other,” said bill sponsor Holly Jones (R-Eureka). 

“Law enforcement and Child Protective Services are often the ones who see animals abused, and children in neglectful and abusive situations, and cross-reporting and training is being implemented across the country to enable those in a multitude of fields to report that abuse.”

      Jones shared with the House Special Committee on Urban Issues statistics to back up her proposal, and she said they are disturbing.

“Seventy-five percent of abused women who have companion animals; dogs, cats, those kinds of thing, have reported history of that companion animal either being threatened or abused by their intimate partner, with children being present for that abuse 90 percent of the time.  Other studies have shown that over half of children have been exposed to animal abuse in their short childhood years.”

      Committee Chairman Mark Sharp (D-Kansas City) said the proposed change could lead to cases of abuse being discovered earlier by authorities.

“If it’s happening with an animal then it’s likely happening with a child, if there is one in the home, so giving that cross-training for our animal abuse folks to be able to recognize this, as often times they are the first person to respond to many issues in a home.”

The relationship between children and their pets is recognized as treasured and crucial to emotional development, and the development of empathy, responsibility, and social skills.  Aislinn McCarthy with the Missouri Alliance for Animal Legislation said it is that much more tragic, then, when a child’s pet becomes a target of abuse.

      “Children perceive their pets as special friends, important family members, providers of social interactions, affections, and emotional support.  In homes where the child’s being abused or neglected, pets take on an even more special role.  They take on the role of an attachment figure.  This pet may be the child’s only experience of love without violence.  This pet may also be the child’s only protector.”

      Jackson County Assistant Prosecuting Attorney Devon Tarantino dealt with special victims cases for four years.  She said animal abuse investigators are, indeed, often the first authorities to visit a home in which children are being abused.

“If they go to a scene and they are able to identify issues or concerns of child abuse or neglect when that is present, adding them to the list of mandated reporters and adding additional training to help them identify the signs of child abuse will help victims get the care and attention they need early and quickly, and I think that is one of the biggest benefits of this bill, is early detection and prevention.”

      Tarantino said delays in detection of abuse in a home are not always the result of investigators not having yet witnessed it.  Often when investigators are present, they are not told about abuse.  She said HB 1298 could make a difference in those situations as well.

“Sometimes our children and adult victims are not ready to talk about their abuse.  They’re just not.  But you know what they are ready to talk about?  Maybe the abuse of their pet or the abuse of another family member, and so say, for instance, you have a child going to the Child Protection Center and they are not ready to disclose their own abuse but they will disclose about their companion animal being abused, and so this bill, in those situations, would allow us to get services and resources in place into that home prior to it really escalating.”

      The committee heard similar testimony from Ashley Stanley, the Director of Community Education and Outreach at Wayside Waifs Animal Shelter in Kansas City.  She told the committee she has encountered many awful and sobering stories of animal abuse that were made more heartbreaking by how children were affected. 

“For children, especially, the first red flags that abuse or neglect may be happening in the home can be spotted in the conversations that they have about their animals.“

“In our work we’re in schools every single day, and throughout the years I’ve heard stories of animals being thrown down stairs; dents left in walls from repeated instances of adults in the home banging their animal’s head into them; one child walked outside one morning to take care of his family dog and found his dog hanging from a tree in their backyard.”

      Stanley joined the advocates who told legislators that Jones’ proposal could save lives.

      “Early intervention on both the human and animal side is crucial to stopping the cycle of violence.  HB 1298 creates a path for early intervention that can save both human and animal lives.  It gives both those working to protect animals and those working to protect children the knowledge and tools to work collaboratively to mitigate abuse in all its forms earlier and more efficiently, ultimately creating healthier and safer communities throughout the state.”

      The committee voted 6-0 to advance HB 1298.  It faces another committee vote before it could be considered by the full House.

House votes to Criminalize Clandestine Tracking of Vehicles

      Legislation that is key in the fight to protect victims of domestic violence was one of the proposals the House sent to the Senate before legislators went home for their spring break.

Representatives Bill Irwin, Cecelie Williams, and Kemp Strickler (Photo: Tim Bommel, Missouri House Communications)

      The House voted unanimously to send to the Senate a bill that would criminalize the placing of tracking devices on a vehicle without the knowledge or consent of all recorded owners of that vehicle.  Missouri has no prohibition on such tracking, which is often used by domestic abusers to follow the movements of their victims.

      The bipartisan legislation was sponsored by three legislators.  One of those is Ditmer Republican Cecelie Williams, who filed House Bill 971.  She has shared several times this session her own experience as a survivor of domestic violence, in explaining why she is carrying such bills.

      Williams said Missouri should be addressing vehicle tracking in law.

      “This is really something that’s installed on your vehicle [or] within your vehicle, that you are unaware of that is being used to track you for any reason at all, whether there is malice or malicious intent behind it, none of that should matter.  It’s that if you are going to put a tracking device on your vehicle, that all owners of the vehicle are aware that it’s there,” Williams told colleagues.

      “What this bill does is it provides a criminal offense, a Class A misdemeanor for the first offense, and a Class B felony for a second offense, by violating this law and putting GPS tracking devices on a vehicle [without notifying] all owners that this was being placed.”

      Two bills similar to Williams’ were filed, and then combined with hers.  One of those, House Bill 978, was sponsored by Lee’s Summit Republican Bill Irwin, a retired Navy Seal and Lees Summit Police officer.  When he was presented this legislation he thought, “This is very much common sense.  Who could be against it?”

      Irwin said he saw firsthand the “evils of tracking,” when deployed to Pakistan as a liaison officer for the Special Operations Command Central to the U.S. Embassy. 

A diplomat he worked with there was a woman known for her diplomatic and physical prowess.  One of Irwin’s colleagues became interested in her but she turned the man down.  What happened next was frightening.

Representatives Bill Irwin, Cecelie Williams, and Kemp Strickler (Photo: Tim Bommel, Missouri House Communications)

      “My military coworker found out that she was returning to the states and [he] took emergency leave to go back prior to her departure.  Fortunately, law enforcement had been appraised of the situation and figured out he was tracking her.  They detained him at the airport and they found in his car a body bag, duct tape, flex cuffs, sharp surgical knives, and a bone saw,” Irwin told the House Transportation Committee.  “Using the tracker evidence and the stuff on him they were able to send him to jail, where I believe he’s still spending time.”

      The sponsor of another version, House Bill 293, is Lee’s Summit Democrat Kemp Strickler.  He said his first introduction to the issue came from a constituent. 

      “Their partner had been tracked without her knowledge by an ex-boyfriend for quite some time, and they only found out about it because they took it into an auto repair or something like that, and they found it and that’s when they learned that she was being tracked.  That was of obvious concern to them and something that he said to me, that’s something we should work with.”

      He also referenced a high-profile double murder-suicide that happened in Lenexa, Kansas, in which a woman from Belton, 22 year old Sara Beck, was murdered.  Investigators believe she was tracked with a GPS device by her ex-boyfriend.

“The ex-boyfriend also set up a geo-fence that would automatically notify him when she showed up at work, when she showed up at a friend’s house, and when she showed up at home,” Strickler told colleagues. 

“Her father said the police have to get a warrant in order to do that to somebody.  Now we’ve got the general public just doing that.”

“This isn’t going to stop it but this will allow us to do something about it when it’s found,” said Strickler. 

“This is a bipartisan bill, this is a public safety bill.  This is going to help protect domestic abuse survivors and hopefully it will, frankly, discourage people from placing them on the vehicles of government officials and legislators, too.”

      The House voted 151-0 to send the legislation to the Senate.

House Votes to Rein In Vehicle Assessments

      The House voted unanimously this week to ensure that Missourians would not experience increases in the taxes they pay for vehicles ever again.

Representative Rodger Reedy (Photo: Tim Bommel, Missouri House Communications)

      House Bill 816 is the latest attempt by representatives to block something that happened post-Covid from being repeated.  During and after the pandemic supply lines for parts and vehicles were hindered, and the demand for, and value of, used vehicles was inflated.  That meant Missourians’ property tax bills also increased.

“If you will remember, in 2021 and ’22, people saw the assessment values go up on their cars and when those assessments went up their taxes went up, and that was kind of caused by the market value of used cars,” recalls bill sponsor Rodger Reedy (R-Windsor). 

He told his colleagues in the House Chamber, “Many of you in this room, if you go back and look at your tax bills from ’21, ’22, ’23, you are paying more money on the same car that was a year older, that had maybe 20 or 30 thousand more miles on it, and it was not right.”

      Reedy said part of the problem is that state law requires assessors to use the October issue of the National Automobile Dealers Associations (NADA) Used Car Guide to determine the value of vehicles.  Reedy and others have proposed for several years now that the law allow the State Tax Commission to select a publication from those available, for assessors to use that year. 

      “I don’t believe that we should be putting in statute that you have to do business with a certain company, and this corrects that … they may be one that bids on it and they may be the best bidder, but it gives the other companies the opportunity to do that as well,” said Reedy.  “What they would do is do a bidding process with different companies to provide that information and then, basically, they would probably use the lowest and best bid, which in turn would save taxpayer dollars.”

      Reedy’s proposal would also state that no vehicle can be assessed at a value greater than it had, the year prior. 

      Though the proposal has not reached the governor’s desk in past years, that has not been for lack of bipartisan support.

Representative Kemp Strickler (Photo: Tim Bommel, Missouri House Communications)

      Lee’s Summit Representative Kemp Strickler (D) said the bill would be, “a great way to make sure that the issues that we saw during Covid don’t reoccur, where again, those used car values, those should be going down and the amount that people pay on those should be going down.  We know that there was an artificial bubble back then.  I think this does a really good job of addressing that and making sure the taxpayers aren’t on the hook if that happens ever again.”

      Representative Del Taylor (D-St. Louis) called the tax increases during Covid an “anomaly” that should be prevented, “and basically he’s saying that no, the assessment cannot exceed what it was last year.  Excellent idea.”

      HB 816 receive no “no” votes in three House committees and the full Chamber, the latter of which voted 157-0 to send it to the Senate.