House prepares extensive foster care reform legislation

An increased focus on issues concerning foster care in Missouri has resulted in a bill containing 11 different reforms meant to make life better for children who are in, and who leave, that care.

Representative Jim Neely chairs the House Special Committee to Improve the Care and Well-Being of Young People and sponsors HCB 11, a comprehensive foster care reform bill. (photo; Tim Bommel, Missouri House Communications – click for larger version)

House Speaker Todd Richardson (R-Poplar Bluff) in January created the Special Committee to Improve the Care and Well-Being of Young People to focus on improving the state’s child welfare system.  That committee is chaired by Cameron Representative Jim Neely (R), who selected 11 of the bills assigned to it to be combined into House Committee Bill 11.

Neely, a doctor, said improving the lives of children has been his priority since a young girl who’d been abused came into his office about ten years ago.

“This young lady said a lot of adults had let her down, and so I chewed on that and thought about life and what I needed to do, and that was probably the seed that caused me to run for office a few years later,” said Neely.

Neely said some of the things HCB 11 would change in Missouri law are “quick” or “simple” fixes that could have significant impacts, especially in situations in which foster children have been described as, “falling through the cracks.”

“There’s an incident in the Kansas City area where a child was over in Kansas and if we’d been able to share information with the State of Kansas we might have been able to prevent a horrid situation over there,” said Neely.  “We’re just trying to make [things] a little more user friendly and get the foster parents a little more safety net.”

HCB 11 includes language that would update background checks on foster families so that the Children’s Division would know immediately if a foster parent is charged with a crime that would disqualify him or her from being a foster parent.  Current law only allows checks every two years.

Representative Sonya Anderson (photo; Tim Bommel, Missouri House Communications – click for larger version)

That portion of the bill came from House Bill 1944 sponsored by Representative Sonya Anderson (R-Springfield).

“House Bill 1944 would allow the Department of Social Services to utilize the RAPBACK program, which is the Record of Arrest and Prosecution, and so it’s a more instant update if a foster care parent or someone who resides in the house has been charged with a crime,” said Anderson.  “We want to make sure that [foster] children are in the safest environment as possible.”

HCB 11 would also expand assessment and treatment services for children in foster care.  It would require such services for all children in foster care – currently it is required only for those under the age of ten – and would require that those services be completed in accordance with the American Academy of Pediatrics’ periodicity schedule.  Currently children are screened every two years.

The original sponsor of that language is Representative Lauren Arthur (D-Kansas City), who said it would ensure that children in foster care receive more appropriate care, and the comprehensive screenings will in turn save the state money by catching medical conditions earlier and aiding in preventative care.

Representative Lauren Arthur (photo; Tim Bommel, Missouri House Communications – click for larger version)

“This would change the requirements so that every child in foster care is receiving these kinds of screenings, not just children under the age of ten.  Additionally it means that they’ll receive more appropriate care, so according to the experts – the American Academy of Pediatrics – our children in foster care will go to the doctor according to their recommendations and that schedule as opposed to the legislature saying they have to go every two years,” said Arthur.  “For older kids in foster care, often when they are pulled out of school more than their peers it adds to a feeling of stigma – they feel like they’re different from their classmates – and we certainly don’t want them to feel different or have to go to the doctor more than anyone else just because they’re in foster care.”

Another portion of HCB 11 comes from House Bill 1862 sponsored by Representative Phil Christofanelli (R-St. Peters).  It would enable investigations of abuse of children in foster care in Missouri when it happens outside of the state.

Current law prevents Missouri Social Services workers from investigating reports of abuse of Missouri children in foster care if the abuse doesn’t occur in Missouri, and prevents them from communicating with counterparts in other states about abuse or potential abuse.  Christofanelli said his bill would remove those barriers and fix what he called a, “bureaucratic technicality.”

“This is just eliminating some loopholes that have resulted in some unfortunate situations in the past and making sure that we have full communication across state lines to protect kids,” said Christofanelli.

He said HCB 11 is combining a number of efforts to fix situations in which lawmakers are told, all too often, that children are being “left behind.”

Representative Phil Christofanelli (photo; Tim Bommel, Missouri House Communications – click for larger version)

“It’s one of the most rewarding parts of being in the legislature and it’s such an easy fix.  It’s shocking to me that this hasn’t been done yet because we’ve seen case after case where problems like this arise across state lines,” said Christofanelli.  “Our kids are our greatest asset here in Missouri and if there’s anything that we can do to help keep them safe then we’re going to do it as the legislature, so I’m honored to be a part of that process.”

Some lawmakers expressed concerns with the portion of the bill because other states might release information about abuse claims – particularly unsubstantiated claims – that Missouri would not release.  They expressed a desire to see that concern addressed before the bill could become law.

The House is prepared to vote on whether to send HCB 11 to the Senate.  The bill is broadly supported, including by Columbia Democrat Martha Stevens, who sits on the Special Committee to Improve the Care and Well-Being of Young People.

Stevens said she’s glad to be on the committee but says it has more work to do even if HCB 11 becomes law, “particularly with children aging out of the foster care system, so I’m hopeful that in the interim, with stakeholders and advocates and experts and folks on both sides of the aisle we can bring forward more solutions next year to help address issues around foster care and support the Missouri youth that are aging out of foster care.”

      Other parts of HCB 11 would:

– Provide free birth certificates to children in foster care, making it easier for them to become independent (found in House Bill 1470 sponsored by Representative Mike Kelley, R-Lamar)

– Allow more time for a case management plan to be developed for a child entering foster care (found in House Bill 1637 sponsored by Representative Neely)

– Allow foster children aged 16 years and older to open a checking or savings account with the consent of the Children’s Division or juvenile court, giving them the ability to cash paychecks and better access to jobs  (found in House Bill 1715 sponsored by Representative Don Phillips, R-Kimberling City)

– Make closed under law any records regarding placement of children into foster care or kinship placements, and specify who can access those records and when (found in House Bill 1966 sponsored by Representative Robert Cornejo, R-St. Peters)

– Allow a child who is homeless or in the custody of the Children’s Division, but the whereabouts of his or her immunization records is unknown, to be enrolled in school for up to 30 days while efforts are made to find those records, and if needed, another 30 days after that for the child to get caught up on immunizations (found in House Bill 2139 sponsored by Representative Lynn Morris, R-Nixa)

– Define when juvenile courts have jurisdiction over a child under 21, streamlining situations in which a child is in a safe situation but juvenile court involvement is interfering with the family (found in House Bill 1728 sponsored by Representative Bill Lant, R-Pineville)

– Establish guidelines for educating children in court-ordered group homes or institutions for delinquent or neglected children (found in House Bill 2625 sponsored by Representative Lyle Rowland R, Cedarcreek)

– Create the “Trauma-Informed Care for Children and Families Board” to encourage cooperation between agencies that deal with children and utilize trauma-informed treatment programs (found in House Bill 2217 sponsored by Representative Cora Faith Walker, D-Ferguson)

House passes ‘pain capable’ abortion ban

The state House has proposed barring abortions in Missouri of any fetus a doctor determines is capable of feeling pain.

Representative Donna Lichtenegger (photo; Tim Bommel, Missouri House Communications – click for larger version)

House Bill 1266 would prevent such abortions unless they are found to be necessary to avert the mother’s death or if there is a serious risk to the mother of substantial and irreversible physical impairment of a major bodily function.  In such cases a doctor would be required to end the pregnancy in a way that gives the fetus the greatest chance of survival without posing such risks to the mother.

The bill requires reporting of such abortions to the Department of Health and Senior Services, and would make a doctor who performs an abortion in violation of the bill’s provisions subject to discipline.

Sponsor Donna Lichtenegger (R-Cape Girardeau) calls it the “Pain Capable Unborn Child Protection Act.”  She and other backers of the bill argue there is scientific evidence that a fetus can feel pain at 22 weeks.

“The most significant reason that [an abortion after that stage is painful for a fetus] is because at 5-months this child literally needs to be torn apart, limb for limb, in order to be aborted.  It is much safer for the mother and for the fetus to be able to have a C-section and it’s much faster than the abortion,” said Lichtenegger, “so there are other ways that this baby can be delivered without tearing it from limb to limb.”

Representative Cora Faith Walker (D-Ferguson) questioned proponents’ arguments about when a fetus can feel pain, and argued that there is an “abundance” of scientific data to the contrary.

Representative Cora Faith Walker (photo; Tim Bommel, Missouri House Communications – click for larger version)

“The actual pathways – the neurological pathways – that are necessary to feel pain in fetuses is typically not developed until well after the 20-week development state,” said Faith Walker.

St. Louis Democrat Sue Meredith said when the bill was heard by a committee, lawmakers heard from parents who had abortions because their children were not forming properly in the womb and faced short and/or painful lives if brought to term.

“These people weren’t getting these abortions because they were getting rid of an unwanted pregnancy … we are telling people who have these abnormally developing fetuses that you have to carry this fetus full-term.  You have to put that baby through that agony of whatever it is – not being able to breath, not being able to think properly – not being able to do the things that one needs to do to live,” said Meredith.

Harrisonville Republican Rick Brattin said he “begrudgingly” supports HB 1266.  He is frustrated that the legislature is debating at what times during a pregnancy it can be terminated rather than seeking to make abortion illegal altogether.

“It’s just mind boggling to me that we are having to even go with something like this and that there’s even debate on a bill like this,” said Brattin.  “I just look for the time and I pray for the time that people are actually awakened by the egregious act of this horrible procedure and this life-ending act and actually ban abortion, not just pain capable.”

The House voted 117-31 to send HB 1266 to the Senate for consideration.

House approves bipartisan collaborative effort to extend Medicaid coverage for postpartum substance abuse care

A bipartisan, collaborative effort to extend Medicaid benefits for postpartum substance abuse treatment has been approved by the Missouri House.

Representatives Marsha Haefner, Martha Stevens, Cora Faith Walker, and Jay Barnes (photos; Tim Bommel, Missouri House Communications – click for larger version)

House Bill 2280 extends MO HealthNet benefits for pregnant women who are receiving substance abuse treatment within 60 days of giving birth for up to 12 additional months.  Any participating woman must follow the treatment in order to benefit.

Bill sponsor Marsha Haefner (R-St. Louis) said extended treatment has been proven necessary for success.

“Opioid and substance abuse during pregnancy is on the rise, with opioid use during pregnancy mirroring that of the general population,” said Haefner.  “The current time offered for substance use disorder treatment, which is 60-days for these new moms, does not allow for enough treatment for most women to experience success with recovery.  If a new mom is doing well then loses support and treatment for her abuse she will often relapse.  Another risk of pulling treatment too soon is after a period of non-use, women experience an increased risk of overdosing because their tolerance is low.”

HB 2280 was combined with similar bills filed by Representatives Cora Faith Walker (D-St. Louis), Martha Stevens (D-Columbia), and Jay Barnes (R-Jefferson City).

Stevens told lawmakers she was glad that the bill will cover a full range of treatments.

She said that one thing that came out of the committee hearing on the bill was that, “new moms need not just substance use disorder treatment.  That we really need to have comprehensive, wrap-around services, and so I’m very pleased that this bill is full Medicaid coverage so that these new moms can get substance use disorder treatment, they can get mental health care, they can go see a primary doctor, and really support them that first year after giving birth.”

Representative Faith Walker commended the lawmakers involved in the legislation for the bipartisan effort that led to its passage.

“It is a very common sense, evidence-based approach to dealing with the opioid epidemic here in the State of Missouri and it will both save taxpayer dollars as well as save lives,” said Faith Walker.  “I want to encourage the body to look at this effort that was put forward by all the bill sponsors moving forward for the rest of the session.”

Representative Keith Frederick (R-Rolla) said the bill represents something the legislature should do to help the most vulnerable in the state.

“The bottom line is that if we have ladies that are pregnant and have the struggle of addiction, they are in a special, vulnerable situation, as is their child,” said Frederick.

The bill’s projected cost is more than $4-million dollars through 2021, but Haefner noted it would save the state money that would have gone to caring for children who could go to state care if their mothers aren’t afforded treatment, and other cost avoidance.  She said the budget the House is debating this week also includes money to pay for the projected costs to extend this coverage.

The bill has been sent to the Senate for its consideration.  If it becomes law, the state will have to seek a waiver from the federal government to allow for the program to be created and implemented.  Missouri would be the first state to seek such a waiver.

Haefner is hopeful the state could get an answer from the federal government by the beginning of 2019.

Democrats propose multi-pronged attack on opioid abuse

Missouri House Democrats say the fight against opioid abuse is about more than passing a statewide prescription drug monitoring program.  They today unveiled a slate of legislation that would attack the problem by addressing a number of other issues.

House Democrat Leader Gail McCann-Beatty and Representative Gina Mitten speak about their caucus’ multi-bill approach to attacking opioid abuse in Missouri. (Photo; Chris Moreland, Missouri House Communications)

“The opioid disorder crisis is multi-faceted,” said House Democrat Leader Gail McCann-Beatty (Kansas City).

Democrats continue to support passage of a statewide prescription drug monitoring program to track the use of prescription narcotics.  Such legislation has advanced farther through the legislative process in each of the past few sessions, but fallen short of passage.  Last year St. Louis Democrat Fred Wessels sponsored such legislation that was combined with a bill sponsored by Sikeston Republican Holly Rehder and fell just short of final passage.  Both representatives will sponsor such legislation again this year.

In addition, Democrats have filed bills that would require pharmacies to post information about methods and locations for the safe disposal of unused medication; require for medical professionals with prescribing authority at least four hours of training on the misuse and abuse of prescription drugs and recognizing addiction in patients; require the Missouri Department of Health and Senior Services to mirror federal regulations for prescribing opioids for chronic pain; require insurance coverage of medication assisted treatment and remove insurer-proposed barriers to addiction services; establish a sterile needle and syringe exchange pilot program; require the Show-Me Healthy Babies program to cover substance abuse treatment for women up to one year post-partum; and expand the use of CBD or hemp oil to include being used as a pain management alternative for those with a history of opioid abuse.

“Substance disorders need to have an all-of-the-above approach and what we’re proposing here is just that.  We’re not only talking about PDMP.  We’re talking about a number of other options; tools that should basically be put in the toolbox of not just the medical community but our entire community,” said Representative Gina Mitten (D-St. Louis).

Mitten is sponsoring the bills that deal with safe disposal of abused prescription medication and additional training for prescribers.

Missouri is the only state in the nation without a statewide prescription drug monitoring program.  Many counties in the state are participating in a program initially launched in the St. Louis region, and Governor Eric Greitens (R) signed an executive order creating a tracking program for some prescription information handled by one benefits provider.

The legislation discussed today by House Democrats is for the 2018 legislative session, which begins January 3.

House endorses new abortion provider regulations; sends bill to the Missouri Senate

The Missouri House has passed a Senate bill that proposes new restrictions on abortion.  The House made several changes to the bill, so it goes back to the Senate for consideration.

Representative Diane Franklin carried Senate Bill 5 in the House during the legislature’s second extraordinary session of 2017. (photo; Tim Bommel, Missouri House Communications)

The bill would allow the attorney general to prosecute abortion law violations without first involving local prosecutors; repeal a St. Louis ordinance that bars discrimination in housing and employment against women who have had an abortion, use birth control, or are pregnant; and require annual, unannounced state inspections of abortion facilities, among other provisions.

“The bill that we received from the Senate, we thought, was a good framework but it did not really specifically meet the governor’s call, so we re-put in provisions that helped to provide for the health and safety of women,” said Representative Diane Franklin (R-Camdenton), who carried Senate Bill 5 in the House.

Democrats argue the legislation is not about women’s health and safety, saying it is about making it more difficult for women to get abortions in Missouri.

“For the entire last week the only word I’ve heard was, ‘abortion,’” said Representative Deb Lavender (D-Kirkwood)“It’s actually a scam that we think – we’re saying – that we’re protecting women when actually all we’re doing is putting additional hurdles in their way for them to access healthcare.”

Franklin said a key provision for her is language that would require that all tissue removed after an abortion is sent to a pathologist, rather than a sample as is required now.  A pathologist would have to account for all tissue and note any issues.  The Department of Health would follow up any inconsistencies with an investigation.  It would also report annually to the legislature all information it gathers regarding fetal tissue handling.

Franklin has carried various forms of such language going back several sessions, after a series of videos emerged alleging that Planned Parenthood was selling fetal tissue after abortions.

“I think that especially important that I worked on have been the fetal tissue portion of that – the tracking of that – so that we have the assurance that it is indeed going where it should be going and that our department is able to keep track of that,” said Franklin.

The bill also aims to bar laws that would interfere with the operations or speech of alternatives to abortion agencies.  Representative Hannah Kelly (R-Mountain Grove) says those agencies do a lot to help pregnant women.

“They offer pregnancy testing; ultrasounds – I’ve heard many, many, many stories directly from young mothers who … were in a place where they didn’t have any other options.  They needed alternatives and they needed help, and coming back to me, in particular, and saying, ‘I saw my baby.  I saw my baby move,” said Kelly.

Democrats are critical of information given out at alternatives to abortion agencies, saying it is medically inaccurate and skewed toward discouraging a woman from having an abortion.  Republicans say the agencies give women information with which they can form their own decisions.

Representative Cora Faith Walker offered an amendment that would have required quarterly reporting from alternatives to abortion agencies, but it was voted down. (photo; Tim Bommel, Missouri House Communications)

Ferguson Democrat Cora Faith Walker also questioned the effectiveness of those agencies.

“In total there are about 70-plus alternatives to abortion agencies that exist here in the state of Missouri and yet we still have issues with infant mortality rates and maternal mortality rates that surpass national averages,” said Walker.  “In specific areas of Missouri where there seem to exist several alternative to abortion agencies that are supposed to be providing healthcare and other services to women as an alternative to abortion, we still have these very, very high infant mortality rates.”

The legislature returned to Jefferson City in a special session to consider abortion legislation at the call of Governor Eric Greitens (R).  Democrats used debate of SB 5 to criticize the governor for what they said was a stunt meant to help him politically.

“Make sure we’re not letting a governor bring us back to special session for political gain,” said St. Louis City Democrat Bruce Franks, Junior“I know how passionate you (Republicans) all are about this issue.  I would never take that away from you.  I know how passionate we (Democrats) are.  But we’re not paying attention to how we’re being played … Now just because this is one of our particular issues that we feel so strongly about doesn’t mean it’s right that we’re here.”

Republicans called the session an important opportunity for the state to reaffirm a commitment to protecting unborn children and making sure women receive proper care from abortion providers.

House Speaker Todd Richardson (R-Poplar Bluff), when asked about lawmakers’ attitudes toward the governor, said, “I think we’ve been focused here in the House on issues, and I think the issues that we’ve worked on back in regular session and through these two special sessions are issues that are of particular importance to the House, and they’re of particular importance to members of the Senate as well, so the fact that we’ve got a governor that’s willing to engage on these issues has been positive and helpful.”

Representative Jay Barnes (left) talks with House Speaker Todd Richardson. Barnes offered several amendments that contributed to the final form of Senate Bill 5. (photo; Tim Bommel, Missouri House Communications)

Democrats note courts have ruled against laws that placed similar restrictions on facilities that provide abortions, and say this legislation will likely be thrown out as well.

“You already know this is going to straight to litigation once it goes into effect, and you also know the [financial cost to the state of defending it],” said St. Louis Democrat Stacey Newman.

Richardson believes if the bill the House passed is challenged in court, it will be upheld.

“This is obviously a very highly litigated area of the law.  It will continue to be a highly litigated area of the law in every state, but I’m very confident that the state of Missouri, if this law is challenged, will prevail,” said Richardson.

The state Senate is expected to debate the House’s changes to SB 5 in the coming days.

Republican plan would allow pharmacists to prescribe birth control pills

The sponsor of legislation that would allow pharmacists to prescribe birth control pills says his bill is both pro-choice and pro-life.

Representative Shamed Dogan (photo; Tim Bommel, Missouri House Communications)
Representative Shamed Dogan (photo; Tim Bommel, Missouri House Communications)

It’s pro-choice in the sense that we are trying to give women more control over their reproductive health and over their family planning, and it’s pro-life in the sense that the bill is intended to reduce unintended pregnancies and abortions,” said Ballwin Republican Shamed Dogan.

He said House Bill 233 could help reduce Missouri’s unplanned pregnancy rate by as much as 25-percent.

HB 233 would let pharmacists prescribe oral contraceptives to those 18 or older regardless of whether that person has a previous prescription.  Those younger than 18 who have evidence of a previous prescription could also be prescribed the pill by a pharmacist.

The legislation is projected to save Missouri money, and Dogan said it would save women money and time by negating the need for some visits to their doctor.

Several groups testified in favor of the bill, including the Teen Pregnancy and Prevention Partnership.  Its Executive Director Meg Boyko said HB 233, “would just be one step in the right direction to lowering barriers to access to care to those teens so they can take responsibility of their health and their health outcomes and prevent teen pregnancy.”

Representative Cora Faith Walker (D-Ferguson) said a similar plan in California didn’t have the results backers hoped it would.

“This is just a different barrier.  By making it behind the counter, making it a requirement for pharmacists to write the prescription, it just kind of shifts the barrier,” said Walker.

“We’re a different state than California,” Dogan responded.  “I think one of the issues that we might have that they don’t face nearly as much is rural folks … I think the fact that many people in rural areas don’t have access to a doctor in the same way that they have a lot more pharmacists in their areas … Yeah there’s still somewhat of a barrier, but it’s not nearly what the barrier is right now.”

Dogan said he favors making birth control over-the-counter, but noted such proposals have not been adopted in states that are more politically progressive than Missouri, and he doesn’t feel such a bill would be likely to pass in the Missouri legislature.

Shannon Cooper testified against HB 233 on behalf of Blue Cross/Blue Shield and the Missouri Coalition.  He said their primary concern was that without the need for a prescription, women would make fewer visits to their doctors.

“Under the [Affordable Care Act] and insurance policies, we provide a free exam once a year and we feel like for a lot of the invincibles that we talk about who don’t think they’re ever going to be ill or have any problems, when they receive these birth control pills and the prescriptions that does drive them back to the physician to get that exam,” said Cooper.  “I think we all know that early detection of any type of disease is one of the best cures for that disease.”

Cooper also expressed concern that HB 233 would allow up to a 12-month supply of birth control pills to be prescribed under certain circumstances.

“We feel like there will be certain individuals who could take advantage, get that supply and then drop off our policies with that 12-month supply,” said Cooper.  “Obviously there’s a cost concern there.”

Others expressed concern that allowing a 12-month supply could lead to wasted pills, such as in cases in which a woman only uses them for a while and then stops for some reason.

Representative Mike Stephens (R-Bolivar), himself a pharmacist, said he hopes the proposal represents a larger effort to expand the availability of medical services.

“If there is a saving grace to the health care system it must include a greatly expanded role in health care delivery and health care access by a wide variety of health care professionals,” said Stephens.

The committee has not voted on HB 233.

Last year similar legislation was passed by the House 97-50, but stalled in the state Senate.