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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.

Attempt to stem catalytic converter thefts to return in 2024 session

Legislators will again this year be asked to stem the thefts of catalytic converters from Missourians and in doing so, it is hoped, get some people into drug treatment programs that could improve their lives.

*Representative Don Mayhew (Photo: Tim Bommel, Missouri House Communications)*

The House in the last two years has given overwhelming approval to bills that would make such thefts a felony, while requiring additional reporting to the state from entities that purchase catalytic converters. The same proposal will be among those filed for the 2024 session after prefiling begins on December 1.

Representative Don Mayhew (R-Crocker) says that the bill has been refined over several sessions.

“I think at this point we have vetted this thing to death,” said Mayhew.

The proposal’s bipartisan support includes Representative Aaron Crossley (D-Independence), who has himself filed a portion of that language. He said the issue has impacted his neighborhood and workplace.

“My neighbors have had issues with cars being stolen. Here at my work, we’ve had cars stolen out of the parking lot the last few weeks because of this issue, so it’s practical and real,” said Crossley.

Mayhew has become adept at explaining the issue, having presented it to his colleagues several times over the years. It begins with the two very different ways catalytic converters are valued: their value when stolen and scrapped, and the value to replace them.

“While most catalytic converter thefts prior to changing this law would have fallen in the category of petty theft – most of them would have been misdemeanors because the actual salvage value of the item is less than $1,000 – the true cost of that stolen catalytic converter is a lot more than that because the person who has to replace that catalytic converter is looking at, at least, a $2,000 bill, so we have to take that into account whenever we consider the ultimate consequences of the act.”

“To me it’s also a working person’s issue,” Crossley said. “When somebody has to go out and replace their catalytic converter and those can cost anywhere from $1,000 to $5,000 to replace, that’s a big chunk of change for a working person to have to go put down just to get a small part for their car replaced.”

Converters are an easy and profitable target because an experienced thief can steal one in as little as 30 seconds, and because they contain rare and valuable metals they can be sold to a salvager for anywhere from $50 to $900.

Even in the case of a new vehicle with full coverage insurance, the deductible cost is usually more than the cost of replacing the converter. Mayhew says most people who are victims of such thefts have liability coverage only.

*Representative Aaron Crossley (Photo: Tim Bommel, Missouri House Communications)*

“I have two elderly ladies in my district who had catalytic converters stolen. They had older model vehicles and the catalytic converter was stolen from their car. Well, now they’re out of a vehicle because they can’t afford the $2,000 it’s going to take to put the catalytic converter back on their car and their car’s not worth $2,000. Those are the people who are getting hurt by this. This is not a victimless crime. This is not a, ‘Oh, the insurance is going to pick up the cost,’ kind of thing because they don’t.”

Democrats have been very vocal in recent years in opposing legislation that would increase sentencing in other areas of law. Crossley says in this case, however, stiffened penalties make sense.

“We do a disservice when we pass laws that aren’t enforceable and don’t have some teeth … so I think finding that balance to make sure that we’re not being overly harsh to Missourians but also understanding that by not having some repercussions that we’re also harming people,” said Crossley.

Mayhew said there would be an element of compassion in increasing these penalties. It could get more people into the drug treatment programs of the state’s courts, which have historically been very effective.

“Most catalytic converters are stolen because the person who’s stealing it has a drug problem. Well until we make it a felony then we can’t get that person to drug court. On a misdemeanor, they don’t go to drug court, but on a felony, then our local prosecutors can, in those cases where it was a person who was simply trying to feed this habit that they’ve acquired, if we can get them to drug court maybe we can kill two birds with one stone,” explains Mayhew. “We can help this person, turn them into a productive citizen, but also reduce the amount of crime that’s happening in our county.”

Mayhew said the proposed changes in reporting requirements for salvagers would also increase accountability for those buyers.

“That accountability takes the form of once a month those who purchase catalytic converters will have to turn in a report to the Department of Revenue, the information, a lot of which they already are required to accumulate whenever they purchase a catalytic converter.”

That includes getting a photocopy of the seller’s driver’s license and recording the license plate number of the vehicle that brought in the converter – both of which are already required – and the proposed new requirements of getting the make, model, and serial number of the vehicle off of which the converter came; and providing a signed affidavit saying the converter wasn’t stolen. These new requirements would only apply to individuals, rather than established businesses.

Crossley supports the additional reporting requirements, and it is this area with which his legislation filed in the 2023 session dealt.

“Adding just a few more requirements to make sure that they’re receiving and buying converters that were actually lawfully obtained is the point,” Crossley said.

Mayhew said such reporting would also let Missouri at last know how many catalytic converters are being salvaged, and “keep honest people honest.

“Right now we are in a ‘hear no evil, see no evil, speak no evil’ kind of situation. As long as I don’t ask you if it’s stolen then I’m not going to be accountable for it, if it is.”

Mayhew notes that in the last two years, legislation dealing with this issue has passed out of the House 153-1 and 143-2, and in at least one of those cases, he said a “no” vote came from someone who thought he was voting on a different amendment. He said the legislation isn’t just a caucus priority, it’s a legislative priority.

He and Crossley hope that 2024 proves to be the year that the measure makes it into statute.

“It’s a growing issue that we have to tackle because nobody is served by not doing anything,” said Crossley.

The new legislative session begins January 3.

Missouri law now includes expanded therapy coverage for children with disabilities

More Missouri children and teenagers with specific developmental or physical disabilities will have insurance coverage for therapeutic care under a House proposal that became law this year.

Representative Chuck Basye (right) stands with Robyn Schelp (center), her son Nathan (in yellow) and their family. (photo: Tim Bommel, Missouri House Communications)

The language, included in Senate Bill 514, expands Missouri law that mandates coverage for therapy for children with autism spectrum disorder. It includes physical, speech, and occupational therapies. It will apply to plans renewed or enacted beginning January 1.

It was sponsored by Rocheport representative Chuck Basye (R), who said estimates placed the number of children this would impact at between 5,000 and 6,000.

“It was the last thing I ever thought I would get behind because I do not have anybody in my family that has a developmental disability,” said Basye. “My brother-in-law is blind … that’s not really a developmental disability but that played a role in it.”

Basye said when he met Robyn Schelp, President of Missouri Disability Empowerment, and her 11 year-old son Nathan, who has a genetic disorder, he heard their plight and thinking about his brother-in-law put it into context.

“Bob had a lot of struggles but he ended up being very, very successful in his life because he got resources he needed at a very young age,” said Basye.

Basye also developed a special bond with Nathan, which we wrote about in March.

Schelp worked in the Capitol for three years, often with Nathan at her side, pushing for this legislation. She said the law will now help children who have a broad array of conditions.

“The ones you’re familiar with; Downs syndrome, CP, MS, but it’s also going to apply to kids like my son, whose diagnoses are so rare that you’ve never even heard of them. It’s any developmental disability,” said Schelp, “Which is really one of our goals, is that we start thinking of disabilities inclusively; that we don’t pick and choose who gets funding, who gets the services, but that we make sure that every child with a disability gets what they need to be successful.”

Legislators heard that making therapies more available to children when they are young makes those therapies more effective, and the benefits are seen in other aspects of their lives.

“Just speech alone, speech and language, the ability to communicate your needs is so important for day-to-day functioning, so it gives them that ability just to be independent and to function in day-to-day life, and it gives them confidence to go up and engage with people, so that’s huge, but it also helps them academically,” said Schelp. “This is a big picture thing. We’re not talking just, ‘Oh, great, now he can say the S sound.’ We are talking, he can now go and engage in his daily life with other people, and the same can be said for occupational therapy and physical therapy.”

Making such therapies available to children earlier in life can also lead to cost savings for families and the state.

“For example, speech, some children need help swallowing. They will aspirate. If they get that therapy then great, they’re going to be able to swallow properly, and if they don’t they might end up with pneumonia and end up in the hospital,” said Schelp. “There are a lot of health consequences that come when kids aren’t getting the therapies that they need. Even just the ability to communicate your needs can keep you healthier and safer.”

Schelp said it is difficult for her to think about how different Nathan’s life might have been if this law had been in place when he was growing up. He was limited to one session of each type of therapy a week, early in his life.

“Had we have had this he could’ve started getting speech therapy three times a week at the age of 2 or at the age of 3. We had to wait until Nathan was 9 before he could start getting those therapies. Just the progress he’s made in the last two years … I just think if he would’ve had that when he was 2 and 3, and early intervention when the development is so crucial, where might we be today?” said Schelp. “If we would’ve had just a solid foundation of speech and language therapies at the beginning to help him, I don’t even want to think about where we could be today, but he went until the age of 9 not able to get, fully, the therapy that he needed.”

Schelp went from being so, as she put it, “out of the loop” in state politics she had to look up who her state representative was. She encourages others to be willing to lobby for the changes they want or need in government.

“You really can do this, and if you don’t do it, it may not get done,” said Schelp. “People don’t know what they don’t know, and if you don’t share your story and let [legislators] know what’s happening, they’re not going to be able to change anything.”

“People will listen if you talk to them. I think we tend to think they won’t listen so we don’t even try, but they will listen … and there are more issues that, now, we’re talking on because we’re realizing we can do this, and if we work together we can get it even farther; we’ll be stronger.”

All 50 states have an autism mandate. This legislation made Missouri the third state to expand that to cover all developmental and physical disabilities.

Basye’s legislation passed out of the House with broad support, 138-4. That bill, House Bill 399, was eventually vetoed by Governor Mike Parson (R) because of an issue with another measure that was amended to it, but the language became law as part of SB 514, which was signed into law July 11.

Schelp’s organization has other issues that it’s working on and Basye said he would be working with her on a least one of them.