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.

Bill to set Marriage Age at 18 clears House Committee

      A proposal to eliminate state-recognized marriage for those under the age of 18 has been advanced by a House Committee.  Several lawmakers expressed support for the change as a way to protect children, especially from traffickers.  Others expressed hesitation about creating a roadblock to young couples who genuinely want to be wed.

Representative Renee Reuter (Photo: Tim Bommel, Missouri House Communications)

      Missouri law was changed in 2018 to allow the issuance of marriage license to those 18 and older, and to those between 16 and 18 with parental consent.  No licenses may be issued to couples in which either party is younger than 16. 

      The sponsor of House Bill 1200, Representative Renee Reuter (R-Imperial), said the 2018 change was an improvement, but it did not go far enough.

      “There are problems in Missouri with human trafficking and … marrying young people off is one way to lock them in to sex trafficking for a while,” Reuter told the Committee on Children and Families“We have to protect people from being trafficked, and so because of that I think we need to look at the law a little differently and I think we need to protect these women, mainly women, who are being damaged by the marriage laws that we have today.”

      She said people who get married younger than 18 are trapped.

      “One cannot get divorced in the State of Missouri until you’re over 18, so should you get married at 16, you’re stuck in that marriage because there’s no way to divorce until you’re 18,” added Reuter, who is an attorney. 

      Reuter cited the stories of women who married when younger than 18 and found themselves in situations of abuse from which they couldn’t escape.

      “They were beaten, raped, and forced into sexual relationships with other people and it just got so bad that they ran away.  When they ran away they would get picked up by authorities, and the first thing they would do is take them home to their husband.  They wouldn’t take them to their parents, they would take them home to their husband … because they were married, and that was just a repeating scenario, and what would happen when they get back is things would even get worse.  They just saw this as a way that they couldn’t get out of, they couldn’t get out of the marriage.  Sometimes [their husband] would put them on a plane and take them to another country and they couldn’t get back.  This is a real problem for people who are caught up in it.  The marriage itself becomes the chains that are around the wrist, to keep them in this situation, and that’s not what marriage is supposed to be about.”

      Some on the committee expressed opposition, saying they know people who were wed when younger than 18.

      “I have multiple friends who have been married at 16, 17 years old and have amazing marriages,” said Representative Mike Costlow (R-Dardenne Prairie), but he said that was only part of his objection.  His greater concern, he said, was about legal recognition for young families.

      “Our age of consent law here in Missouri begins at 17.  [For this bill to become law] would mean that we are saying you can legally go out, have sex, get pregnant, create a family unit, but you cannot get married to be recognized under the law that way, at 17.”

      Some, like Carthage Republican Cathy Jo Loy, wondered whether the legislation could include an exception for marriages that are not in some way coerced.

      “Right now I’m supportive of this bill, but I’m really having a hard time wrapping my head around the fact that not all young marriages are that situation.”

      Representative Ann Kelley (R-Lamar) said HB 1200 could result in a law that misses its target.

“If you’re going to do something bad, you’re going to do it no matter what, right … so who pays for it?  The people that are wanting to get married for the right reasons, they’re the ones that are paying for it.  I understand where you’re coming from, I just wish there were some exceptions or something in here to allow the ones that have good intentions to go ahead and get married.”

      Upon hearing those concerns, Reuter suggested that her colleagues consider another way to look at such situations.

       “In the Catholic church, you can get a divorce under Missouri law but the church does not recognize it unless you get an annulment, and to me they could come up with something like that within the church, but within the law I think we need to take this approach.”

      Ozark Republican Jamie Gragg said the bill is in line with what has been the focus of the Committee on Children and Families in recent years.

“My grandparents were married at 14.  We don’t live in the same world today, anymore, and our ultimate goal, and I think everything we’ve done here in this committee this whole year is protecting children, and that’s where our focus has to be and I think that your bill is doing just that … [regardless of] what used to be or what is allowed in other countries or other religions, here in America we have to protect the kids.  We have to.”

      The Committee’s top Democrat, Raychel Proudie (Ferguson), said there are parallels between what this bill seeks to address, and the fact that judges in Missouri typically refuse to finalize a divorce if one party in the marriage is pregnant.  That has effectively prevented pregnant women in abusive relationships from being able to divorce their partner. 

      “If you’re not 18, regardless of what your situation is currently you just have to be there, and if you’re pregnant you really have to just be there, so it’s a bad situation all around.”      

      Proudie is one of the sponsors of a bill to deal with that situation, which was recently advanced by the Children and Families Committee.

      Committee chair Holly Jones (R-Eureka) illustrated a further point in support of HB 1200.  She asked Reuter, “Is there another contract that we can enter into under the age of 18 that’s legally binding?”

“I am not aware of any,” Reuter said.

      A Senate version of this legislation made it to the House in April last year but did not reach the Governor’s desk.

      In spite of the concerns that were voiced, HB 1200 was passed out of the committee with a 15-0 vote.  The legislation now goes to another committee which could vote to send it to the full House.

House panel asked to stem ‘medical kidnappings’ by the state

      A House committee has been presented with stories of a parent’s nightmare:  children being taken by the state based on false suspicions of parental abuse.  Legislators are being asked to address the issue, but finding a balance is difficult when the safety of children is at stake.

Representatives Jamie Gragg and Holly Jones (Photo: Mike Lear, Missouri House Communications)

      The stories shared some similarities.  Parents take a child to a doctor for care for a broken bone.  A medical professional suspects the parent of abuse and contacts the state.  The state takes the child and its siblings from the parents. 

      Months or more go by.  Eventually, a medical diagnosis reveals an explanation for the broken bones that doesn’t involve abuse.  After many frustrating circumstances, much heartache, and the passage of a lot of time, parents and children are reunited, but there are no apologies and much, much damage has been done.

      “The bigger picture, again, is:  we don’t have any rights at all, as soon as anybody says, ‘This is abuse,’” Rebecca Wanosik told the House Committee on Children and Families

      Wanosik was one of those who shared her ordeal with the Committee, as was Tessa Gorzik.

      Gorzik said, “It’s not a one-time thing and you’re done, whether you are convicted of it or not, or accused of it or not.  It’s ‘you’re guilty’ from day one and you have to fight your whole entire life to get those allegations overturned when there should have never been allegations from the get-go if they had done their job appropriately from the get-go.”

     This is what Representatives Holly Jones (R-Eureka) and Jamie Gragg (R-Ozark) are trying to address with House Bills 2690 and 2691.  They are proposing that when a child is placed into 24-hour protective custody due to suspicion of child abuse, custody cannot be extended if a parent or other authorized guardian presents proof that contradicts the allegation of abuse. 

      Jones said it would allow a parent to present a second opinion.

      “There are children that have never been diagnosed [with diseases that can cause injuries that resemble abuse], so there’s no proof to be had, as of yet.  That’s the spirit of the bill, is to be able to offer parents an option when some of these medical conditions could be happening and they’re being accused of child abuse when no such abuse is occurring.”

      Wanosik said such provisions would have saved her a great deal of pain. 

      She said five of her children were taken from her in 2015 when the youngest, then nine weeks old, was found during a doctor visit to have three rib fractures and an arm fracture.  She said her family was denied second opinions and denied access to her child’s medical records. 

      While her children were in state custody, the infant developed more fractures.  Rather than see this as a possible sign that the parents weren’t responsible, the state said the parents could have caused these new fractures during visits, despite those visits being supervised.

      Eventually, a medical diagnosis revealed another explanation for the injuries, but the allegations did not go away.

      “They ruled by a preponderance of evidence that my baby was clearly a victim of child abuse and neglect but they couldn’t pin a perpetrator, and then they gave me my children back,” said Wanosik.  “It’s very common, actually, because you’re not held to the same standard [of] the criminal court and there was never enough evidence for us to be criminally charged,” so they just kept running us through the family court system.”

      Now, Wanosik is the Treasurer for a group called Fractured Families, a group that advocates for situations like hers.  

      “I wholeheartedly believe that [HBs] 2690 and 2691 are going to open up the gateway to at least provide protection for families in the fact that we [could, if it passed,] access the child, the [medical] records.”

      The Committee’s members responded favorably to the proposals but expressed concern that the language needs to be refined. 

      Ferguson Representative Raychel Proudie (D) said it’s unclear to whom any kind of proof of a medical condition would need to be presented.

      “You’re at my house, I’m about to go to jail, you’re about to take my kids, I have the proof, who do I show?  Do I show the police?  The nurse?  It’s the weekend.  It’s a Saturday.  Court’s closed.  My kid has been in your possession now for over 24 hours and I don’t know to whom I am showing this proof.  How do we remedy that?”

      The Missouri Network Against Child Abuse (formerly Missouri KidsFirst), an entity respected by many lawmakers when considering child abuse legislation, spoke in opposition to the bills.  Its Executive Director, Jessica Seitz, said the bills focus on one piece of an abuse allegation.

      “In the overall investigation of an allegation of abuse, the medical opinion is not the arbiter, the decider of the outcome.  It is one part of the investigation.”  

      Further, Seitz said the “proof” the bill centers on is not defined, calling the language, “vague and problematic, and being unspecified puts us at risk of a child being left in an unsafe situation.”

      Seitz challenged the premise of the bill, that there is a need for a state law to allow parents to get a second opinion when they are being investigated for child abuse.

      “A second opinion is always welcome in the court process, but just introducing a second opinion as a part of the overall investigation … should not short circuit the process and mandate the outcome, introducing one factor in the overall investigation.  We risk putting our kids in danger.”

      However, Seitz emphasized respect for the efforts of Jones and Gragg, saying she wants to work with them to improve the system.

      Jones said she remains adamant that something must change, because the damage done to children and their families when the state takes children away is long-lasting and runs deep.

      “That’s one of the reasons why we’re trying to move forward with this bill so quickly, is that our foster care system is not only so overrun and it’s such a huge part of the children and families organization throughout the state, this is really going to cut back on the mental health issues and the trauma to families,” Jones said.

      Committee member Ed Lewis (R-Moberly) acknowledged Seitz’s concerns but told her, “We are going to move forward with this bill, if I have anything to say about it, but you need to be a part of the picture.  Your organization needs to be a part of the picture because if you’re not, it’s not going to be the balanced, thread-the-needle approach that has to happen so that we both protect those children who are actually being abused and … I would say [just] as important, [is] protecting those families and those parents and those children who aren’t being abused but get caught up in the system.”

      Gragg echoed Lewis’ sentiment, telling the committee he knew addressing this issue would be challenging.

      “There’s a very fine line that we’re trying to close the gap on, from protecting the kids that need protecting … and also not taking advantage, or overstepping, with those [cases of children with parents] that are falsely accused of something.  We’re trying to narrow that gap, and the problem with that narrow line, that fine line, is it ain’t straight.  That is for sure.”