Missouri legislature votes to ease regulation of hair braiders, curb future business regulations

Legislation aimed at decreasing regulation of Missouri businesses has been approved by the General Assembly.

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

The state House voted Tuesday for the final passage of House Bill 1500, which started off as a bill to ease regulations of hair braiders, but added to it is language that will make the state think twice about imposing regulations on new professions.

In order to charge for braiding someone’s hair in Missouri a person must undergo 1,500 hours of training to obtain a cosmetology license.  The sponsor of HB 1500, Ballwin Republican Shamed Dogan, said that training does not cover hair braiding.  Dogan said that’s overly burdensome on people who often learn braiding as a practice handed down by family through generations.

“I’m very grateful that we’re going to be able to take hair braiding from a 1,500 hour license requirement to merely four to six hours of watching an instructional video on health and safety,” said Dogan.

Critics of an earlier version of HB 1500 said they were concerned hair braiders whose training was not extensive enough could pose health risks, including that they would not be able to recognize diseases involving the scalp and could spread those conditions.

HB 1500 now requires that a hair braider watch a four-hour video on health and safety.  House Democrat Leader Gail McCann Beatty (D-Kansas City) said she would have liked more hours to be required, but is glad that is a requirement and not optional, as it was under an earlier version of the bill.

“I think the definition of a good bill is one that no one is totally happy with,” said McCann Beatty.

The Senate added to House Bill 1500 the language of House Bill 1928, sponsored by Yukon Republican Robert Ross, which aims to discourage unnecessary state regulation of businesses.  The bill also lays out what considerations must be made before a regulation is imposed.

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

“This bill will require that we look through and actually quantify the risk that is going to exist to the public in the operation of this unlicensed profession and why we, as a state, would need to step in and regulate that,” said Ross.  “It also states that … if we’re going to impose regulation on this that we should start with the least restrictive form of regulation, and then based on that risk to the public, then move that up.”

“That will fulfill the promise that many of us – most of us – have made, to reduce regulations,” said Representative Keith Frederick (R-Rolla) of Ross’ language, “and the best way to reduce them is don’t put them in place in the first place unless they’re really essential.”

Kansas City Republican Kevin Corlew encouraged his colleagues to vote for HB 1500 as it returned from the Senate.

“I think this bill enables small business and entrepreneurs to do what they love to do, to do something that they’re good at and to make a living out of it.  This is a bill that enables government to get out of the way, cut unnecessary red tape, and allow entrepreneurs to do their craft,” said Corlew.

With the House’s 137-11 vote on Tuesday the legislation is now ready to be delivered to Missouri’s governor.

House approves bill taking multiple approaches to opioid addiction fight

The Missouri House has voted to take more steps toward fighting opioid addiction, with more such efforts likely to come from the chamber before the session ends in May.

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

House Bill 2105 has been sent to the state Senate for consideration.  The bill has a number of provisions.  Sponsor Keith Frederick (R-Rolla) said the overarching idea behind the bill is to see a shift in the response to opioid addiction from law enforcement and incarceration to treatment availability.

“That’s the thing that’s lacking so much now, is we don’t have enough health care providers to provide access to what’s called, ‘medication assisted therapy,’” said Frederick.  “It is basically using medications like buprenorphine and Suboxone that get rid of the craving for narcotics and it allows people to get back to a useful, functional, rewarding life, but they need the medication on an ongoing basis and for that we need healthcare providers to help provide access to that sort of treatment, and we don’t have enough of those now.”

Frederick said the main provision of HB 2105 would create the “Improved Access to Treatment for Opioid Addictions” Program (IATOA).  It would use assistant physicians – a position created by legislation passed in 2014 – to work in a collaborative way with licensed doctors to provide addiction treatment throughout the state.

Those assistant physicians will be supported by the ECHO program (Extension for Community Healthcare Options) – a program that uses videoconferencing to connect experts with providers statewide to help providers offer specialized care.  Frederick said a module has been created for ECHO that focuses on opioid addiction treatment.

“These assistant physicians will have to become waivered – so they have to take a course on addiction treatment, and then they submit that to the DEA – the DEA can then give them a waiver to prescribe this medication, then they have to work in a collaboration with an experienced addiction treatment specialist, and then they’re also supported by the ongoing education of the ECHO opioid addiction module,” said Frederick.  “It’s a wonderful, collaborative way to bring access to this really life-changing, life-saving treatment to people struggling with addiction instead of their ending up in prison.”

Frederick said this program would be among the first of its kind in the nation, and other states are already taking note of it and considering how to create their own.

Another of HB 2105’s main provisions would limit to a seven-day supply the amount of an opioid drug that could be prescribed to someone for acute pain.  Frederick said this is meant to keep people from becoming addicted while not limiting such drugs to those who rely on them for long-term pain management.

“The difference between somebody who’s addicted and somebody who’s dependent is a pretty big difference,” said Frederick.  “The idea is to prevent people like the high school athlete who has a knee injury and the doc gives him 150 Percocet or whatever – it’s to nip that in the bud; prevent new people from getting addicted, but while acknowledging that there are people in our state that have chronic pain and they’re getting along pretty well, thank you very much.  So, I don’t believe we should be going after that patient that is needing ongoing medication on a regular basis but their life is stable and they’re doing well.”

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

The bill would also create the Prescription Abuse Registry – a registry a person could voluntarily add himself or herself to – for individuals who have struggled with addiction.  The registry would do no more than notify doctors who choose to check it that those on the list have had a substance abuse problem.  That language was added by Representative Jay Barnes (R-Jefferson City).

“I think a lot of times people with substance abuse problems, at some point in their life they try to get clean,” Barnes said.  “At that point in time … they’re in a position when they may want to put themselves on a list like this, but if they have a relapse … being on a list like this would give providers a tool that if they suspect the person of doctor shopping, to check the list and say, ‘What’s going on here?  I know that you’re on this list.  I know that you’ve had a problem with opioids in the past … what are we doing?’”

A person could petition to be removed from the list five years after adding her or his name to it.

Other provisions in HB 2105 would create a drug take-back program for disposal of unused prescriptions; and bar the Department of Corrections from preventing offenders from receiving medication-assisted treatment for substance abuse or dependence.

The bill would also discontinue patient satisfaction scores of doctors, to the extent allowed by federal law.  Frederick said this is to keep doctors from being giving low scores by patients with addiction issues to whom they refused to prescribe opioids.  Such false, punitive low scoring can hurt doctors’ reputations, and hurt them financially.

The House voted 128-4 to send HB 2105 to the Senate.  Representative Frederick is also handling HCB 15 which will also contain multiple provisions aimed at fighting opioid abuse.  That legislation could be coming out of the committee process and ready for debate in the full House in the next few weeks.

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.

House rejects greater penalties for assaulting, killing police dogs, following emotional debate

The Missouri House has defeated a bill to increase penalties for assaulting or killing a law enforcement animal amid emotional debate led by black Democrats, who emphasized what they say those dogs represent to their communities.

Representative Robert Cornejo (photo; Tim Bommel, Missouri House Communications)

House Bill 1649 would increase those penalties as high as a class-C felony, which carries up to ten years in prison, for killing a police dog or injuring it to the extent it cannot continue to be used as a police dog.

The sponsor of House Bill 1649, St. Charles Republican Robert Cornejo, has offered similar legislation for several years.  He said the penalties for hurting or killing a police dog are too lenient.

“Even if you treat it as property, with the tens of thousands of dollars that are invested in this property I don’t think that the punishment should be the same as failing to return a library book that’s worth ten bucks.  I think this is something that is right-sizing the punishment,” said Cornejo.

The bill was given initial approval last week but only after many Democrats spoke against it saying that police dogs have, in the words of Minority Leader Gail McCann Beatty (Kansas City), “been used as a weapon against black citizens.”

House Minority Leader Gail McCann Beatty (photo; Tim Bommel, Missouri House Communications)

During debate before the vote whether to send the bill to the Senate, Representative Bruce Franks, Junior, (D-Ferguson) spoke with Cornejo about what police dogs meant to him.

“I can remember when I was in elementary school how much I would hate watching civil rights videos because of what they did with those dogs,” said Franks.

Some Republicans also talked about issues they had with the legislation.  Shamed Dogan (R-Ballwin) said under HB 1649 the penalties for killing or disabling a police dog would be greater than those for second degree rape or assaulting a person in a nursing home.  He also said the bill leaves no room for self-defense against a police dog and does not account for incidents in which a dog might be used improperly by police.

“This piece of legislation does not allow me to stand my ground against a police dog,” said Dogan.  “It is the irony of all ironies that those of us who support the Second Amendment would say that I have a right to self-defense, that I have a right to use deadly force against other people when I believe that my life is in jeopardy from them, but if I’m being charged at by a police dog then that right just goes away and I have to take whatever that dog is going to give me.”

Some Republicans said the issues that were raised caused them to change from favoring the bill in last week’s vote to opposing it.  Rolla Republican Keith Frederick told Beatty the legislation needs to be reconsidered.

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

“I think if I were in the African American community and hearing the discussion that you’ve done today, I would very much be saying to myself, ‘You know, this is not good optics, for sure; it’s not a good perception,’” said Frederick.

The vote on the bill was 73-68, short of the 82 needed to send it to the Senate.  Cornejo noted that there were 14 members absent for that vote and said the bill could be brought up again for consideration, or that the issue should still receive attention.

“I think if we had full attendance the bill would’ve passed,” said Cornejo.  “I know, speaking with somebody already since the vote, there may be a motion to [reconsider] or we could revisit this issue as an amendment on the floor in the future.”

Beatty said she was, “a little bit,” surprised that the bill failed.

“I was very impressed by the fact that folks actually listened,” said Beatty.  “I don’t think when we did the perfection [vote] that people understood the deep-seeded anguish that people felt over this particular bill, particularly when we were basically saying that animal’s life takes precedent.”

Democrats also called for other bills dealing with police matters to be advanced.

“Until we face this issue head-on and look at the legislation that’s out there and really deal with the issue little pieces like this are not going to fix it and there’s going to be unintended consequences,” said Beatty.

Missouri House votes a second time to ease state’s motorcycle helmet law

The state House has voted twice this session to relax Missouri’s law requiring that helmets be worn by motorcycle riders.

Representative Shane Roden offered an amendment to a Senate bill to ease Missouri's motorcycle helmet law.  (photo; Tim Bommel, Missouri House Communications)
Representative Shane Roden offered an amendment to a Senate bill to ease Missouri’s motorcycle helmet law. (photo; Tim Bommel, Missouri House Communications)

Members voted earlier this month to pass House Bill 576, and on Tuesday voted for an amendment to Senate Bill 8, both containing the same language.  They would allow riders 21 and older who have completed a motorcycle safety course or who have had their motorcycle license for at least two years to ride without a helmet if they have insurance.

Missouri legislators have for years debated easing the state’s helmet law.  While both measures received favorable votes, the issue stirs passion in both proponents and opponents, and both sides of the issue are bipartisan.

Rolla representative and doctor Keith Frederick (R) said he generally, “doesn’t want the government telling people what to do,” but riders without helmets could cost taxpayers a lot of money.

“Somebody has a bad accident and they have a head injury that incapacitates them for years, it’s … I think the gentleman from the White District in the past has pointed out the lifetime cost is average about $4.5-million,” said Frederick.

Kansas City Democrat Ingrid Burnett said she could not support the amendment after the death of a close family friend.

“He hated wearing a motorcycle helmet but he wore his helmet when he was in Missouri because Missouri had a helmet law, but when he was traveling back to Oakland and going through a state where there was no law, he had a serious accident and lost his life,” said Burnett.

The amendment to SB 8 was offered by Cedar Hill representative Shane Roden, who said he rides motorcycles himself.  He said he would wear a helmet most of the time even if the law is changed, but he wants the freedom to ride without it.

He argued that nearly half of fatal motorcycle accidents involved riders that had more than the legal limit of alcohol in their systems, “so if we want to talk about reducing fatalities maybe we need to start enforcing DWIs a little bit stronger, so I would say if you really want to make an effective reduction in deaths, maybe we need to go on the campaign about riding while intoxicated or buzzed driving.”

Representative Keith Frederick opposes proposals this year to relax Missouri's motorcycle helmet law.  (photo; Tim Bommel, Missouri House Communications)
Representative Keith Frederick opposes proposals offered again this year by fellow Republicans to relax Missouri’s motorcycle helmet law. (photo; Tim Bommel, Missouri House Communications)

St. Joseph Republican Delus Johnson said as a motorcycle rider, he feels he is “grouped in” by the state’s helmet law with those who ride while intoxicated or ride recklessly.

“Why am I being punished?” asked Johnson.  “Why am I grouped in with these drunks that are riding motorcycles that probably don’t have a motorcycle license, they don’t have motorcycle insurance.  If they’re not wearing a helmet and they get in a wreck they’re breaking the law anyway.  Why are we grouped in with those lawbreakers?”

Supporters also argue that allowing people to ride in Missouri without helmets would increase tourism.  They say many riders and groups deliberately avoid the state because of its helmet law.

HB 576, sponsored by High Ridge Republican John McCaherty, is awaiting a vote by a Senate committee.  SB 8 has been sent back to the Senate with several amendments that that chamber must consider.

House members again asked to consider legalizing medical marijuana in Missouri

The Missouri House is again being asked to consider legalizing marijuana for some medical purposes.

Representative Jim Neely (right) listens as Jackson County Sheriff Mike Sharp (left) testifies in favor of Neely's medical marijuana legislation, HB 437.  Jackson said he has a nephew that could benefit from medical marijuana.  (photo; Tim Bommel, Missouri House Communications)
Representative Jim Neely (right) listens as Jackson County Sheriff Mike Sharp (left) testifies in favor of Neely’s medical marijuana legislation, HB 437. Jackson said he has a nephew that could benefit from medical marijuana. (photo; Tim Bommel, Missouri House Communications)

House Bill 437 would allow the use of marijuana to treat irreversible debilitating diseases or conditions.  Its sponsor, Cameron Republican Jim Neely, said it would expand on two Missouri laws.  One allows the use of a cannabis extract, cannabidiol (CBD) oil, for treating intractable epilepsy.  The other is the “right to try” law that lets doctors and patients use drugs that haven’t completed the approval process through the federal Food and Drug Administration.

The bill would have the Missouri Department of Health and Senior Services create a list of conditions for which patients could be allowed to use medical marijuana.  That list would have to include any conditions or diseases for which a clinical trial of medical marijuana has completed its first phase.

The bill would allow the Department to issue medical cannabis registration cards to Missourians 18 and older for whom a doctor has signed a statement saying the individual suffers from epilepsy or an irreversibly debilitating disease, could benefit from medical cannabis, and has considered all other treatment options.  Parents would be allowed to obtain registration cards for their children.

The House Committee on Health and Mental Health Policy heard from Doctor Adrianne Poe, who told the committee cannabis-based pain treatments would be safer than commonly used opioid-based medications.  She cited a report from the National Academy of Sciences, which said that cannabis is safe and effective in treating pain.

“That is in direct opposition to all of the literature that we have that shows there is not a shred of evidence for the safe and effective use of chronic opioids for chronic pain,” said Poe.  “According to the CDC guidelines which tell us that the very first thing that physicians need to do is find an alternative therapy to opioids for the treatment of chronic pain.  The National Academies has given us an answer on that and the answer is cannabis.”

Heidi Rayl told lawmakers Missouri should not stop with the passage of the law that has allowed her to treat her son’s seizures with CBD oil.

“This is where our state is lacking.  One type of medication does not treat everyone.  I, as Zaden’s mother, should have the right to choose what is best for him,” said Rayl.

Legislators were also told the passage of medical marijuana legislation would put Missouri’s laws in conflict with federal laws.

Jason Grellner with the Missouri, and National, Narcotics Officers' Association testifies against medical marijuana legislation.  (photo; Tim Bommel, Missouri House Communications)
Jason Grellner with the Missouri, and National, Narcotics Officers’ Association testifies against medical marijuana legislation. (photo; Tim Bommel, Missouri House Communications)

Jason Grellner with the Missouri, and National, Narcotics Officers’ Associations, told the committee, “If you pass legislation that is in violation of the Supremacy Act of the United States regarding scheduled drugs, I don’t think you want me choosing which laws I enforce and which ones I do not.”

He also said passing a medical marijuana law would mean bypassing the FDA and its consumer protections.

“If I go to a Wallgreen’s in L.A. and buy a Tylenol and I go to a Wallgreen’s in New York City and buy a Tylenol, I am assured under FDA regulations that that is the same drug.  If I walk into a medical marijuana shop and buy purple Kush on Wednesday, there is really no assurance in any state that has medical marijuana that if I go back on another day or to another medical marijuana shop that I am getting the same drug, because there is no standardization of dose,” said Grellner.

Last year the House came the closest it’s ever been to passing medical marijuana legislation, but finally rejected a bill that would have allowed medical marijuana use only by terminal cancer patients in hospice care.

The committee’s chairman, Representative Keith Frederick (R-Rolla), said he is “contemplating” whether to have the committee vote on HB 437.