The Missouri House has voted to take more steps toward fighting opioid addiction with a focus on shifting the response to addiction from law enforcement and incarceration to treatment availability.
As the sponsor said, “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.’ 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.”
The main provision of the bill 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. The assistant physicians would 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. The sponsor said the 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 the bill’s main provisions would limit the amount of an opioid drug that could be prescribed to someone for acute pain to a seven-day supply. The provision 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 sponsor said, “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.”
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. A person could petition to be removed from the list five years after adding her or his name to it.
Other provisions in the bill 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. The sponsor said the change would keep doctors from being given low scores by patients with addiction issues to whom they refused to prescribe opioids. He said such false, punitive low scoring can hurt doctors’ reputations, and hurt them financially.
The legislation now moves to the Senate for consideration.
House Approves Legislation to Save State Dollars and Improve Access to Birth Control (HB 1499)
The members of the House gave bipartisan approval this week to a measure aimed at increasing women’s access to birth control while saving the state money. The legislation would allow health care providers to use a long-acting reversible contraceptive (LARC) for a patient other than the one to whom it was initially prescribed.
When a woman in Missouri chooses to have a LARC implanted her doctor must order that device and the woman must return for another office visit to have it implanted. If the woman changes her mind before the second visit and doesn’t want the device, Missouri law doesn’t allow it to be used for another patient. It must be returned to its manufacturer and often it is destroyed.
The bill’s sponsor said because Medicaid pays for those devices, the passage of his bill would save the state money. He said, “The State of Missouri currently wastes hundreds of thousands of dollars every year as well as very expensive devices every year, and this bill will allow those devices to be reassigned which will save taxpayer money and will help to save women time and money with extra doctor’s visits.”
The sponsor noted that in Fiscal Year 2017 about 1,800 LARCs were “abandoned” by patients in Missouri. Approximately 1,000 of those could have been used for other patients and that would have saved Missouri about $220,000.
The bill is now under consideration in the Senate.
Bills Headed to the Senate
HBs 2337 & 2272 would modify the fee requirements for every individual or entity making a filing with the Department of Insurance, Financial Institutions and Professional Registration. Supporters say the bill is necessary to keep the Department of Insurance funded. In 2014 we had a fund balance of $14 million and the General Assembly swept over $12 million of this revenue to use for different projects. Insurance receives no General Revenue and is funded by these fees. The insurance industry agrees that these fees need to be increased so that the department can continue regulating the industry.
HB 1296 would establish "Toby's Law," which requires any person who has pled guilty to or been found guilty of driving while intoxicated to complete a victim impact program approved by the court. Supporters say a program like this could keep people from continuing to drink and drive and it could even encourage some people to get sober. Most counties already have a program like this and most judges already require it, but this bill would require all counties to have this type of program.
HB 2255 would modify provisions relating to the Science, Technology, Engineering, and Mathematics Initiative. Supporters say the bill would benefit students interested in a career in STEM subjects.
HB 2231 would remove the requirement that land surveyors submit letters of reference in order to be licensed. Supporters say the letters of reference don't currently serve any purpose because the board does not deny applicants based on the content of these letters.
HB 1419 would require certain health care professionals to complete two hours of suicide prevention training as a condition of licensure. Supporters say many suicide victims see a physician in the month before their death, but many health care professionals do not have the training necessary to recognize or treat suicidal patients.
HB 1275 would establish the "Allan Purdy Work-Study Program" to be administered by the Coordinating Board for Higher Education. Supporters say the bill would promote workforce development while providing financial aid. They say work-study is a missing piece of Missouri's available financial aid program, and this bill would help fill that gap.
HB 1629 would provide that a doctoral degree from programs accredited or provisionally accredited by the Psychological Clinical Science Accreditation System are acceptable for licensure as a psychologist if the program meets certain requirements. Supporters say the bill would allow the state to license psychologists who have gone to schools accredited by the Psychological Clinical Science Accreditation System (PCSAS). There are currently 35 programs across the country that are recognized by PCSAS but until states recognize PCSAS for licensure purposes those programs also have to be accredited by the American Psychological Association. Supporters say the PCSAS is an accepted accreditation program within the industry and there is no reason for the state not to recognize it.
HB 1252 would add digital mammography and breast tomosynthesis to the definition of low-dose mammography screening and require reimbursement rates to accurately reflect the resource costs. Supporters say these mammograms are 3-D and are much more accurate and have less false readings. They say these will save money because of not having to re-do a mammogram.
HB 2562 would establish treatment court divisions, which would include, but not be limited to, Adult Treatment Court, Driving While Intoxicated (DWI) Court, Family Treatment Court, Juvenile Treatment Court, and Veterans Treatment Court. Supporters say that treatment court is successful, and there is an indication that similar courts for other issues could be successful, too. They say the local courts can and should set their own policies for these types of courts, but the legislation establishes best practices for them. The intention is to help advance the ball toward institutionalizing the concept of treatment court.
SB 592 now heads back to the Senate after the House made changes to the bill. The legislation would modify the state’s election laws. Supporters say the bill is a product of consensus and would provide many necessary changes that would make the operations of local election authorities and the Office of the Secretary of State more efficient, allowing them to provide better service to the public. The bill would also make the absentee voting process easier by extending mail time. Many of the changes in the bill have been vetted in prior years and much of the bill consists of fixes to minor problems and technical changes.
HCR 59 would designate the month of August as "Minority Organ Donor Awareness Month" in Missouri. The legislation would encourage and recommend that people of the state of Missouri observe Minority Organ Donor Awareness Month through activities which will specifically address the need to increase awareness of organ donation by all ethnic groups and the need for organ donors. Such activities could include prayer breakfasts, health walks, and donor drives.
HCR 69 would urge the President of the United States to authorize a state funeral when the last of the World War II Medal of Honor Recipient dies.
HCR 73 would recognize the Gold Star Families Memorial Monument at the College of the Ozarks campus in Point Lookout, Missouri, as the official Gold Star Families Memorial Monument of Missouri. It would also urge the Missouri Department of Transportation to prepare and establish appropriate highway signage to recognize the location and directions to the Missouri Gold Star Families Memorial Monument and the Missouri Vietnam Veterans Memorial. The signage would be paid for by the College of the Ozarks.
HCR 70 would declare youth violence as a public health epidemic and support the establishment of statewide trauma-informed education. It would also designate June 7 of each year as “Christopher Harris Day” in Missouri to remember children in St. Louis and throughout the state of Missouri lost to violence.