As of Aug. 27, 2012 three bills the MSMA advocated for and helped to pass made their way into the Missouri statute books.
Spinal Injections
SB 682/Sponsored by Sen. Tom Dempsey & Rep. Todd Richardson
The new law reserves nerve ablation, of spinal pumps and stimulators, and discectomy to the purview of physicians. The law also applies to the diagnosis and treatment of chronic pain outside of a surgical, obstetrical, or post-operative course of care. This law will sunset in 2016, at which time MSMA and the legislature will revisit the issue.
Nurse Chart Review
By amendment to HB 1563/Sponsored by Sen. Jay Wasson
This law allows a physician other than the supervising physician to perform the review of a nurse’s charts as long as that physician is designated in the collaborative practice agreement. Previous law stated only the supervising physician in a collaborative practice agreement can perform the required review of the nurse’s charts.
School Nurse Asthma Treatment
HB 1188/Sponsored by Rep. Sue Allen
This law allows school boards to authorize licensed school nurses to maintain a supply of asthma-related rescue medication. To obtain the medication, a prescription must be written for the school and must be filled at a licensed pharmacy. The school nurse is to determine the amount of medication that should be maintained. The nurse or other employee trained and supervised by the nurse will have discretion to administer the medication when they believe a student is having a life-threatening asthma-related episode.MSMA Advocacy Results in HIV Testing Rule Change(9/12/2012)
With the support of MSMA, the Missouri Department of Health and Senior Services (DHSS) has changed the state regulations governing written consent and pre-test consulting for HIV testing.
The outgoing rules were almost 20 years old, and MSMA worked with the DHSS to bring them into compliance with the more up-to-date CDC guidelines.
Missouri law does not specifically require a patient’s separate written consent for HIV testing, but does require a pre-test consultation, which implies that specific consent should be obtained.
In 2006, the CDC officially revised its guidelines to recommend against mandatory pre-test counseling and separate written consent for HIV testing, holding instead that consent should be incorporated into the patient’s general informed consent for medical care on the same basis as are other screening or diagnostic tests.
The new Missouri rule modifies the consent obligations by requiring them to be consistent with the CDC’s guidelines, and clarifies that the scope of consultation is to be governed by the physician’s professional judgment based on the clinical situation at hand. The change goes into effect on October 4, 2012.
Medicaid Primary Care Fees Increase(9/12/2012)
A provision in the federal Affordable Care Act requires state Medicaid programs to reimburse certain Medicaid physicians providing primary care services at Medicare’s payment rates in 2013 and 2014.
This will mean a substantial increase for a large number of primary care Evaluation and Management codes, and others.
For example, an established patient office visit (99213) will increase from $36.38 to $69.35; and an initial hospital care service (99223) will grow from $105.94 to $194.06. Scores of other primary care procedures will see similar improvements.
In order to be eligible for the for the increased payment, the practitioner must be a physician, or under the supervision of a physician, who is either board certified in family practice, general internal medicine, or pediatrics, or can demonstrate that he or she has furnished E&M and vaccine services that equal at least 60% of the Medicaid codes billed in the most recent calendar year.
The fee increase goes into effect on January 1, 2013, but all eligible physicians are strongly encouraged to apply now to receive the enhanced reimbursement. The application/certification form can be found at the Missouri Medicaid website.
