The debate in Washington D.C. on Medicaid and possible reforms to how the program is administered continues. In the meantime, the state of Missouri remains responsible for this multibillion dollar program and the hundreds of thousands of Missourians that depend on it for health care coverage.
BJC, as a whole, is a fair representation of the larger health care provider community. We deliver care in a variety of settings: hospital, home, work and school. We teach the next generation of doctors and nurses. And, we treat patients in urban settings, rural ones, disparate regions and more affluent zip codes. Because of this, we are well positioned to educate policy makers on the potential impacts of health care reforms. We intend to do so as it relates to changes in Missouri's Medicaid program, whether block grants, per capita caps or other delivery and administration reform ideas under consideration in Jefferson City and Washington D.C.
Because of the significant amount of risk that many policymakers are suggesting the state assume in some of these reform proposals, we will also continue to advocate for specific patient and provider protections to be added to state law governing Medicaid HMOs.
In 2016, Missouri adopted a sweeping reform to the state statutes governing insurance companies, providers, and the Medicaid program to expand the reach of virtual care throughout the state. This reform was a win-win for patients and providers. Access to specialists and time-sensitive care would be improved, care would be required to maintain the same standards as in-person visits, and providers would be guaranteed equity in reimbursement between in-person visits and their virtual counterparts.
More than a year later, however, the Department of Social Services, which oversees Missouri's Medicaid program, has yet to adopt the rules needed to align Medicaid with the new state laws. Providers who are treating Medicaid patients, therefore, are not being reimbursed for services that state law has authorized and patients are more limited in the services they can receive and from where they can receive them. BJC Government Relations has been encouraging the Department to adopt these rules. In the meantime, we are currently working to draft a new law that would remove the Department's ability to stonewall access to virtual care.
There is near universal consensus that a lack of providers in the U.S. health care industry is a looming threat to the health of Americans. Here in Missouri, we are no different. However, we have yet to respond, as many other states have, by granting advanced practice nurses their own license with a scope of practice that aligns with their education and experience. We will continue to advocate for this important change to Missouri law until it becomes a reality.
Consumers have long been wary of “gatekeeper” insurance policies (those that require a primary care physician referral to see a specialist). In Missouri, insurance laws allow for gatekeepers in very limited circumstances, specifically in HMO plans that, by law, have a variety of added consumer protections to help mitigate the risks consumers take in purchasing these limiting plans.
In 2016, the insurance industry attempted to change the law to allow for “gatekeeper” provisions within the Exclusive Provider Organization (EPO) plan market. As the name implies, these type of plans are already severely narrow as they restrict patients to an exclusive network of providers (and generally deny claims outside this network). Missouri’s EPO laws lack the same consumer protections that are found in the HMO statutes and the insurance industry’s attempt to add “gatekeepers” to EPO plans would be extremely harmful to patients and the providers they rely on for care. In 2017, we will continue to vigorously oppose the insurance companies’ attempts to sell these substandard policies in Missouri.
Prescription Drug Monitoring Program
Opioid abuse is on the rise and Missouri is the last state in the country without a statewide program to monitor for doctor shopping and drug abuse through a prescription drug monitoring program. Though support for programs and laws aimed at helping to curb opioid addiction is near the top of the list in political consensus nationwide, Missouri remains the outlier. In 2018, we will again advocate for our state to join the rest of the nation in monitoring the sale of narcotics to ensure our patients receive proper treatment and our providers can rest assured they are not contributing to the epidemic of opioid abuse. We will also continue to advocate in favor PDMPs being established by local governments in lieu of a state solution.
Access to Mental and Behavioral Health Services
After decades of taking a back seat to other social issues, it has become obvious we need to address the broken system of care for millions of Americans suffering from mental illness. Access to treatment and a push to get treatment—including appropriate pharmaceuticals along with therapy, social assistance, housing, and peer counseling—can make a dramatic difference.
BJC is committed to being a part of the solution through identifying ways to better enable access to care, incentivize more people to become mental health providers, and to address funding for community providers who have been tasked to care for the bulk of those with mental and behavioral health conditions.
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Page updated 11/1/17