Category Archives: Health Care

Why I Oppose PDMP and Hope You Will Too

Dear Colleague:

According to the Supreme Court, the “right to privacy” is a “fundamental human right” and “the right most valued by civilized men.” Far from being a mere “emanation” or “penumbra,” the right to privacy finds explicit support in the First, Second, Third, Fourth, and Fifth Amendments to the United States Constitution.

The idea that there are vast spaces in our lives upon which government should not, and, by constitutional and statutory limits, cannot intrude is a fundamental principle of liberty and a quintessentially American idea.

In 1928, Supreme Court Justice Louis Brandeis warned that telephone wiretapping was just the first of many new technologies capable of invading the privacy of Americans:

The progress of science in furnishing the Government with means of espionage is not likely to stop with wiretapping. Ways may someday be developed by which the Government, without removing papers from secret drawers, can reproduce them in court, and by which it will be enabled to expose to a jury the most intimate occurrences of the home. Advances in the psychic and related sciences may bring means of exploring unexpressed beliefs, thoughts, and emotions. “That places the liberty of every man in the hands of every petty officer” was said by James Otis of much lesser intrusions than these. To Lord Camden, a far slighter intrusion seemed “subversive of all the comforts of society.” Can it be that the Constitution affords no protection against such invasions of individual security?

      Olmstead v. United States, 277 U.S. 438 (1928), 474, J. Brandeis dissenting.

Justice Brandeis was ahead of his time. The Court held that the Fourth Amendment did not protect telephone conversations intercepted by government wiretap.

It should not be surprising that Justice Brandeis was on the losing side. It often takes government decades to catch up with new technologies and understand their broader implications. 

Nearly 40 years later, Brandeis was vindicated in Katz v. United States, 389 U.S. 347 (1967), a case where the Supreme Court held in a 7-1 decision that warrantless wiretapping is prohibited by the Fourth Amendment. Just a year later, Congress passed the Wiretap Act to require a super-warrant before government could intercept a person’s communications. Then, in 1986, in a minor miracle, Congress got ahead of the computer technology curve bypassing the Electronic Communications Privacy Act, which was designed to give the same protections to electronic communications that already existed in statute for wire and oral communications.

The Wiretap Act and ECPA are just two examples of dozens of how American legislatures have taken action to protect privacy. As Congress put it in the legislative history to the ECPA:

[T]he law must advance with the technology to ensure the continued vitality of the Fourth Amendment. Privacy cannot be left to depend solely on physical protection, or it will gradually erode as technology advances. Congress must act to protect the privacy of our citizens. If we do not, we will promote the gradual erosion of this precious right.

Rather than pass legislation that intrudes on privacy, Congress and state legislatures have consistently enacted statutes to enhance privacy. To my knowledge (with two significant exceptions), federal and state statutory enactments affecting privacy have been almost completely one-sided.

I give you this history as background to why I oppose a dragnet prescription drug monitoring program and strongly believe you should too.

Under PDMPs, all painkiller prescriptions are monitored by government. The tracking occurs whether the Missourian is an innocent 82 year old grandmother with a broken hip or a three-time convicted drug dealer. Because you receive the prescription, government tracks you.

The PDMP logic tree works like this: because some people abuse prescription painkillers, government should track all people who use them – regardless of whether a person has done anything wrong.

When you take a step back, it should not take long to see how absurd this logic is. If it’s acceptable logic for prescription painkillers, why should we stop there? There are a host of public health risks more serious than prescription drug abuse to which the same logic could be applied.

For example, according to the CDC, nearly 2,000 Missourians die annually from alcohol-related deaths, significantly more than drug overdoses. The data are clear: Alcohol is a worse problem for society. If government simply put a tracker in every grocery store in our state, problem drinkers could be identified and deaths avoided. By the logic of trackers of prescription drug monitoring programs, you’re a technophobe if you wouldn’t support such a database. After all, lives are at stake!

How about junk food? Obesity and its related illnesses cost American taxpayers billions of dollars a year in Medicaid and Medicare. Its associated illnesses also kill more Americans than alcohol and drug overdoses combined. Junk food purchases are far less private today than prescriptions. Every grocery store tracks what you buy, and many provide the data to third-parties for internal (or perhaps external) marketing purposes. Because the data are maintained by third-parties and there’s no statutory protection, Americans have no privacy right in their junk food purchases at all. So why not enact a law requiring grocery stores to pass along their data on massive junk food purchasers? The Department of Health and Senior Services could use the information to aggressively target those Missourians who buy too much junk food.

Tanning beds? It took three years to pass legislation in Missouri just to require tanning bed proprietors to get parental consent before allowing a minor to tan. Yet, we also know tanning is a leading cause of skin cancer. It will literally kill you. So why not require proprietors to report the name of every person to use a tanning bed every time they use one? DHSS could use the data to bombard the most frequent users with anti-tanning messages, and we’d likely save some lives.

Smoking? Similar story.

Next, move beyond behaviors that can only harm a single person. If you buy the logic that government should track a law-abiding person’s behavior to save them from themselves, then you must certainly also agree that government should be able to track someone to prevent them from harming someone else. Just put the product into the same logic structure as the PDMP argument: some people will misuse X, therefore government should track all people who use X.

In this second category, government would start with guns. How would you feel if, instead of replacing X with “prescription painkillers,” we used the word “guns?” There may be some Democrats in the House who would be yes votes, but I doubt there’d be a single Republican. And yet, it’s the same argument.

Back to alcohol, some people misuse X and drive cars, therefore government should track all people who use cars. The technology is available to put a breathalyzer in every car. We could eliminate drunk driving accidents by requiring every driver to blow into a breathalyzer every time they started their car. If you’re for a PDMP, you should consider this as well.

PDMP proponents are well-intentioned. We all would like to reduce drug abuse and deaths in Missouri. But we should not do so in a way that treads upon the privacy rights of hundreds of thousands of Missourians who have done nothing wrong.

Until this year, it was PDMP or nothing. This year, however, there’s a better option available. House Bill 1922 protects the innocent and limits a prescription drug abuse database to those Missourians who have actually done something to create the reasonable suspicion that they are a drug abuser. It would work like the problem gambler’s list, and would capture a significant majority of those Missourians whose prescription drug use eventually puts their life in jeopardy.

PDMP proponents have reacted to this non-dragnet approach by arguing it would not be capable of identifying a potential drug abuser before they become one. That is true. But think about the implication of that argument? Do you want to live in a society where government tracks your activities so that it can stop you from doing something you haven’t yet decided to do? I’m confident algorithm-makers think computers can categorize people better than humans. But we’re each more than a computer program, and the thought that government might create a program designed with a “pre-crime” component is scarier than the tracking itself.

There’s also a second key difference that I believe illustrates the absurdity of the dragnet approach. HB 1922 provides that a person whose name is submitted for inclusion on the prescription drug abuse registry has the right to a hearing before being placed on the list. This is not in the bill merely because I think it’s a good idea to give a person the right to prove their innocence. Instead, it is necessary under the Constitution. Putting someone on a list to which a stigma would attach is something for which we must also give them the right to contest. The dragnet approach, on the other hand, does not require any hearing. In this case, when government violates the rights of everyone, it need not make any provision for procedural due process for those who object.

If you have voted no on PDMP in the past, I request that you remain steadfast in your opposition. If you have voted yes, I respectfully ask that you reconsider. You wouldn’t vote to create a government database tracking every alcohol, cigarette, tanning bed, junk food, or gun purchase. And you shouldn’t vote to create a government database for tracking prescription drugs either. Instead of the dragnet approach, signal your support for a targeted list of known drug-abusers. This will allow doctors to cross-check patients they suspect of pill-shopping. It will give recovering drug addicts a tool in their recovery. And it will protect the innocent.


Rep. Jay Barnes

Injecting Market Forces Into Missouri’s Health Care Welfare System

Imagine going to a grocery store where there are no prices on the food and the government has told you that it will pay for whatever you or the clerk think you need. How much restraint would you exercise? How much restraint would you expect the clerk to exercise? Most of us like to think that we’d do the right thing, and I believe most people would. But, as Madison pointed out, “If men were angels, no government would be necessary.” 

Incredibly, in many parts of our state (and nation), Medicaid operates on a fee-for-service basis similar in concept to the absurd thought experiment outlined above. A Medicaid recipient who has no money presents at a health care provider for services. The recipient pays no co-pay – or only a nominal amount. And at no point does price ever matter.  And then they send the bill to you, the taxpayer. It’s all gas, no brakes.

By contrast, in the I-70 corridor, recipients are covered by managed care plans which operate similarly to private health insurance plans. They inject a level of oversight into Medicaid transactions to protect taxpayers from wasteful and, in some cases, fraudulent health care claims. The I-70 corridor managed care plans have proven to be more affordable to Missouri taxpayers without sacrificing quality for recipients.

But Medicaid-managed care needs reform as well. Under the current system, managed care companies do not compete directly on price. Instead, the Department of Social Services names its price and asks the managed care companies to match it. Though DSS engages a top-flight actuarial firm to set its price, the more efficient approach would be to allow free market forces to establish the price, versus the decision of a single firm. If the price is too low, managed care companies will let DSS know and no bids will be received. If, however, the price is too high, no managed care company is going to tell DSS they’ve priced the bid wrong. Instead, they’ll be happy to pocket higher profits off of Missouri taxpayers.

Nor are recipients in the current managed care corridor given financial incentives to use taxpayer resources wisely. Because recipients have only limited financial resources, there are no penalties for misuse of the ER. Likewise, there are no bonuses for healthy or appropriate behaviors.

For the last two years, I’ve worked with many elected officials, health care providers, and ordinary citizens to develop a better plan for Missouri’s Medicaid system. House Bill 1901, sponsored by Rep. Noel Torpey, is one result of that work, and the House Committee on Government Oversight and Accountability has spent three weeks hearing the bill. To inject market forces into Missouri’s Medicaid system, House Bill 1901 would:

  • Eliminate fee-for-service and expand managed care statewide;
  • Require actual price competition in the bidding process for managed care companies;
  • Foster competition by allowing networks of health care providers to form Accountable Care Organizations to compete with more traditional managed care companies;
  • Turn recipients into participants by empowering them to choose their own health plan based on cost and services;
  • Encourage participants to choose low-cost plans by offering financial incentives for them to select the most affordable option. Just as you and I have financial incentives to choose more affordable health insurance plans, so should Medicaid participants.
  • Provide participants with a state-funded cost-sharing card that the participant must use each time they receive a health care service. To encourage healthy behaviors, if the participants use care efficiently and go to preventive care appointments, they should be rewarded. If they misuse the ER, they should be penalized.

House Bill 1901 is similar to previous proposals by stalwart conservatives like former Gov. Matt Blunt, Texas Gov. Rick Perry, and former Indiana Gov. Mitch Daniels – each of whom proposed increasing Medicaid eligibility far beyond what is contemplated in HB 1901. If passed, this market-based Medicaid plan could serve as a conservative model for the rest of the country on how to inject market forces into the system to save taxpayer money and improve the quality of care.

If we could turn the clock back to 2007, I believe HB 1901 would be considered a leading conservative alternative to ObamaCare. It extends health care coverage to the working poor who otherwise can’t  afford private health insurance. This can save money over the long-term.  I believe ideas still matter, regardless of political labels people try to affix to them, and I’m hopeful that HB 1901’s conservative plan for Missouri Medicaid will be passed into law.

School-Based Health Clinics Work

On Monday, the House Committee on Government Oversight and Accountability passed HB 1052, a bill to encourage the construction of school-based health care clinics in high-poverty school districts. Many other states, most notably Texas, have robust school-based clinic programs. The following is a memo from my Legislative Assistant Emily Walker summarizing research on these clinics. Conclusions: they work to save money, reduce unnecessary ER visits, and improve the health and education outcomes of students in schools where these clinics exist. 

To:       Representative Barnes

From:   Emily Walker

Re:       School Based Health Clinics

Date:   February 6, 2014


Question:        What are the value of School Based Health Clinics based on academic studies and real world data?


            School Based Health Centers (SBHCs) have developed in the past three decades as a solution to health care access problems in younger populations.  These in-school clinics help to “overcome utilization barriers in a way not previously documented in other clinical settings, even when serving populations that suffer from significant health disparities.”[1] Based on census data collected by the School-Based Health Alliance for 2010-2011, there were 1381 school based clinics that provided primary care and responded to the surveys.[2] SBHCs are found in a variety of communities: 54.2% in urban areas, 27.8% rural areas, 18.0% suburban areas.[3]  Of the responding clinics, 94.4% are located within school buildings.[4] The numbers of these clinics are growing and Missouri already has four located within our state.[5]

            There is no set funding or structured mechanisms for SBHCs.  Financing may come from a variety of sources and control comes from multiple levels (private sector, local government, state government, etc.)  Other states have successfully implemented these clinics on a state level.  Texas recently passed an expansion measure in 2009 to further support SBHCs.[6] HB 281 was a bipartisan bill passed unopposed in the House Public Education and Senate Education committees and signed into law by Governor Perry.[7]  This expansion of the program included stabilized and increased grant funding for the programs.[8]  According to the Census data collected by the School-Based Health Alliance, Texas had 87 school-based health clinics at the time of the survey.[9]

            There are many benefits to the school-based health clinic system.  These clinics have consistently shown decreases in emergency department visits, increases in primary care access, increases in immunizations, and better quality of health care for children who traditionally lack health care resources.  SBHCs knock down many of the barriers that children from high-risk families often battle, including: lack of private health insurance, transportation to appointments, parental absence from work, lack of awareness, and other stressors that keep children away from health professionals.[10] Not only do these programs give children access to health care, the ultimate goal of the clinics serves the ultimate goal of education programs.  As Adams and Johnson explain, “the program is aimed at improving school attendance and classroom performance and the longer-term prospects for these children as they mature”[11] 

            Numerous studies have found the cost saving measures that school-based clinics provide for public insurance programs. In Adams and Johnson’s article, An Elementary School-Based Health Clinic: Can it Reduce Medicaid Costs?, the authors answered the title question in the affirmative.[12]  This study compared children served by a school-based clinic to demographically similar children who did not have access to the same kind of clinic.[13]  There were no significant differences between the groups before the clinic opened, but two years after its opening, the children with access to the clinic had significantly lower instances of inpatient visits, non emergency department transportation, drug, and emergency department Medicaid expenses.[14]  These lower instances of high cost health care items meant that the school-based clinic helped to curb costly health care mechanisms for the children who had access to the SBHC.

            Another study also examined the affect of school-based clinics on the frequency of emergency department visits.  In Young, D’angelo, and Davis’ 2001 article Impact of a School-Based Health Center on Emergency Department Use by Elementary School Students, the authors wrote that emergency room visits are often non-urgent and have the negative effects of increasing medical costs and fragmenting health care.[15]  In their study, the authors examined elementary aged children (5-12) from an inner city neighborhood.[16]  The clinic served a school that had a student population of 95% of the population on free/reduced lunch and 60% African American/40% White.[17]  This study used a retrospective audit of emergency department records that compared the year before implementation of a school-based clinic to the year after its inception.[18] There was a significant drop in emergency room visits after the school-based clinic was introduced to the school.[19]  The results of this study show that SBHCs help to decrease non-urgent emergency department visits, and therefore the higher costs of these visits.

            Key, Washington, and Hulsey provided their findings of lesser emergency department visits by adolescents enrolled in SBHCs into their 2002 article, Reduced Emergency Department Utilization Associated with School-Based Clinic Enrollment.  This was another retrospective cohort study that examined emergency department utilization rates before and after adolescents enrolled in a SBHC.[20]  The subject school was an urban, public high school that’s student population was made up of 80% free/reduced lunch recipients and 99% African American.[21] The study showed a decrease in the emergency department visit rate for both groups from the base year, but this decrease was only statistically significant for the students who chose to enroll in the SBHC (enrollees had a 41% decrease of emergency room visits after enrolling in the clinic).[22]  The authors noted that because the study compared a population with prior emergency room use and then recorded the changes following the enrollment in a SBHC, the SBHC should be attributed as the cause of the decrease.[23]

            Beyond the scope of saving money on decreased emergency room visits, SBHCs serve other important interests as well.  One major benefit to note is the ability of SBHCs to help with vaccination rates in adolescents. In the article Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery, the authors performed a study to determine if SBHCs can improve rates of immunizations among at risk children and adolescent populations.[24] The study was a retrospective cohort analysis of children and adolescents who were split into groups that received health care from either a Denver SBHC or Community Health Center (CHC).[25]  For most types of vaccinations, children and adolescents were more likely to be up-to-date on their immunizations if they received health care from SBHCs.[26]  Along with this, for vaccines that require multiple doses over a set period of time, SBHCs were more likely to guarantee children received all doses.[27]  The authors noted a variety of reasons for why SHBCs are better for vaccinations, including: easier access to care, reminders to come back for care are easier, the tracking system is easier within the school system, many SBHCs see patients without any payment requirements, parents do not have to leave work, and students do not have to leave campus for the care.[28]

            Finally, a more recent study addresses all of the issues discussed above and the overall strong benefits of SBHCs.  In the article School-Based Health Centers: Improving Access and Quality to Care for Low Income Adolescents, the authors wanted to examine all of the advantages of SBHCs.[29] This was a retrospective cohort study that tracked the use of health care and markers of quality of care for adolescents enrolled in SBHCs compared to adolescents who used other community care entities.[30]  The SBHCs helped to increase uninsured adolescents access to care for primary health care.[31]  This increase in access to care through SBHCs led adolescents to report a higher likelihood to have three or more primary care visits, less emergency department visits, more health maintenance visits, and a higher likelihood to receive a flu vaccine, a tetanus booster, and a Hepatitis B vaccine.[32]  The authors of this study strongly established that SBHCs provide underserved adolescents and children with better access to care and an overall higher quality of health care than traditional community health systems do.

            There are multiple studies available to show the benefits of SBHCs to serve populations of children and adolescents that traditionally have not received quality health care.  These clinics have statistically shown they can reduce Medicaid expenditures through better preventive care measures, they increase immunization rates, and overall, they provide higher quality of care for a population that is often underserved.

[1] Steven Federico, et. al., Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery, 100:9 American Journal of Public Health,1630-1634 (2010).

[2], 2010-2011: Census Report of School-Based Health Centers, School Based Health Alliance, 2012, (last visited February 6, 2014).

[3] Id.

[4] Id.

[5] Id.

[6], Legislative Efforts, Texas Association of School-Based Health Centers, 2009, (last visited February 6, 2014).

[7] Id.

[8] Id.

[9] 2010-2011: Census Report of School-Based Health Centers.

[10] Thomas Young, et. al., Impact of a School-Based Health Center on Emergency Department Use by Elementary School Students, 71:5 Journal of School Health, 196 (2001).

[11] E. Kathleen Adams and Veda Johnson, An Elementary School-Based Health Clinic: Can it Reduce Medicaid Costs?, 105 Pediatrics, 780-788 (2000).

[12] Id.

[13] Id.

[14] Id.

[15] Young, D’angelo, and Davis.

[16] Id.

[17] Id.

[18] Id.

[19] Id.

[20] Janice Key M.D., E. Camille Washington, M.D., Thomas C. Hulsey M.S.P.H., Sc. D., Reduced Emergency Department Utilization Associated with School-Based Clinic Enrollment, 30:4 Journal of Adolescent Health, 273-278 (2002).

[21] Id.

[22] Id.

[23] Id.

[24] Id.

[25] Id.

[26] Id.

[27] Id.

[28] Id.

[29] Mandy A. Allison, MD, MSPH, et al. School-Based Health Centers—Improving Access and Quality of Care for Law-Income Adolescents, 120:4 Pediatrics, 887-894 (2007).

[30] Id.

[31] Id.

[32] Id.

Request to Allow Missouri Consumers the Freedom to Keep the Health Plan

This morning I sent the following letter to Director John Huff at the Department of Insurance requesting the Department to reverse course and allow Missouri consumers the freedom to renew their existing health plans free from Obamacare mandates:

Dear Director Huff:

In the past few weeks, millions of Americans have suffered cancellation of their existing health insurance policies as a result of the Affordable Care Act. In many states, the impact of these new regulations was mitigated by state departments of insurance which allowed health insurance consumers to renew their policies early – thus giving those policies “grandfather” status for approximately another year and avoiding cancellations. Unfortunately, Missourians did not have that option. In fact, according to the New York Times, Missouri was one of just seven states that refused to allow early renewals to avoid the blunt impact of Affordable Care Act mandates.[1] 

This was the result of Bulletin 13-01, a directive of the Department which warned health insurers that the Department would interpret three statutes to prohibit early renewals – even at the consumer’s option. To my knowledge, these statutes had never been interpreted in such a manner. While the Department’s position is a colorable interpretation, it is at least equally reasonable for the Department to conclude that renewals at a consumer’s option are legal. In addition, when interpreting ambiguous statutes, I believe the best policy position for the Department is to choose the path which permits the greatest amount of consumer freedom.

I write today in light of the spate of recent cancellations around the country and ask you to reconsider, rescind, and replace Bulletin 13-01 with a new Bulletin reversing the Department’s interpretation of the relevant statutes. Doing so quickly would give as many Missourians as possible the opportunity to renew their policies before their cancellation at the end of the year – mitigating some of the negative impacts of the Affordable Care Act. I will also be pre-filing legislation to (1) clarify the meaning of “renewal” in these statutes, and (2) require the Department to allow consumers to renew existing plans. I look forward to hearing your response regarding the request to immediately rescind Bulletin 13-01.


Rep. Jay Barnes

c.c. The Honorable Jay Nixon

[1] The other states were Massachusetts, New York, Rhode Island, Washington, Oregon, and California. States That Had Already Been Allowing Policyholders to Renew Their Plans Before President Obama Made His Announcement, NY Times, published November 20, 2013 at

I also sent the following press release to the Associated Press and a few other outlets. 


Rep. Jay Barnes Requests Dept. of Insurance Reverse Decision Prohibiting Missouri Consumers from Renewing Health Plans Early to Avoid ACA Insurance Cancellations

Jefferson City – State Representative Jay Barnes (R-Jefferson City) has requested that the Missouri Department of Insurance reverse an earlier decision which made it impossible for Missourians to avoid Affordable Care Act insurance cancellations. Barnes specifically asks for the replacement of Bulletin 13-01, a directive sent by the Department in early June warning insurance companies that they could not renew policies early, even at the option of the consumer, to avoid ACA-mandated cancellations.

“We have a duty to protect Missourians the best we can from the ill effects of Obamacare,” said Barnes. “Rescinding Bulletin 13-01 quickly would give as many Missourians as possible the freedom to renew their existing insurance policies. Reversing course is the right thing – and the smart thing – for Governor Nixon and the Department of Insurance to do.” 

Important Source Documents:

By the time I returned to my office I learned that Gov. Nixon announced, via press release, that insurance companies would be allowed to continue cancelled plans. My thoughts: as stated in my press release above, this is the right thing, and the smart thing to do for Missouri consumers suffering policy cancellations due to ACA-mandates. I’m pleased with the quick turnaround – and I still believe Bulletin 13-01 should be withdrawn in its entirety. 

Rep. Sue Allen – Medicaid Managed Care Proposals

Rep. Sue Allen will present legislative language on Medicaid managed care Wednesday morning before the House Interim Committee on Government Oversight and Accountability. Her proposals can be found in HB 925 and HB 926 from 2013.

Rep. Keith Frederick Medicaid Transformation Proposal

Rep. Keith Frederick will present language similar to HB 608 from 2013 this afternoon before the House Interim Committee on Medicaid Transformation.

The updated version of that legislation can be found here:

Rep Frederick Medicaid Pilot

Managed Care and Cost-Sharing Language

I’ve uploaded a PDF of proposed statutory changes to Medicaid which I will present at next weeks hearings of the House Interim Committee on Medicaid Transformation.

As with previous presentations, the inclusion of this proposal does not mean I or the committee will necessarily be endorsing it for passage by the General Assembly. What it does mean is that it contains key concepts which I believe should be discussed for Medicaid Transformation.

Managed Care and Cost Sharing

In addition to this proposal, the Committee will also receive presentations by Rep. Keith Frederick and Rep. Sue Allen, who will be presenting versions of bills they filed last year. I will post those bills tomorrow. 

Switching Next Week’s Hearings

The Interim Committee on Medicaid Transformation is reversing the order of topics to be discussed next week. The following is the schedule we will follow: 

October 29th, 1:00 p.m. – “Skin in the Game”

  • Cost Sharing
  • Debit Cards
  • HDHP w/ HSAs

October 30th, 8:00 a.m. – Delivery Models and Managed Care Bidding

  • Fee-for-service
  • ASOs
  • ACOs
  • HMOs and PPOs
  • Health Care Homes

Hearing on Services Covered

The House Interim Committee on Medicaid Transformation will take testimony tomorrow on services covered by Medicaid and Medicaid fraud. I’ve attached a PDF of a list of potential services covered in the form of a section of a potential state statute.

MoHealthNet Services Covered

The following witnesses are also expected to testify: 

·         Joel Ferber,  Legal Services– Medicaid Services overview

·         Dr. Michael Bleich, BJC Goldfrab School of Nursing

·         Brent McGinty, Coalition of Committee Mental Health Centers—substance abuse 

·         Jack Hollister, MO Psychological Association 

·         Dan Body, Regional VP for Behavioral Health for SSM Healthcare 

·         Brent Gilstrap, President of MO Mental Health Counselors Association 

·         Sherriff’s Association on topic of Mental Health coverage

·         Jane Moore, MO Hospice and Palliative Care Association 

·         Lynne Barbour, DDS MO Dental Association

·         Dr. Gary Henley  Coalition for Dental Health

·         John Kopp, Deputy Director of Medicaid Fraud Control Unit, Mo. AG

Schedule for House Interim Committee on Medicaid Transformation

Here is the schedule for the House Interim Committee on Medicaid Transformation. The Committee will be taking expert testimony on these days – but only on the general topic areas listed for each day. Though the general areas of topics will stay the same, the bullet points underneath each topic are likely to grow as committee members submit ideas.

If you have subject-matter expertise and would like to testify on any of these topics, please contact Emily Walker in my office at 573.751.2412.  

October 15th, 1:00 pm—Medicaid Fraud, Services Covered

  • Qui Tam
  • Medicaid Malpractice Reinsurance
  • Mental Health Services
  • Chiropractic
  • Other Services

October 29th, 1:00 p.m. – Delivery Models and Managed Care Bidding

  • Fee-for-service
  • ASOs
  • ACOs
  • HMOs and PPOs
  • Health Care Homes

October 30th, 8:00 a.m. – “Skin in the Game”

  • Cost Sharing
  • Debit Cards
  • HDHP w/ HSA

November 5th, 1:00 p.m. – ABD and Other Higher Cost Recipients

  • Aged, Blind, Disabled
  • Frequent Fliers

November 6th, 8:00 – Eligibility in Different Categoricals

  • Parents
  • Healthy Childless Adults
  • Medically Frail
  • Children
  • Pregnant Women
  • Women with Cancer
  • Ticket-to-Work

November 19th, 1:00 – Conclusions