Congressman Jason Smith came to the house this week, and I had time to visit with him. I told him again that I admired his vote against the huge spending bill several weeks ago. I asked him about why Congressman Hartzler and Congressmen Graves voted for that spending bill, and he wasn't really sure.

This Capitol Report will give you an account of what is transpiring in your State Capitol, from the perspective of a citizen legislator.  I try to give you a feel for the process and the substance of what is being talked about with an "Inside Baseball" approach.

Congressman Jason Smith
Congressman Jason Smith came to the house this week, and I had time to visit with him.  I told him again that I admired his vote against the huge spending bill several weeks ago.  I asked him about why Congressman Hartzler and Congressmen Graves voted for that spending bill, and he wasn't really sure.

This week's Committee on Health and Mental Health Policy Hearing
We heard four bills this week in the committee I chair, the Committee on Health and Mental Health Policy.
The first bill heard makes adjustments to laws concerning prescription drug step therapy. When used, step therapy protocols require people needing medicine to try the safest and most cost-effective drugs before more costly or risky drugs will be covered by an insurance provider. Although step therapy is good for controlling costs, it can be harmful to stable patients who get new insurance, or switch providers. Often, they must restart the process with level one drugs, independent of what medication worked best for them on their old plan. The HB2029 will make it easier to bypass step-therapy. More discussions on this bill will take place at a later committee hearing.

Another bill we heard was HB 1923, a bill relating to Telehealth. The portion of this bill that deals with “Store and Forward” is from a bill I filed last session. In 2013 we passed SB 262 that authorized commercial insurance reimbursement for telehealth, though it did not authorize “Store and Forward” technology. HB 1923 will allow “Store and Forward” technology for use with Medicaid, and therefore will also authorize it to use with commercial insurance, since they were not willing to reimburse so long as Medicaid failed to recognize it for reimbursement.
Next we heard and passed HB 1387, adding Severe Combined Immunodeficiency (SCID) to the list of diseases tested for during newborn screening. Early detection of SCID is essential to effective treatment. Currently, it is the only one of the recommended diseases Missouri does not screen for. Due to the urgency and importance of infant health, we passed this bill with an emergency clause that allows it to be enacted immediately after it passes.

 I was also able to present house bill 1682 entitled the healthcare freedom act, a bill that I sponsored. This provides that the state shall not require a physician to participate in any particular health care plan as a condition of licensure. The licensing of a physician should be based on his or her qualifications, training, and experience and track record, and not on any economic decisions about whether or not the physician participate in a health care plan that the  Government favors.
Submitted by office intern, Jill Haake

Missouri Association of Nurse Anesthetists
MoANA, the Missouri Association of Nurse Anesthetists was in the capitol for their advocacy day. Pictured with me are the anesthetist that work with me at Phelps County Regional Medical Center and two students who will be working with me in the near future. Pictured is Chris Black, Curtis Robison, Jason Corey, Becky Heidotten and Angela Delaria.

District MoDOT Tour
Monday morning I toured around the district with the  MODOT district engineer, Preston Kramer looking at transportation issues, roads and bridges and low wter crossings.   I also invited Mr. Don Mayhew, Surveyor in Pulaski county who is also an engineer to accompany us.  Don has had a concern about a section of Highway 133 for some time now and this was a good opportunity for me to bring this stretch of raod to the attention of MODOT.

We inspected a bridge just south of Jerome that was built in 1944 (72 years ago) that had a 50 –year design life when it was constructed. Mr. Kramer shared with me that it is one of the 641 bridges statewide that are currently on the critical condition bridge list. This bridge is currently safe for use, but if were to show further significant signs of deterioration, it could have to be closed.  The detour would be 27  miles.

We looked at the section of I-44 that has repeatedly been under water when severe flooding occurs along the Gasconade. It would cost approximately $30 Million to raise the ¼ mile of roadway out of the flood plain.

We looked at several low water crossings,  in particular, the two areas where we suffered tragic loss of five soldiers, and in another location a young couple due to the raging floodwaters.  We also looked at some roadways that have recently had the 2-foot shoulder additions, a section on route 133 that Mr. Mayhew had concerns with.    This is an area where the roadway has quite a few steep hills in a short section of the road  that impairs visibility in such a way as to hide vehicles in the troughs. There have been a number of deaths from cars entering the passing lane when oncoming traffic was not visible. The area does have double yellow lines indicating it's unsafe and unlawful to enter the passing lanes, but when people look with their own eyes and it appears that there's no oncoming vehicle, particularly at night, some of them make the tragic mistake of pulling out to pass.  We also looked at route 17 and Route T near Waynesville.

We do have transportation needs in our state and insufficient funds available to carry out all the work that ideally would be done if those funds were available.  In the last election the taxpayers defeated a sales tax that was to be dedicated to funding our transportation infrastructure. I am not a proponent of a tax increase, but rather favor finding funds in our current budget to address our most pressing needs. The feedback I have gotten from constituents reflects a poor appetite for any new taxes.
Submitted by Office staff

Floor Activity
Second Round of Ethics Reform Bills Headed to the Senate (HB 2166, HB 2203, HB 2226)
On the first day of the legislative session, House Speaker Todd Richardson called on the Missouri House to make substantive ethics reform a top priority for the 2016 legislative session. Just a few weeks later, the House had made good on his promise by approving seven separate bills that take a multitude of steps to improve the culture at the state Capitol.
This week the House gave overwhelming approval to HB 2166 to alleviate the undue influence of lobbyists in Jefferson City by banning gifts and meals provided by lobbyists to elected officials; HB 2203 to limit how long campaign funds can be invested and how they can be used; and HB 2226 to prohibit task force and commission appointees from profiting from the recommendations they make. All three bills now head to the Missouri Senate for discussion.
The bills join four pieces of legislation already moving through the Senate. HB 1452 would require elected officials to file a personal financial disclosure twice each year. Current law requires only a single disclosure each year. HB 1575 would require elected officials to report lodging and travel expenses in a timely fashion. The bill requires the expenses to be filed within 30 days of the reportable event. HB 1979 would require elected officials to have a one-year “cooling off” period after leaving office before they could become lobbyists. HB 1983 would make it clear that no statewide official or member of the General Assembly can serve as a paid political consultant while in office. All four bills have already received a public hearing in the Senate Rules, Joint Rules, Resolutions, and Ethics Committee.
Helping Small Businesses to Grow and Prosper (HB 1870)
The House approved and sent to the Senate this week a piece of legislation meant to cut the bureaucratic red tape that too often stifles the growth of small businesses in Missouri. House members approved legislation to revive the Big Government Get Off My Back Act for tax years 2016 through 2021.
The act originally ran from 2009 to 2014 and was instrumental in prohibiting new rules and regulations on small businesses, as well as unnecessary fee increases. The act also gives a $10,000 tax deduction for any small business, with 50 employees or less, that hires additional employees and pays them at least the average county wage. In its final year in 2014, the act provided tax relief to 196 small businesses throughout Missouri. Proponents hope to provide assistance to even more businesses by reviving the program.

Submitted by House Staff

Women Legislators of Missouri Scholarship
JEFFERSON CITY, Mo. –Women Legislators of Missouri are encouraging young women set to graduate from high school to apply for a $500 college scholarship. Each year the group selects one student from each of Missouri’s congressional districts to receive the award. Members hope to spread the word about the scholarship opportunity so that female students from all parts of the state will apply.

The Women Legislators of Missouri Caucus created the senior scholarship program to provide financial assistance to students on the basis of leadership, academics and community service. Candidates must fill out an application and are required to submit a 500-word essay answering the question, “If you were a state legislator, what would you hope to accomplish and why?”
A link to download the scholarship is located at
Applications must be mailed to:  Representative Patricia Pike, Missouri State Capitol , 201 West Capitol Ave., Jefferson City, Missouri  65101 or submitted via email to with the subject WLM Essay Contest.  The submission deadline is Thursday, March 3, 2016.
The group will select recipients and then a hold a reception in their honor on Monday, April 18, 2016 in the State Capitol. Following the reception, the scholarships will be presented to the recipients in the Missouri House Chamber.   For further information, contact 573-751-5388.

At the MoHealthNet Oversight Committee meeting in Jefferson City Thursday
On Thursday last week I really needed to be in three places at once. For a couple of hours in the morning, I went over to the Capital Plaza Hotel, where a summit meeting on the use of Telehealth technology was taking place. I participated in a legislative forum where a number of us from the House and Senate provided information and answered questions, and asked some questions about the field communications technology use in the delivery of healthcare. It was quite an exciting discussion with many innovative techniques and approaches under development. I told the group in attendance of about 150 people, that in my opinion we should try to prevent undue government intervention in this area, and simply allow innovation to occur. There will be some need to provide a level of consumer protection, but in my view the government’s role should be as small as possible.  At noon, I returned to the Capitol, and was present in the Select Committee on Social Services to advocate for the passage of House Bill 1658, that addresses medical student depression and suicide. I was able to secure passage of that bill out of the select committee and it is now headed for the house floor provided the speaker and floor later determined it to be a worthy endeavor to take up.
Following that, I made my way to another location here in Jefferson City to participate in another committee of which I am a member, the MoHealthNet Oversight Committee.   During that meeting we received lots of updates on how our state is serving the needs of Medicaid recipients. We were also presented plans for implementing the expansion of "Managed Care" for our Medicaid recipients statewide. This was an effort that I quite vocally opposed last session, and strongly urged the house to vote down the budget bill that contained the language that would transfer our Medicaid population out of the I-70 corridor from a “fee for service” practice model to a managed care model. My opinion was, based on the evidence and my research that changing to a managed care model  statewide would result in restricted access to care for these quite vulnerable individuals on the lower socio-economic  scale in our state.  At the MoHealthNet Oversight committee meeting, the Missouri Hospital Association made a presentation to us comparing fee for service to managed care. It was pointed out that in recent years the use of the emergency room has gone up for patients enrolled in managed care plans more than for those enrolled in a fee for service plan. This provided further data that the managed care plans restrict access, thereby forcing people to use the only access point at their disposal, the emergency room – with its much higher costs.
 At that meeting, working in conjunction with Senator Schaaf, I offered a motion for the oversight committee to express its objection to the Department of Health and Senior Services, and the Governor’s action to proceed with implementation of expansion of managed care state wide for our Medicaid population, in the absence of the necessary report from a committee studying this topic, and in the absence of the approval of the Oversight Committee. The resolution that I offered at that meeting last Thursday passed by a vote of 6 to 1.   We shall now see if the state proceeds with plans to expand managed care to the rest of the Medicaid population in Missouri, or if it reconsiders and awaits the proper approvals before moving ahead.