State Republican lawmakers are moving forward with plans to make executive departments more vigilant in their review of Medicaid providers.
In a hearing to review its first of two reports Thursday, the Missouri Senate Interim Committee on Medicaid Accountability and Taxpayer Protection discussed its recommendations for the Department of Health and Senior Services and the Department of Social Services.
The interim committee was created to develop recommendations concerning the MOHealthNet program, abortion providers and aligning the way public dollars are spent with the values of Missourians.
The state has the power to set qualifications for Medicaid providers to be certified and determine the fitness of providers, and it has regulations already on the books.
Based on the committee's previous hearings, which garnered more than 40 pieces of testimony from citizens, various state departments, Medicaid providers and interest groups, it is recommending DHSS and DSS collaborate to modify and expand Missouri's rules for becoming a MOHealthNet provider.
The committee wants DHSS and DSS to include violations of state law relating to abortion facilities including failure to get informed parental consent for an abortion, failure to retain records, or failure to cooperate with DHSS during an investigation — as reasons for why a provider could be terminated or rejected from the MOHealthNet program.
The committee is also recommending an expedited process allowing DSS to use information provided through DHSS investigations to identify patterns of violations or a provider's lack of qualifications to be certified as a MOHealthNet provider.
Committee Chairman Sen. Bill White, R-Joplin, said the measures are intended to make the executive departments be more stringent in their reviews, not change how they conduct analysis of criteria.
"The recommendations for regulatory changes are nothing different than we already have that we're requesting they expand and be more rigid in — or diligent I guess is the right word," White said.
White said the language of the recommendation simply provides the department discretion to determine if a provider is out of compliance with its regulations, so it wouldn't force the department to automatically terminate or reject providers because it doesn't meet all criteria.
Medical providers who have been terminated from another state's Medicaid program, for example, could still be accepted by MOHealthNet if they're found to be back in compliance with state standards.
The recommendations raised concerns for committee Democrats Sen. Lauren Arthur, D-Kansas City, and Sen. Jill Schupp, D-St. Louis County.
"If this is a backdoor attempt to defund Planned Parenthood, I do worry about the impact that would have on healthcare access," Arthur said. "As we heard during testimony, the role that they play is sort of as a social safety net provider, so I do have concerns about that and it doesn't seem like there's a great solution for who would fill that gap."
Arthur said she's also concerned there's no guarantee the new rules wouldn't jeopardize Missouri's federal Medicaid funding altogether.
"Until there's that assurance that we're in compliance, I think that we're taking a gamble that I'm not comfortable with," Arthur said.
White said the recommendations shouldn't change any of the state's current practices enough to bring it out of compliance with federal standards, and is broad enough to apply to all abortion providers, not just Planned Parenthood.
Schupp said she was concerned about DHSS and DSS sharing information and DSS making determinations without conducting its own investigations.
She pointed to a recent case where DHSS filed complaints against Planned Parenthood for being out of compliance, resulting in removal of their MOHealthNet certification. Planned Parenthood was then found to be in compliance by a court and had their certification reinstated.
"I just wonder what your intent is and how those rules will be written," Schupp said. "We don't want people who prefer to have coverage to be denied coverage, and we don't want to have a chilling effect on people going to access the care, the healthcare they need."
White said DSS doesn't currently conduct a complete, independent investigation anyway, and the new collaboration could promote quicker determinations of compliance.
White said he hopes to have the completed report available for committee members to sign today and send to the executive branch by Monday.
The report includes recommendation for the executive branch to issue an executive order in regards to the rulemaking, meaning action could be taken as early as next week.
The committee meets next Oct. 7 to ask questions of MOHealthNet representatives about transparency and new efficiency measures. The committee is also expecting to produce a second report on the topic of transparency.