The Missouri General Assembly voted in the waning days of the session in May to phase out substantial parts of the state's certificate-of-need process.
It also joined the chorus of states mandating that insurance companies pay for minimum hospital stays for new mothers, and will require hospitals and healthcare employers to do criminal background checks on new employees.
And in a significant fiscal move, the Legislature earmarked savings from Medicaid managed care to assure primary-care access for the uninsured. A projected $103 million to be saved over two years now will be reserved for uninsured care.
The CON program will end on Dec. 31, 2001, with three exceptions:
Nursing home and residential-care beds, including those within hospitals.
Long-term acute-care beds.
Construction of new hospitals.
The bill raises some thresholds for consideration by the committee. On the acute-care side, where the thresholds had been $600,000 for capital projects and $400,000 for equipment purchases, they are now $1 million for capital and $1 million for equipment. Nursing home thresholds are unchanged.
All new long-term acute-care beds will be reviewed and are subject to the moratorium on new nursing home beds. That moratorium has been continued to Dec. 31, 1999.
For the first two years the bill is in effect, certain long-term-care providers may increase their licensed beds by 10 beds or 10%, whichever is less.
Tom Cranshaw, senior vice president of Health Midwest in Kansas City, said the late sunset date is designed to allow managed-care plans more time to penetrate the state, giving them more influence in the marketplace. "That will create a very competitive self-regulation. That will be the method by which unnecessary duplication and costly services will be prevented in the future."
The Missouri Hospital Association had favored the changes and had lobbied to phase out the program by 1999, said Dwight Fine, vice president for state legislation.
The obstetric length-of-stay bill requires insurers to pay for 48 hours in the hospital after a vaginal birth and 96 hours after a Caesarean section. Health plans have until Jan. 1, 1997, to include this provision in their policies.
Mothers and babies may be discharged sooner if the plan covers at least two home visits.
The requirement that hospitals run background checks on new employees was not advocated by the Missouri Hospital Association but was added to the CON bill at the end of the session, Fine said. After Aug. 27, 1997, hospitals, nursing homes, home-care agencies and staffing agencies must obtain a criminal background check from the Missouri Highway Patrol at a cost of $10. The fee may be charged to the job applicant.