HB 432 —ANY WILLING PROVIDERS OF HEALTHCARE (Rep. Schaaf)
 Prohibits health insurers, the Missouri Medicaid Program, and the federal Medicare Program from discriminating against any provider located within the geographic coverage area of a health benefit plan who is willing to meet the terms and conditions for participation in the plan.
 Currently on the House Perfection Calendar.
MSOA Position: We support ‘patient freedom of choice’ laws like HB 432 that allow patients to choose their own doctor. HB 432 expands patient access to physicians.
SB 577 —MOHealthNet (Medicaid Transformation) & Pay for Performance (Sen. Shields)
 Subjects physicians to new pay-for-performance requirements for Medicaid patients.
“The MO HealthNet division shall by rule and regulation develop pay-for-performance payment program guidelines. The pay-for-performance payment program guidelines shall be developed and maintained by the professional services payment committee, as established in section 208.197. Providers operating under a risk- bearing care coordination plan and an administrative services organization plan, as defined in section 208.950, shall be required to participate in a pay-for-performance payment program, and providers operating under the state care management point of service plan, as defined in section 208.950, shall participate in the pay-for-performance payment program.
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MSOA Position: Experimentation with payment options directed at quality outcomes should be coupled with reliable annual positive updates in payment. Without additional funds made available for the higher value-based payments, higher payments for some physicians would automatically require lower payments for others.
 Senate Bill 577 also app ears to give the HMO’s ‘health care advocates’ authority to refer patients directly to physical therapists:
“Participants who engage in a discussion with their health care advocate on the participant's recommended plan of care may access physical therapy, speech therapy, or occupational therapy, or a combination of therapy if the general assembly has passed an appropriation and the governor has signed the appropriation for the therapy and the therapy is part of the participant's plan of care that includes evidencedbased performance measures.”
MSOA Position: We recommend SB 577 be amended to reflect the existing PT scope of practice consistent with a physician’s referral and oversight of the patient’s physical therapy treatment plan.

SB 305 —MEDICAL IMAGING AND RADIATION THERAPY ACT (Sen. Kennedy)
 Any person administering medical imaging and radiation therapy procedures is required to be licensed by the newly created Medical Imaging and Radiation Therapy Board of
Examiners.
 The act exempts resident physicians, and those enrolled in schools of medicine, dentistry, chiropractic, podiatry, dental hygiene, medical imaging, or radiation therapy who are under supervision of a licensee, and persons licensed to practice medicine, dentistry, podiatry, chiropractic, osteopathy veterinary medicine, or as a nurse or dental hygienist from licensure.
 Senate Bill 305 (Sen. Kennedy) —currently on the Senate Calendar
 House Bill 208 (Rep. Schaaf) —House Hearing Completed
MSOA Position:
Orthopaedic surgeons rely on medical imaging every day as they strive to provide the highest level of orthopaedic care to their patients.
 Orthopaedic surgeons receive extensive training and testing in imaging services and are well-qualified to provide such services.
 Orthopaedic physicians a re familiar with the patient’s clinical condition, medical history and previous test results.
 Orthopaedic have the expertise, educational background and experience to perform and interpret images that could impact clinical decision-making.
The proposed licensing provisions may require orthopaedic physicians to employ a
“licensed” technologist on-site or arrange for an off-site credentialed radiologist to over-read all films.
 MSOA strongly believes that specialists who have the appropriate training in an imaging modality should be allowed to provide the imaging services.
 Requiring a radiologist or certified technologist does not ensure quality. Moreover, this type of requirement limits the ability of orthopaedic physicians from offering patient-centered diagnosis in a timely manner by potentially causing patients to wait longer and drive further to receive care.

SCOPE OF PRACTICE ISSUES
1. HCS HB 497 —PHYSICIAN ASSISTANTS (Rep. Sater)
 Expands the definition of "supervision" of physician assistants to allow supervising physicians to be available via telecommunication for consultation, assistance, or intervention.
 Supervising physicians must be present a minimum of 66% of the clinic's hours for practice supervision and collaboration when utilizing physician assistants, and physician assistants must practice within 30 miles of the supervising physician.
 Passed the House. Awaiting Senate Committee Hearing.
MSOA Position: We support. MSOA took the lead in encouraging a compromise on this issue three years ago. Orthopaedic physicians rely on Physician Assistants to provide critical follow-up and chronic care to patients.
2. PHYSICIAN-OWNED PHYSICAL THERAPY SERVICES (POPTS)
 Nothing currently pending to alter status quo.
MSOA Position: Since 1995, Missouri State Law has prohibited physicians from referring patients for physical therapy services with whom the physician has a direct or indirect ownership interest. In Missouri, a physical therapist may employ a physician…but a physician cannot employ a physical therapist.
MSOA believes leaving a doctor’s office to access a free-standing physical therapy practice inconveniences the consumer, impedes motivation for rehabilitation, delays care, and is, ultimately, a barrier to treatment. We support giving patients access to physical therapy services within a physician’s office.
3. ATHLETIC TRAINERS
 Nothing currently pending to alter status quo.
 Issue: Currently, licensed athletic trainers can deliver physical medicine and rehabilitation to athletes. Licensed athletic trainers can also see non-athletes if the AT is under the supervision of a physical therapist. It is my understanding that physical therapists and large physical therapy corporations are utilizing PT techs, PT assistants,
AT techs, etc. instead of licensed Athletic Trainers.
 Proposed Change: The Missouri Athletic Trainer Practice Act 2007 appears to delete the provision for treatment of non-athletes. It is not clear whether that means ATs will only be able to treat athletes during competition. Or, if this simply removes the exception allowing ATs to treat non-athletes without supervision by the PT.
MSOA Position: Orthopaedic physicians —including sports medicine doctors—work regularly with licensed athletic trainers to care for high school athletes and college athletes.
We support giving athletic trainers direct supervision by orthopaedic physicians similar to physician assistants.