Journal of the House

First Regular Session, 94th General Assembly

SEVENTY-THIRD DAY, Friday, May 11, 2007

The House met pursuant to adjournment.

            Speaker Jetton in the Chair.

            Prayer by Ralph Robinett, Sergeant-at-Arms.

              When Every Day is Special

              O Lord, today is truly special, for it comes as a gift from You to us.

              We are surrounded by the marvelous things You have made: babies are born, leaves bud on the trees, bodies heal after illness, people build friendships.

              Help us to always see Your hand in our world, even on what seems like the most ordinary of days. Open our eyes to see Your love in countless little things, and in that way become aware of the grand scale of Your grace.

              Make our hearts sing with Your praise today and every day.

              Today is truly special for it is a gift from You to us. Thank You for this day. Amen.

            The Pledge of Allegiance to the flag was recited.

            The Speaker appointed the following to act as Honorary Pages for the Day, to serve without compensation: Tyler Matthew Loveall, Judith Svetanics, Neil Svetanics and Laura Ransin.

            The Journal of the seventy-second day was approved as printed.

            Representative Pratt assumed the Chair.

HOUSE COURTESY RESOLUTIONS OFFERED AND ISSUED

            House Resolution No. 3561 through House Resolution No. 3609

COMMITTEE REPORT

            Committee on Fiscal Review, Chairman Guest reporting:

            Mr. Speaker: Your Committee on Fiscal Review, to which was referred HCS SS SCS SB 577 (Fiscal Note), begs leave to report it has examined the same and recommends that it Do Pass.

HOUSE BILL WITH SENATE AMENDMENT

            SS#2 SCS HCS HBs 444, 217, 225, 239, 243, 297, 402 & 172, relating to a deduction for social security, was taken up by Representative Jetton.

            Representative Nieves assumed the Chair.

            Representative Pratt resumed the Chair.

            On motion of Representative Jetton, SS#2 SCS HCS HBs 444, 217, 225, 239, 243, 297, 402 & 172 was adopted by the following vote:

            On motion of Representative Jetton, SS#2 SCS HCS HBs 444, 217, 225, 239, 243, 297, 402 & 172 was truly agreed to and finally passed by the following vote:

            Representative Pratt declared the bill passed.

RECESS

            On motion of Representative Dempsey, the House recessed until 11:45 a.m.

            The hour of recess having expired, the House was called to order by Representative Cooper (120).

MESSAGES FROM THE SENATE

             Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on SCS HCS HB 10, and has taken up and passed CCS SCS HCS HB 10.

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on SCS HCS HB 11, as amended, and has taken up and passed CCS SCS HCS HB 11.

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on SCS HCS HB 12, and has taken up and passed CCS SCS HCS HB 12.

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on SCS HCS HB 13, and has taken up and passed CCS SCS HCS HB 13.

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the President Pro Tem has appointed the following Conference Committee to act with a like Committee from the House on SS SCS HB 255, as amended: Senators Vogel, Scott, Ridgeway, Green and Shoemyer.

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and passed SS#2 SCS HCS HB 818, entitled:

            An act to repeal sections 103.085, 143.121, 143.782, 313.321, 376.426, 376.776, 376.960, 376.961, 376.964, 376.966, 376.986, 376.989, 379.930, 379.936, 379.938, 379.940, 379.942, 379.943, 379.944, and 379.952, RSMo, and to enact in lieu thereof forty-nine new sections relating to health insurance, with an effective date for certain sections.

            With Senate Amendment No. 2.

Senate Amendment No. 2

AMEND Senate Substitute No. 2 for Senate Committee Substitute for House Committee Substitute for House Bill No. 818, Page 70, Section 376.990, Line 20 of said page, by inserting before the word “third” the following:

              “licensed”.

            In which the concurrence of the House is respectfully requested.

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on HCS SB 81, as amended, and has taken up and passed CCS HCS SB 81.

            Emergency clause adopted.

            Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate refuses to concur in HCS SCS SB 86, as amended, and requests the House to recede from its position and, failing to do so, grant the Senate a conference thereon.

HOUSE BILL WITH SENATE AMENDMENTS

            SS#2 SCS HCS HB 818, as amended, relating to health insurance portability, was taken up by Representative Ervin.

            Representative Ervin moved that the SS#2 SCS HCS HB 818, as amended, be adopted.

            Representative Donnelly made a substitute motion that the House refuse to adopt SS#2 SCS HCS HB 818, as amended, and request the Senate to recede from its position and, failing to do so, grant the House a conference.

            Which motion was defeated by the following vote:

            On motion of Representative Ervin, SS#2 SCS HCS HB 818, as amended, was adopted by the following vote:

            On motion of Representative Ervin, SS#2 SCS HCS HB 818, as amended, was truly agreed to and finally passed by the following vote:

            Representative Cooper (120) declared the bill passed.

            Speaker Jetton resumed the Chair.

THIRD READING OF SENATE BILLS

            SB 513, relating to the Professional and Practical Nursing Student Loan Program, was taken up by Representative Wasson.

            On motion of Representative Wasson, SB 513 was truly agreed to and finally passed by the following vote:

            Speaker Jetton declared the bill passed.

            HCS SS SCS SB 577, relating to the Missouri HealthNet Program, was taken up by Representative Schaaf.

            Representative Schaaf offered House Amendment No 1.

House Amendment No. 1

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 25, Section 208.001, Subsection 1, Lines 1 through 4, by deleting all of said lines and inserting in lieu thereof the following:

              "208.001. 1. Sections 105.711, 135.096, 135.575, 191.411, 191.900, 191.905, 191.907, 191.908, 191.909, 191.910, 191.914, 191.1050, 191.1053, 191.1056, 192.632, 198.069, 198.097, 208.001, 208.146, 208.151, 208.152, 208.153, 208.197, 208.201, 208.212, 208.213, 208.215, 208.217, 208.225, 208.230, 208.612, 208.631, 208.640, 208.659, 208.670, 208.690, 208.692, 208.694, 208.696, 208.698, 208.750, 208.930, 208.950, 208.952, 208.954, 208.956, 208.960, 208.962, 208.964, 208.968, 208.975, 208.978, 375.020, 375.143, 473.398, and 620.510 RSMo, may be known as and may be cited as the "Missouri Continuing Health Improvement Act" "; and

              Further amend said bill, Page 44, Section 208.153, Line 30, by deleting the word "any" and inserting in lieu thereof the words "all or part of a"; and

              Further amend said bill, page and section, Line 31, by inserting after the word "pass" the words "the pertinent portion, as defined by departmental regulation, of"; and

              Further amend said bill, Page 45, Section 208.197, Subsection 2, Line 16, by deleting the word "encourage" and inserting in lieu thereof "discourage"; and

              Further amend said bill, Page 70, Section 208.950, Subsection 1, Subdivision (12), Line 58, by inserting before the word "the", the words "if the participant has a PCP, the office or clinic of a participant's PCP or PCP extender, and any team of individuals associated with that office or clinic, or if the participant has no PCP,"; and

              Further amend said bill, Page 70, Section 208.950, Line 61, by deleting the words "The home is led by a clinically appropriate provider, who"; and

              Further amend said bill, Pages 70 to 71, Section 208.950, Lines 62 through 69, by deleting said lines; and

              Further amend said bill, Page 71, Section 208.950, Subsection 1, Subdivision (14), Line 75, by inserting after "208.152" the words "and other budgeted services"; and

              Further amend said bill, Page 71, Section 208.950, Subsection 1, Subdivision (19), Line 93, by deleting the word "select" and inserting in lieu thereof "selected"; and

              Further amend said bill, Page 73, Section 208.950, Subsection 1, Subdivision (25), Line 146, by deleting the word "existing"; and

              Further amend said bill, Page 80, Section 208.954, Subsection 1, Subdivision (1), Paragraph (a), Line 4, by inserting after the word "and" the word "of"; and

              Further amend said bill, Page 81, Section 208.954, Subsection 2, Line 50, by inserting after the word "all" the word "primary"; and

              Further amend said bill, Page 83, Section 208.956, Subsection 1, Subdivision (6), Line 15, by inserting after the word "professionals" the words "of which, one shall be a dentist,"; and

              Further amend said bill, Page 92, Section 208.964, Subdivision (6), Lines 87 through 88, by deleting the words "not included as part of an ASO plan, managed care plan, or component state plan for such population." and inserting in lieu thereof the following:

              "may include services of a component state plan upon approval of the department of mental health, but said ABD participants shall not be included as part of an ASO plan or a managed care plan."; and

              Further amend said bill, Page 95, Section 208.975, Subsection 7, Lines 54 and 55, by deleting the words "seven hundred fifty thousand dollars within any three-year span." and inserting in lieu thereof the following:

              "two million dollars per fiscal year."; and

              Further amend said bill, Page 101, Section 620.510, Subsection 3, Subdivision (5), Line 18, by inserting after the word "services," and words "and the director of the department of mental health,"; and

              Further amend said bill, Page 103, Section 4, by deleting the said section; and

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

            Representative Tilley offered House Amendment No. 1 to House Amendment No. 1.

House Amendment No. 1

to

House Amendment No. 1

AMEND House Amendment No. 1 to House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 1, Line 1, by inserting before the word "AMEND" the words 'AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 15, Line 40, by inserting before the word "A" the words "The person so referred shall be subject to the penalties provided for under 42 U.S.C. Chapter 7, Subchapter XI, Section 1320a-7." '.

            On motion of Representative Tilley, House Amendment No. 1 to House Amendment No. 1 was adopted.

            On motion of Representative Schaaf, House Amendment No. 1, as amended, was adopted.

            Representative Hobbs offered House Amendment No. 2.

House Amendment No. 2

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 22, Section 191.1050, Lines 9 and 10, by deleting all of said lines and inserting in lieu thereof the following:

              "section 632.005, RSMo, rural health clinic, or any group of licensed health care professionals in an area of defined need that is designated by the department as"; and

              Further amend said bill, Page 22, Section 191.1053, Line 15, by inserting after all of said lines the following:

              "4. The department may promulgate rules to implement the provisions of sections 191.1050 to 191.1056. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2007, shall be invalid and void."; and

              Further amend said bill, Page 22, Section 191.1056, Line 3, by inserting after the second appearance of the word "fund" on said line the following:

              ", with the approval of the oversight committee created in section 208.956, RSMo,"; and

              Further amend said title, enacting clause and intersectional references accordingly.

            On motion of Representative Hobbs, House Amendment No. 2 was adopted.

            Representative Portwood offered House Amendment No. 3.

House Amendment No. 3

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 2, Section A., by inserting after all of said section the following:

              “103.003. As used in sections 103.003 to 103.175, the following terms mean:

              (1) "Actuarial reserves", the necessary funding required to pay all the medical expenses for services provided to members of the plan but for which the claims have not yet been received by the claims administrator;

              (2) "Actuary", a member of the American Academy of Actuaries or who is an enrolled actuary under the Employee Retirement Income Security Act of 1974;

              (3) "Agency", a state-sponsored institution of higher learning, political subdivision or governmental entity or instrumentality;

              (4) "Alternative delivery health care program", a plan of covered benefits that pays medical expenses through an alternate mechanism rather than on a fee-for-service basis. This includes, but is not limited to, health maintenance organizations and preferred provider organizations, all of which shall include chiropractic physicians licensed under chapter 331, RSMo, in the provider networks or organizations;

              (5) "Board", the board of trustees of the Missouri consolidated health care plan;

              (6) "Claims administrator", an agency contracted to process medical claims submitted from providers or members of the plan and their dependents;

              (7) "Coordination of benefits", to work with another group-sponsored health care plan which also covers a member of the plan to ensure that both plans pay their appropriate amount of the health care expenses incurred by the member;

              (8) "Covered benefits", a schedule of covered services, including chiropractic services, which are payable under the plan;

              (9) "Dental plan", any contractual arrangement to provide, either directly or through arrangement with others, specified dental benefits to members on a fixed prepayment basis or as a benefit of such subscribers' participation or membership in any other contract, agreement, or group or any corporation, partnership, or other entity which undertakes to provide or arrange specified dental benefits on a prepayment or other basis or to indemnify for specified dental benefits;

              [(9)] (10) "Employee", any person employed full time by the state or a participating member agency, or a person eligible for coverage by a state-sponsored retirement system or a retirement system sponsored by a participating member agency of the plan;

              [(10)] (11) "Evidence of good health", medical information supplied by a potential member of the plan that is reviewed to determine the financial risk the person represents to the plan and the corresponding determination of whether or not he or she should be accepted into the plan;

              [(11)] (12) "Health care plan", any group medical benefit plan providing coverage on an expense-incurred basis, any HMO, any group service or indemnity contract issued by a health plan of any type or description;

              [(12)] (13) "Medical benefits coverages" shall include services provided by chiropractic physicians as well as physicians licensed under chapter 334, RSMo;

              [(13)] (14) "Medical expenses", costs for services performed by a provider and covered under the plan;

              (15) "Member", any person who is a participant in the Missouri consolidated health care plan, including eligible subscribers and subscribers' spouses and unemancipated children;

              [(14)] (16) "Missouri consolidated health care plan benefit fund account", the benefit trust fund account containing all payroll deductions, payments, and income from all sources for the plan;

              [(15)] (17) "Officer", an elected official of the state of Missouri;

              [(16)] (18) "Participating member agency", a state-sponsored institution of higher learning, political subdivision or governmental entity that has elected to join the plan and has been accepted by the board;

              [(17)] (19) "Plan year", a twelve-month period designated by the board which is used to calculate the annual rate categories and the appropriate coverage;

              [(18)] (20) "Provider", a physician, hospital, pharmacist, psychologist, chiropractic physician or other licensed practitioner who or which provides health care services within the respective scope of practice of such practitioner pursuant to state law and regulation;

              [(19)] (21) "Retiree", a person who is not an employee and is receiving or is entitled to receive an annuity benefit from a state-sponsored retirement system or a retirement system of a participating member agency of the plan or becomes eligible for retirement benefits because of service with a participating member agency;

              (22) "Subscriber", a person who is either:

              (a) An eligible employee of the state or a participating member agency;

              (b) An eligible retiree of the state or a participating member agency;

              (c) An eligible surviving spouse or dependent of a deceased employee or deceased employee or deceased retiree of the state or a participating member agency;

              (d) A former employee of the state or a participating member agency who is eligible for coverage under the federal Consolidated Omnibus Budget Reconciliation Act; or

              (e) A person eligible for medical assistance under section 208.146, RSMo, and not otherwise eligible for coverage under the Missouri consolidated health care plan and who elects dental or vision coverage or both through the Missouri consolidated health care plan;

              (23) "Vision plan", any contractual arrangement to provide, either directly or through arrangement with others, specified vision benefits to members on a fixed prepayment basis or as a benefit of such subscribers' participation or membership in any other contract, agreement, or group or any corporation, partnership, or other entity which undertakes to provide or arrange specified vision benefits on a prepayment or other basis or to indemnify for specified vision benefits.

              103.005. For the purpose of covering medical, dental, and vision expenses of the officers, employees and retirees, the eligible dependents of officers, employees and retirees and to the surviving spouses and children of deceased officers, employees and retirees of the state and participating member agencies of the state, and providing dental and vision benefits to eligible participants of medical assistance under section 208.146, RSMo, there is hereby created and established a health care plan which shall be a body corporate, which shall be under the management of the board of trustees herein described, and shall be known as the "Missouri Consolidated Health Care Plan". Notwithstanding any provision of law to the contrary, such plan may sue and be sued, transact business, contract, invest funds and hold cash, securities and other property and shall be vested with such other powers as may be necessary or proper to enable it, its officers, employees, and agents to carry out fully and effectively all the purposes of sections 103.003 to 103.175.

              103.087. For purposes of this section, the terms "medical assistance subscriber" or "medical assistance participant" shall mean a person receiving medical assistance under section 208.146, RSMo. Except as otherwise provided by sections 103.003 to 103.175, dental and vision benefits coverage as provided by sections 103.003 to 103.175 shall be made available to persons receiving medical assistance under section 208.146, RSMo. Spouses or unemancipated children under the age of twenty-three of such persons shall also be eligible to receive such dental and vision benefits.

              (1) Dental and vision plans shall be available for enrollment by medical assistance eligible participants no earlier than January 1, 2008, and no later than July 1, 2008;

              (2) The cost of providing dental and vision benefits to medical assistance eligible subscribers and subscribers' dependents not otherwise eligible for coverage through the Missouri consolidated health care plan shall not be allowed to adversely affect the state's or participating member agencies' rates or benefits;

              (3) An initial thirty-day enrollment period shall be available for persons eligible for medical assistance not otherwise eligible for coverage under the Missouri consolidated health care plan to enroll in the dental or vision benefits or both under the Missouri consolidated health care plan. This initial thirty-day enrollment period shall begin from such person's initial date of approval under medical assistance under section 208.146, RSMo;

              (4) There shall be an annual thirty-day enrollment period, at a time designated by the board, during which persons eligible for medical assistance not otherwise eligible for coverage under the Missouri consolidated health care plan shall be able to enroll in the dental or vision plans or both;

              (5) Medical assistance participants not otherwise eligible for coverage under the Missouri consolidated health care plan shall also be eligible to enroll in the dental or vision plans or both as a medical assistance participant within sixty days of a loss of other group dental or vision coverage, or both, provided that such coverage was in place for at least twelve consecutive months immediately prior to the loss and that such loss was due to:

              (a) The subscriber's or the subscriber's spouse's termination of employment; or

              (b) Termination of group dental or vision coverage, or both, by the employer;

              (6) Coverage for such dental and vision benefits to medical assistance subscribers and subscribers' dependents shall terminate when the medical assistance participant ceases to be eligible for medical assistance;

              (7) Monthly, in accordance with a schedule developed by the board, or its designee, the medical assistance subscriber shall promptly pay to the executive director an amount equal to the amount of the premium due based upon the participation in the dental or vision plans, or both, as billed by the Missouri consolidated health care plan. Such premium shall be set by the board and shall cover all associated costs, including administrative costs, of the plan for providing such services to medical assistance participants. The executive director shall promptly deposit such amounts to the benefit trust fund account;

              (8) The plan shall not assume responsibility for any liabilities incurred by the medical assistance program or its eligible participants or its participants' spouses or unemancipated dependents prior to the group's effective date;

              (9) If so determined by the board, the department of social services shall reimburse the plan for any initial start-up costs incurred by the plan solely on behalf of the medical assistance participants and necessary in order for the medical assistance participants to be included in the plan;

              (10) If a medical assistance subscriber fails to make any payment due the plan, the board may immediately terminate the medical assistance subscriber's and associated members' enrollment in the plan and stop paying claims accrued during the period of nonpayment. Any subscriber terminated for non-payment of premiums shall not be eligible for coverage until the next annual enrollment period as provided in subdivision (4) of this section.”; and

              Further amend said bill, Page 26, Section 208.146, Lines 1 to 62, by deleting all of said lines and inserting in lieu thereof the following:

              “208.146. 1. The program established under this section shall be known as the "Ticket to Work Health Assurance Program". Subject to appropriations and in accordance with the federal Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA), Public Law 106-170, the medical assistance provided for in section 208.151 may be paid for a person who is employed and who:

              (1) Except for earnings, meets the definition of disabled under the Supplemental Security Income Program or meets the definition of an employed individual with a medically improved disability under TWWIIA;

              (2) Has earned income, as defined in subsection 2 of this section;

              (3) Meets the asset limits in subsection 3 of this section;

              (4) Has net income, as defined in subsection 3 of this section, that does not exceed the limit for permanent and totally disabled individuals to receive nonspenddown MO HealthNet under subdivision (24) of subsection 1 of section 208.151; and

              (5) Has a gross income of two hundred fifty percent or less of the federal poverty level, excluding any earned income of the worker with a disability between two hundred fifty and three hundred fifty percent of the federal poverty level. For purposes of this subdivision, "gross income" includes all income of the person and the person's spouse that would be considered in determining MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151. Individuals with gross incomes in excess of one hundred percent of the federal poverty level shall pay a premium for participation in accordance with subsection 4 of this section.

              2. For income to be considered earned income for purposes of this section, the department of social services shall document that Medicare and Social Security taxes are withheld from such income. Self-employed persons shall provide proof of payment of Medicare and Social Security taxes for income to be considered earned.

              3. (1) For purposes of determining eligibility under this section, the available asset limit and the definition of available assets shall be the same as those used to determine MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151 except for:

              (a) Medical savings accounts limited to deposits of earned income and earnings on such income while a participant in the program created under this section with a value not to exceed five thousand dollars per year; and

              (b) Independent living accounts limited to deposits of earned income and earnings on such income while a participant in the program created under this section with a value not to exceed five thousand dollars per year. For purposes of this section, an "independent living account" means an account established and maintained to provide savings for transportation, housing, home modification, and personal care services and assistive devices associated with such person's disability.

              (2) To determine net income, the following shall be disregarded:

              (a) All earned income of the disabled worker;

              (b) The first sixty-five dollars and one-half of the remaining earned income of a nondisabled spouse's earned income;

              (c) A twenty-dollar standard deduction;

              (d) Health insurance premiums;

              (e) A seventy-five dollar a month standard deduction for the disabled worker's dental and optical insurance when the total dental and optical insurance premiums are less than seventy-five dollars;

              (f) All Supplemental Security Income payments, and the first fifty dollars of SSDI payments;

              (g) A standard deduction for impairment-related employment expenses equal to one-half of the disabled worker's earned income.

              4. Any person whose gross income exceeds one hundred percent of the federal poverty level shall pay a premium for participation in the medical assistance provided in this section. Such premium shall be:

              (1) For a person whose gross income is more than one hundred percent but less than one hundred fifty percent of the federal poverty level, four percent of income at one hundred percent of the federal poverty level;

              (2) For a person whose gross income equals or exceeds one hundred fifty percent but is less than two hundred percent of the federal poverty level, four percent of income at one hundred fifty percent of the federal poverty level;

              (3) For a person whose gross income equals or exceeds two hundred percent but less than two hundred fifty percent of the federal poverty level, five percent of income at two hundred percent of the federal poverty level;

              (4) For a person whose gross income equals or exceeds two hundred fifty percent but less than three hundred percent of the federal poverty level, six percent of income at two hundred fifty percent of the federal poverty level;

              (5) For a person whose gross income equals or exceeds three hundred percent but less than three hundred fifty percent of the federal poverty level, seven percent of income at three hundred percent of the federal poverty level.

              5. Recipients of services through this program shall report any change in income or household size within ten days of the occurrence of such change. An increase in premiums resulting from a reported change in income or household size shall be effective with the next premium invoice that is mailed to a person after due process requirements have been met. A decrease in premiums shall be effective the first day of the month immediately following the month in which the change is reported.

              6. If an eligible person's employer offers employer-sponsored health insurance and the department of social services determines that it is more cost effective, such person shall participate in the employer-sponsored insurance. The department shall pay such person's portion of the premiums, co-payments, and any other costs associated with participation in the employer-sponsored health insurance.

              7. Those persons found eligible for medical assistance through this section shall have the right to purchase dental or optical insurance or both through the Missouri Consolidated Health Care Plan.”; and

              Further amend said bill, Pages 60 and 61, Section 208.640, Lines 1 to 41, by deleting all of said lines and inserting in lieu thereof the following:

              “208.640. 1. Parents and guardians of uninsured children with incomes [between] above one hundred [fifty-one and] fifty percent and below three hundred percent of the federal poverty level who do not have access to affordable employer-sponsored health care insurance or other affordable health care coverage may obtain coverage pursuant to this section.

              2. For families with gross income above one hundred fifty percent to one hundred eighty-five percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of three percent of one hundred fifty percent of the federal poverty level for a family of three [less than or equal to one hundred thirty-three percent of the monthly average premium required in the state's current Missouri consolidated health care plan]. For families with gross income above one hundred eighty-five percent to two hundred twenty-five percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of four percent of one hundred eighty-five percent of the federal poverty level for a family of three. For families with gross income above two hundred twenty-five percent and below three hundred percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of five percent of two hundred twenty-five percent of the federal poverty level for a family of three. Health insurance plans that do not cover an eligible child's pre-existing condition shall not be considered "affordable employer-sponsored health care insurance or other affordable health care coverage" for purposes of sections 208.631 to 208.657.

              3. The parents and guardians of eligible uninsured children pursuant to this section are responsible for a monthly premium [equal to the average premium required for the Missouri consolidated health care plan] as required by annual state appropriation; provided that the total aggregate cost sharing for a family covered by these sections shall not exceed five percent of such family's income for the years involved. No co-payments or other cost sharing is permitted with respect to benefits for well-baby and well-child care including age-appropriate immunizations. Cost-sharing provisions pursuant to sections 208.631 to 208.657 shall not exceed the limits established by 42 U.S.C. Section 1397cc(e).

              208.658. Up to one percent of any federal funds received under the provisions of Title XXI of the Social Security Act, as amended, and up to one percent of any state funds used to match those federal funds may be used for outreach through the MO HealthNet division for children's health program established under sections 208.631 to 208.657. The MO HealthNet division may contract with local public health agencies for purposes of this section. The provisions of this section shall be subject to appropriation.”; and

              Further amend said bill, Page 64, Section 208.696, Line 19, by deleting the word “and”; and

              Further amend said bill, Page 64, Section 208.696, Line 20, by inserting immediately following the word “care”; the following “partnership approved”; and

              Further amend said bill, Page 65, Section 208.696, Lines 23 to 24, by deleting all of said lines and inserting in lieu thereof the following:

              “eligibility;

              (7) Develop requirements that all long-term care policies sold in the state of Missouri shall include coverage for all home and community based services, including but not limited to consumer-directed services, in-home, home health, and assisted living services;

              (8) Develop requirements that all long-term care insurance policies sold in the state of Missouri shall disallow exclusions based on pre-existing conditions;

              (9) Develop requirements that vendors of long-term care policies shall not charge a higher fee for premiums for individuals with pre-existing conditions or disabilities; and

              (10) Develop requirements that all vendors of long-term care insurance shall provide each potential purchaser with accurate and verifiable information on the rates, expressed as a percentage of all claims for long-term care services which the vendor has denied in the past twelve months”; and

              Further amend said bill, Page 103, Section 4, by inserting after all of said section the following:

              “Section 5. The provisions in section 103.005, RSMo, relating to dental and vision benefits for medical assistance participants under section 208.146, RSMo, section 103.087, RSMo, section 208.146, RSMo, and subsection 7 of section 208.151, RSMo, shall expire six years after the effective date of this act.”; and

              Further amend said bill, Page 107, Section B., by inserting after all of said section the following:

              “Section C. The repeal and reenactment of sections 103.003, 103.005, and 208.151, and the enactment of sections 103.087 and 208.146, shall be effective upon notice to the revisor of statutes that a waiver or approval of a state plan amendment has been obtained from the Secretary of the Department of Health and Human Services by the director of the department of social services.”; and

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

            Representative Page requested a division of the question on House Amendment No. 3.

House Amendment No. 3

PART I

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 2, Section A., by inserting after all of said section the following:

              “103.003. As used in sections 103.003 to 103.175, the following terms mean:

              (1) "Actuarial reserves", the necessary funding required to pay all the medical expenses for services provided to members of the plan but for which the claims have not yet been received by the claims administrator;

              (2) "Actuary", a member of the American Academy of Actuaries or who is an enrolled actuary under the Employee Retirement Income Security Act of 1974;

              (3) "Agency", a state-sponsored institution of higher learning, political subdivision or governmental entity or instrumentality;

              (4) "Alternative delivery health care program", a plan of covered benefits that pays medical expenses through an alternate mechanism rather than on a fee-for-service basis. This includes, but is not limited to, health maintenance organizations and preferred provider organizations, all of which shall include chiropractic physicians licensed under chapter 331, RSMo, in the provider networks or organizations;

              (5) "Board", the board of trustees of the Missouri consolidated health care plan;

              (6) "Claims administrator", an agency contracted to process medical claims submitted from providers or members of the plan and their dependents;

              (7) "Coordination of benefits", to work with another group-sponsored health care plan which also covers a member of the plan to ensure that both plans pay their appropriate amount of the health care expenses incurred by the member;

              (8) "Covered benefits", a schedule of covered services, including chiropractic services, which are payable under the plan;

              (9) "Dental plan", any contractual arrangement to provide, either directly or through arrangement with others, specified dental benefits to members on a fixed prepayment basis or as a benefit of such subscribers' participation or membership in any other contract, agreement, or group or any corporation, partnership, or other entity which undertakes to provide or arrange specified dental benefits on a prepayment or other basis or to indemnify for specified dental benefits;

              [(9)] (10) "Employee", any person employed full time by the state or a participating member agency, or a person eligible for coverage by a state-sponsored retirement system or a retirement system sponsored by a participating member agency of the plan;

              [(10)] (11) "Evidence of good health", medical information supplied by a potential member of the plan that is reviewed to determine the financial risk the person represents to the plan and the corresponding determination of whether or not he or she should be accepted into the plan;

              [(11)] (12) "Health care plan", any group medical benefit plan providing coverage on an expense-incurred basis, any HMO, any group service or indemnity contract issued by a health plan of any type or description;

              [(12)] (13) "Medical benefits coverages" shall include services provided by chiropractic physicians as well as physicians licensed under chapter 334, RSMo;

              [(13)] (14) "Medical expenses", costs for services performed by a provider and covered under the plan;

              (15) "Member", any person who is a participant in the Missouri consolidated health care plan, including eligible subscribers and subscribers' spouses and unemancipated children;

              [(14)] (16) "Missouri consolidated health care plan benefit fund account", the benefit trust fund account containing all payroll deductions, payments, and income from all sources for the plan;

              [(15)] (17) "Officer", an elected official of the state of Missouri;

              [(16)] (18) "Participating member agency", a state-sponsored institution of higher learning, political subdivision or governmental entity that has elected to join the plan and has been accepted by the board;

              [(17)] (19) "Plan year", a twelve-month period designated by the board which is used to calculate the annual rate categories and the appropriate coverage;

              [(18)] (20) "Provider", a physician, hospital, pharmacist, psychologist, chiropractic physician or other licensed practitioner who or which provides health care services within the respective scope of practice of such practitioner pursuant to state law and regulation;

              [(19)] (21) "Retiree", a person who is not an employee and is receiving or is entitled to receive an annuity benefit from a state-sponsored retirement system or a retirement system of a participating member agency of the plan or becomes eligible for retirement benefits because of service with a participating member agency;

              (22) "Subscriber", a person who is either:

              (a) An eligible employee of the state or a participating member agency;

              (b) An eligible retiree of the state or a participating member agency;

              (c) An eligible surviving spouse or dependent of a deceased employee or deceased employee or deceased retiree of the state or a participating member agency;

              (d) A former employee of the state or a participating member agency who is eligible for coverage under the federal Consolidated Omnibus Budget Reconciliation Act; or

              (e) A person eligible for medical assistance under section 208.146, RSMo, and not otherwise eligible for coverage under the Missouri consolidated health care plan and who elects dental or vision coverage or both through the Missouri consolidated health care plan;

              (23) "Vision plan", any contractual arrangement to provide, either directly or through arrangement with others, specified vision benefits to members on a fixed prepayment basis or as a benefit of such subscribers' participation or membership in any other contract, agreement, or group or any corporation, partnership, or other entity which undertakes to provide or arrange specified vision benefits on a prepayment or other basis or to indemnify for specified vision benefits.

              103.005. For the purpose of covering medical, dental, and vision expenses of the officers, employees and retirees, the eligible dependents of officers, employees and retirees and to the surviving spouses and children of deceased officers, employees and retirees of the state and participating member agencies of the state, and providing dental and vision benefits to eligible participants of medical assistance under section 208.146, RSMo, there is hereby created and established a health care plan which shall be a body corporate, which shall be under the management of the board of trustees herein described, and shall be known as the "Missouri Consolidated Health Care Plan". Notwithstanding any provision of law to the contrary, such plan may sue and be sued, transact business, contract, invest funds and hold cash, securities and other property and shall be vested with such other powers as may be necessary or proper to enable it, its officers, employees, and agents to carry out fully and effectively all the purposes of sections 103.003 to 103.175.

              103.087. For purposes of this section, the terms "medical assistance subscriber" or "medical assistance participant" shall mean a person receiving medical assistance under section 208.146, RSMo. Except as otherwise provided by sections 103.003 to 103.175, dental and vision benefits coverage as provided by sections 103.003 to 103.175 shall be made available to persons receiving medical assistance under section 208.146, RSMo. Spouses or unemancipated children under the age of twenty-three of such persons shall also be eligible to receive such dental and vision benefits.

              (1) Dental and vision plans shall be available for enrollment by medical assistance eligible participants no earlier than January 1, 2008, and no later than July 1, 2008;

              (2) The cost of providing dental and vision benefits to medical assistance eligible subscribers and subscribers' dependents not otherwise eligible for coverage through the Missouri consolidated health care plan shall not be allowed to adversely affect the state's or participating member agencies' rates or benefits;

              (3) An initial thirty-day enrollment period shall be available for persons eligible for medical assistance not otherwise eligible for coverage under the Missouri consolidated health care plan to enroll in the dental or vision benefits or both under the Missouri consolidated health care plan. This initial thirty-day enrollment period shall begin from such person's initial date of approval under medical assistance under section 208.146, RSMo;

              (4) There shall be an annual thirty-day enrollment period, at a time designated by the board, during which persons eligible for medical assistance not otherwise eligible for coverage under the Missouri consolidated health care plan shall be able to enroll in the dental or vision plans or both;

              (5) Medical assistance participants not otherwise eligible for coverage under the Missouri consolidated health care plan shall also be eligible to enroll in the dental or vision plans or both as a medical assistance participant within sixty days of a loss of other group dental or vision coverage, or both, provided that such coverage was in place for at least twelve consecutive months immediately prior to the loss and that such loss was due to:

              (a) The subscriber's or the subscriber's spouse's termination of employment; or

              (b) Termination of group dental or vision coverage, or both, by the employer;

              (6) Coverage for such dental and vision benefits to medical assistance subscribers and subscribers' dependents shall terminate when the medical assistance participant ceases to be eligible for medical assistance;

              (7) Monthly, in accordance with a schedule developed by the board, or its designee, the medical assistance subscriber shall promptly pay to the executive director an amount equal to the amount of the premium due based upon the participation in the dental or vision plans, or both, as billed by the Missouri consolidated health care plan. Such premium shall be set by the board and shall cover all associated costs, including administrative costs, of the plan for providing such services to medical assistance participants. The executive director shall promptly deposit such amounts to the benefit trust fund account;

              (8) The plan shall not assume responsibility for any liabilities incurred by the medical assistance program or its eligible participants or its participants' spouses or unemancipated dependents prior to the group's effective date;

              (9) If so determined by the board, the department of social services shall reimburse the plan for any initial start-up costs incurred by the plan solely on behalf of the medical assistance participants and necessary in order for the medical assistance participants to be included in the plan;

              (10) If a medical assistance subscriber fails to make any payment due the plan, the board may immediately terminate the medical assistance subscriber's and associated members' enrollment in the plan and stop paying claims accrued during the period of nonpayment. Any subscriber terminated for non-payment of premiums shall not be eligible for coverage until the next annual enrollment period as provided in subdivision (4) of this section.”; and

              Further amend said bill, Page 26, Section 208.146, Lines 1 to 62, by deleting all of said lines and inserting in lieu thereof the following:

              “208.146. 1. The program established under this section shall be known as the "Ticket to Work Health Assurance Program". Subject to appropriations and in accordance with the federal Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA), Public Law 106-170, the medical assistance provided for in section 208.151 may be paid for a person who is employed and who:

              (1) Except for earnings, meets the definition of disabled under the Supplemental Security Income Program or meets the definition of an employed individual with a medically improved disability under TWWIIA;

              (2) Has earned income, as defined in subsection 2 of this section;

              (3) Meets the asset limits in subsection 3 of this section;

              (4) Has net income, as defined in subsection 3 of this section, that does not exceed the limit for permanent and totally disabled individuals to receive nonspenddown MO HealthNet under subdivision (24) of subsection 1 of section 208.151; and

              (5) Has a gross income of two hundred fifty percent or less of the federal poverty level, excluding any earned income of the worker with a disability between two hundred fifty and three hundred fifty percent of the federal poverty level. For purposes of this subdivision, "gross income" includes all income of the person and the person's spouse that would be considered in determining MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151. Individuals with gross incomes in excess of one hundred percent of the federal poverty level shall pay a premium for participation in accordance with subsection 4 of this section.

              2. For income to be considered earned income for purposes of this section, the department of social services shall document that Medicare and Social Security taxes are withheld from such income. Self-employed persons shall provide proof of payment of Medicare and Social Security taxes for income to be considered earned.

              3. (1) For purposes of determining eligibility under this section, the available asset limit and the definition of available assets shall be the same as those used to determine MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151 except for:

              (a) Medical savings accounts limited to deposits of earned income and earnings on such income while a participant in the program created under this section with a value not to exceed five thousand dollars per year; and

              (b) Independent living accounts limited to deposits of earned income and earnings on such income while a participant in the program created under this section with a value not to exceed five thousand dollars per year. For purposes of this section, an "independent living account" means an account established and maintained to provide savings for transportation, housing, home modification, and personal care services and assistive devices associated with such person's disability.

              (2) To determine net income, the following shall be disregarded:

              (a) All earned income of the disabled worker;

              (b) The first sixty-five dollars and one-half of the remaining earned income of a nondisabled spouse's earned income;

              (c) A twenty-dollar standard deduction;

              (d) Health insurance premiums;

              (e) A seventy-five dollar a month standard deduction for the disabled worker's dental and optical insurance when the total dental and optical insurance premiums are less than seventy-five dollars;

              (f) All Supplemental Security Income payments, and the first fifty dollars of SSDI payments;

              (g) A standard deduction for impairment-related employment expenses equal to one-half of the disabled worker's earned income.

              4. Any person whose gross income exceeds one hundred percent of the federal poverty level shall pay a premium for participation in the medical assistance provided in this section. Such premium shall be:

              (1) For a person whose gross income is more than one hundred percent but less than one hundred fifty percent of the federal poverty level, four percent of income at one hundred percent of the federal poverty level;

              (2) For a person whose gross income equals or exceeds one hundred fifty percent but is less than two hundred percent of the federal poverty level, four percent of income at one hundred fifty percent of the federal poverty level;

              (3) For a person whose gross income equals or exceeds two hundred percent but less than two hundred fifty percent of the federal poverty level, five percent of income at two hundred percent of the federal poverty level;

              (4) For a person whose gross income equals or exceeds two hundred fifty percent but less than three hundred percent of the federal poverty level, six percent of income at two hundred fifty percent of the federal poverty level;

              (5) For a person whose gross income equals or exceeds three hundred percent but less than three hundred fifty percent of the federal poverty level, seven percent of income at three hundred percent of the federal poverty level.

              5. Recipients of services through this program shall report any change in income or household size within ten days of the occurrence of such change. An increase in premiums resulting from a reported change in income or household size shall be effective with the next premium invoice that is mailed to a person after due process requirements have been met. A decrease in premiums shall be effective the first day of the month immediately following the month in which the change is reported.

              6. If an eligible person's employer offers employer-sponsored health insurance and the department of social services determines that it is more cost effective, such person shall participate in the employer-sponsored insurance. The department shall pay such person's portion of the premiums, co-payments, and any other costs associated with participation in the employer-sponsored health insurance.

              7. Those persons found eligible for medical assistance through this section shall have the right to purchase dental or optical insurance or both through the Missouri Consolidated Health Care Plan.”; and

            On motion of Representative Portwood, Part I of House Amendment No. 3 was adopted by the following vote:

House Amendment No. 3

PART II

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Pages 60 and 61, Section 208.640, Lines 1 to 41, by deleting all of said lines and inserting in lieu thereof the following:

              “208.640. 1. Parents and guardians of uninsured children with incomes [between] above one hundred [fifty-one and] fifty percent and below three hundred percent of the federal poverty level who do not have access to affordable employer-sponsored health care insurance or other affordable health care coverage may obtain coverage pursuant to this section.

              2. For families with gross income above one hundred fifty percent to one hundred eighty-five percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of three percent of one hundred fifty percent of the federal poverty level for a family of three [less than or equal to one hundred thirty-three percent of the monthly average premium required in the state's current Missouri consolidated health care plan]. For families with gross income above one hundred eighty-five percent to two hundred twenty-five percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of four percent of one hundred eighty-five percent of the federal poverty level for a family of three. For families with gross income above two hundred twenty-five percent and below three hundred percent of the federal poverty level for the purposes of sections 208.631 to 208.657, "affordable employer-sponsored health care insurance or other affordable health care coverage" refers to health insurance requiring a monthly premium of five percent of two hundred twenty-five percent of the federal poverty level for a family of three. Health insurance plans that do not cover an eligible child's pre-existing condition shall not be considered "affordable employer-sponsored health care insurance or other affordable health care coverage" for purposes of sections 208.631 to 208.657.

              3. The parents and guardians of eligible uninsured children pursuant to this section are responsible for a monthly premium [equal to the average premium required for the Missouri consolidated health care plan] as required by annual state appropriation; provided that the total aggregate cost sharing for a family covered by these sections shall not exceed five percent of such family's income for the years involved. No co-payments or other cost sharing is permitted with respect to benefits for well-baby and well-child care including age-appropriate immunizations. Cost-sharing provisions pursuant to sections 208.631 to 208.657 shall not exceed the limits established by 42 U.S.C. Section 1397cc(e).

              208.658. Up to one percent of any federal funds received under the provisions of Title XXI of the Social

Security Act, as amended, and up to one percent of any state funds used to match those federal funds may be used for outreach through the MO HealthNet division for children's health program established under sections 208.631 to 208.657. The MO HealthNet division may contract with local public health agencies for purposes of this section. The provisions of this section shall be subject to appropriation.”; and

            Representative Portwood moved that Part II of House Amendment No. 3 be adopted.

            Which motion was defeated by the following vote:

House Amendment No. 3

PART III

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 64, Section 208.696, Line 19, by deleting the word “and”; and

              Further amend said bill, Page 64, Section 208.696, Line 20, by inserting immediately following the word “care”; the following “partnership approved”; and

              Further amend said bill, Page 65, Section 208.696, Lines 23 to 24, by deleting all of said lines and inserting in lieu thereof the following:

              “eligibility;

              (7) Develop requirements that all long-term care policies sold in the state of Missouri shall include coverage for all home and community based services, including but not limited to consumer-directed services, in-home, home health, and assisted living services;

              (8) Develop requirements that all long-term care insurance policies sold in the state of Missouri shall disallow exclusions based on pre-existing conditions;

              (9) Develop requirements that vendors of long-term care policies shall not charge a higher fee for premiums for individuals with pre-existing conditions or disabilities; and

              (10) Develop requirements that all vendors of long-term care insurance shall provide each potential purchaser with accurate and verifiable information on the rates, expressed as a percentage of all claims for long-term care services which the vendor has denied in the past twelve months”; and

              Further amend said bill, Page 103, Section 4, by inserting after all of said section the following:

              “Section 5. The provisions in section 103.005, RSMo, relating to dental and vision benefits for medical assistance participants under section 208.146, RSMo, section 103.087, RSMo, section 208.146, RSMo, and subsection 7 of section 208.151, RSMo, shall expire six years after the effective date of this act.”; and

              Further amend said bill, Page 107, Section B., by inserting after all of said section the following:

              “Section C. The repeal and reenactment of sections 103.003, 103.005, and 208.151, and the enactment of sections 103.087 and 208.146, shall be effective upon notice to the revisor of statutes that a waiver or approval of a state plan amendment has been obtained from the Secretary of the Department of Health and Human Services by the director of the department of social services.”; and

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

            On motion of Representative Portwood, Part III of House Amendment No. 3 was adopted by the following vote:

            Representative Bearden offered House Amendment No. 4.

House Amendment No. 4

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 73, Section 208.950, Lines 145-153, by deleting all of said lines and inserting in lieu thereof the following:

              "state beginning with the next contract renewal period. The division may promulgate rules to compare different methods for dental management. Such rules shall include but are not limited to methods to compare cost, outcomes, encounter data, network adequacy including availability of specialty providers, timeliness of service delivery, delivery of preventative services and emergency services, and patient satisfaction. Once such rules have been adopted the division may, in the following contract period in one managed care region, negotiate with one managed care organization to have dental services for enrolles provided using the division's technology and internal resources and negotiate with one managed care organization to have dental services for enrollees provided using an administrative services organization to be contracted separately from the managed care organization. Three months prior to the end of at least a twelve-month contract period a comparison of the methods of dental management shall be conducted by the division in accordance with the rules, and the results reported to the oversight committee, who shall"; and

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

            Representative Skaggs raised a point of order that House Amendment No. 4 amends previously amended material.

            The Chair ruled the point of order not well taken.

            On motion of Representative Bearden, House Amendment No. 4 was adopted.

            Representative Bearden offered House Amendment No. 5.

House Amendment No. 5

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Page 36, Section 208.152, Line 89, by inserting after the word “appropriations” the following:

              “. Until such time as a four-tier level is implemented, each resident of such facility who qualifies for assistance under section 208.030, RSMo shall, at a minimum, if prescribed by a physician, be authorized one hour of personal care services per day. Authorized units of personal care services shall not be reduced or tier level lowered unless an order approving such reduction or lowering is obtained from the resident’s personal physician. Such authorized units of personal care services or tier level shall be transferred with such resident if her or she transfers to another such facility”; and

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

            On motion of Representative Bearden, House Amendment No. 5 was adopted.

            Representative Kraus offered House Amendment No. 6.

House Amendment No. 6

AMEND House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Section 208.152, Page 43, Line 318, by inserting after all of said line the following:

              “(11) Pursuant to federal law and subject to appropriations, MO HealthNet participants shall submit to random testing for illegal drugs to remain eligible for MO HealthNet services.”; and

              Further amend said bill by amending the title, enacting clause, and intersectional references accordingly.

            Representative Tilley assumed the Chair.

            Representative Schaaf offered House Amendment No. 1 to House Amendment No. 6.

House Amendment No. 1

to

House Amendment No. 6

AMEND House Amendment No. 6 to House Committee Substitute for Senate Substitute for Senate Committee Substitute for Senate Bill No. 577, Line 4, by deleting the words "Pursuant to" and inserting in lieu thereof the word "Notwithstanding".

            Speaker Jetton resumed the Chair.

            On motion of Representative Schaaf, House Amendment No. 1 to House Amendment No. 6 was adopted.

            Representative Page offered House Amendment No. 2 to House Amendment No. 6.

            Representative Pratt raised a point of order that House Amendment No. 2 to House Amendment No. 6 goes beyond the scope of the bill.

            The Chair ruled the point of order well taken.

            On motion of Representative Kraus, House Amendment No. 6, as amended, was adopted by the following vote: