HB 32 --  ESSENTIAL COMMUNITY PROVIDERS (Bland)

Individual physicians can be called "Essential Community
Providers" when they practice in medically underserved areas is
designated by the Department of Health and Human Services. The
Essential Community Provider is required to spend a minimum of
20 hours per week in the health professional shortage area and
be available to patients during evenings and weekends. Essential
Community Providers must have hospital staff privileges or be
affiliated with doctors who have such privileges. Essential
Community Providers can not be direct employees of a health care
insurer.

Health care insurers that market a group policy or contract for
health care coverage are required to offer it to all Essential
Community Providers in the service areas of the plan. The terms
of the contract offered to Essential Community Providers must be
as favorable as the terms offered to other physician providers
for the scope of services rendered.  Names of individual
Essential Community Providers will be published and distributed
to consumers and enrollees of the plan when the Essential
Community Provider is a primary care physician. When the
Essential Community Provider is a specialist, his or her name
will appear on the list of specialists distributed to the
primary care physicians in the plan. Health care insurers may
terminate the contract of a physician for cause. The name
"Essential Community Provider" cannot be transferred to another
physician or site.  Physicians may apply to the director of the
Department of Health to be named an Essential Community Provider.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
$75,000 in FY 1998, $85,000 in FY 1999, & $90,000 in FY 2000.

HB 32 -- ESSENTIAL COMMUNITY PROVIDERS

SPONSOR:  Bland

COMMITTEE ACTION:  Voted "do pass" by the Committee on Public
Health & Safety by a vote of 8 to 7 .

Individual physicians can be called "Essential Community
Providers" when they practice in medically underserved areas
according to the Department of Health and Human Services. The
Essential Community Provider is required to spend a minimum of
20 hours per week in the health professional shortage area and
be available to patients during evenings and weekends. Essential
Community Providers must have hospital staff privileges or be
affiliated with doctors who have such privileges. Essential
Community Providers can not be direct employees of a health care
insurer.

Health care insurers that market a group policy or contract for
health care coverage are required to offer it to all Essential
Community Providers in the service areas of the plan. The terms
of the contract offered to Essential Community Providers must be
as favorable as the terms offered to other physician providers
for the scope of services rendered.  Names of individual
Essential Community Providers will be published and distributed
to consumers and enrollees of the plan when the Essential
Community Provider is a primary care physician. When the
Essential Community Provider is a specialist, his or her name
will appear on the list of specialists distributed to the
primary care physicians in the plan. Health care insurers may
terminate the contract of a physician for cause. The name
"Essential Community Provider" cannot be transferred to another
physician or site.  Physicians may apply to the director of the
Department of Health to be named an Essential Community Provider.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund is
$75,000 for FY 1998, $85,000 for FY 1999, and $90,000 for FY
2000.

PROPONENTS:  Supporters say that physicians who care for the
indigent when it was not profitable need to be included on the
panels of managed care so that they may continue to thrive as
caregivers to the underserved. The capitated income streams of
"dual eligibles" people who qualify for Medicare and Medicaid
will be blended together under federal law to end the
duplicative services provided. Minority health is a public
health issue.  Culturally competent care needs to be provided to
underserved populations both urban and rural.

Testifying for the bill were Representative Bland; Brain Injury
Assn. of Missouri; Missouri Department of Health; Samuel V.
Rogers Community Health Care; Kansas City Medical Society, Mound
City Medical Society; Missouri Pan-Medical Society; and United
Automobile Workers(UAW)

OPPONENTS:  Those who oppose the bill say that this bill looks
at the independent practice model physician and omits the group
model and the staff model practice. Some groups are against a
mandate in a business setting. Mandates are counterproductive in
this managed care environment. This bill would add
administrative costs. These costs would be passed on to small
employers. An Essential Community Provider has no patient
volume.  They would not bring a good return on investment.

Testifying against the bill were Kaiser Permanente; Blue
Cross/Blue Shield of Missouri; Missouri Chamber of Commerce; and
Associated Industries of Missouri;

Harolyn Light, Research Analyst

HB 32 -- Essential Community Providers

Sponsor:  Bland

Individual physicians can be called "Essential Community
Providers" when they practice in medically underserved areas
according to the Department of Health and Human Services. The
Essential Community Provider is required to spend a minimum of
20 hours per week in the health professional shortage area and
be available to patients during evenings and weekends. Essential
Community Providers must have hospital staff privileges or be
affiliated with doctors who have such privileges. Essential
Community Providers can not be direct employees of a health care
insurer.

Health care insurers that market a group policy or contract for
health care coverage are required to offer it to all Essential
Community Providers in the service areas of the plan. The terms
of the contract offered to Essential Community Providers must be
as favorable as the terms offered to other physician providers
for the scope of services rendered.  Names of individual
Essential Community Providers will be published and distributed
to consumers and enrollees of the plan when the Essential
Community Provider is a primary care physician. When the
Essential Community Provider is a specialist, his or her name
will appear on the list of specialists distributed to the
primary care physicians in the plan. Health care insurers may
terminate the contract of a physician for cause. The name
"Essential Community Provider" cannot be transferred to another
physician or site.  Physicians may apply to the director of the
Department of Health to be named an Essential Community
Provider.