A Look at Missouri’s 2018 General Election Outcomes By Jay Hahn • MAOPS Lobbyist 1423 Randy Lane Non-Profit U.S. Postage D. Jefferson City, MO 65101 Twelve months ago, we wrote about the importance of Missouri’s United States Senate O. (573) 634-3415 PAID race – not just for Missouri but on a national scale. During the race, President Trump visited Jefferson City, MO Missouri on six different occasions in order to “drive out the base” during midterm elections. www.maops.org At the conclusion of those elections, Missourians spoke with an overwhelming voice on ballot Permit No. 169 measures and candidates. Republican Josh Hawley, who was elected as an “outsider” to the office of Attorney General in 2016, defeated incumbent Democrat Claire McCaskill for U.S. Senate with a strong margin of 51% to 45%. The election of Hawley left a vacancy in the December 2018/January 2019 Office of the Attorney General. On November 13, 2018, Governor Parson appointed State Treasurer Eric Schmitt to serve in that role. Schmitt’s appointment as Attorney General will leave yet another vacancy in an elected statewide office for Governor Parson to fill. This will mean half of Missouri’s A Message from the President statewide officeholders were appointed, rather than elected, to their seats. By David Tannehill, DO, FACP • 2018-2019 MAOPS President

Missouri Republicans defended their majority status in both the state House and Senate. In the Senate, Happy holidays, MAOPS! It has been my pleasure serving the profession so far this year Republicans hold 24 seats, with Democrats holding 10. In the House, the Republicans continue to hold a super- and I am excited about the possibilities that the new year brings! 2018 saw successes on majority, consisting of more than three-fourths of the seats in the House. In light of the fact that Republicans many fronts. At the legislative and regulatory levels, MAOPS successfully fended off further control both the executive and the legislative branches of government, a super-majority, needed to override expansion of non-physician clinicians’ scope of practice, legislatively fixed Anthem’s ill- the Governor, will likely be unnecessary in the upcoming session. This election, in the Missouri House of advised ER visit denial practices and quashed punitive aspects of MO HealthNet’s Opioid Representatives, three Republican seats flipped to Democrats and three Democrat seats flipped to Republicans. Prescribing Initiative. Additionally, we successfully passed several resolutions at the AOA’s The net result is that the Republicans will continue to have 116 seats and the Democrats will continue to have 47 House of Delegates, including my efforts to get the AOA’s endorsement of “physician seats. nondisclosure” in licensure to ensure physicians seeking help to ensure wellness are not discriminated against during the licensing process. Recently MAOPS held its first ever Representative Elijah Haahr ascended to serve as Speaker of the House of Representatives a few months Physician Wellness Retreat and it was a huge success! So much so, another event is being early as former Speaker Todd Richardson accepted an appointment from Governor Parson as the planned for Fall 2019 – stay tuned for more information on this fantastic interactive event. state’s Medicaid director. Representative Rob Vescovo will continue to serve as Majority Floor Leader. @maops_president Overall, MAOPS has had a great year! Representative John Wiemann was elected to serve as the next Speaker Pro Tem. On the minority side in the House of Representatives, Representative Crystal Quade was elected to serve as Minority Floor Leader, and 2019 will bring new challenges. But, as always, challenges bring opportunity. As your President, I look forward to Representative DaRon McGee was elected to serve as Assistant Minority Floor Leader. leading the association into the new year and facing those challenges, and molding them into opportunities. I would like to personally thank Brian & Chris Bowles and our staff at the Central Office for their hard work and The Missouri Senate also elected new leadership. Senator Dave Schatz was elected President Pro Tem, Senator dedication to our association and profession. I would like to ask each of you to consider increasing your support Caleb Rowden was elected Majority Floor Leader, Senator Gina Walsh was re-elected as Minority Floor Leader, of the profession as part of your promise to yourself for the new year. Whether that commitment comes in and Senator Shalonn “Kiki” Curls was elected Minority Assistant Floor Leader. the simple form of renewing your membership promptly, getting a new member to join, attending a D.O.c- A-Day event, volunteering for a committee, serving at the annual convention, or going to your next district Missouri’s 100th General Assembly, First Regular Session, will convene on January 9, 2019, at 12 pm. December meeting - no contribution is too small, no effort too meager and all of it is deeply appreciated. MAOPS and the 1, 2018, marked the opening day for legislative pre-filing with the Missouri Senate pre-filing 160 bills and 14 osteopathic profession needs you and your unique talents! Thank you for the great care you provide to your resolutions. The House of Representatives, not to be outdone, pre-filed 204 bills and 7 resolutions. Legislators patients and for your continued support of MAOPS! can continue to file legislation for the next three months. New leadership in both the House and the Senate will undoubtedly mean new legislative priorities for both. During our upcoming session, we anticipate a variety Merry Christmas and Happy New Year! of legislative proposals regarding the Governor’s two primary policy areas: infrastructure and workforce development. MO HealthNet Opioid Prescribing Initiative Changes Direction As always, it is an honor working on behalf of the Missouri Association of Osteopathic Physicians & Surgeons and I look forward to serving you this upcoming legislative session. In March 2018, physicians across the state were alarmed when they began receiving letters with a punitive tone from MO HealthNet Divisions’s (MHD) Opioid Prescribing Initiative (OPI). Since that time, MAOPS has participated To stay up-to-date on the bills and issues MAOPS is following, be sure to review the legislative as a member of MHD’s Opioid Policy Advisory Council (OPAC) with the purpose of assisting MO HealthNet in updates in our bi-monthly e-newsletter. Often, we will solicit your comments or assistance in their efforts to eliminate the opioid epidemic in a manner that respects what physicians do for their patients, reaching out to your legislators. To ensure you receive timely communications, update your and allows them to continue to provide high-quality care without fear of punitive repercussions. member profile atwww.maops.org. In July, we reported that our advocacy efforts helped convince MHD to suspend the dissemination of punitive letters through the end of 2018. We are now happy to report that this suspension has been extended indefinitely. Workplace Violence: MHD has acknowledged that the initial tactics were ineffective in reaching the goal of patient protection. MHD In the Know... and the OPAC have worked to change the punitive focus of the OPI to one of education and advocacy. HHS Secretary Alex Azar hinted in Have you been a victim? recent remarks that Medicaid may Data from the Bureau of Labor Statistics shows that nearly 75% Future communications from MHD regarding the OPI should focus on educating physicians on opioid prescribing soon allow hospitals and health systems of workplace assaults occur in health care and social service best-practices, new alternative therapy policies and practices, and patient education. Rest assured, MAOPS will to directly pay for beneficiaries’ settings. Employees in healthcare facilities are four times more continue its involvement on the OPAC to ensure members are represented. housing, healthy food and other social likely to be victims of assault than others. Have you been a victim determinants of health. CMS has of workplace violence due to your position as a physician? If so, MAOPS encourages physicians experiencing issues with opioid prescribing and pain management therapies already approved similar experiments let us know. Ensuring that physicians and healthcare workers are through MHD to contact MAOPS Executive Director Brian Bowles for assistance. │5│in at least four states. safe at work is a priority of MAOPS. │1 │ Buprenorphine and the Harrison Narcotics MEMBER QUESTION OF THE MONTH Medical Marijuana Act of 1914 “I recently received a letter from a Managed Medicaid company stating I had failed an What does this mean for physicians? By Mark Stringer • Director of the Department of Mental Health audit for appointment availability. I am booked six weeks out and they say I need to see the In early November, Missouri voters approved a constitutional amendment legalizing medical marijuana in Officers patient within 30 days of the appointment request. What do I do?” Missouri with a 4% retail tax. The amendment officially took effect December 6. Physicians need to be aware what this constitutional amendment does and does not allow. Any statute or rules and regulations implemented President: David Tannehill, DO, FACP In 2017, 50,000 individuals died from The managed care companies are required to do these audits to deter discrimination against Medicaid must be within these new constitutional rights of Missourians. The state legislature will handle the law-making; the patients. Respond to the letters in writing with a certified letter. Write the medical director of the managed care President-Elect: Steven Brushwood, DO an opioid-related overdose. That Department of Health and Senior Services will handle the rules and regulations. The Constitution itself cannot be company explaining your situation. Let them know that you do not discriminate between patients regardless of changed without another vote of the people. 1st Vice President: Michael Brown, DO is the equivalent of a fully loaded payer type and that your schedule is usually full at least six weeks out. Ask them for a response and document 2nd Vice President: Chris Wolf, DO, FAAPMR Boeing 727 aircraft’s passengers all communications. Physicians need to be aware the law does not make it legal for them to “prescribe” marijuana to patients. Immediate Past President: John Bailey, DO perishing every day for a year. It is still a federally designated Schedule I drug. Physicians can recommend qualified patients receive an identification card issued by the Department of Health and Senior Services. The card must be renewed annually Personal Advocacy Can Prevent Burnout and will initially cost $25. Additionally, upon application, a qualified patient may apply for an identification card Central Office Team Our responses to aviation disasters – and medical conditions with By Victoria Damba, DO • MAOPS Legislative Committee Chair lower mortality rates – are swift and far-reaching. In the midst of that will allow them to grow up to six marijuana plants for personal use. This card will initially cost $100. Executive Director: Brian Bowles the worst drug crisis in our history, there already exists an extremely Recently MAOPS held their first Physician Wellness Retreat. It was an amazing weekend of effective intervention: the medication buprenorphine. However, [email protected] camaraderie, soul-searching, and learning. Physicians and spouses were treated to a variety of A qualified patient is defined as a Missouri resident diagnosed with at least access to this medication is seriously limited. Why? Much of the experiences to work on treating themselves. Associate Executive Director: Chris Bowles mystery and stigma surrounding this medication has nothing to do one of the following “qualifying medical conditions”: with prescribing complexity or significant dangers associated with its [email protected] Among the many topics we discussed was the importance of working together with our peers • Intractable migraines unresponsive to • A chronic medical condition that is use. Rather, it has nearly everything to do with an arcane law called to improve our lives. We all know how much fun it is to get together with friends to talk about other treatments normally treated with a prescription the Harrison Narcotics Tax Act of 1914. Executive Assistant: Leigh Haslag our families, concerns and profession. These gatherings are therapeutic in themselves. I tell • Cancer medication that could lead to physical

[email protected] patients all the time, “sometimes you just have to talk about your problems.” • Epilepsy or psychological dependence, when On its face, the Act was merely a law for the orderly marketing • Glaucoma a physician determines that medical of opiates. The right of a physician to prescribe was spelled out in Director of Education & Strategic Projects: Alicia McGirl As physicians, a lot of our problems stem from so many organizations, insurance companies, government • HIV and AIDS use of marijuana could be effective in seemingly unambiguous terms: “Nothing contained in this section [email protected] agencies, and licensing boards (naming just a few), who constantly want to tell us how to do our job. Often, • Any terminal illness treating that condition and would serve shall apply... to the dispensing or distribution of any of the aforesaid we tend to vent about these issues to our colleagues, but not to those who can actually make substantive • A chronic medical condition that causes as a safer alternative to the prescription drugs to a patient by a physician… in the course of his professional Communication Coordinator: Gabby Keller changes. I would like to suggest and encourage you to channel your frustrations in a direction that can make a severe, persistent pain or persistent medication practice only.” Unfortunately, after passage of the law, the “course [email protected] difference and is also therapeutic. muscle spasms including but not limited • Debilitating psychiatric disorders of professional practice” clause was interpreted by law-enforcement to those associated with multiple • In the professional judgment of a to mean that a doctor could not prescribe opiates to an “addict” Central Office Phone Number: 573.634.3415 I suggest we all be active in advocating for ourselves, our peers and our patients. How do you do that, you sclerosis, seizures, Parkinson’s disease, physician, any other chronic, debilitating to maintain his addiction. Addiction was not considered a disease, Central Office Fax Number: 573.634.5635 may ask? Well, it is really quite simple: you take a trip to Jefferson City. MAOPS has a very engaging opportunity and Tourette’s syndrome or other medical condition an “addict” was not considered a patient, and opiates dispensed called the D.O.c.-A-Day program. In its 10th year, this program entails spending half a day (or more if you or prescribed were therefore not being supplied “in the course of his want) talking with and educating your legislators about the issues that pose the biggest hurdles to you and your www.maops.org professional practice.” patients. It’s an opportunity to engage in meaningful discussion with those making decisions on your behalf. I’ve The amendment states that physicians shall not be subject to criminal or civil liability or sanctions under Missouri made it a point to attend at least one day every year for nine straight years! I used to be very intimidated about law or discipline by the Missouri State Board of Registration for the Healing Arts for owning, operating, investing Taking this power away from doctors effectively led thousands to going to the Capitol and talking with legislators, but then I realized, “I am the physician! I am highly educated in in, being employed by, or contracting with an entity licensed or certified pursuant to law, or for issuing a hospitals and asylums seeking relief from their disease since they were the matter of taking care of people with health concerns and they are not. Therefore, they do not have a clue physician certification to a patient diagnosed with a qualifying medical condition. A physician cannot issue unable to be treated by their doctor. Unintended consequences how things actually work in my office and I do! So why should I be intimidated?!” Once I came to this realization, a certification for the medical use of marijuana for a non-emancipated qualifying patient under the age of of this 1914 Act have been occurring ever since. At its core, the my time advocating at the Capitol became not only therapeutic but enjoyable. MAOPS staff does a great job eighteen without the written consent of the patient’s parent or legal guardian. Physicians should be aware that MAOPS Trustee Election Act was a response to society’s firmly held belief that instead of a briefing us before we go to the Capitol and providing whatever level of support we need while there. If you the amendment does not protect them or their patients from negligence or professional malpractice when they disease, addiction was a moral failing. Today, this 1914 law has been are new and nervous, they can do the talking. I have found that after just a couple of minutes in the offices of have undertaken any task under the influence of medical marijuana. Process Changes translated into significant hurdles in prescribing life-saving medication legislators, I gain the comfort level I need to say what I need to say. for those with opioid use disorder given the requirements under the The MAOPS Board of Trustees has MAOPS President David Tannehill, DO, FACP says, “I suspect that Missouri physicians will be approached DATA 2000 Act. By involving yourself in this type of activity you get to talk about the challenges, the successes and the failures unanimously approved the Leadership frequently by patients desiring medical marijuana.” He reminds physicians, “As with any drug we consider for in your office with someone who may actually be able to do something about it. You can stress all you want, Development Committee’s proposal our patients, their health and well-being should be of primary concern. Recommending medical cannabis to a Consider this: physicians have been able to prescribe far more but if you don’t talk to someone that can help, nothing will be fixed. The other fun thing about the D.O.c.-A- to change the election process for patient should be based on sound medical reasoning; the same we would use for prescribing any drug for any dangerous opiates for years, with restrictions only arising from this Day Program is that you get to socialize with peers with common interests, maybe even some old classmates. at-large Trustees. The background for condition.” It is important to emphasize that the FDA has not yet approved cannabis for use as a treatment for crisis. Buprenorphine saves lives, but its use is severely restricted. I’d suggest contacting some colleagues and friends around the state to organize an annual “get-together” in the changes and the new election any indication and it is still classified as a Schedule I drug making it federally illegal to possess. Absent a rewrite of the laws, physicians should do what they can Jefferson City, advocating for the profession while you catch up personally. methodology is described in detail at to educate themselves about the medication, save lives, and help www.maops.org/ElectionChanges. Per the amendment, rules and regulations must be promulgated by June 2019 with qualifying patients contribute to lasting recovery for individuals with opioid use disorder. I encourage you to take charge of your personal well-being, by participating in something that could make a being able to submit applications for identification cards in July. While it is possible these processes could real difference for you, your patients and the young physicians who will be following in your footsteps. At the Members are encouraged to review be completed earlier than these dates, MAOPS believes physicians can comfortably inform patients “that MAOPS, along with the Missouri Department of Mental Health, Physician Wellness Retreat, the number one identified cause of stress and anxiety for our group was our job; the proposed changes and submit while medical marijuana has been legalized in the state, it will not be available to qualified patients until rules will be offering the required waiver training needed to prescribe specifically, those things that we felt we had little control over like government intervention. I can tell you that comments by January 10, 2019. The and regulations are finalized probably not until at least late 2019.” Physicians will have to make their own buprenorphine on April 26, 2019 at the Midwest Osteopathic Annual MAOPS D.O.c.-A-Day program offers us a platform to not only make a difference but also feel better about Board will discuss all comments prior to determinations as to if they will provide certifications to qualified patients. Convention. Take advantage of this opportunity to help your patients ourselves. How about making it one of your New Year’s resolutions to join me this year and participate in the making a final decision. Any changes with opioid use disorder. Register for this training at... D.O.c.-A-Day Program and take control of our situation? would go into effect for the 2020 MAOPS will provide continued updates on medical marijuana as we learn more. We invite all physicians to election. www.MAOPS.org/MAT attend the Midwest Osteopathic Annual Convention in Branson April 24-28, 2019 as we will provide additional To sign up or learn more about the D.O.c.-A-Day program visit... www.MAOPS.org/DocADay education on this topic. Visit www.MAOPS.org/MOAC for more information! │2││2│ │3│ │4│