STL Post-Dispatch: Miss a doctor visit? You might have to pay a fine under a Missouri proposal

By Kurt Erickson • St. Louis Post-Dispatch May 30, 2016 (23)

JEFFERSON CITY • Just like hotels and car rental companies that charge people who miss their reservations, Missouri doctors could start requiring certain patients to pay a fee if they miss their appointments.

Under a proposal heading to Gov. Jay Nixon’s desk, Medicaid providers could impose a missed appointment fee on MO HealthNet patients who miss or fail to cancel 24 hours in advance.

It also allows providers to refuse to schedule new appointments until the missed appointment fee is paid. The charge for the first missed appointment is $5, the second is $10 and the third is $20.

The idea behind the proposal is to ensure people show up for appointments to avoid the lost time and revenue it could cause to Medicaid providers. The measure was sponsored by Republican Sen. David Sater, R-Cassville. The Senate’s two doctors — Republicans Rob Schaaf of St. Joseph and Bob Onder of Lake Saint Louis — both voted “yes.”

Democratic lawmakers opposed the measure, which is part of a larger overhaul of state Medicaid rules. MO HealthNet is the name of Missouri’s Medicaid system.

While Nixon, a Democrat, isn’t saying whether he supports the idea, health care experts say the fee is unlikely to win approval from the federal government.

“They’ve consistently told states they cannot impose a missed appointment fee. I’m not sure that will ever be approved,” said St. Louis University School of Law Professor Sidney Watson of the Center for Health Law Studies.

Watson said there are other ways to address missed appointments, including reminder systems by phone, text or email and a revised scheduling system that takes into account potential no-shows.

During debate on the measure in May, Democratic Sen. Jill Schupp of Creve Coeur said she opposes punishing people for missing appointments.

“When we are discouraging people from seeing their doctor because we put financial obstacles in their way, I think we are doing a disservice not only to them, but to all of us,” Schupp said. “Sometimes things come up with families a day before” an appointment.

Matt Salo, executive director of the National Association of Medicaid Directors, said he doesn’t believe the federal government has ever approved a policy allowing for financial penalties for missed appointments.

But, he said it is an issue that has been discussed more in recent years.

“There’s definitely been a surge in interest in looking at ways to impress upon the beneficiary the need to be more actively engaged in their own health care and health care decisions, sometimes this can be called ‘personal responsibility’ or ‘skin in the game,’” Salo said.

As the measure moved through the House and Senate, however, neither the Missouri Hospital Association nor the Missouri State Medical Association took a formal position on the legislation.

Jeff Howell, director of government relations for the medical association, agreed that the state would have a tough time getting a federal waiver if Nixon signs the measure into law.

Nixon’s office isn’t weighing in with details, but a point person on health care issues in his administration sounded like the idea might not go anywhere.

“Only one state has ever been granted authority to charge for missed appointments,” said MO HealthNet Director Joe Parks.

“All we will say right now is that the bill will undergo a full and fair review,” spokesman Scott Holste said.

The legislation is Senate Bill 608.

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