Missouri Departments Adjust Budgets to Support Governor's Prescription Drug Monitoring Program

Last week, Gov. Eric Greitens' surprised legislators with an executive order to establish a program that analyzes prescription data. Now, departments are trying to figure out how to fund it.

by Crystal Thomas, The Joplin Globe, Mo. / July 27, 2017
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(TNS) -- After lawmakers were caught off guard by Gov. Eric Greitens' executive order to establish a program that analyzes prescription data last week, their first question was where the money to fund it was coming from, after two years of budget shortfalls.

As per the Missouri Constitution, authority to spend money going into the state's treasury derives from the state Legislature — each expenditure is debated by committees in each chamber and passed as bills before the governor can sign the expense into law.

With the governor's executive order, the expense for the new program was able to bypass the budget process completely, which has some lawmakers worried.

To ramp up for the program, the Department of Social Services will transfer federal dollars blocked off for its share of Medicaid into a Department of Health and Senior Services federal fund, according to DSS Communications Director Rebecca Woelfel. That money — about $472,950 — will then go toward the salaries of four employees, a contract with pharmacy benefit manager Express Scripts and as well as operating expenses for the new program.

"The governor wants us to be more integrated," Dr. Randall Williams, DHSS director, said of the state's agencies.

According to the governor's executive order, the Department of Health and Senior Services will house the prescription drug monitoring program, which will use prescription data, with personal information removed, through pharmacy benefit managers to find health care professionals who are prescribing too many opioids.

"Given of the nature of this crisis, Governor Greitens has encouraged the entire Cabinet to identify all available state resources that could help our state address this emergency," Parker Briden, the governor's press secretary, wrote in an email.

The House budget chairman, Rep. Scott Fitzpatrick, R-Shell Knob, said that departments that split federal Medicaid dollars have some discretion as into which department the dollars are deposited.

"I would maintain they cannot use Medicaid appropriations that are not specifically related to Medicaid," Fitzpatrick said. "That's what's cut and dry."

With Congress setting the ramifications for what federal dollars can be used for, Fitzpatrick said the money has to follow those guidelines.

Sen. David Sater, R-Cassville, said he was "disconcerted" that the governor would direct departments to appropriate money and his interpretation is that the act is unconstitutional. Even if it's not, departments shuffling around money without lawmaker approval opens the state up to a lawsuit.

"What's the point of having a Senate and a House if the governor is going to do that?" Sater said. "There's a separation of powers for a reason."

As the head of Senate committee that looks at health care appropriations, Sater said that the Legislature would look into the budgets of both departments for "adjustments." Oftentimes, whenever a department has spent above its authority, lawmakers have taken to cutting its budget.

Former House Budget Chairman Tom Flanigan, R-Carthage, said that the governor creating and funding a new program was "not normal."

"It doesn't smell right to me," Flanigan said. "Once his project seed money runs out this year, what is he going to do next year?"

Missouri is the only state in the nation in which prescribers and pharmacists can't see a new patient's prescription history to determine if they might be an addict. Lawmakers have failed to pass a program that would do so for years, and the state has become a destination for those in surrounding states to get pills.

Restrictions

The governor's prescription drug monitoring program will not include any interstate or intrastate data sharing, according to Dr. Randall Williams, director of the Missouri Department of Health and Senior Services.

©2017 The Joplin Globe (Joplin, Mo.) Distributed by Tribune Content Agency, LLC.