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FRA renewal derails session — but what is it? 

The final week of session saw a standoff between Senate Republicans over attempts to extend the state’s federal reimbursement allowances (FRA) for the next year. 

After much discussion the final week of session, the fate of the program hangs in the balance; lawmakers have returned home, and the Sept. 30 sunset for the program looms. From what the program does to the possible future of the conflict, here’s a look at the state’s FRA program and the controversy that left it in flux. 

What is the FRA?

The program taxes providers — covering hospitals, nursing homes, ambulances, pharmacies, and facilities for the intellectually disabled — which is then matched by federal dollars at a higher rate, reimbursing providers and leaving the state with extra money by reducing the burden on the state’s Medicaid program, known as MO HealthNet

Per the Missouri Hospital Association, the program began in 1991 in response to budgetary challenges faced by the state’s hospitals and the government. Though it began as a voluntary program, it was enacted into law as a provider tax the following year.

According to the association, the allowance is the third-largest source of revenue for the state. 

This isn’t the first time the renewal came with a fight; two years ago, it took weeks of back-and-forth debate and overnight filibusters to renew the program through 2020. 

The upper chamber crossed swords over a provision that would have included managed care in the program. Conservative members then attacked the measure as an attempt to enact a new tax. The addition was eliminated to usher the bill across the finish line, setting a precedent for “clean” FRA bills. 

What happened this session?

This session’s attempts at renewal for another year hit a roadblock in the upper chamber in the form of GOP Sens. Paul Wieland and Bob Onder. A handful of confrontations with Sen. Dan Hegeman over his FRA renewal bill —  which excluded an amendment from Wieland that would have prohibited the use of the funds for drugs or devices “that may cause the destruction of, or prevent the implantation of, an unborn child” — was a major roadblock. 

Wieland’s language was adopted by the body earlier in the session but was absent when Hegeman’s next substitute made it to the floor. Wieland and Onder spearheaded the opposition on several occasions, waylaying the bill through the end of session.

Another Senate bill that arrived with an amendment from the lower chamber included the FRA extension, a provision that was quickly shepherded through the House. Wieland and Onder again stood in opposition to it the evening before session’s end, delaying other pending legislation before moving to send the bill to conference. The motion passed by one vote before the body adjourned for the night; with the final day in the Senate derailed and no further action taken, neither version made it through.  

Senate Minority Floor Leader John Rizzo said the fracas was the result of unkept promises from Republican leadership who promised a clean FRA package.  

Secretary of State Jay Ashcroft supported the proposed amendment, saying he would “continue to defend life at all costs and encourage the legislature to do the same by restricting FRA monies.” 

What’s next?

With the Sept. 30 deadline months away, legislators are expected to return to consider the issue yet again in the form of a special session. On the House side, Budget Committee Chair Rep. Cody Smith told reporters he expected his chamber to pass the issue without much difficulty if the General Assembly were recalled to resume the conversation.

“We will come in and do our part, renew the FRA,” Smith said. “It’s a pivotal piece of the state budget.”

Speaker Rob Vescovo said the future of the issue was up to the governor, something both chambers agreed on. While a special session is expected this summer, a myriad of priorities that failed to cross the finish line this year — from eminent domain restrictions to unemployment overpayment forgiveness and election security — could be the catalyst for the call.