Missouri Senate

Senate Committee Substitute

The act modifies definitions for "ambulatory surgical center", "health care provider" and "financial data" in Section 192.665 and creates a new definition for "ambulatory medical treatment centers" in Section 197.200. New language in Sections 192.665 and 192.667, RSMo, changes "hospitals" to "health care providers" and includes hospitals and ambulatory medical treatment centers within the definition of "health care provider". Also, Section 197.200, RSMo, modifies the definition of "ambulatory surgical center" to provide that such centers shall be a subcategory of ambulatory medical treatment centers. Further, LASIK eye surgeries and dermatological surgeries involving local anesthesia are exempted from the definition of ambulatory medical treatment centers.

Section 197.205 provides that the Department of Health and Senior Services may establish subcategories of licensure for the various types of ambulatory medical treatment centers.

The annual license fee for applications is changed from two hundred dollars to a sufficient amount to be determined by the Department. All licenses fees shall be deposited in the "Ambulatory Medical Treatment Center Fund", which is created in the State Treasury (Section 197.210).

The Department shall issue licenses to ambulatory medical treatment centers if each member of the surgical or medical staff is a physician, dentist or podiatrist currently licensed to practice in Missouri. Also, if the applicant performs surgical procedures, childbirths, cardiac catheterization or endoscopy, the applicant must also submit a working agreement with at least one hospital in the same community in which the ambulatory medical treatment center is located, and the agreement must provide that the surgical or medical staff makes himself of herself available to provide on-call services at the hospital on the same basis as other similarly credentialed practitioners. Alternatively, the applicant shall submit a copy of a current working agreement regarding emergency transfers and admittance of patients. This act also allows a non-metropolitan ambulatory medical treatment center to affiliate with a hospital outside the county if the distance by road is no greater than the distance between the ambulatory medical treatment center and a hospital in the same county. If hospitals and ambulatory medical treatment centers are unable to negotiate a working agreement, then they must enter into binding arbitration based on the American Arbitration Association (Section 197.215).

The regulations adopted by the Department of Health and Senior Services regarding ambulatory medical treatment centers must be consistent with Medicare or the joint commission on accreditation of health organizations participation and standards, which are developed by nationally recognized and accredited entities. The department will waive enforcement of new or additional construction, life safety and building code standards until after the ambulatory medical treatment center undergoes substantial renovation or replacement. Current construction and life safety standards for ambulatory surgical centers will continue to apply to facilities licensed on the effective date of the act. Further, the Department will not be required to lower its current standards for centers that are already in operation (Section 197.225).

Section 197.230 requires the department to conduct inspections of ambulatory medical treatment centers. The centers are to have the opportunity to use inspections from recognized accrediting organizations in lieu of state inspection and the department shall attempt to schedule inspections such that an ambulatory medical treatment center is not subject to more than one inspection in any twelve-month period. However, the department will not conduct inspections that duplicate certification or accreditation standards (Section 197.232).

By July 1, 2006, the State Board of Registration for the Healing Arts shall promulgate guidelines and standards for the performance of office-based surgery. By January 15, 2007, the Board shall present a report to the Governor and the General Assembly addressing patient safety, trends regarding office-based surgery, and recommendations for legislative action (Section 1).

This act also authorizes the release of health care data to patient safety improvement organizations for use in improving the quality of health care delivery. Standards are established for data confidentiality and the use of the data in lawsuits (Section 2 through 5).

The Act also creates a new Section, 375.939, which prohibits a health care provider, as defined in Section 376.1350, RSMo, from eliminating the need for or waiving insurance copayments. However, copayment restrictions will not supercede federal laws and the restriction on waivers of co-payments will apply to other coinsurance obligations.

ADRIANE CROUSE