Missouri Senate

Perfected

MINIMUM HEALTH PROMOTION STANDARD FOR STATE BUILDINGS

This act requires the Office of Administration, in consultation with the Department of Health and Senior Services to submit a report to the Governor and General Assembly by December 31, 2008, detailing the opportunities for the state to implement a minimum health promotion standard for construction or substantial renovation of a state building. The report on minimum health standards shall also include estimates of any additional costs or savings from incorporating new architectural features. The health promotion standards to be developed in the report shall consist of architectural features designed to promote and encourage a healthier workplace and environment for those working and using the resources in a state building. SECTION 8.365

HEALTH CABINET AND HEALTH POLICY COUNCIL

This act creates the Missouri Health Cabinet. The cabinet shall ensure that the public policy of the state relating to health is developed to promote interdepartmental collaboration and program implementation in order that services designed for health are planned, managed, and delivered in a holistic and integrated manner to improve the health of Missourians.

The cabinet is created in the executive office of the Governor and shall meet for its first organizational session no later than October 1, 2008. Thereafter the cabinet shall meet at least six times each year, with two of the meetings in different regions of the state in order to solicit input from the public. The cabinet shall consist of six members, including the Governor, the director of the Departments of Health and Senior Services, mental health, insurance, financial institutions and professional registration and the commissioner of education. The president pro tem of the Senate, the Speaker of the House, the Chief Justice of the Supreme Court, the Attorney General, and the Commissioner of the Office of Administration, and the director of Agriculture, or their appointed designees shall serve as ex officio members of the cabinet.

The Governor shall appoint a Health Policy Council to assist the cabinet in its tasks. Beginning August 28, 2008, the chairs of the MO HealthNet Oversight Committee and the Comprehensive Entry-Point System Subcommittee, shall be members on the Health Policy Council. The council shall replace the State Boards of Health and Senior Services, which are repealed under the act. The members of the council shall consist of representatives from the health care or health policy field. SECTIONS 26.850 TO 26.856

REPORT ON SHIFTING DEMOGRAPHICS

The Lieutenant Governor, in his or her capacity as the senior advocate for the state, shall coordinate with all the directors of the departments in this state to review their major policies, programs, and structures in light of the state's increasingly older and more diverse population. A policy brief shall be submitted to the Governor and General Assembly by July 1, 2009, and shall highlight critical functions or issue areas that would be affected by shifting demographics and how such issues should be addressed within the next ten years. SECTION 26.900

CAFETERIA PLAN FOR INSURANCE PREMIUMS

This act allows the Commissioner of Administration to deduct cafeteria plan administrative fees and any amount necessary for the participation in the cafeteria plan from the employee's compensation warrant, unless the employee affirmatively elects not to participate in the plan. Vendors are allowed to solicit the selection of products currently allowed to be included in cafeteria plans, on site in state facilities. SECTION 33.103

This provision is similar to SCS/SB 1015 (2008) and HB 1535 (2008).

PREVENTIVE SERVICES

Beginning January 1, 2010, the Missouri Consolidated Health Care Plan shall include, as part of its covered benefits, all of the preventive benefits recommended by the federal U.S. Preventive Services Task Force. Any additional costs for such preventive services shall not be paid by the state employee. SECTION 103.185

TAX CREDITS AND DEDUCTIONS

This act increases the amount of tax credits available for taxpayers who modify their home to be accessible for seniors or disabled people who reside with such taxpayer. Under current law, up to one hundred thousand dollars in tax credits remaining unused under the rebuilding communities tax credit program are allocated for use by taxpayers who modify their homes for disabled persons residing with such taxpayers. This act increases the amount of available tax credits by allocating all unused tax credits under the rebuilding communities tax credit program for use by taxpayers who modify their homes for seniors or disabled persons residing with such taxpayers. The rebuilding communities tax credit program is capped at ten million dollars annually. Constructing additional rooms in the dwelling or a new structure on the property for the purpose of accommodating the senior or disabled person is added as a new eligible cost for which the tax credit may be claimed. SECTIONS 135.535 AND 135.562

This provision is substantially similar to SB 717 (2008).

This act provides an income tax deduction in the amount equal to 100% of the premium paid by the taxpayer during the taxable year for high deductible health plans established and used with a health savings account under the applicable provisions of the Internal Revenue Code to the extent the amount is not deducted on the taxpayer's federal income tax return for that taxable year. SECTION 143.116

OPPORTUNITY FOR HUMAN PAPILLOMAVIRUS IMMUNIZATIONS

This act provides that female students enrolling in sixth grade may receive, at the option of a parent or guardian, an immunization for the human papillomavirus (HPV). The Department of Health and Senior Services shall directly mail age appropriate information to parents or guardians of female students entering grade 6 regarding the connection between HPV and cervical cancer and the availability of the HPV immunization. Such information shall include the risk factors for developing cervical cancer, the connection between HPV and cervical cancer, how it is transmitted and how transmission can be prevented, the latest scientific information about the immunization's effectiveness, information about the importance of pap smears, and a statement explaining that questions from parents or guardians may be answered by a health care provider.

Each mailing shall request that the parents of female students entering grade 6 voluntarily furnish a written statement to the department, not later than 20 days after the first day of school, stating that they have received the information and that the student has received the immunization or the parents have decided not to have the student immunized. The informational mailing sent to parents shall have displayed in bold type that the request from the parent or guardian for the written statement is voluntary. The form to be returned by the parents shall not request identifying information about the student, parent or guardian. Nothing in the act shall be construed to prevent school attendance if a parent has opted not to have the student receive the HPV immunization or has not furnished the written statement.

Subject to appropriations, if a parent or guardian chooses to have the female student immunized for the HPV infection but is unable to pay, the student shall be immunized at public expense at or from the county, district, city public health center or a school nurse or with the costs of immunization paid through the Mo HealthNet program, private insurance or in a manner to be determined by the department of health and senior services subject to state and federal appropriations.

Beginning July 1, 2009, the department shall submit to the general assembly a report detailing the number of sixth grade female students who have and have not been immunized against the HPV infection and the number of non-responses to the request for the written statement. The information derived from the written statement shall be used for statistical purposes only and shall not be used to personally identify any parent or guardian, or any student. SECTION 167.182

This provision is identical to SS/SCS/SB 778 (2008).

LOCAL COMMUNITY HEALTH COALITIONS

The Department of Social Services shall administer a grant in the amount of 350,000 dollars to a local government entity or local health department to be used for the establishment of a study to assess the feasibility of pilot projects in the greater St. Charles and Southeast bootheel areas of the state. Any grant awarded shall be matched in equal value by the grant recipient. The pilot projects shall have the involvement of the local community health coalition to establish new approaches to expand coverage for the uninsured population in the respective communities and to create healthier populations through a single comprehensive health care plan. The program shall be administered by the Department of Health and Senior Services and shall have a six-year sunset. SECTION 191.845

TRANSPARENCY OF HEALTH CARE SERVICES

This act establishes guidelines for transparency in pricing and quality of health care services. Criteria is established for insurers to use in programs that publicly assess and compare the quality and cost efficiency of health care providers. A provider cannot decline to enter into a provider contract with an insurer solely because the insurer uses quality and cost efficiency of health care data programs.

A person who sells or distributes health care quality and cost efficiency data in a comparative format to the public is required to identify the source used to confirm the validity of the data and its analysis as an objective indicator of health care quality. This provision does not apply to articles or research studies that are published in peer-reviewed academic journals that do not receive funding from or is affiliated with a health care insurer, or by state or local governments. The Department of Health and Senior Services is required to investigate complaints of alleged violations and is authorized to impose a penalty of up to $1,000. Alleged violations by health insurers will be investigated and enforced by the Department of Insurance, Financial Institutions, and Professional Registration. SECTIONS 191.1005 to 191.1010

These provisions are similar to certain provisions in HCS/HBs 2413, 2355 & 2398 (2008).

MISSOURI HEALTHY WORKPLACE RECOGNITION PROGRAM

This act requires the Department of Health and Senior Services to develop the Missouri Healthy Workplace Recognition Program for the purpose of granting official state recognition to employers with more than fifty employees for excellence in promoting health, wellness, and prevention. The criteria for awarding such recognition shall include at a minimum whether the employer offers workplace wellness programs; incentives for healthier lifestyles; opportunities for active community involvement and exercise, and encouragement of well visits with health care providers. SECTION 191.1025

INTERNET WEB-BASED PRIMARY CARE ACCESS PILOT PROJECT

This act requires the General Assembly to appropriate 400,000 dollars from the Health Care Technology Fund to the Department of Social Services to award a grant to implement an Internet web-based primary care access pilot project designed as a collaboration between private and public sectors to connect, where appropriate, a patient with a primary care medical home, and schedule patients into available community-based appointments as an alternative to non-emergency use of the hospital emergency room as consistent with federal law and regulations. The criteria for the grant are specified in the act. SECTION 191.1200

TELEHEALTH

This act expresses the state's recognition of the delivery of health care via telehealth as a safe, practical and necessary practice in the state. By January 1, 2009, the Department of Health and Senior Services shall promulgate quality control rules to be used in removing and improving the service of telehealth practitioners.

Beginning July 1, 2009, all health carriers shall reimburse services provided through telehealth in the same manner they would reimburse a standard office visit or consultation by the provider or specialist. The Department of Social Services shall promulgate rules for the MO HealthNet program consistent with this provision. SECTIONS 191.1250 to 191.1277

COMMUNITY AND FAITH-BASED ORGANIZATIONS

This act requires the Office of Minority Health to solicit proposals from such community programs and organizations to develop solutions regarding health and wellness. SECTION 192.083

SCHOOL-BASED INFLUENZA VACCINATION PILOT PROGRAM

This act provides that by July 1, 2009, the Department of Health and Senior Services shall establish a school-based influenza vaccination pilot program. Participation in the program will be voluntary for both the students and school districts. When creating the program, the department shall use a vaccine that will consume the fewest medical supplies, speed administration by health officials, and contain the least potential adverse events. The department shall also take into account the cost and benefits, fiscal impact, and any barriers to implementing such a program.

The department shall also work to increase influenza immunization awareness and participation among parents of children six months to five years of age in child care facilities.

This program will expire in six years unless re-authorized by the General Assembly. SECTION 192.631

This provision is identical to SCS/SB 1169 (2008).

MISSOURI FREE CLINICS FUND

This act creates the "Missouri Free Clinics Fund" to be administered by the Department of Social Services for use by clinics in the Missouri free clinics association to increase their infrastructure and bolster their sustainability in order to serve a greater number of people in a more effective manner. For a one-time funding appropriation of 500,000 dollars from the General Assembly, the Department shall disburse funds to the association, to be equitably and evenly distributed to all free clinics in this state, in accordance with applicable guidelines, policies, and requirements established by the department. SECTION 192.990

PRESCRIPTIVE AUTHORITY FOR ADVANCED PRACTICE NURSES

Currently, advanced practice registered nurses have the authority to administer, dispense and prescribe certain drugs while operating under a collaborative practice agreement. This act authorizes advanced practice registered nurses who hold a certificate of controlled substance prescriptive authority from the board of nursing to prescribe controlled substances in schedules III, IV, and V while operating under a collaborative practice agreement.

The act contains requirements that must be contained in all collaborative practice agreements including:

• Names, addresses, and phone numbers of the collaborating individuals.

• A list of offices where the collaborating physician has authorized the APRN to prescribe.

• A requirement that notice shall be displayed at all offices where an APRN is prescribing, that informs patients that they may be seen by an APRN.

• All specialty or board certifications.

• The details of the collaboration including geographic proximity, and how absences are handled.

• A description of the prescriptive authority including a list of controlled substances the physician authorizes.

• A list of all other practice agreements involving the collaborating individuals.

• The duration of the agreement.

• A description of the time and manner of the collaborating physician's review of the APRN’s prescribing practices.

The act modifies requirements for all collaborative arrangements including the following:

• Physicians shall not collaborate with more than 3 full time APRNs

• APRNs shall practice for 1 month in a setting where the collaborating physician is continuously present.

• Neither physicians nor APRNs shall be required to enter collaborative practice agreements.

The act defines advanced practice registered nurse, certified advanced registered nurse practitioner, certified clinical nurse specialist, certified nurse midwife, and certified registered nurse anesthetist.

The act includes experience and practice requirements that are prerequisites for the board of nursing to grant a certificate of controlled substance prescriptive authority. SECTIONS 195.070, 195.100, 334.104, 335.016, and 335.019

These provisions are identical to SCS/SB 724 (2008).

TOBACCO USE PREVENTION, AND CESSATION FUND

This act creates the tobacco use prevention and cessation fund. Beginning fiscal year 2009, payments received from the strategic contribution fund will be deposited into the newly created fund to be used to fund tobacco prevention and cessation programs. At least 25 percent of the moneys from the fund shall be used for youth smoking prevention programs modeled upon evidence-based programs proven to reduce youth smoking in one or more jurisdictions within the United States. SECTION 196.1200

This provision is substantially similar to SCS/SB 946 (2008).

ADVERSE HEALTH EVENTS

This act requires hospitals to report whenever they have a "serious reportable event in health care," as identified by the National Quality Forum. Such events include wrong-site surgery, retention of a foreign object in a patient after surgery, and death or serious disability associated with medication error.

The initial report of the event shall be reported to the patient safety organization no later than the close of business on the next business day following discovery of the incident. The initial report shall include a description of immediate actions taken by the hospital to minimize the risk of harm to patients and prevent reoccurrence. Within 45 days after the event occurred, the hospital shall submit to the patient safety organization a root cause analysis and a prevention plan.

The patient safety organization shall publish an annual report to the public on reportable incidents. The report shall show the number and rate per patient encounter by region and by category of reportable incident and may identify reportable incidents by type of facility.

A claim for payment filed by a hospital reporting a reportable incident under these provisions shall not be subject to the Unfair Claims Settlement Practices Act. SECTIONS 197.551 to 197.590

These provisions are substantially similar to SCS/SB 916 (2008).

MO HEALTHNET

Current law as to MO HealthNet eligibility was modified to reflect changes for custodial parents under 100 percent of the federal poverty level and how subject to appropriation certain earned income shall be disregarded for these participants. Individuals eligible due to the disregard provision who are at least 19 years of age and less than 65 years of age shall receive health care coverage under the Insure Missouri plan, unless they are dual Medicare and Medicaid eligible or pregnant. SECTION 208.145

The Professional Services Payment Committee shall be required to review and make recommendations to the MO HealthNet Division regarding standards and policies for denying payment to a health care provider for treatment costs associated with preventable errors. SECTION 208.149

Prescribed medically necessary therapy services, including physical, occupational, and speech therapy, shall be covered under the Mo HealthNet program. SECTION 208.152.

This act also adds as a covered service under the MO HealthNet program comprehensive day rehabilitation services. SECTION 208.152

This provision is identical to SB 972 (2008).

The MO HealthNet program shall not require a pharmacist filling any prescription for any drug that has been prescribed as an immunosuppressant that denotes that the drug is from a specific manufacturer, be it generic or name brand, to be interchanged from another manufacturer other than the one specified in the prescription, unless the MO HealthNet participant is notified of the interchange, in writing or verbally, upon the delivery of the prescription. If such drug is interchanged with notice to the MO HealthNet participant, the pharmacist who fills such prescription shall also notify the prescribing health care professional before the delivery of the prescription, unless authorized to make such interchange under current state law. This requirement shall not apply to prescriptions dispensed for inpatients of a hospital, nursing home, assisted living facility, or inpatients of a mental health or residential facility. SECTION 208.207

This provision is substantially similar to SCS/SB 918 (2008).

This act requires third party payers to honor MO HealthNet subrogation claims for up three years from the date of service and grants the MO HealthNet Division authority to collect from third party payers through subrogation of claims. SECTION 208.215

This act modifies the membership of the MO HealthNet Oversight Committee by adding an optometrist, a nurse, a mental health professional, a licensed physical therapist, as well as representatives from a not-for-profit health network serving rural counties and providing both patient-based and provider member services, a representative of a long-term care facility, a representative from the durable medical equipment industry, a Medicaid managed care organization, a rural health clinic and a federally qualified health clinic. This act also specifies that the committee shall have three patient advocates rather than two. Of the three advocates, one advocate shall represent children, one the disabled, and one the elderly community. In addition, rather than designating two primary care physicians and two physicians, the act now references four licensed physicians, two each from rural and urban areas, and board certified in their specialty. SECTION 208.955

This provision is similar to SS/SCS/SB 821 (2008).

This act also establishes the Insure Missouri program to be administered by the Department of Social Services to provide health care coverage. The department shall be required to apply to the United States Department of Health and Human Services for a waiver and/or a state plan amendment to implement the program.

Under no circumstances shall less than ninety-three percent of the funds appropriated by the general assembly for the plan be used to fund payment for health care services. SECTIONS 208. 1300 to 208.1345

In implementing provisions related to coverage of the uninsured and payments to providers for providing care to the uninsured under Insure Missouri and the MO HealthNet program, the MO HealthNet Division shall take into consideration the special needs of Missouri's Tier I Safety Net providers so that they are not disproportionately impacted by regulations promulgated by the Division as it implements the provisions of such programs. SECTION 1

HEALTH INSURANCE

The Department of Insurance, Financial Institutions and Professional Registration shall administer a grant program to assist the start-up of non-profit broker organizations. Eligible participants shall apply to the department for a grant, using a competitive application process prescribed by the department. The department shall award one grant not to exceed twenty-five thousand dollars. The department shall establish eligibility and give preference to applicants who demonstrate the ability to enhance representation of low-cost health insurance coverage models in the market. This program shall expire in 6 years unless re-authorized by the General Assembly. SECTION 376.025

Under this act, health carriers are allowed to include wellness and health promotion programs, condition or disease management programs, health risk appraisals programs, and similar provisions in high deductible health plans or policies that comport with federal requirements, provided that such wellness and health promotion programs are approved by the Department of Insurance, Financial Institutions and Professional Registration. SECTION 376.685

This act adds to the list of mental health services covered by all health insurance companies and health maintenance organizations in this state to include the services of licensed marital and family therapists. SECTION 376.811

This act provides that no application shall be submitted to an applicant for enrollment in a Medicare Advantage plan until two business days have passed since the initial personal solicitation and the applicant has signed a disclosure form. Personal solicitation includes either an on-site presentation at a facility or a home meeting with an insurance agent. The disclosure shall be signed and dated by both the applicant and the agent on the day of the initial personal solicitation and shall include:

-A statement that Medicare Advantage plans are not Medigap supplement plans;

-A statement advising the applicant to confirm with his or her health care providers whether or not the provider has contracted with the Medicare Advantage plan to provide medical services; and

-A statement advising the applicant to contact either a trusted family member, friend or the state health insurance assistance program, known as CLAIM.

In addition to the disclosure, the agent shall also be required to provide a list of providers contracting with the Medicare Advantage plan to provide medical services in the applicant's regional area. Such list may be in the form of a provider directory or other similar document.

The director of the Department of Insurance, Financial Institutions and Professional Registration shall prescribe the format and content of the disclosure including size, color and prominence of type. Anyone who violates the provisions of this act shall be subject to civil penalties and fines. SECTION 376.845

This provision is substantially similar to SCS/SB 773 (2008) and SB 973 (2008).

This act modifies the provisions of Missouri's high risk pool to provide that the twelve-month preexisting condition exclusion period shall not apply for coverage if the person applying for pool coverage has at least three months of uninterrupted prior insurance coverage, so long as the application for pool coverage is made not later than sixty-three days following the loss of such health insurance coverage. SECTION 376.986

Under this act, the director of Insurance, Financial Institutions and Professional Registration is authorized to allow health reimbursement arrangement only plans that encourage employer financial support of health insurance or health related expenses recognized under the rules of the Internal Revenue Service to be approved for sale in connection with or packaged with individual health insurance policies otherwise approved by the director. SECTION 376.1600

The director shall study and recommend to the General Assembly changes to remove any unnecessary application and marketing barriers that limit the entry of new health insurance products into the Missouri market. The director shall examine state statutory and regulatory requirements along with market conditions which create barriers for the entry of new health insurance products and health insurance companies. The director shall also examine proposals adopted in other states that streamline the regulatory environment to make it easier for health insurance companies to market new and existing products. The director shall submit a report of his or her findings and recommendations to each member of the General Assembly no later than January 1, 2009. SECTION 376.1618.

ADRIANE CROUSE