Missouri Senate

House Committee Substitute

HEALTH INFORMATION ORGANIZATIONS (Sections 191.236, 191.237, and 191.238)

This act creates the Missouri Health Information Exchange Commission, which shall have the authority to develop a health information organization approval process. The approval process shall include compliance with commonly and equally applied standards relating to interoperability between approved health information organizations, transparency, financial and operational sustainability, and data security. The Commission shall also develop re-approval and investigational processes.

Additionally, this act requires the state to end the practice of conveying "state designated entity" status to any health information organization, as well as requiring the state to cease awarding and funding single feasible source vendor contracts to health information organizations operating within the state. Instead, only approved health information organizations shall be qualified to respond to contracting procurement opportunities. The state shall not restrict the availability of or access to any state agency-sponsored data sets.

Finally, this act requires approved health information organizations to exchange standard-based clinical summaries for patients and clinical and claims data from any agency within the state with all other approved health information organizations within the state. Failure to do so shall result in the suspension or revocation of approval status and the immediate termination of any contracts, grants, and any other form of state funding.

These provisions are identical to provisions in HCS/SCS/SB 107 (2015), HCS/SCS/SB 146 (2015), HCS/SS/SB 416 (2015), and HCS/SS/SCS/SB 517 (2015).

PERINATAL ADVISORY COUNCIL (Section 192.380)

This act establishes the Perinatal Advisory Council, which shall be comprised of representatives from specified community and health organizations and professions. After receiving public input, the Council shall make recommendations for the division of the state into neonatal and maternal care regions. The Council shall establish criteria for levels of birthing center care and base its levels of care designations upon evidence and best practices as identified by the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists. By January 1, 2017, and every year thereafter, hospital license applications shall include the appropriate level of maternal care and neonatal care designations as determined by the Council. By the same date, any hospital operated by a state university shall report to the Department of Health and Senior Services, upon the Department's request, the appropriate level of maternal care designation and neonatal care designation. The Department may partner with appropriate nationally recognized nonprofit organizations with relevant expertise to administer the provisions of this act.

This provision is similar to HB 735 (2015), substantially similar to SCS/SB 342 (2015) and provisions in HCS/SS/SCS/SB 354 (2015), and identical to provisions in HCS/SCS/SB 107 (2015), HCS/SCS/SB 146 (2015), HCS/SCS/SB 197 (2015), HCS/SCS/SB 230 (2015), and HCS/SB 533 (2015).

X-RAY INSPECTIONS (Section 192.500)

This act provides that inspections of cone beam computed tomography systems and panoramic x-ray systems shall not be required to be inspected more frequently than every 6 years. A cone beam computed tomography system is a medical imaging device which uses x-ray computed tomography to capture data using a cone-shaped x-ray beam. A panoramic x-ray system is an imaging device that captures the entire mouth in a single, 2-dimensional image that includes the teeth, upper and lower jaws, and surrounding structures and tissues.

This provision of this act shall automatically sunset on August 28, 2017, unless reauthorized.

This provision is identical to HB 832 (2015).

PRESCRIPTION AUTHORITY (Sections 195.070, 334.037, and 334.104)

This act allows certain advanced practice registered nurses and assistant physicians to prescribe Schedule II - hydrocodone. Hydrocodone prescriptions are limited to a one five day supply without refill (195.070, 334.037, 334.104, 334.747).

These provisions are similar to HB 720 (2015) and SB 313 (2015), substantially similar to HCS/HB 720 (2015) and provisions in HCS/SCS/SB 107 (2015) and HCS/SS/SB 457 (2015), and identical to provisions in SCS/HCS/HB 709 (2015) and HCS/SCS/SB 458 (2015)

PATIENT STATUS NOTIFICATION (Section 197.130)

This act requires hospital admissions staff to provide written notice to each patient when each patient is admitted to the hospital under observational status during the intake process, at any time that the patient's status changes, and upon discharge. Hospital admissions staff shall provide written notice to a patient, upon discharge, of that patient's inpatient status, observational status, or both. Each written notice shall include: (1) a statement regarding the patient's status; (2) a statement regarding how observation status may affect the patient's Medicare, MO HealthNet, or private insurance coverage for hospital services, home- and community-based care, or rehabilitative services at a skilled nursing facility; and (3) a recommendation that the patient contact their health insurance provider for more information about placement in observation status.

This provision is identical to HCS/HB 712 (2015), substantially similar to HB 712 (2015), and similar to SB 298 (2015).

ELIGIBILITY VERIFICATION (Section 208.065)

This act requires the Department of Social Services, by January 1, 2016, to contract with a private vendor to verify that eligibility requirements are being met by recipients of public assistance, including supplemental nutrition assistance program, temporary assistance for needy families, child care assistance, and MO HealthNet. The Department will retain final determination of eligibility. The Department and the contractor are required to file an annual report with the Governor and the General Assembly regarding the eligibility data.

This provision is substantially similar to HB 985 (2015) and provisions in SCS/HCS/HB 796 (2015), HCS/SCS/SB 35 (2015), and HCS/SCS/SB 322 (2015), and similar to SB 151 (2015).

OUT-OF-STATE MO HEALTHNET PARTICIPANTS (Section 208.078)

This act provides that when the Department of Social Services receives information, including from a MO HealthNet managed care plan, that a MO HealthNet participant, excluding a child in the custody of the state, resides out of state, such participant's MO HealthNet services shall be terminated as provided for under law.

This provision is identical to SCS/SB 35 (2015) and provisions in HCS/SCS/SB 35 (2015), and substantially similar to HB 424 (2015) and SB 35 (2015).

TELEHEALTH SERVICES (Sections 208.670, 208.671, 208.673, 208.675, 208.677, and 608.686)

This act specifies the licensed individuals who shall be considered eligible health care providers for the provision of telehealth services. Additionally, this act specifies the originating sites where a MO HealthNet participant may receive telehealth services, as well as requiring that such originating sites ensure the immediate availability of clinical staff during the telehealth encounter if a participant requires assistance.

This act establishes a statewide home telemonitoring program, subject to appropriations. Home telemonitoring services are health care services that require scheduled remote monitoring of data related to a patient's health. The act specifies the individuals for whom home telemonitoring services may be made available. If the Department of Social Services determines that home telemonitoring is not cost effective, the Department may discontinue the program and stop providing reimbursement through MO HealthNet for such services.

This act addresses the use of asynchronous store-and-forward technology in the practice of telehealth services for MO HealthNet recipients. "Asynchronous store-and-forward" is defined in the act as the transfer of a patient's clinically important digital samples, such as still images, videos, audio, and text files, and relevant data from an originating site through the use of a camera or similar recording device that stores digital samples that are forwarded via telecommunication to a distant site for consultation by a consulting provider without requiring the simultaneous presence of the patient and the patient's treating provider. The Department of Social Services, in consultation with the departments of Mental Health and Health and Senior Services, shall promulgate rules governing the use of asynchronous store-and-forward technology in the practice of telehealth in MO HealthNet. The act also specifies reimbursement for asynchronous store-and-forward services for the treating provider and the consulting provider.

This act establishes the "Telehealth Services Advisory Committee" to advise the Department of Social Services and to propose rules relating to telehealth services through asynchronous store-and-forward technology. The act specifies the committee members, appointments, and other terms.

These provisions are substantially similar to HCS/HB 319 (2015), HCS/HB 965 (2015), HB 1014 (2015), SCS/SB 230 (2015) and provisions in HB 319 (2015), HB 340 (2015), and HCS/SCS/SB 230 (2015).

JOINT COMMITTEE ON PUBLIC ASSISTANCE (Section 208.952)

This act modifies the Joint Committee on MO HealthNet to create a permanent Joint Committee on Public Assistance. The committee shall have as its purpose the study of the efficacy of the public assistance programs within the state, determine the resources needed to continue and improve the programs, and develop recommendations on how to reduce dependency and promote public assistance recipient self-sufficiency as may be appropriate. The committee shall receive and obtain information from the departments of Social Services, Mental Health, Health and Senior Services, Elementary and Secondary Education, and any other department as applicable, regarding projected enrollment growth, budgetary matters, and any other information deemed relevant to the committee's purpose.

The committee shall meet at least twice a year. A portion of the meeting shall be set aside for public testimony. The committee is authorized to hire staff and enter into employment contracts, including an executive director, to conduct special reviews or investigations of the state's public assistance programs. The committee shall also conduct an annual rolling 5-year forecast of the state's public assistance programs and make recommendations to the General Assembly.

This provision is similar to SB 9 (2015), SB 197 (2015), SCS/SB 197 (2015), SB 230 (2015), SB 301 (2015), and provisions in HCS/SCS/SB 197 (2015).

FARM-TO-TABLE PROGRAM (Sections 262.960, 262.962, and 348.407)

This act changes the "Farm-to-School Act" and program to the "Farm-to-Table Act" and program. Under this act, the program will connect Missouri farmers to institutions in order to provide such institutions with locally grown agricultural products. This act defines "institutions" as facilities including schools, correctional facilities, hospitals, nursing homes, and military bases. This act also requires the Department of Agriculture to develop program goals by December 31, 2018.

Currently, certain state departments are required to make staff available to the program, including the Department of Health and Senior Services, the Department of Elementary and Secondary Education, and the Office of Administration. This act adds the Department of Corrections to this staff requirement.

Currently, the Farm-to-Table Task Force is composed of certain members. Under this act, one representative will also be added to the Task Force from the Department of Corrections, the Department of Health and Senior Services, and from a military base in this state. Currently, the Director of the Department of Agriculture and the Director of the Department of Elementary and Secondary Education may each appoint 2 members to the Task Force. Under this act, each may only appoint 1 member. Further, the Director of the Department of Corrections and the Director of the Department of Health and Senior Services shall each appoint 1 member. Under this act, the Task Force is required to prepare a report for the Governor, General Assembly, and the Director of each entity represented on the Task Force by December 31 of each year.

Currently, the Farm-to-School Act and Program is set to expire on December 31, 2015. This act repeals this expiration date. This act has a delayed effective date of January 1, 2016.

These provisions are identical to HCS/HB 1184 (2015).

PHYSICAL DISABILITY SPECIALTY PLATES AND TAGS (Section 301.142)

This act adds physical therapists to the list of authorized health care practitioners who may sign statements necessary for a person to receive a windshield placard or special plates for a temporary or permanent physical disability.

This provision is identical to provisions in HCS/HB 720 (2015), HCS/SB 254 (2015), HCS/SB 458 (2015), SCS/HCS/HB 1002 (2015), HCS/SCS/SB 107 (2015), HCS/SCS/SB 146 (2015), HCS/SCS/SB 197 (2015), HCS/SS/SCS/SB 354 (2015), and HCS/SCS/SB 380 (2015), and substantially similar to provisions in HCS/SCS/SB 230 (2015) and CCS#2/HCS/SB 254 (2015).

COLLABORATIVE PRACTICE (Section 334.104)

The act states that when a physician reviews pursuant to a collaborative practice arrangement an advanced practice registered nurse's delivery of health care services, which includes chart review, the collaborating physician need not be present at the health care practitioner's site (334.104).

Current law provides that an advanced practice registered nurse shall practice with the collaborating physician continuously present for one-month before practicing in a setting where the collaborating physician is not continuously present. This act states that this requirement does not apply to collaborative arrangements between a physician and an advanced practice registered nurse if the collaborative physician is new to a patient population to which the collaborating advanced practice registered nurse, assistant physician, or assistant physician is already familiar.

This provision is identical to provisions in HCS/SCS/SB 146 (2015), substantially similar to provisions in HCS/HB 720 (2015), HCS/SCS/SB 107 (2015), HCS/SS/SB 416 (2015), HCS/SB 458 (2015), and HCS/SS/SCS/SB 517 (2015), and similar to provisions in SCS/HCS/HB 709 (2015), HB 720 (2015), and SB 415 (2015).

MEDICATION SYNCHRONIZATION (Section 376.379)

This act requires health carriers or managed care plans offering health benefit plans that provide prescription drug coverage to offer medication synchronization services that allows for the alignment of refill dates for an enrollee's prescription drugs that are covered benefits. The health carrier or managed care plan shall not charge an amount in excess of the otherwise applicable co-payment amount under the health benefit plan and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met (376.379).

This provision is identical to provisions in HCS/SB 458 (2015) and SB 528 (2015), and substantially similar to provisions in HCS/HB 198 (2015) and HCS/SS/SB 457 (2015).

PHARMACY BENEFITS MANAGERS (Section 376.388)

The act requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy's contracting representative to include sources utilized to determine maximum allowable cost and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the maximum allowable cost list of drugs (MAC list) or modify maximum allowable cost pricing within seven days if the drugs do not meet the standards as provided in the act.

A PBM shall reimburse pharmacies for drugs subject to maximum allowable cost pricing based upon pricing information which has been updated within seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from only on manufacturer and is generally available for purchase from national or regional wholesalers.

All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list (376.388).

This provisions is identical to provisions in HCS/SB 458 (2015), substantially similar to provisions in HCS/SS/SB 457 (2015) and SS/SB 457 (2015), and similar to HB 780 (2015) and SB 325 (2015).

VISION INSURANCE (Section 376.685)

This act prohibits an agreement, for the provision of services, between a health carrier or other insurer that writes vision insurance and an optometrist from requiring an optometrist to provide additional services or materials at a fee limited or set by the plan or carrier unless the services or materials are reimbursed as covered services under the contract. A provider is prohibited from charging more for services or materials that are not covered under a health benefit or vision plan than the usual and customary rate charged for those services or materials. The reimbursement paid by the health benefit or vision plan for covered services or materials must be reasonable and cannot provide nominal reimbursement in order to claim a service or material is a covered service. This act prohibits a vision care insurance policy or vision care discount plan that provides covered services for materials from having the effect, directly or indirectly, of limiting the choice of sources and suppliers of materials by a patient of a vision care provider.

This provision is identical to HB 202 (2015) and is substantially similar to SB 692 (2014).

SARAH HASKINS