Missouri State Senate

House Committee Substitute

HCS/SS/SCS/SB 517 - This act modifies several provisions of law, including: (1) health information organizations, (2) death certificates, (3) professional registration and regulation, and (4) collaborative practice arrangements.

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 38 (2015), HCS/SCS/SB 107 (2015), HCS/SCS/SB 146 (2015), and HCS/SS/SB 416 (2015).

DEATH CERTIFICATES (Sections 193.015 and 193.145)

This act adds advanced practice registered nurses, assistant physicians, and physician assistants to specified phases of the death certification process, including data provision, investigation into the causes of death, certification of death, and authorization for the final disposition of the decedent's body.

These provisions are similar to HB 1113 (2015), HCS/HB 1113 (2015), HCS/SCS/SB 107 (2015), and SCS/HCS/HB 618 (2015).

PROFESSIONAL REGISTRATION AND REGULATION (Sections 324.001 and 621.280)

This act provides that the state shall not impose a substantial burden on an individual's pursuit of his or her occupation or profession unless there is an important governmental interest for the state to protect the general welfare. If an important governmental interest does exist, then the regulation adopted shall be the least restrictive type of regulation consistent to the public interest to be protected.

The act establishes certain criteria under which to review all bills purposing to regulate an occupation or profession not previously regulated. If the legislature determines that the state has an important interest in regulating the occupation or profession then the least restrictive type of regulation shall be implemented.

An applicant group, defined as an organization or individual that proposes that any occupation or profession be regulated, shall submit a written report to the applicable standing committees in the Senate and House of Representatives containing certain information as specified in the act including a definition of the problem and why regulation of the profession is necessary, harm to the public by not regulating the profession and efforts to address the harm caused, alternatives to the regulation, the benefit to the public if the regulation becomes law, and the expected costs of regulation.

The act states that practitioners actively engaged in a newly regulated occupation or profession for at least one year prior to the effective date of the regulation statute shall have a property right in their continued legal ability to engage in their occupation or profession. The decision of any newly created board or commission charged with regulating or licensing an occupation or profession to refuse licensure to a pre-existing practitioner shall be in writing, specify the reasons for denial, and inform the practitioner of the right to appeal before the Administrative Hearing Commission.

These provisions are identical to provisions in HCS/SS/SB 416 (2015) and substantially similar to HCS/HB 634 (2015), HB 634 (2015), and provisions in HCS/SCS/SB 107 (2015) and HCS/SCS/SB 146 (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/SS/SB 416 (2015), and substantially similar to provisions in HCS/SCS/SB 38 (2015), HCS/SCS/SB 107 (2015), HCS/SCS/SB 146 (2015), and HCS/SB 458 (2015).

SARAH HASKINS

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