Missouri Senate

Senate Amendment

MEDICAL PRACTICE FREEDOM ACT - 324.048

The act provides that licensure requirements for physicians, chiropractors, optometrists, and dentists shall be based on skill and academic competence, and licensure shall not be conditioned on participation in a health insurance plan, or a public health care system or service initiative.

EXAMINATION AND LICENSURE REQUIREMENTS FOR PHYSICIANS - 334.040, 334.280

Applicants for licensure as a physician or surgeon must provide proof of successful completion of the USMLE or the COMLEX, rather than just proof of completion. The act repeals the provision authorizing the State Board of Registration for the Healing Arts to determined the passing score of the USMLE.

The act removes the provision that states that in order for the Board to waive licensure requirements for an applicant who is licensed in another state the applicant must be certified by a certifying agency in the applicant's area of speciality.

The state shall not require adherence to the Federation of State Medical Boards' framework as a condition for physician license renewal or any form of specialty medical board certification to practice medicine within the state. The State Board of Registration for the Healing Arts or any other state agency shall not discriminate against physicians who do not maintain specialty medical board certification.

These provisions are similar to language in HB 1816 (2016), SB 772 (2016), HB 683 (2015), SB 411 (2015), SS/SB 400 (2015), and HB 671 (2015).

MAINTENANCE MEDICATION - 338.202

This act provides that a pharmacist may dispense varying quantities of maintenance medication per fill up to the total number of dosage units as authorized by the prescriber, unless the prescriber has specified that dispensing a prescription for maintenance medication in an initial amount is medically necessary. When the dispensing of the maintenance medication is based on refills then the pharmacist shall dispense no more than a 90 day supply and the patient must have already been prescribed the medication for 3 months.

VISION INSURANCE - 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. Nothing in this act shall prohibit an optometrist from contractually opting in to an optometric services discount plan sponsored by a stand-alone vision plan, medical plan, health benefit plan, or health insurance policy, notwithstanding any other provisions in the act.

This provision is identical to SCS/SB 830 (2016) and similar to HB 202 (2015) and SB 692 (2014).

PRESCRIPTION EYE DROPS - 376.1237

The act also extends the sunset provision for coverage of early refills of prescription eye drops with the authorization of a health care provider from January 1, 2017, to January 1, 2020.

This provision is identical to SB 868 (2016).

JESSI BAKER

SA 1 - THIS AMENDMENT REQUIRES THE DEPARTMENT OF HEALTH AND SENIOR SERVICES, BEGINNING JANUARY 1, 2017, AND SUBJECT TO APPROPRIATIONS, TO EXPAND CURRENT NEWBORN SCREENING REQUIREMENTS TO INCLUDE SEVERE COMBINED IMMUNODEFICIENCY, ALSO KNOWN AS BUBBLE BOY DISEASE.

SA 2 - THE "MISSOURI PALLIATIVE CARE AND QUALITY OF LIFE INTERDISCIPLINARY COUNCIL" IS CREATED, WHICH SHALL CONSULT WITH AND ADVISE THE DEPARTMENT OF HEALTH AND SENIOR SERVICES ON MATTERS RELATED TO THE ESTABLISHMENT, MAINTENANCE, OPERATION, AND OUTCOMES EVALUATION OF PALLIATIVE CARE INITIATIVES IN THE STATE, AS WELL AS SUBMIT AN ANNUAL REPORT TO THE GENERAL ASSEMBLY ASSESSING THE AVAILABILITY OF PALLIATIVE CARE IN THE STATE FOR PATIENTS AT EARLY STAGES OF SERIOUS DISEASE AND ANALYZING BARRIERS TO GREATER ACCESS TO PALLIATIVE CARE.

THE AMENDMENT ALSO CREATES THE "PALLIATIVE CARE CONSUMER AND PROFESSIONAL INFORMATION AND EDUCATION PROGRAM," WHICH SHALL BE DESIGNED TO MAXIMIZE THE EFFECTIVENESS OF PALLIATIVE CARE IN THE STATE BY ENSURING THE PUBLIC AVAILABILITY OF COMPREHENSIVE AND ACCURATE INFORMATION ABOUT PALLIATIVE CARE. THE PROGRAM SHALL ENCOURAGE HOSPITALS TO HAVE A PALLIATIVE CARE PRESENCE ON THEIR INTRANET OR INTERNET WEBSITE AND TO DEVELOP AND DISTRIBUTE INFORMATION ABOUT PALLIATIVE CARE TO PATIENTS. THE PROGRAM SHALL EXPIRE ON AUGUST 28, 2022.

THESE PROVISIONS ARE IDENTICAL TO SB 635 (2016) AND SCS/HB 808 (2015).

SA 4 - UNDER THE AMENDMENT, PHYSICIAN ASSISTANTS AND ASSISTANT PHYSICIANS WITH A SUPERVISION AGREEMENT WITH THE ATTENDING PHYSICIAN ARE ALLOWED TO DETERMINE THAT THE PHYSICAL OR CHEMICAL RESTRAINT, ISOLATION, OR SECLUSION OF A PATIENT IN MENTAL HEALTH FACILITY OR PROGRAM IS OR IS NOT NECESSARY.

THIS PROVISION IS SIMILAR TO SB 1056 (2016).

SA 5 - UNDER THIS AMENDMENT, NO INDIVIDUAL OR HEALTH CARE ENTITY ORGANIZED UNDER THE LAWS OF THE STATE SHALL BE SUBJECT TO ANY ADVERSE ACTION BY THE STATE, INCLUDING CIVIL OR CRIMINAL PROSECUTION, DENIAL OF ANY RIGHT OR PRIVILEGE, THE IMPOSITION OF A CIVIL OR ADMINISTRATIVE PENALTY OR SANCTION, OR DISCIPLINARY ACTION BY ANY ACCREDITATION OR LICENSING BOARD OR COMMISSION IF SUCH INDIVIDUAL OR HEALTH CARE ENTITY, IN ITS NORMAL COURSE OF BUSINESS AND WITHIN ITS APPLICABLE LICENSES AND REGULATIONS, ACTS IN GOOD FAITH ON ANY ORDER, RECOMMENDATION, OR STATEMENT BY A NEUROLOGIST RELATING TO THE MEDICAL USE AND ADMINISTRATION OF HEMP EXTRACT.