Missouri Senate

House Committee Substitute

SHOW-ME FREEDOM FROM OPIOID ADDICTION DECADE (Section 9.240): This act designates the years of 2017-2027 as the "Show-Me Freedom From Opioid Addiction Decade".

This provision is identical to a provision contained in HCS/HB 1197 (2017).

HEALTH RECORDS OF THE DECEASED (Section 191.227): This act changes the fees for the search, retrieval, and copying of a patient's health care records by a health care providers. Additionally, a health care provider may disclose a deceased patient's health care records or payment records to specified persons in the act. This act repeals a provision of the Uniform Vital Statistics Law permitting the disclosure of a listing of persons who are born or die on a particular date but not any information from the vital record other than the name and date of such birth or death.

These provisions are identical to provisions contained in HCS/HB 144 (2017) and SCS/HCS/HB 381 (2017).

HEALTH CARE DIRECTIVES REGISTRY (Section 194.600): This act requires the Department of Health and Senior Services to contract with a third party for the establishment of a health care directives registry for the purpose of providing a place to securely store an advance health care directive online and to give authorized health care providers immediate access to the directive. The third party contractor shall be solely responsible for the administration and maintenance of the registry. All data and information contained in the registry shall remain confidential and shall be exempt from the Sunshine law. An "advance health care directive" is defined as either a power of attorney for health care or a declaration signed by an adult declarant containing the person's direction concerning a health care decision.

All documents shall be submitted electronically to the registry at intake points, such as licensed health care providers and licensed attorneys, and signed electronically with a unique identifier, such as a Social Security number, a driver's license number, or another unique government-issued identifier. The electronic submission will be accompanied by a fee not to exceed ten dollars.

The Department may promulgate rules to carry out the provisions of this act which may include, but not be limited to, a determination of who may access the registry, including physicians, other licensed health care providers, the declarant, and his or her legal representative or designee.

These provisions are identical to SB 50 (2017), SB 887 (2016) and substantially similar to SS/SCS/SB 122 (2015).

IMMUNITY FOR MEDICAL ASSISTANCE (Section 195.205): Under this act, a person who, in good faith, seeks or obtains medical assistance for himself or herself or someone else who is experiencing a drug or alcohol overdose or other medical emergency shall not be arrested, charged, prosecuted, convicted, or have his or her property subject to civil forfeiture or otherwise penalized for offenses specified in the act if the evidence, charge, prosecution, conviction, seizure, or penalty was gained as a result of seeking or obtaining medical assistance.

This act shall not prevent a police officer from arresting a person for an outstanding warrant or prevent a person from being arrested, charged, or prosecuted based on an offense other than the specified offenses in the act, whether the offense arises from the same circumstances as the seeking of medical assistance. Additionally, the protection of prosecution under this act for possession offenses shall not be grounds for suppression of evidence or dismissal in charges unrelated to this act.

Finally, any police officer who is in contact with any person or persons in need of emergency medical assistance under this act shall provide appropriate information and resources for substance-related assistance.

These provisions are identical to HB 294 (2017).

OVERDOSE MEDICATION (Section 195.206): The act gives the Director of the Department of Health and Senior Services, or a licensed physician with the express written consent of the Director if the Director is not a licensed physician, the authority to issue a statewide standing order for an opioid antagonist. A physician issuing such an order shall not be subject to any criminal or civil liability or professional disciplinary action associated with the order.

This provision is identical to a provision contained in HCS/HB 1197 (2017).

IMMUNIZATION EDUCATION (Section 198.053): Under this act, all Missouri assisted living facilities shall, no later than October 1 each year, notify residents and staff where in the facility the latest edition of the Vaccine Informational Sheet published by the Centers for Disease Control has been posted. Nothing in this act shall be construed to require any assisted living facility to pay for an influenza vaccination, allow the Department of Health and Senior Services to promulgate any rules to implement this provision, or cite any facility for acting in good faith to post the Vaccine Informational Sheet.

This provision is identical to a provision in HCS/SCS/SB 334 (2017) and HCS/SB 363 (2017), and similar to HB 778 (2017).

DIVISION OF PROFESSIONAL REGISTRATION (Section 324.003): This act provides the acceptable ways in which a professional licensee or holder of a permit, certificate, or registration may submit payment, application, requests for educational time extensions, or notify his or her licensing board for changes to items required as part of licensure to the Division of Professional Registration or its component boards, committees, offices, and commissions.

These provisions are substantially similar to provisions in HCS/SB 125 (2017).

SPORTS MEDICINE SERVICES (Section 334.010): This act permits a physician to travel into Missouri with an athletic team and provide sports-related medical services to specified individuals related to the athletic team so long as the physician is currently licensed to practice medicine in another state and has a written agreement with an athletic team located in the state where the physician is licensed. The act prohibits such physician from providing medical services at a health care facility in Missouri.

These provisions are identical to SB 494 (2017), SCS/HCS/HB 122 (2017) and SCS/HB 815 (2017).

ASSISTANT PHYSICIANS (Section 334.036): This act modifies the definition of "assistant physician" to allow any medical school graduate who has met the requirements to be an assistant physician between August 28, 2014, and August 28, 2017, and who applies for licensure as of the effective date of this act, be deemed to be in compliance with the requirements of becoming an assistant physician.

This provision contains an emergency clause and is identical to HCS/HB 330 (2017).

LICENSED PRACTICAL NURSES (Section 335.099): This act provides that a licensed practical nurse may provide certain services under the MO HealthNet Personal Care Program without the direction of a registered nurse without impacting the eligibility of a residential care facility or assisted living facility to participate in the Program or receive reimbursement for services.

This provision is identical to a provision contained in SCS/HB 815 (2017).

VACCINE PROTOCOL (Section 338.010): This act requires pharmacists to administer vaccines by protocol in accordance with treatment guidelines established by the Centers for Disease Control and Prevention (CDC).

MAINTENANCE MEDICATION (Section 338.202): Current law provides that dispensing of maintenance medication based on refills authorized by the physician or prescriber on the prescription be limited to no more than a 90 day supply of the medication. This act changes the supply amount to no more than 180 days. This act also repeals a provision that required the medication to have been prescribed for at least a 3 month period. Certain health carriers are not required to cover more than a 90 day supply of maintenance medication.

This act provides that the supply limitations shall not apply if the prescription is issued by a practitioner located in another state and dispensed to a patient located in another state. Additionally, the supply limitations shall not apply if the prescription is dispensed directly to a member of the United States Armed Forces serving outside the United States.

These provisions are substantially similar to HCS/HB 657 (2017), and similar to SB 312 (2017) and SB 533 (2017).

DRUG TAKE-BACK PROGRAM (Section 338.710): This act gives the Missouri Board of Pharmacy the ability to allocate funds to develop a drug take-back program.

This provision is identical to a provision contained in HCS/HB 1197 (2017).

AUDIOLOGISTS (Section 345.051): This act provides that license renewal for speech-language pathologists and audiologists shall occur no less frequently than every three years. Additionally, the the continuing education requirements for licensed speech-language pathologists and audiologists is limited to 30 hours triennially.

This provision is identical to a provision contained in SCS/HB 815 (2017) and HCS/SB 125 (2017), and similar to a provision contained in HB 813 (2017).

PAIN CONTROL (Section 374.426): The act specifies that patient scoring of pain control shall not be required when defining data standards for quality of care and patient satisfaction.

This provision is identical to a provision contained in HCS/HB 1197 (2017).

DRUG, VETERANS, AND FAMILY COURTS (Sections 478.004 & 487.200): This act defines "medication-assisted treatment" as the use of pharmacological medications in combination with counseling and

behavioral therapy to provide a whole patient approach to the

treatment of substance abuse disorders. A drug, veterans, or

family court shall not prohibit a participant from medication-assisted treatment nor require a participant to refrain from using medication-assisted treatment as a condition of successful completion of the program. A participant shall not be in violation of the terms or conditions of the drug, veterans, or family court on the basis of his or her receiving medication-assisted treatment.

These provisions are identical to provisions contained in HCS/HB 1197 (2017), HCB 1 (2017), and HCS/HB 219 (2017).

INFORMATION FORM: (Section 630.870): The act requires that the Department of Mental Health make available an information form that discloses the risks, benefits, and side effects of taking opioid medication.

IMPROVED ACCESS TO TREATMENT FOR OPIOID ADDICTIONS ACT (Section 630.875): The act creates the "Improved Access to Treatment for Opioid Addictions Program", (IATOA), which shall disseminate information and best practices regarding opioid addiction. Assistant physicians who participate in the IATOA program shall complete the necessary requirements to prescribe buprenorphine within 90 days of joining the program. The Department of Mental Health may develop curriculum, examinations, and certification on the subject of opioid addiction and treatment. An assistant physician in the IATOA program may serve several functions, as set forth in the act. When an overdose survivor comes to an emergency room, an assistant physician shall provide treatment options and support to the survivor, when reasonably practicable.

NEONATAL ABSTINENCE SYNDROME (Section 630.880): The act allows the Department of Mental Health to study the establishment of a regional neonatal abstinence syndrome step-down program.

RISKS ASSOCIATED WITH OPIOID MEDICATION (Section 630.890): The act requires the Department of Mental Health to development a plan to inform and educate citizens on the risks associated with opioid medications, including opioid addiction. The plan shall also provide evidence-based treatment services for parents or caregivers of children who are at risk of being placed out of the home due to the parents' or caregivers' use of opioid medication or other substance abuse.

The provisions relating to opioids are identical to provisions contained in HCS/HB 1197 (2017).

JAMIE ANDREWS