Conference Committee Substitute

CCS/HCS/SB 951 - This act modifies provisions relating to health care, including: (1) Diabetes Awareness Month; (2) Show-Me Freedom from Opioid Addiction Decade; (3) health care records; (4) telehealth; (5) disposal of unused controlled substances; (6) hospital regulations; (7) long-term care certificates of need; (8) Department of Mental Health contracts; (9) newborn eye drops; (10) assistant physicians; (11) collaborative practice and supervisory agreements; (12) psychologists; (13) patient satisfaction scores; (14) health insurance coverage; (15) blood draws by certain medical professionals; (16) blood alcohol content; (17) the "Improved Access to Treatment for Opioid Addiction Act"; and (18) mental health professionals.


This act establishes November as Diabetes Awareness Month.

This provision is identical to HB 1247 (2018).


This act establishes 2018 to 2028 as the "Show-Me Freedom from Opioid Addiction Decade."

This provision is identical to a provision in SCS/HCS/HB 2105 (2018) and HCB 15 (2018).

HEALTH CARE RECORDS (Section 191.227)

Currently, patients may request copies of health history or treatment records from providers. This act specifies that a response to such request may include a statement or record that no such health history or treatment record responsive to the request exists.

Additionally, the fees for the search, retrieval, and copying of health care records shall be the fees in effect on February 1, 2018, increased or decreased annually under this provision.

This provision is substantially similar to a provision in CCS/HCS/SS/SCS/SB 826 (2018).

TELEHEALTH (Sections 191.1145, 208.670, 208.671, 208.673, 208.675, and 208.677)

This act repeals existing provisions of law relating to MO HealthNet telehealth, including provisions relating to MO HealthNet reimbursement for asynchronous store-and-forward technology, MO HealthNet telehealth rules promulgation, originating sites, and the Telehealth Services Advisory Committee.

This act requires the Department of Social Services to reimburse health care providers for telehealth services if such providers can ensure that the services are rendered with the same standard of care that would be provided in person. The Department shall not restrict the originating site through rule or payment as long as the provider can ensure the services meet the requisite standard of care. No payment for telehealth services shall depend on a minimum distance requirement between the originating and distant sites. Reimbursement for asynchronous store-and-forward may be capped at the reimbursement rate for services provided in person. Prior to the provision of telehealth services provided in a school, the parent or guardian of a child shall provide the necessary authorization.

Additionally, this act specifies that a health carrier shall not be prohibited from reimbursing non-clinical staff for services provided through telehealth if otherwise allowable by law.

These provisions are substantially similar to SCS/HCS/HB 1617 (2018).


Under this act, a Drug Enforcement Agency-authorized collector, in accordance with federal regulations, may accept unused controlled substances from ultimate consumers, even if the authorized collector did not originally dispense the drug. This provision shall supercede and preempt any local drug disposal ordinance or regulation.

Additionally, the Department of Health and Senior Services shall develop an education and awareness program regarding drug disposal, including the development of a web-based resource and promotional activities.

These provisions are identical to provisions in CCS/HCS/SS/SCS/SB 826 (2018) and are substantially similar to provisions in SS/HCS/HB 1618 (2018), HB 2105 (2018), and HCB 15 (2018).

HOSPITAL REGULATIONS (Sections 197.052 and 577.029)

Under this act, an applicant or holder of a hospital license may define or revise the premises of a hospital campus to include property adjacent to the campus but for a single intersection.

Additionally, hospital licensure regulations may incorporate by reference Medicare conditions of participation.

These provisions are identical to provisions in the truly agreed to and finally passed HB 2183 (2018).


This act changes the definition of "new institutional health service", as it applies to changes in licensed bed capacity, to apply only to long-term care facilities.

Currently, a health care facility seeking to increase its total number of beds by ten or less or ten percent or less of its total bed capacity over a two-year period may be eligible for a non-applicability review under the certificate of need program. Under this act, a long-term care facility shall only be eligible for a non-applicability review if the facility has had no patient care class I deficiencies within the last eighteen months and has maintained at least an 85% average occupancy rate for the previous six quarters.

This provision is identical to the truly agreed to and finally passed HB 2183 (2018) and substantially similar to SB 1040 (2018).


Current law permits the Department of Social Services to enter into contracts with an entity for the provision of the medical insurance information of certain persons applying for or receiving MO HealthNet benefits. Such information is limited to those insurance benefits that could have been claimed and paid by an insurance policy or are otherwise covered by MO HealthNet. Under this act, the Department of Mental Health may enter into such contracts for the medical insurance information of persons receiving Department of Mental Health services.

This provision is identical to a provision in CCS/HCS/SB 660 (2018), SB 1083 (2018), and HB 2716 (2018).

NEWBORN EYE DROPS (Section 210.070)

This act modifies existing law regarding the administration of prophylactic eye drops to newborns after delivery by repealing the requirement that the administration of eye drops be reported within 48 hours to the local board of health or county physician. Instead, this act provides that administration of such eye drops shall not be required if a parent or legal guardian objects.

This provision is substantially similar to a provision in CCS/HCS/SS/SCS/SB 826 (2018), SB 970 (2018), and HB 2117 (2018).

ASSISTANT PHYSICIANS (Sections 334.036 and 334.037)

This act changes the examination requirement for an assistant physician to require that an assistant physician complete Step 2 instead of Step 1 and Step 2, of the United States Medical Licensing Examination within a three-year period before applying for licensure, but in no event more than three years after graduation from a medical college.

An assistant physician licensure fee cannot be more than the licensure fee for a physician assistant. Additionally, no rules can require an assistant physician to complete more hours of continuing medical education than a licensed physician.

This act repeals the requirement that an assistant physician has to enter into a collaborative practice agreement within six months of initial licensure.

A health carrier or health benefit plan shall reimburse an assistant physician on the same basis that it covers a service when it is provided by another comparable mid-level provider.

No rule or regulation shall require the collaborating physician to review more than ten percent of the assistant physician's patient charts or records during the one-month period that the physician is continuously present while the assistant physician is practicing medicine.

An assistant physician may prescribe buprenorphine for up to a 30-day supply without refill in certain circumstances.

An assistant physician who is providing opioid addiction treatment may receive a certificate of prescriptive authority without having completed 120 hours of practice in a four month period with a collaborating physician.

Nothing in these provisions shall limit the authority of hospitals or hospital medical staff to make employment or medical staff credentialing or privileging decisions.

These provisions are similar to provisions in SCS/HCS/HB 2127 (2018), SB 1055 (2018), HCS/HB 1574 (2018), and HCS/HB 2233 (2018).

COLLABORATIVE PRACTICE AND SUPERVISORY AGREEMENTS (Sections 334.037, 334.104, 334.735, and 334.747)

Current law authorizes physicians to enter into a collaborative practice agreement with 3 advanced practice registered nurses (APRN) and 3 assistant physicians, and a supervising agreement with 3 licensed physician assistants. This act authorizes physicians to enter into a collaborative practice agreement or a supervising agreement with 6 APRNs, assistant physicians, licensed physician assistants, or any combination thereof.

The limitation on collaborative practice agreements and supervision agreements shall not apply to the supervision of certified registered nurse anesthetists in the provision of anesthesia services under the supervision of an anesthesiologist or other physician, dentist, or podiatrist who is immediately available if needed.

Current law also states that a physician and a physician assistant in a supervisory agreement shall practice no further than 50 miles by road from each other. This act repeals the 50 mile limitation and states that the physician assistant shall practice within a geographic proximity to be determined by the Board of Registration for the Healing Arts.

No supervision requirements in addition to the minimum federal law shall be required for a physician-physician assistant team working in a certified community behavioral health clinic or a federally qualified health center.

Advanced practice registered nurses and physician assistants may prescribe buprenorphine for up to a 30-day supply without refill in certain circumstances.

These provisions are similar to SCS/HCS/HB 2127 (2018), SCS/SB 745 (2018) HCS/HB 1574 (2018), HB 244 (2017), and HB 1697 (2016).

PSYCHOLOGISTS (Sections 337.025, 337.029, and 337.033)

This act provides that a doctoral degree in psychology from a program accredited, or provisionally accredited, by the Psychological Clinical Science Accreditation System is acceptable to meet various requirements for licensure as a psychologist if the degree program meets certain requirements as set forth in the act.

These provisions are identical to provisions in CCS/HCS/SB 660 (2018) and HCS/SB 796 (2018).


Under this act, the Director of the Department of Insurance, Financial Institutions and Professional Registration shall not require patient scoring of pain control in defining data standards for quality of care and patient satisfaction. Beginning August 28, 2018, the Director shall discontinue the use of patient satisfaction scores and shall not make them available to the public to the extent allowable by federal law.

This provision is identical to a provision in SCS/HCS/HB 2105 (2018).

HEALTH INSURANCE COVERAGE (Sections 376.811 and 376.1550)

The act requires every insurance company and health service corporation to offer, in all health insurance policies, coverage for medication-assisted treatment for substance use disorders.

This provision is substantially similar to a provision in HCB 15 (2018).

Additionally, this act repeals the exclusion of chemical dependency from the definition of "mental health condition" in relation to mental health insurance coverage.


This act requires the consent of a patient or a warrant before a licensed physician, registered nurse, phlebotomist, or trained medical technician may draw blood at the request of a law enforcement officer for the purpose of determining the alcohol content of the blood.

This provision is identical to a provision in CCS/HCS/SS/SB 870 (2018) and similar to a provision in HCS/SB 951 (2018) and HCS/HB 2413 (2018).


This act establishes the "Improved Access to Treatment for Opioid Addictions Program" to disseminate information and best practices regarding opioid addiction and to facilitate collaborations to better treat and prevent opioid addiction in Missouri, as specified in the act. The program shall facilitate collaborations between health care providers and provide resources to providers.

This act also specifies that assistant physicians who participate in the program shall complete the necessary requirements to prescribe buprenorphine within 30 days of joining. The program may develop curriculum and benchmark examinations on the subject of opioid addiction and treatment. A remote collaborating physician working with an on-site assistant physician shall be considered on-site for the purposes of the program. Additionally, an assistant physician collaborating with a physician who is waiver-certified for the use of buprenorphine may participate in the program in any area of the state and provide all services and functions of an assistant physician and other duties as specified in the act.

Under this act, when an overdose survivor arrives in an emergency department, the assistant physician serving as a recovery coach or another properly trained coach shall meet with the survivor and provide treatment options and support.

This provision is substantially similar to a provision in SCS/HCS/SB 2105 (2018) and HCB 15 (2018).


The act adds psychiatric physician assistants, psychiatric advanced practice registered nurses, and psychiatric assistant physicians to the definition of mental health professionals for the purposes of provisions of law relating to alcohol and drug abuse and comprehensive psychiatric services and adds a definition for each term.

This provision is identical to a provision in CCS/HCS/SB 660 (2018), SCS/HCS/HB 2127 (2018), and HB 1719 (2018) and similar to HB 2295 (2018).


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