HB 758 Modifies provisions relating to health care

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Current Bill Summary

- Prepared by Senate Research -

SCS/HB 758 - This act modifies several provisions relating to health care, including: (1) life-sustaining treatment policies; (2) medication-assisted treatment; (3) pregnancy-associated mortality; (4) infection control data reporting; (5) physician assistants; (6) opioid prescriptions for sickle cell patients; (7) medical marijuana edibles; (8) hospital inspections; (9) long-term care certificates of need; (10) certified nursing assistants; (11) the "Authorized Electronic Monitoring in Long-Term Care Facilities Act"; (12) MO HealthNet per diem reimbursement rates; (13) telehealth; and (14) credentialing procedures for health care practitioners.


This act establishes "Simon's Law" prohibiting any health care facility or health care professional from instituting a do-not-resuscitate or similar order without the written or oral consent of at least one parent or legal guardian of a non-emancipated minor patient or resident. If oral consent is granted, at least 2 witnesses other than the parent, guardian, or physician shall be present and willing to attest to the consent. Such consent shall immediately be recorded in the patient's medical record. Consent granted under the provisions of this act may be revoked orally or in writing by the grantor and shall take precedence over any previous granted consent. These requirements shall not apply if a reasonably diligent effort has been made over a 48-hour period to contact and inform a known parent or guardian without success.

In cases of a child under the jurisdiction of a juvenile court, a juvenile or family court may issue an end-of-life medical decision order, a physician's order, or any other medical decision order, or appoint a guardian for that purpose. The Children's Division shall not be appointed as a guardian for such purposes. If a child under the custody of a juvenile court is returned to his or her parent or guardian, the parent or guardian may revoke consent, orally or in writing, for end-of-life medical decisions ordered by the court.

Nothing in this act shall require health care providers to provide or continue any treatment that would be medically inappropriate because, in their reasonable medical judgment, providing such treatment would either create a greater risk of causing or hastening the patient's death or would be potentially harmful or cause unnecessary pain, suffering, or injury to the patient. Additionally, nothing in this act shall require health care providers to continue cardiopulmonary resuscitation or manual ventilation beyond a time in which, in their reasonable medical judgment, there is no further benefit to the patient or likely recovery of the patient.

This provision is identical to provisions in SS/SCS/HCS/HB 397 (2019), as amended, SB 406 (2019), and SCS/HB 138 (2019).

MEDICATION-ASSISTED TREATMENT (Sections 191.1164, 191.1165, 191.1167, and 191.1168)

This act establishes the "Ensuring Access to High Quality Care for the Treatment of Substance Use Disorders Act". These provisions specify that medication-assisted treatment (MAT) services shall include, but not be limited to, pharmacologic and behavioral therapies. Formularies used by a health insurer or managed by a pharmacy benefits manager, and medical benefit coverage in the case of medications dispensed through an opioid treatment program, shall include all certain specified medications. All MAT medications required for compliance with these provisions shall be placed on the lowest cost-sharing tier of the formulary.

MAT services provided for under these provisions shall not be subject to: annual or lifetime dollar limits; limits to predesignated facilities, specific numbers of visits, days of coverage, days in a waiting period, scope or duration of treatment, or other similar limits; financial requirements and quantitative treatment limitations that do not comply with the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA); step therapy or other similar strategies when it interferes with a prescribed or recommended course of treatment from a licensed health care professional; or prior authorization.

These provisions shall apply to all health insurance plans delivered in the state.

These provisions are similar to SB 507 (2019).

PREGNANCY-ASSOCIATED MORTALITY (Sections 192.067 and 192.990)

This act establishes the "Pregnancy-Associated Mortality Review Board" within the Department of Health and Senior Services to improve data collection and reporting regarding maternal mortality and to develop initiatives that support at-risk populations. The Board shall consist of no more than 18 members appointed by the Director of the Department, as specified in the act, with diverse racial, ethnic, and geographic membership. Before June 30, 2020, and each year thereafter, the Board shall submit a report on maternal mortality in the state and proposed recommendations to the Director of the Centers for Disease Control and Prevention, the Director of the Department, the Governor, and the General Assembly.

The Department shall have the authority to request and receive data for maternal deaths from specified entities. All individually identifiable or potentially identifiable information and other records shall be kept confidential as described in the act.

This act is similar to SB 480 (2019) and HB 664 (2019).


Under this act, hospitals and the Department of Health and Senior Services shall not be required to comply with infection data reporting requirements of current law applying to hospitals if the Centers for Medicare and Medicaid Services (CMS) also requires the submission of such data, except that the Department shall post a link on its website to the publicly reported data on CMS's website. Additionally, hospitals that have established antimicrobial stewardship programs, as required under current law, shall meet the National Healthcare Safety Network requirements for reporting antimicrobial usage or resistance when CMS's conditions of participation requiring such reporting become effective. Nothing shall prohibit a hospital from voluntarily reporting the data prior to the effective date of the conditions of participation.

This provision is identical to SB 435 (2019) and a provision in the perfected SS/SCS/SBs 70 & 128 (2019) and substantially similar to HB 1057 (2019).

PHYSICIAN ASSISTANTS (Sections 193.015, 195.100, 334.037, 334.104, 334.108, 334.735, 334.736, 334.747, 334.749, 338.010, 630.175, and 630.875)

This act modifies provisions of current law relating to supervision agreements between physicians assistants and supervising physicians by changing such agreements to collaborative practice arrangements with collaborating physicians. Collaborative practice arrangements shall delegate to the physician assistant the authority to prescribe, administer, or dispense drugs, including certain controlled substances, and provide treatment to patients. Geographic proximity requirements shall be determined by the Board of Registration for the Healing Arts. Further requirements of collaborative practice arrangements are specified in the act. No collaborative practice arrangement shall supercede existing hospital licensing regulations governing hospital medication orders for inpatient or emergency care.

Additionally, the physician assistant program accrediting entity is changed under this act to include other accreditation programs.

These provisions are identical to HCS/HB 840 (2019).


This act excludes patients undergoing treatment for sickle cell disease from the initial opioid prescription limitations in current law.

This provision is identical to SB 450 (2018) and HB 986 (2019).


This act prohibits the sale of edible marijuana-infused products that are designed, produced, or marketed in a manner to appeal to persons under 18 years of age, including, candies, lollipops, cotton candy, or products in the shape of a human, animal, or fruit. Each increment of an edible marijuana-infused product containing 10 or more milligrams of tetrahydrocannabinols (THC) shall be stamped with a diamond containing the letters "THC" and the number of milligrams of THC in that increment. Any medical marijuana licensed or certified entity regulated by the Department of Health and Senior Services found to have violated this act shall be subject to Department sanctions, including an administrative penalty.

This provision is identical to a provision in SCS/SB 335 (2019) and in the perfected SCS/SB 6 (2019).


This act prohibits the Department of Health and Senior Services from assigning an individual to inspect or survey a hospital if the inspector or surveyor was an employee of such hospital or another hospital within its organization or a competing hospital within 50 miles of the hospital to be inspected or surveyed within the previous 2 years. The Department shall require inspectors or surveyors to disclose the name of every hospital in which he or she was employed in the previous 10 years, the length of service, and the job title held, as well as the same information for any immediate family member employed at a hospital. Such information shall be considered a public record.

If any person has reason to believe that an inspector or surveyor has any personal or business affiliation that would result in a conflict of interest, he or she may notify the Department. If the Department has reason to believe the information to be true, the Department shall not assign the inspector or surveyor to the hospital or any hospital within its organization.

This provision is identical to SCS/SB 415 (2019) and a provision in the perfected SS/SCS/SBs 70 & 128 (2019) and substantially similar to HB 758 (2019).

CERTIFICATES OF NEED (Sections 197.305 and 197.318)

This act modifies provisions related to certificates of need by removing references to non-applicability reviews, changing the average occupancy rate for long-term care facilities seeking increased licensed bed capacities from 90% average occupancy rate for the previous six quarters to 85% average occupancy rate for the previous six quarters. Additionally, a long-term care facility may transfer or sell licensed and available beds, but any facility doing so shall not expand its licensed bed capacity for a period of five years and until the average occupancy of licensed and available beds in that licensure category within a 15-mile radius is 85% for the prior six quarters. Any facility which transfers or sells licensed and available beds shall have an average occupancy rate of less than 70% in the last six quarters.

These provisions are identical to HCS/HB 1170 (2019).


This act requires certified nursing assistant training programs to be offered at skilled nursing or intermediate care facility units in Missouri veterans homes and hospitals. Certified nursing assistants shall include certain employees at such units and hospitals who have completed the training and passed the certification examination. Training shall include on-the-job training at certain locations and the act repeals language pertaining to continuing in-service training. Persons who have completed the required hours of classroom instruction and clinical practicum for unlicensed assistive personnel under state regulations shall be allowed to take the certified nursing assistant examination and shall be deemed to have fulfilled the classroom and clinical standards requirements for designation as a certified nursing assistant. Finally, the Department of Health and Senior Services may offer additional training programs and certifications to students already certified as nursing assistants as specified in the act.

This provision is identical to SB 490 (2019), a provision in the perfected SS/SCS/SBs 70 & 128 (2019), and HB 817 (2019) and similar to SB 1062 (2018) and HB 2597 (2018).

THE "AUTHORIZED ELECTRONIC MONITORING IN LONG-TERM CARE FACILITIES ACT" (Section 198.610, 198.612, 198.614, 198.616, 198.618, 198.620, 198.622, 198.624, 198.626, 198.628, and 198.630)

This act establishes the "Authorized Electronic Monitoring in Long-Term Care Facilities Act". Under these provisions, a long-term care facility resident may conduct authorized electronic monitoring of his or her room if the facility permits such monitoring devices in its policies and procedures. Nothing in this act shall permit the use of electronic monitoring devices to take still photographs or for the non-consensual interception of private communications. The resident or the resident's representative, parent, or specified individuals, any roommates, and the facility shall consent in writing on a form prescribed by the Department, as specified in the act. Electronic monitoring shall be at the resident's own expense, including purchase, installation, and maintenance. The device shall be placed in a conspicuous location.

No person shall tamper with an installed device or any recording without the permission of the resident or resident's representative. A violation of this provision is a Class B misdemeanor. Any person who violates this provision in the commission of or to conceal a misdemeanor offense shall be guilty of a Class A misdemeanor or in the commission of or concealment of a felony such person shall be guilty of a Class D felony.

No facility shall access any video or audio recording created by a device without the written consent of the resident or resident's representative. Any copy shall only be disseminated as specified in the act. Any person who has reasonable cause to believe, as a result of a video or audio recording by a device under this act, that a resident has been a victim of sexual assault shall report such suspicions to the local law enforcement as specified in the act.

Each facility, if the facility's policies authorize electronic monitoring devices, shall post a sign at all building entrances stating such devices may be in use. Each facility shall annually report to the Department the number of authorized devices and consent forms. No facility shall be civilly or criminally liable for a violation of a resident's right to privacy arising out of any electronic monitoring under this act. Finally, no person shall intentionally retaliate or discriminate against any resident for consenting to a monitoring device or prevent the installation or use of an authorized device by a resident.

These provisions are substantially similar to provisions in HCS/HB 1635 (2018).


Under this act, any intermediate care facility or skilled nursing facility participating in MO HealthNet that incurs total capital expenditures in excess of $2,000 per bed shall be entitled to obtain a recalculation of its Medicaid per diem reimbursement rate based on its additional capital costs or all costs incurred during the facility fiscal year during which such capital expenditures were made.

This provision is identical to the perfected SB 11 (2019), a provision in SCS/HCS/HB 466 (2019), a provision in SCS/SB 82 (2019), SB 863 (2018), and a provision in SB 906 (2018) and similar to SB 818 (2018) and HB 2068 (2018).

TELEHEALTH (Section 335.175)

This act removes the sunset provision on the utilization of telehealth for advanced practice registered nurses in rural areas of need.

This provision is identical to HB 226 (2019) and provisions in HCS/HB 301 (2019).


Under current law, a health carrier is required to send notice to a practitioner of the health carrier's receipt of the practitioner's application that seeks authorization for the practitioner to provide patient care services as a member of the health carrier's network. Under this act, a health carrier is required to assess a health care practitioner's credentialing information and to make a decision as to whether to approve or deny the application within 60 days, rather than 60 business days, of the date of receipt of the completed application. Once a practitioner has been credentialed or re-credentialed with a health carrier, the health carrier shall provide retroactive payments for any covered services performed by the practitioner during the application period.

This provision is identical to SB 396 (2019) and HB 654 (2019).


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