SS#2/HB 219 - This act modifies several provisions relating to health care, including: (1) the Health Professional Student Loan Repayment Program; (2) medication-assisted treatment; (3) pregnancy-associated mortality; (4) infection data reporting; (5) physician assistants; (6) electronic prescribing; (7) opioid prescriptions for sickle cell patients; (8) hospital inspections; (9) certified nursing assistants; (10) Ticket to Work Health Assurance Program; (11) MO HealthNet benefits for former foster youth; (12) MO HealthNet per diem reimbursement rates; (13) the Missouri RX Plan; (14) suspension of MO HealthNet benefits of offenders in correctional facilities and jails; (15) the prescribing of long-acting or extended-release opioids by dentists; (16) telehealth; (17) tobacco cessation; (18) pharmacist voluntary compliance agreements; (19) pharmacy pilot projects; (20) unanticipated out-of-network health care services; (21) utilization reviews; and (22) health insurance reimbursement.
HEALTH PROFESSIONAL STUDENT LOAN REPAYMENT PROGRAM (Sections 191.603, 191.605, and 191.607)
This act adds psychiatrists to the Health Professional Student Loan Repayment Program. The Department of Health and Senior Services shall designate areas of need for psychiatric services when such areas have been designated as mental health care professional shortage areas by the federal Department of Health and Human Services or when the Director of the Department of Health and Senior Services has determined such areas to have an extraordinary need.
These provisions are identical to the perfected SB 358 (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 identical to SCS/SB 480 (2019) and similar to HB 664 (2019).
INFECTION DATA REPORTING (Section 192.667)
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).
ELECTRONIC PRESCRIBING (Sections 195.060, 195.550, 196.100, 221.111, 338.015, 338.055, and 338.056)
Under this act and beginning January 1, 2021, no person shall issue a prescription for any Schedule II, III, or IV controlled substance unless the prescription is electronic and made to a pharmacy, excluding prescriptions issued in circumstances specified in the act. Pharmacists receiving a written, oral, or faxed prescription shall not be required to verify that the prescription falls into one of the exceptions and may continue to dispense medication from an otherwise valid non-electronic prescription. An individual who violates this provision may be subject to disciplinary action by his or her professional licensing board.
These provisions are identical to provisions in SCS/HB 240 (2019), substantially similar to SCS/SB 262 (2019), and similar to HB 293 (2019).
OPIOID PRESCRIPTIONS FOR SICKLE CELL PATIENTS (Section 195.080)
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).
HOSPITAL INSPECTIONS (Section 197.108)
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).
CERTIFIED NURSING ASSISTANTS (Section 198.082)
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).
TICKET TO WORK HEALTH ASSURANCE PROGRAM (Section 208.146)
This act changes the Ticket to Work Health Assurance Program's expiration date from August 28, 2019, to August 28, 2025.
This provision is identical to SB 232 (2019) and a provision in SCS/HCS/HB 466 (2019).
MO HEALTHNET BENEFITS FOR FORMER FOSTER YOUTH (Section 208.151)
Under this act, persons who reside in Missouri, are at least 18 years of age and under 26, and who have received foster care for at least six months in another state shall be eligible for MO HealthNet benefits.
This provision is identical to the perfected SB 514 (2019), a provision in SS/SCS/HCS/HB 397 (2019), as amended, and a provisions in SCS/HCS/HB 466 (2019).
MEDICAID PER DIEM REIMBURSEMENT RATES (SECTION 208.225)
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).
MISSOURI RX PLAN (Section 208.790)
Under current law, only Medicaid dual eligible individuals meeting certain income limitations are eligible to participate in the Missouri RX Plan. This act removes the Medicaid dual eligible requirement, while retaining the income limitations.
This provision is identical to SB 78 (2019), a provision in SCS/HCS/HB 466 (2019), SB 563 (2018), HB 1276 (2018), and HB 2278 (2018).
SUSPENSION OF MO HEALTHNET BENEFITS OF OFFENDERS IN CORRECTIONAL FACILITIES AND JAILS (Sections 217.930 and 221.125)
Under this act, MO HealthNet benefits shall be suspended, rather than cancelled or terminated, for offenders entering into a correctional facility or jail if the Department of Social Services is notified of the person's entry into the correctional center or jail, the person was currently enrolled in MO HealthNet, and the person is otherwise eligible for MO HealthNet benefits but for his or her incarcerated status. Upon release from incarceration, the suspension shall end and the person shall continue to be eligible for MO HealthNet benefits until such time as he or she is otherwise ineligible.
The Department of Corrections shall notify the Department of Social Services within 20 days of receiving information that person receiving MO HealthNet benefits is or will become an offender in a correctional center or jail and within 45 days prior to the release of such person whose benefits have been suspended under this act. City, county, and private jails shall notify the Department of Social Services within 10 days of receiving information that person receiving MO HealthNet benefits is or will become an offender in the jail.
These provisions are identical to SB 393 (2019), provisions in the perfected SS/SCS/SBs 70 & 128 (2019), and provisions in SCS/HCS/HB 466 (2019).
PRESCRIBING OF LONG-ACTING OR EXTENDED RELEASE OPIOIDS BY DENTISTS (Section 332.361)
Under this act, long-acting or extended-release opioids shall not be used to treat acute pain in dentistry. If the dentist, in his or her professional judgment, believes a long-acting or extended-release opioid is necessary to treat the patient, the dentist shall document and explain in the patient's dental record the reason for the necessity for the long-acting or extended-release opioid.
Dentists shall avoid prescribing doses greater than 50 morphine milligram equivalents (MME) per day for treatment of acute pain. If the dentist believes doses greater than 50 MME are necessary to treat the patient, the dentist shall document and explain the reason for the dose greater than 50 MME.
The Missouri Dental Board is required, under this act, to maintain an MME conversion chart and instructions for calculating MMEs on its website.
This provision is identical to the perfected SB 275 (2019).
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 a provision in SCS/HB 758 (2019), HB 226 (2019), and provisions in HCS/HB 301 (2019).
TOBACCO CESSATION (Sections 338.010 and 338.665)
Under this act, the practice of pharmacy shall include the prescribing and dispensing of any nicotine replacement therapy product. A nicotine replacement therapy product is defined as any drug, regardless of whether it is available over-the-counter, that delivers small doses of nicotine to a person and that is approved by the Food and Drug Administration (FDA) for the sole purpose of aiding in tobacco or smoking cessation. The Board of Pharmacy and the Board of Healing Arts shall, under this act, jointly adopt regulations governing a pharmacist's authority to prescribe and dispense nicotine replacement therapy products. Neither Board shall separately promulgate rules governing a pharmacist's authority to prescribe and dispense such products.
This provision is substantially similar to SB 309 (2019) and HCS/HB 725 (2019).
PHARMACIST VOLUNTARY COMPLIANCE AGREEMENTS (Section 338.140)
Under current law, the Board of Pharmacy may issue letters of reprimand, censure, or warning to any pharmacist licensed, registered, or with a permit in the state for any violations that could result in disciplinary action. Under this act, the Board may enter into a voluntary compliance agreement with a pharmacist to ensure or promote compliance with current law and the rules of the Board, in lieu of disciplinary action. The agreement shall be a public record, and the time limitation set forth under current law for commencing a disciplinary proceeding shall be tolled while an agreement authorized under this act is in effect.
This provision is identical to SB 253 (2019).
PHARMACY PILOT PROJECTS (Section 338.143)
Under this act, the Board of Pharmacy may approve, modify, and establish requirements for pharmacy pilot or demonstration research projects related to technology assisted verification or remote medication dispensing that are designed to enhance patient care or safety, improve patient outcomes, or expand access to pharmacy services. Such pilot or research projects shall be within the scope of the practice of pharmacy, be under the supervision of a Missouri licensed pharmacist, and comply with applicable compliance and reporting as established by the Board.
Board approval of such pilot or research projects shall be limited to a period of up to 18 months. The Board may approve an additional 6 month expansion if it is deemed necessary or appropriate to gather or complete research data or if it is deemed to be in the best interests of the patient. The board may rescind approval of a pilot program at any time if it is deemed necessary or appropriate in the interest of patient safety.
The provisions of this act shall expire on August 28, 2023. The Board shall provide a final report on the approved projects and related data or findings to the General Assembly on or before December 31, 2022. The name, location, approval dates, general description of and responsibilities for an approved pilot project shall be deemed an open record.
This provision is identical to SCS/SB 274 (2019).
UNANTICIPATED OUT-OF-NETWORK HEALTH CARE SERVICES (Section 376.690)
This act specifies that health care professionals shall, rather than may, utilize the process outlined in statute for claims for unanticipated out-of-network care.
This provision is identical to the perfected SB 103 (2019).
UTILIZATION REVIEWS (Sections 374.500, 376.1350, 376.1356, 376.1363, 376.1364, 376.1372, and 376.1385)
This act replaces "utilization review organization" with "utilization review entity", and "prospective review" with "prior authorization review" throughout the statutes relating to utilization reviews. Additionally, this act adds health care services that are denied under a utilization review to the definition of "adverse determination", including with regard to the reconsideration process. The definitions of "adverse determination" and "certification" are modified to refer to decisions made by "a utilization review entity" rather than a health carrier's "designee utilization review entity". "Certification" is also modified to require a guarantee of payment, provided the patient is still an enrollee at the time the certified health care service is provided. "Clinical review criteria" is modified to include several specific policies and rules, as well as any other criteria or rationale used by a health carrier or utilization review entity to determine appropriateness or necessity of health care services. "Health care service" is modified to specifically include the provision of drugs or durable medical equipment.
The act replaces references to "initial certification" with "certification" and "initial determination" with "determination". Currently, notice of an adverse determination is required to include instructions for requesting a written statement of the clinical rationale, including the clinical review criteria used to make the determination. This act repeals this requirement, specifies that the adverse determination notice shall include a written statement of the clinical rationale, requires notice to the health care provider, and repeals the requirement that notice of the adverse determination must be requested. Written procedures to address a failure or inability of a provider or enrollee to provide all information necessary to make a decision shall be made available on the health carrier's website or provider portal. Provided the patient is an enrollee of the health benefit plan, no utilization review entity shall revoke, limit, condition, or otherwise restrict a prior authorization within 45 working days of its receipt by a health care provider. Provided the patient is an enrollee of the health benefit plan at the time the service is provided, no health carrier, utilization review entity, or health care provider shall bill an enrollee for any health care service for which a prior authorization was in effect at the time the service was provided, except as consistent with cost-sharing requirements applicable to covered benefits.
Under the act, any utilization review entity performing prior authorization review shall provide a unique confirmation number to a provider upon receipt from that provider of a request for prior authorization. Confirmation numbers shall be transmitted or otherwise communicated through the same medium through which the requests for prior authorization were made.
No later than January 1, 2021, utilization review entities shall accept and respond to requests for prior authorization of drug benefits through a secure electronic transmission using the National Council for Prescription Drugs SCRIPT Standard Version 2017071 or a backwards-compatible successor adopted by the United States Department of Health and Human Services.
No later than January 1, 2021, utilization review entities shall accept and respond to requests for prior authorization of health care services and mental health services electronically, which shall not include facsimile, proprietary payer portals, and electronic forms.
No later than January 1, 2021, utilization review entities shall develop a single secure prior authorization cover page for all its health benefit plans utilizing prior authorization review, which the carrier or its utilization review entity shall use to accept and respond to, and providers shall use to submit, requests for prior authorization. The cover page shall include, but not be limited to, fields for certain information as specified in the act.
The act requires health carriers and utilization review entities to make available on its website or provider portal any current prior authorization requirements or restrictions, including written clinical criteria. Requirements and restrictions, including step therapy protocols, shall be described in detail. No health carrier or utilization review entity shall amend or implement a new prior authorization requirement or restriction prior to the change being reflected on the carrier or review entity's website or provider portal. Health carriers and utilization review entities shall provide in-network health care providers with written or electronic notice of the new or amended requirement not less than 60 days prior to implementing the requirement or restriction.
This act modifies the panel for a second-level grievance review for an adverse determination to require a majority of persons that are "clinical peers licensed to practice" rather than "appropriate clinical peers" in the same or similar specialty as would typically manage the case being reviewed.
These provisions are similar to SCS/SB 298 (2019).
HEALTH INSURANCE REIMBURSEMENT (Section 376.1345)
This act prohibits health carriers and entities acting on their behalf from restricting methods of reimbursement to a method requiring health care providers to pay a fee to redeem the amount of their claim for reimbursement, discount the amount of their claim for reimbursement, or remit any other form of remuneration in order to redeem the amount of their claim for reimbursement. Health carriers initiating or changing the method of reimbursement to such forms shall notify health care providers of the fee, discount, or other remuneration required to receive reimbursement through the new or different method and provide clear instructions to the provider as to how to select an alternative payment method. A health carrier shall allow the provider to select to be reimbursed electronically. Violation of these provisions shall be deemed an unfair trade practice under the Unfair Trade Practice Act.
These provisions are similar to SCS/SB 298 (2019), SB 302 (2019), and HB 492 (2019).
SA#1: REQUIRES HEALTH BENEFIT PLANS TO PROVIDE COVERAGE FOR CERTAIN OFF-LABEL USES OF DRUGS FOR CANCER TREATMENT
SA#2: MODIFIES PROVISIONS RELATING TO MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS
SA#3: PERMITS THE DEPARTMENT OF HEALTH AND SENIOR SERVICES TO CHARGE AN ADMINISTRATIVE FEE TO COVER THE COSTS OF ADMINISTERING THE MEDICAL MARIJUANA PROGRAM
SA#4: MODIFIES PROVISIONS RELATING TO SUICIDE ASSESSMENT AND TRAINING FOR MARITAL AND FAMILY THERAPISTS
SA#5: ESTABLISHES THE TASK FORCE ON SUBSTANCE ABUSE PREVENTION AND TREATMENT