Missouri Senate

House Committee Substitute

JOINT COMMITTEE ON SUBSTANCE ABUSE PREVENTION AND TREATMENT (Section 21.790)

This act establishes the "Joint Committee on Substance Abuse Prevention and Treatment". The Committee shall be comprised of sixteen members, including six from the House of Representatives, six from the Senate, and four appointed by the Governor, as specified in the act. The Committee shall conduct hearings on current and future drug and substance use and abuse in Missouri, explore solutions to such issues, and draft or modify legislation as necessary to effectuate the goals of finding and funding education and treatment solutions. The Committee shall report annually to the General Assembly and Governor with recommendations for legislation pertaining to substance abuse prevention and treatment.

This provision is identical to HB 240 (2019).

TREATMENT OF SUBSTANCE USE DISORDERS (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".

Under this act, 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 medications set forth in the act. 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; 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.

Drug courts or other diversion programs that provide for alternatives to jail or prison for persons with a substance use disorder shall be required to ensure all persons under their care are assessed for substance use disorders using standard diagnostic criteria. Such court or program shall make the MAT services available, consistent with a treatment plan developed by a physician, and shall not impose any limitations on the type of medication or treatment prescribed.

These provisions are substantially similar to SCS/SB 507 (2019), HCS/SS/SCS/SBs 70 & 128 (2019), HB 904 (2019), and provisions contained in SCS/HB 758 (2019).

INFECTION CONTROL 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).

PREGNANCY-ASSOCIATED MORTALITY (Section 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 at least 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 shall be removed before any case is reviewed by the Board.

This act is similar to SCS/HB 758 (2019), SB 480 (2019) and HB 664 (2019).

COLLABORATIVE PRACTICE ARRANGEMENTS (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 removes the definitions of "supervision", "physician assistant supervision agreement", and references to "supervision agreement" or "supervising physician" and replaces such references with "collaborative practice arrangement" or "collaborating physician". "Collaborative practice arrangement" is defined as a written agreement, jointly agreed upon protocols, or standing orders for the delivery of health care services.

A physician assistant, or an assistant physician in a collaborative practice arrangement with a physician may, under this act, prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between the physician and patient. (Section 334.108)

Under this act, a physician assistant is defined as a person who has graduated from a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant, prior to 2001, or the Committee on Allied Health Education and Accreditation or the Commission on Accreditation of Allied Health Education Programs, rather than a person accredited by the American Medical Association's Committee on Allied Health Education and Accreditation.

Current law requires a supervising physician designated in a supervision agreement to see a patient for evaluation and approve or formulate a plan of treatment for new or significantly changed conditions no more than two weeks after the patient has been seen by a physician assistant. Such supervising physician shall determine and document the completion of at least a one-month period of time during which the physician assistant shall practice with the supervising physician continuously present before practicing in a setting where a supervising physician is not continuously present. This act repeals such provisions.

Under this act, a physician may enter into a collaborative practice arrangement with a physician assistant. Such arrangements, which shall be in writing, may delegate to a physician assistant the authority to prescribe, administer, or dispense drugs, and provide treatment which is within the skill, training, and competence of the physician assistant. Such arrangements may delegate the authority to administer, dispense, or prescribe controlled substances listed in Schedules III, IV, and V, and Scheduled II-hydrocodone. Schedule III and Schedule II-hydrocodone prescriptions shall be limited to a 12-hour supply without a refill. Such arrangement shall include certain provisions set forth in the act.

Within 30 days of any change, and upon each renewal of an arrangement, the State Board of Registration for the Healing Arts shall require every physician to identify whether the physician is engaged in any collaborative practice arrangement, and report to the Board the name of each physician assistant with whom the physician has entered into such an arrangement. Such information may be made available to the public, and the Board is required to track the reported information.

A collaborating physician shall determine and document the completion of a period of time during which the physician assistant shall practice with the physician before practicing in a setting where the collaborating physician is not continuously present. This limitation, however, shall not apply to collaborative arrangements of providers of population-based public health services. No arrangement shall require a physician assistant to collaborate with any physician against the physician assistant's will. (Section 334.735)

These provisions are identical to provisions contained in HB 705 (2019) and HB 840 (2019).

ELECTRONIC PRESCRIPTIONS (Sections 195.060, 195.550, 196.100, 221.111, 338.015, 338.055, 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 discipline by his or her professional licensing board. The Department of Health and Senior Services shall enforce the provisions of this act.

These provisions are identical to SCS/SB 262 (2019) and are similar to HB 293 (2019).

PRESCRIPTION LIMITATIONS (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 (2019) and HB 986 (2019).

PRESCRIPTION OF NICOTINE REPLACEMENT THERAPY PRODUCTS (Section 338.010 and 338.800)

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 act is identical to HCS/HB 725 (2019), and is substantially similar to SB 309 (2019).

PRESCRIBING AUTHORITY OF 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.

OUT-OF-NETWORK CARE (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 act is identical to SB 103 (2019) and to a provision in the HB 83 (2019).

CREDENTIALING PROCEDURES FOR HEALTH CARE PRACTITIONERS (Section 376.1578)

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), HCS/HB 654 (2019), and is substantially similar to a provision contained in SCS/HB 758 (2019).

DRUG TRAFFICKING OFFENSES (Sections 579.065 and 579.068)

This act modifies current law for the Class B felony offense of trafficking of drugs in the first degree by removing the ceiling of the ranges of grams or milligrams of various controlled substances a person knowingly distributes, delivers, manufactures, produces, or attempts to so, including heroin, cocaine, LSD, PCP, phencyclidine, marijuana, and amphetamines and methamphetamines. Additionally, this act adds specified amounts of flunitrazepam, gamma-hydroxybutyric acid, and fentanyl and carfentanyl to the list of controlled substances for the Class B felony and the Class A felony offenses.

This act also modifies current law for the Class C felony offense of trafficking of drugs in the second degree by removing the ceiling of the ranges of grams or milligrams of various controlled substances a person knowingly possesses, purchases, or brings into the state, including heroin, cocaine, LSD, PCP, phencyclidine, marijuana, and amphetamines and methamphetamines. Additionally, this act adds fentanyl and carfentanyl to the list of controlled substances for the Class C felony and the Class B felony offenses. Trafficking in the second degree for less than one gram of flunitrazepam shall be a Class C felony for the first offense and a Class B felony for the second and subsequent offense.

This act is similar to provisions in the perfected SCS/SB 6 (2019).

JOSIE BUTLER