Missouri Senate

House Amendment

SICKLE CELL AWARENESS WEEK (Section 9.236)

This act establishes the third full week in September each year as "Sickle Cell Awareness Week".

This provision is identical to a provision in HCS/SS/SCS/SB 46 (2021).

HYPOPLASTIC LEFT HEART SYNDROME AWARENESS DAY (Section 9.288)

This act establishes April 18th of each year as "Hypoplastic Left Heart Syndrome Awareness Day" in Missouri.

This provision is identical to the perfected SB 93 (2021).

TARDIVE DYSKINESIA AWARENESS WEEK (Section 9.289)

This act designates the first full week of May each year as "Tardive Dyskinesia Awareness Week" to promote awareness of the movement disorder tardive dyskinesia. This provision shall expire on August 28, 2026.

This provision is identical to the perfected SCS/SB 403 (2021).

EMERGENCY HEALTH CARE SERVICES (Sections 173.260, 190.001, 190.060, 190.098, 190.100, 190.101, 190.103, 190.104, 190.105, 190.108, 190.109, 190.120, 190.131, 190.133, 190.142, 190.143, 190.146, 190.160, 190.165, 190.171, 190.173, 190.176, 190.180, 190.185, 190.190, 190.196, 190.200, 190.241, 190.243, 190.248, 190.257, and 287.243)

Under this act, the Department of Health and Senior Services shall cooperate with hospitals to provide public and professional information related to emergency medical services systems. The department may also provide public information of hospital designations as trauma, stroke, or STEMI centers. The department shall make publicly available research and guidelines recommended by the Time Critical Diagnosis Advisory Committee for recommended treatment standards. The act adds the state EMS medical director to the State Advisory Council on Emergency Medical Services, and requires the committee to review and make recommendations regarding all proposed community and regional time-critical diagnosis plans.

Currently, the Department makes recommendations for treatment standards, establishes protocols for transport of patients, and approves the development of regional or community-based plans for transporting STEMI or stroke patients. This act includes trauma patients.

Currently, the Department shall conduct a site review of a hospital to determine the applicable level of trauma center, STEMI, or stroke center criteria. Under this act, the site review may occur onsite or by any reasonable means of communication or combination thereof. In developing trauma, STEMI, or stroke center designation criteria, the Department shall use, as practicable, peer-reviewed and evidence-based clinical research and guidelines.

Currently, the Department shall conduct an onsite review of every trauma, STEMI, or stroke center every 5 years. Under this act, a site review shall be conducted every 3 years. The Department may deny, place on probation, suspend, or revoke a center's designation if it has been determined there has been a substantial failure to comply with certain regulations. Centers that have been placed in a probationary status shall show compliance with these regulations within 12 months, unless otherwise provided by a settlement agreement between the center and the Department with a maximum duration of 18 months.

This act modifies provisions governing alternative trauma, stroke, and STEMI center designations by repealing current law establishing various designation levels and requiring the Department to designate hospitals seeking alternative designation in manner that corresponds to a similar national designations.

This act modifies data submission requirements for designated centers to require submission to either a state or national registry. Additionally, this act repeals requirements that the data collections system to meet certain standards. The act provides that no hospital submitting data to a national data registry under the act shall withhold authorization from the Department to access the data through the national registry.

This act repeals provisions of current law granting the Board of Registration for the Healing Arts the sole authority to establish education requirements for physicians practicing in an emergency department in a trauma, STEMI, or stroke center. Instead, the Department shall not have authority to establish additional education requirements for emergency medicine board-certified or eligible physicians who are participating in the American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine maintenance of certification process and who are practicing in the emergency department of a designated center. The Department shall deem the education requirements of such entities to meet the standards for designation. Education requirements for other certified physicians, nurses, and other providers who provide care at the designated center shall mirror, but not exceed, those established by national designating or verifying bodies of trauma, stroke, or STEMI centers.

Under this act, the Department may only establish appropriate fees to offset the costs of center surveys.

Failure of a hospital to provide all medical records and quality improvement documentation necessary for the Department to implement the provisions of this act shall result in the revocation of the hospital's designation as a trauma, STEMI, or stroke center. Any medical records obtained by the Department shall be used only for purposes of implementing this act and the names of hospitals, physicians, and patients shall not be released by the Department or members of review teams.

This act adds physician assistants to the list of providers who shall instruct ambulance personnel to transport a severely ill patient to a trauma, STEMI, or stroke center.

This act establishes the "Time Critical Diagnosis Advisory Committee" within the Department for the purpose of advising and making recommendations to the Department on improving public and professional education related to time critical diagnosis; engagement in cooperative research endeavors; developing standards and policies relating to time critical diagnosis; and reviewing and recommending community and regional time critical diagnosis plans. The director of the Department shall appoint 16 members to the committee, as specified in the act.

This act repeals a provision of law relating to peer review systems for trauma, STEMI, and stroke cases.

This act repeals the requirement under current law that hospitals disclose data elements under the Missouri Brain and Spinal Cord Injury Registry to the Department.

This act makes technical changes to the trauma, STEMI, and stroke center designation statutes.

These provisions are identical to provisions in HCS/SS/SCS/SB 43 (2021) and HCS/HB 1295 (2021) and similar to SB 541 (2021).

AMBULANCE DISTRICTS (Section 190.053)

Under current law, if any ambulance district board member fails to attend a training session within 12 months of taking office, the member shall not be compensated for meeting attendance until he or she has completed the training. Under this act, if such board member fails to attend a training session with 12 months of taking office, regardless of whether the member received an attendance fee for a training session, the board member shall be ineligible to run for reelection for another term of office until the board member satisfies the training requirement of this provision. This change only applies to members elected after August 28, 2021.

This provision is identical to a provision in HCS/HB 1016 (2021), HCS/SS/SCS/SB 43 (2021), and SB 512 (2021).

HEALTH INFORMATION NETWORKS (Section 191.237)

Under this act, a participant in a health information network may disclose, access, or use individually identifiable information through the network in accordance with this act and the federal Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH); provided, that an individual has the right to opt out of having his or her identifiable information accessible or delivered through the network. A health information network shall implement policies governing privacy and security of individually identifiable information accessible or delivered through the network. Participants shall maintain a written notice of privacy practices for the network, and shall post such practices on their publicly accessible website.

A health information network shall not be considered a health care provider under this act and shall not be subject to liability for damages or costs arising out a civil action related to rendering of or failure to render health care services. Participants and staff, officers, and members of the board of directors of a health information network shall not be liable in actions for damages or costs, as described in the act. Individually identifiable information received from participants and accessed through a network under this act shall not be subject to discovery or subpoena and no health information network or participant shall be compelled by a request for production, subpoena, court order, or otherwise, to disclose individually identifiable information received from another participant.

These provisions shall not be construed as implementing a prescription drug monitoring program under the Department of Health and Senior Services' authority or compelling a health care provider to report prescription drug information to the Department.

These provision are similar to SB 537 (2021) and SB 1049 (2020).

COMMUNICABLE DISEASES (Section 191.677, 545.940, 575.155, and 575.157)

Under current law, it is illegal for a person knowingly infected with HIV to donate blood, organs, tissue, or sperm, unless for medical research, as well as illegal for such person to ack recklessly in exposing another person to HIV without their knowledge and consent.

This act modifies those provisions to make it unlawful for a person knowingly infected with a serious infectious or communicable disease to: (1) donate blood, organs, tissue, or sperm, unless for medical research or as deemed medically appropriate by a licensed physician; (2) knowingly expose another person to the disease through an activity that creates a substantial risk of transmission; or (3) act in a reckless manner by exposing another person to the disease through an activity that creates a substantial risk of disease transmission. A "serious infectious or communicable disease" is defined as a non-airborne or non-respiratory disease spread from person to person that is fatal or causes disabling long-term consequences in the absence of lifelong treatment and management. The penalty for donation of blood, organs, tissue, or sperm while knowingly infected with the disease or knowingly exposing another person to the disease shall be a Class D felony, rather than the current Class B felony, and a Class C felony, rather than the current Class A felony, if the victim contracts the disease. The penalty for recklessly exposing another person is a Class A misdemeanor.

It shall be an affirmative defense to this offense if the person exposed to the disease knew that the infected person was infected with the disease at the time of the exposure and consented to the exposure.

This act specifies the actions to be taken during a judicial proceeding to protect the identifying information of the victim and the defendant from public release, except as otherwise specified. Additionally, this act changes similar provisions involving exposure of persons in correctional centers, jails, or certain mental health facilities to HIV or hepatitis B or C to exposure to a serious infectious or communicable disease when the nature of the exposure to the bodily fluid has been scientifically shown to be a means of transmission of the disease.

These provisions are substantially similar to HCS/HB 755 (2021) and similar to SCS/SB 65 (2021) and HB 1691 (2020).

FORENSIC EXAMINATIONS (Sections 192.2520 and 197.315)

This act requires the statewide coordinator for the telehealth network for forensic examinations of victims of sexual offenses to regularly consult with Missouri-based stakeholders and clinicians regarding the training programs offered by the network, as well as the implementation and operation of the network. Current law permits the training to be offered online or in person and this act requires that the training be made available online and permits it to be offered in person. Providers shall not be required to utilize this training, so long as the training utilized by providers is, at a minimum, equivalent to the network's training.

Current law requires licensed hospitals to perform forensic examinations of victims of sexual offenses beginning January 1, 2023. Under this act, such requirement shall only occur beginning January 1, 2023, or no later than 6 months after the establishment of the telehealth network, whichever is later. Under current law, victims under the age of 14 shall be referred to a SAFE CARE provider, as defined by law; the act provides that victims between 14 and 17 years of age may be referred as well. Lastly, no individual hospital shall be required to comply with these provisions unless and until the Department of Health and Senior Services provides such hospital with access to the network for mentoring and training services without charge.

These provisions are identical to provisions in HCS/SS/SCS/SB 43 (2021) and similar to SB 550 (2021).

MO HEALTHNET ANTIPSYCHOTIC MEDICATION (Sections 208.226 and 208.227)

Currently, no restrictions to access shall be imposed that preclude the availability of any individual atypical antipsychotic monotherapy for the treatment of certain disorders in MO HealthNet participants. Under this act, no such restrictions shall be imposed for any individual antipsychotic medication. Additionally, this act modifies current law regarding the MO HealthNet Division's requirements to issue a provider update regarding cost considerations when enumerating treatment and utilization principles, as well as repeals language regarding the Division's adherence to certain principles when implementing new policies and clinical edits for antipsychotic drugs.

This provision is substantially similar to SB 173 (2021), SB 666 (2020), and HB 867 (2019).

FEMININE HYGIENE PRODUCTS (Sections 217.199 and 221.065)

The Director of Corrections and any sheriff or jailer who holds a person in custody shall ensure that an appropriate quantity of feminine hygiene products are available at no cost to female offenders while confined in any correctional center or jail. The General Assembly may appropriate funds to assist with the funding of this requirement.

These provisions have an emergency clause.

These provisions are identical to SB 128 (2021) and HB 318 (2021) and similar to provisions in the perfected SS/SB 212 (2021).

ASSISTANT PHYSICIANS (Section 334.036)

This act repeals provisions of current law limiting assistant physicians to providing primary care services in pilot project areas, while retaining the authority to practice in medically underserved areas of the state. Additionally, no individual shall hold an assistant physician license for more than 3 years.

COVID-19 VACCINE ADMINISTRATION (Section 338.010)

This act modifies the definition of pharmacy to include the administration of COVID-19 vaccines.

HIV POSTEXPOSURE PROPHYLAXIS DISPENSATION (Section 338.010

This act allows a pharmacist to dispense medication for HIV postexposure prophylaxis subject to a written protocol authorized by a licensed physician. Such prophylaxis shall include drugs approved by the Food and Drug Administration that meet the same clinical eligibility recommendations provided in current HIV guidelines published by the Centers for Disease Control and Prevention. The State Board of Registration for the Healing Arts and the State Board of Pharmacy shall jointly promulgate rules and regulations for the administration of this act and shall not do so separately.

These provisions are identical to SCS/SB 79 (2021) and similar to HB 2304 (2020).

"RX CARES FOR MISSOURI" PROGRAM (Section 338.710)

This act modifies the expiration date of the RX Cares for Missouri Program from August 28, 2019, to August 28, 2026.

This provision is identical to SB 519 (2021) and provisions in the perfected SS/SB 63 (2021).

CHILD HEARING AIDS (Section 376.1228)

This act requires health benefit plans delivered, issued, continued, or renewed on or after January 1, 2022, to provide coverage to children under 18 years of age for those hearing aids which are covered for children receiving benefits under MO HealthNet.

This provision is identical to the perfected SS/SCS/SB 43 (2021) and a provision in SCS/HS/HB 432 (2021) and similar to HB 289 (2021).

PREPAID DENTAL PLANS (Section 376.1575)

This act adds prepaid dental plans to the definition of "health carrier" for purposes of statutes regulating the assessment and validation of practitioners' qualifications to provide patient care services and act as a member of the health carrier's provider network.

This provision is identical to SB 484 (2021) and HB 1002 (2021).

SPECIAL VICTIMS (Section 565.058)

This act provides that any special victim, as defined by law, shall not be required to reveal any current address or place of residence except to the court when in the private chamber of a judge for the purpose of determining jurisdiction and venue. Additionally, any special victim may file a petition with the court alleging assault in any degree by using his or her identifying initials instead of his or her legal name if said petition alleges that he or she would be endangered by such disclosure.

This provision is identical to SB 513 (2021) and HCS/HB 1022 (2021).

OFFENSES OF INTERFERENCE WITH HEALTH CARE FACILITIES AND AMBULANCES (Section 574.203 and 574.204)

This act creates the offense of interference with a health care facility if such person willfully or recklessly interferes with a health care facility or an employee of such by causing a peace disturbance while inside the facility, refusing an order to vacate a facility, or threatening to inflict injury on patients or employees of the facility or damage the property of the facility. Such offense shall be a Class D misdemeanor on the first offense and a Class C misdemeanor for an subsequent offense. "Health care facility" is defined as a hospital that provides health care services directly to patients.

This act creates the offense of interference with an ambulance service if the person willfully or recklessly interferes with access to or from an ambulance or disrupts ambulance service by threatening to inflict injury on any person providing ambulance services or damage the ambulance. Such offense shall be a Class D misdemeanor on the first offense and a class C misdemeanor for an subsequent offense.

These provisions are identical to HCS/HB 1022 (2021).

SYRINGE ACCESS PROGRAMS (Sections 579.040 and 579.076)

Under this act, any entity registered with the Department of Health and Senior Services that possesses, distributes, or delivers hypodermic needles or syringes for the purposes of operating a syringe exchange program or otherwise mitigating health risks associated with unsterile injection drug use shall be exempt from the offense of unlawful distribution, delivery or sale of drug paraphernalia, if such entity is not located within 500 feet of a school building, as well as the offense of unlawful manufacturing with intent to deliver drug paraphernalia.

These provisions are substantially similar to HB 1486 (2020), SB 668 (2020), HCS/SS/SB 580 (2020), and HCS/HB 168 (2019) and similar to SCS/HB 1620 (2019).

SARAH HASKINS

HA# 1: MODIFIES AND EXTENDS MO HEALTHNET FEDERAL REIMBURSEMENT ALLOWANCE TAXES (FRA) FROM 2021 TO 2022; ADDS THE "KRATOM CONSUMER PROTECTION ACT"; MODIFIES PROVISION IN HCS RELATING TO THE "JUSTICE FOR SURVIVORS ACT"; MODIFIES PROVISIONS RELATING TO MO HEALTHNET COVERAGE OF CONTRACEPTIVES; REMOVES PROVISION IN HCS RELATING TO ASSISTANT PHYSICIANS; MODIFIES PROVISION IN HCS RELATING TO COVID-19 VACCINE ADMINISTRATION; AND MODIFIES PROVISION IN HCS RELATING TO INTERFERENCE WITH AN AMBULANCE