Missouri Senate

Perfected

MEDICAL PRECEPTORSHIP TAX CREDIT (Section 135.690)

For all tax years beginning on or after January 1, 2023, this act authorizes a taxpayer to claim a tax credit for serving as a community-based faculty preceptor for a medical student core preceptorship or a physician assistant student core preceptorship, as such terms are defined in the act. The tax credit shall be equal to $1,000 for each preceptorship, but not to exceed $3,000 in any tax year. Tax credits authorized by the act shall not be refundable or transferable, and shall not be carried forward or backward to any other tax year. The total amount of tax credits authorized in a given year shall not exceed $200,000. Additional tax credits may be authorized provided in amount not to exceed the excess funds available in the Medical Preceptor Fund, as created by the act.

Beginning January 1, 2023, the Division of Professional Registration of the Missouri Department of Commerce and Insurance shall increase the license fees for physicians and surgeons by $7 and for physician assistants by $3, with such revenues to be deposited in the Medical Preceptor Fund. At the end of each tax year, an amount equal to the total dollar amount of tax credits claimed during the tax year shall be transferred to the General Revenue Fund.

This provision is substantially similar to a provision in HCS/SB 710 (2022), SCS/SB 801 (2022), a provision contained in SS/HB 502 (2021), HCS/SCS/SB 403 (2021), HCS/SS/SB 580 (2020), and HB 2036 (2020).

MEDICAL STUDENT LOAN PROGRAMS (Sections 191.500, 191.515, 191.520, 191.525, 335.230, and 335.257)

This act modifies provisions of current law relating to the medical student loan program administered by the Department of Health and Senior Services by adding psychiatry, dental surgery, dental medicine, or dental hygiene students to the list of eligible students in the program, as well as adding psychiatric care, dental practice, and dental hygienists to the definition of "primary care". Additionally, this act modifies the loan amount students may be eligible to receive from $7,500 each academic year to $25,000 each academic year.

This act also modifies the Nursing Student Loan Program by modifying the amount of financial assistance available to students from $5,000 each academic year for professional nursing programs to $10,000 each academic year and from $2,500 each academic year for practical nursing programs to $5,000 each academic year.

Finally, this act modifies the Nursing Student Loan Repayment Program by removing the June and December deadlines for qualified employment verification while retaining the requirement that such employment be verified twice each year.

These provisions are similar to SB 757 (2022) and provisions in SCS/SB 1045 (2022).

OLDER AMERICANS ACT (Sections 192.2001, 251.070, and 660.010)

This act transfers authority for the implementation of the federal Older Americans Act of 1965 from the Department of Social Services to the Department of Health and Senior Services.

These provisions are similar to SB 1045 (2022).

OVERSIGHT OF HEALTH CARE FACILITIES (Sections 192.2225, 197.100, 197.256, 197.258, 197.415, 198.006, 198.022, 198.026, 198.036, 198.525, 198.526, and 198.545)

Currently, the Department of Health and Senior Services conducts at least two inspections per year for licensed adult day care programs, at least one of which is unannounced. Under this act, the Department shall be required to conduct at least one unannounced inspection per year.

Currently, the Department conducts an annual inspection of licensed hospitals. Under this act, such inspections shall instead be performed in accordance with the schedule set forth under federal Medicare law.

A hospice currently seeking annual renewal of its certification shall be inspected by the Department of Health and Senior Services. Under this act, the Department may conduct a survey to evaluate the quality of services rendered by the applicant. Additionally, current law requires annual inspections of a certified hospice and this act instead requires such inspections to be performed in accordance with the schedule set forth under federal Medicare law.

Currently, the Department conducts an inspection of licensed home health agencies at least every 1 to 3 years, depending on the number of months the agency has been in operation following the initial inspection. Under this act, such inspections shall instead be performed in accordance with the schedule set forth under federal Medicare law.

This act updates a reference to a Missouri regulation regarding long-term care facility orientation training.

Current law requires the Department to inspect long-term care facilities at least twice a year, one of which shall be unannounced. Under this act, the Department shall be required to conduct at least one unannounced inspection per year. Additionally, current law requires that the Department issue a notice of noncompliance or revocation of a license by certified mail to each person disclosed to be an owner or operator of a long-term care facility. This act instead requires that such notice be sent by a delivery service to the operator or administrator of the facility.

Finally, this act modifies the "Missouri Informal Dispute Resolution Act" relating to informal dispute resolutions between the Department of Health and Senior Services and licensed long-term care facilities. Current law requires the Department to send to a facility by certified mail a statement of deficiencies following an inspection. This act requires that such notice be sent by a delivery service that provides dated receipt of delivery. Additionally, current law provides a facility ten calendar days following receipt of notice to return a plan of correction to the Department. This act changes the ten calendar days to ten working days.

These provisions are identical to SB 1029 (2022) and provisions in SCS/SB 1045 (2022) and substantially similar to provisions of SB 342 (2021).

ORGAN DONATION (Sections 194.210, 194.255, 194.265, 194.285, 194.290, 194.297, 194.299, 194.304, 194.321, 301.020, and 302.171)

This act modifies the "Revised Uniform Anatomical Gift Act". Currently, moneys in the Organ Donor Program Fund are limited to use for grants by the Department of Health and Senior Services to certified organ procurement organizations for the development and implementation of organ donation programs, publication of informational booklets, maintenance of an organ donor registry, and implementation of organ donation awareness programs in schools. This act modifies the fund to be used by the Department for educational initiatives, donor family recognition efforts, training, and other initiatives, as well as reimbursement for expenses incurred by the Organ Donation Advisory Committee. The Department shall no longer be required to disperse grants to organ procurement organizations, but shall have the authority to enter into contracts with such organizations or other organizations and individuals for the development and implementation of awareness programs. Additionally, the moneys in the fund shall be invested and interest earned shall be credited to the fund. The fund may seek other sources of moneys, including grants, bequests, and federal funds.

Currently, applicants for motor vehicle registrations and driver's licenses may make a one dollar donation to the organ donor program fund. This act changes that to a donation of not less than one dollar.

Finally, this act makes technical changes to the organ donation statutes.

These provisions are substantially similar to SB 1146 (2022) and provisions in SCS/SB 1045 (2022).

This act prohibits hospitals, physicians, procurement organizations, or other person from considering COVID-19 vaccination status of a potential organ transplant recipient or potential organ donor in any part of the organ transplant process.

This provision is identical to a provision in HB 1861 (2022) and HCS/HBs 2358 & 1485 (2022).

HOME HEALTH LICENSING (Sections 197.400, 197.405, and 197.445)

Current law limits licensed home health agencies to those that provide two or more home health services at the residence of a patient according to a physician's written and signed plan of treatment. This act permits such licensed entities to provide treatment according to written plans signed by physicians, advanced practice registered nurses or physician assistants, as specified in the act.

These provisions are identical to provisions in HCS/HB 2434 (2022) and substantially similar to SCS/SB 830 (2022) and SB 177 (2021).

PHYSICAL THERAPISTS (Sections 334.100,334.506, and 334.613)

This act modifies provisions relating to the practice of physical therapy. Under this act, physical therapists

may evaluate and initiate treatment on a patient without a prescription or referral from an approved health care provider. Physical therapists may provide certain educational information, fitness or wellness programs, screenings, and consultations without a prescription or referral regardless of whether a patient is symptomatic.

This act repeals provisions allowing a physical therapist to examine and treat recurring self-limited injuries within one year of diagnosis and chronic illnesses that have been previously diagnosed by an approved healthcare provider. Additionally, this act repeals provisions of existing law permitting the Board of Registration for the Healing Arts to file a complaint against a physical therapist for practicing or offering to practice independent of a prescription and the direction of certain health care providers listed in current law.

These provisions are similar to provisions in HB 1555 (2022) and HCS/SB 330 (2021).

ADVANCED PRACTICE REGISTERED NURSES (Sections 334.104, 335.011, 335.016, 335.036, 335.046, 335.051, 335.056, 335.061, 335.066, 335.071, 335.076, 335.081, 335.175, and 335.221)

This act repeals the requirement of geographic proximity between advanced practice registered nurse and physicians in a collaborative practiced arrangement, as well as limiting telehealth in collaborative practice arrangements to rural areas of need.

These provisions are identical to HCS/HB 2434 (2022).

Currently, advanced practice registered nurses are certified as such by a national organization. This act creates a license to practice advanced practice, professional, or practical nursing. This act modifies existing definition and licensure statutes to create these new licenses and sets forth the educational and experience requires to obtain an advanced practice registered nurse license.

These provisions are identical to HB 1578 (2022).

PHARMACISTS (Sections 338.010, 338.011, and 338.165)

This act modifies several provisions relating to the administration of medications by pharmacists. First, this act modifies the definition of a medication therapeutic plan by repealing language defining it by the prescription order so long as the prescription order is specific to each patient for care by a pharmacist. This act also repeals language from current law defining the practice of pharmacy as including the administration of specific vaccines by written physician protocol for specific patients and adds language defining the practice of pharmacy as including the ordering and administering of U.S. FDA-approved or authorized vaccines, excluding specified vaccines, to persons at least 7 years of age or the CDC-approved age, whichever is older, pursuant to rules promulgated by the Board of Pharmacy and the Board of Registration for the Healing Arts or rules promulgated under a state of emergency.

Under current law, any pharmacist who accepts a prescription order for a medication therapeutic plan shall have a written protocol from the referring physician. This act repeals this provision and permits a pharmacist with a certificate of medication therapeutic plan authority to provide medication therapy services pursuant to a statewide order issued by the Department of Health and Senior Services or pursuant to a written protocol with a licensed physician.

This act repeals provisions of current law requiring pharmacists to administer vaccines by protocol in accordance with treatment guidelines established by the CDC and provisions requiring a pharmacist who is administering a vaccine to request a patient remain in the pharmacy a safe amount of time after administration of the vaccine to observe any adverse reactions.

Under this act, a licensed pharmacist may order and administer medication approved or authorized by the FDA to address a public health need, as authorized by the state or federal government, during a state or federally-declared public health emergency. Additionally, a licensed pharmacist may administer medication pursuant to a statewide standing order issued by the Director of the Department of Health and Senior Services, if a physician, or a physician on behalf of the Director, to address a public health need.

Finally, medication therapy services may be provided by a pharmacist for patients of a hospital pursuant to a statewide standing order issued by the Department or pursuant to a physician protocol.

These provisions are substantially similar to SB 1126 (2022) and HB 2452 (2022).

REPEAL OF CERTAIN STATUTES RELATING TO THE DUTIES OF THE DEPARTMENT OF HEALTH AND SENIOR SERVICES (Sections 191.743, 196.866, and 196.868)

Currently, physicians or health care providers who are providing services to women with high-risk pregnancies are required to identify such women and report them to the Department of Health and Senior Services within 72 hours for referral for services. The provision authorizing Department services for such women has previously been repealed and this act repeals the reporting requirements for the physicians and health care providers.

Additionally, producers of ice cream, mellorine, or other frozen dessert products are required to be licensed by the Department and pay an associated license fee. This act repeals such requirement and fee.

These provisions are identical to SB 1100 (2022) and provisions in SCS/SB 1045 (2022).

SARAH HASKINS