Missouri Senate

House Committee Substitute

SICKLE CELL (Section 9.236 and 208.184)

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

This provision is identical to HCS#2/SB 710 (2022), SB 1145 (2022), a provision in HB 2559 (2022), HCS/SS/SCS/SB 46 (2021), and CCS#2/HCS/SS/SB 64 (2021).

Under this act, the Advisory Council on Rare Diseases and Personalized Medicine within the MO HealthNet Division shall annually review specified issues relating to sickle cell disease, including medications and treatment options. After each annual review, the Division may develop a report of the review to be made available to the public.

This provision is identical to a provision in HCS#2/SB 710 (2022) and similar to a provision in SB 1147 (2022) and HB 2559 (2022).

SUBSTANCE ABUSE AWARENESS AND PREVENTION MONTH (Section 9.347)

This act establishes October as "Substance Abuse Awareness and Prevention Month".

This provision is identical to HB 1838 (2022).

BLACK MATERNAL HEALTH WEEK (Section 9.364)

This act establishes the week of April 11 through April 17 of each year as "Black Maternal Health Week".

MINORITY HEALTH MONTH (Section 9.365)

This act establishes April as "Minority Health Month".

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 provisions in HCS#2/SB 710 (2022), SCS/SB 801 (2022), SS/HB 502 (2021), HCS/SCS/SB 403 (2021), HCS/SS/SB 580 (2020), and HB 2036 (2020).

"STOP THE BLEED ACT" (Section 160.485)

This act establishes the "Stop the Bleed Act", requiring the Department of Elementary and Secondary Education to develop a traumatic blood loss protocol for school personnel before January 1, 2023, as specified in the act. The Department shall require school personnel to receive annual training in the use of bleeding control kits. Each school district and charter school shall implement the traumatic blood loss protocol before the end of the 2022-23 school year. The bleeding control kits in each classroom and training in their use shall be subject to appropriations by the General Assembly. School personnel who use the kits in good faith under this section shall be immune from civil liability unless the act or omission constitutes gross negligence or willful, wanton, or intentional misconduct.

This provision is substantially similar to HCS/HB 1722 (2022).

"WILL'S LAW" (Section 167.625 and Section B)

This act establishes "Will's Law," requiring individualized health care plans to be developed by school nurses in public schools and charter schools. Such plans shall be developed in consultation with a student's parent or guardian and appropriate medical professionals that address procedural guidelines and specific directions for particular emergency situations relating to the student's epilepsy or seizure disorder. Plans are to be updated at the beginning of each school year and as necessary. Notice must be given to any school employee that may interact with the student, including symptoms of the epilepsy or seizure disorder and any medical and treatment issues that may affect the educational process.

All school employees shall be trained every two years in the care of students with epilepsy and seizure disorders. Training shall include an online or in-person course of instruction approved by the Department of Health and Senior Services. School personnel shall obtain a release from a student's parent to authorize the sharing of medical information with other school employees as necessary.

This act protects school employees from being held liable for any good faith act or omission while performing their duties.

This contains an emergency clause.

This provision is identical to provisions in HCS#2/SB 710 (2022), SCS/SB 187 (2021), and HCS/SS/SCS 152 (2021) and substantially similar to HB 2588 (2020).

SUICIDE AWARENESS AND PREVENTION (Sections 170.047, 170.048, 173.1200, and 338.061)

This act establishes the "Jason Flatt/Avery Reine Cantor Act", which provides that beginning in the 2023-2024 school year, each school district may offer at least 2 hours of suicide prevention training for all practicing teachers. All teachers, principals, and licensed educators may attend such a training or complete training on suicide prevention through self-review of suicide prevention materials. The Department of Elementary and Secondary Education may develop materials to be used for such training or may offer districts materials developed by a third party.

This provision is identical to a provision in HCS/SS/SCS/SBs 681 & 662 (2022) and HCS/HB 2136 (2022).

Beginning July 1, 2023, this act requires a public school or charter school with pupils in grades seven to twelve, as well as a public institution of higher education, that issues pupil or student identification cards to print the 3-digit dialing code that directs calls and routes text messages to the Suicide and Crisis Lifeline, 988.

These provisions are identical to provisions in HCS/SS/SCS/SBs 681 & 662), provisions in HCS/HB 2136 (2022), and similar to SCS/SB 1142 (2022).

This act also establishes the "Tricia Leann Tharp Act" and states that the Board of Pharmacy shall recommend 2 hours of continuing education in suicide awareness and prevention for all licensed pharmacists. The 2 hours of suicide awareness and prevention education would count toward the total continuing education requirement for license renewal for every pharmacist. The Board of Pharmacy is authorized to develop guidelines suitable for training materials.

This provision is identical to provisions in HB 1644 (2022), HCS/HB 2136 (2022), HCS/HB 1677 (2022), HB 2316 (2022), and HCS/HB 2452 (2022).

ALZHEIMER'S STATE PLAN TASK FORCE (Sections 172.800, 191.116, and Section B)

This act repeals an obsolete reference to the Alzheimer's Disease and Related Disorders Task Force. Additionally, the act changes the date that the Alzheimer's State Plan Task Force shall submit a report of recommendations from June 1, 2022, to November 1, 2022.

This provision has an emergency clause.

This provision is substantially similar to a provision in HCS#2/SB 710 (2022) and SCS/SB 1045 (2022).

PEER REVIEW COMMITTEES (Section 190.245)

Under this act, any emergency medical services provider licensed under certain provisions of state law shall be considered a health care professional for purposes of liability and disclosure of materials produced by a peer review committee. Any quality improvement or quality assurance activity required by such licensed individuals shall be considered an activity of a peer review committee.

This provision is identical to HB 2109 (2022) and SB 1059 (2022).

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 substantially similar to provisions in HCS#2/SB 710 (2022), SB 757 (2022), and SCS/SB 1045 (2022).

THE 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 provisions in HCS#2/SB 710 (2022) and SCS/SB 1045 (2022).

ORGAN DONATION (Sections 194.210, 194.255, 194.265, 194.285, 194.290, 194.297, 194.299, 194.304, 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 provisions in HCS#2/SB 710 (2022), SB 1146 (2022), and provisions in SCS/SB 1045 (2022).

DRUG PARAPHERNALIA (Section 195.010)

This act excludes from the definition of drug paraphernalia fentanyl testing strips.

This provision is identical to a provision in HCS#2/SB 710 (2022).

ADDICTION MITIGATION MEDICATION (Section 195.206)

Under this act, the Director of the Department of Health and Senior Services, if a licensed physician, or a licensed physician on behalf of the Director, may issue a statewide standing order for an addiction mitigation medication, defined as naltrexone hydrochloride administered in a manner approved by the U.S. Food and Drug Administration or any accepted medical practice method of administering.

Any licensed pharmacist may sell and dispense an addiction mitigation medication under a physician protocol or a statewide standing order. A pharmacist who, acting in good faith and with reasonable care, sells or dispenses the addiction mitigation medication and an appropriate device to administer the drug, and the protocol physician, shall not be subject to any criminal or civil liability or professional disciplinary action for prescribing or dispensing the medication and any outcome resulting from the administration of the medication. A physician issuing the statewide standing order shall likewise face no liability or professional discipline relating to the order or administration of the medication.

It shall be permissible for any person to possess an addiction mitigation medication.

This provision is identical to SB 1037 (2022).

"KRATOM CONSUMER PROTECTION ACT" (Section 196.1170)

This act creates the "Kratom Consumer Protection Act". Any dealer, as such term is defined in the act, preparing, distributing, selling, or exposing for sale a food represented to be a kratom product shall disclose on the product label the factual basis upon which the representation is made. Such dealer shall not prepare, distribute, sell, or expose for sale a kratom product: (1) adulterated with a dangerous non-kratom substance, including a substance that affects the quality or strength of the kratom product so as to render the product injurious to a consumer; (2) contaminated with a dangerous non-kratom substance, including a substance that is poisonous or otherwise deleterious; (3) containing a level of 7-hydroxymitragynine in the alkaloid fraction that is greater than 2% of the alkaloid composition of the product; (4) containing any synthetic alkaloids; or (5) does not include on its package or label the amount of mitragynine and 7-hydroxymitragynine contained in the product.

A dealer shall not distribute, sell, or expose for sale a kratom product to an individual under 18 years of age.

A dealer who violates certain labeling provisions of this act may be assessed a fine as specified in the act and a dealer who violates other provisions, including sales to minors and sales of contaminated or adulterated kratom products, shall be guilty of a Class D misdemeanor. Such dealer may also be subject to a civil cause of action by any aggrieved person for damages incurred.

This act shall preempt any existing or future order, ordinance, or regulation of kratom by any political subdivision of this state.

This act is identical to HB 1667 (2022) and SB 774 (2022) and HCS/HB 350 (2021) and substantially similar to HB 2061 (2020), provisions in HCS/SS/SB 580 (2020), and HCS/SCS/SB 662

(2020).

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 provisions in HCS#2/SB 710 (2022), SB 1029 (2022), and SCS/SB 1045 (2022) and substantially similar to provisions of SB 342 (2021).

HOME HEALTH LICENSING (Section 198.400)

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, nurse practitioners, clinical nurse specialists, or physician assistants, as specified in the act.

This provision is substantially similar to SCS/SB 830 (2022) and SB 177 (2021).

SUPPLEMENTAL HEALTH CARE SERVICES AGENCIES (Sections 198.640 to 198.648 and 210.921)

Under this act, a person who operates a supplemental health care services agency shall annually register with the Department of Health and Senior Services, as described in the act. A supplemental health care services agency is described as an agency that provides or procures employment for health care personnel in assisted living facilities, intermediate care facilities, residential care facilities, or skilled nursing facilities, or an agency that operates a digital website or smartphone application that facilitates the provision of such personnel.

A supplemental health care services agency shall, as a condition of registration, meet minimum criteria set forth in the act, including licensure and certification of health care personnel, background checks, proof of insurance, not restrict the employment opportunities of the health care personnel, reporting requirements, record maintenance, and liability.

This act modifies provisions of law relating to the release of information from the Family Care Safety Registry by modifying the definition of "employment purposes" to include direct or prospective independent contractor relationships of health care personnel with a supplemental health care services agency.

This provision is identical to HCS#2/SB 710 (2022) and similar to SB 1011 (2022) and SB 478 (2021).

MO HEALTHNET FOR PREGNANT AND POSTPARTUM WOMEN (Sections 208.151, 208.662, and B)

Currently, low-income pregnant and postpartum women receiving benefits through MO HealthNet for Pregnant Women or Show-Me Healthy Babies are eligible for pregnancy-related coverage throughout the pregnancy and for 60 days following the end of the pregnancy. Under this act, MO HealthNet coverage for these low-income women will include full Medicaid benefits for the duration of the pregnancy and for one year following the end of the pregnancy. This coverage shall begin April 1, 2022, or the effective date of the act, whichever is later, and shall continue during any period of time the federal authorization for such coverage is in effect. Currently, the federal American Rescue Plan of 2021 has authorized 5 years of this coverage.

These provisions have an emergency clause.

These provisions are substantially similar to SCS/SBs 698 & 639 (2022) and provisions in HCS/SS#2/SB 823 (2022), and SCS/HB 2012 (2022).

MO HEALTHNET SERVICES FOR CHILDREN WITH MEDICALLY COMPLEX CONDITIONS (Section 208.152)

Under this act, children with medically complex conditions shall be eligible for health home services beginning October 1, 2022.

THE MO RX PLAN (Section 208.798)

This act changes the expiration date of the Missouri Rx Plan from August 28, 2022, to August 28, 2029.

This provision is identical to SB 1179 (2022).

PHYSICAL THERAPISTS (Section 334.530 and 334.655)

Currently, a candidate for a physical therapy or physical therapist assistant license shall submit evidence of completion of physical therapy education program to the Board of Registration for the Healing Arts. This act adds that candidates may submit evidence of eligibility to graduate from such a program within 90 days. Additionally, this act requires applicants to meet the qualifying standards for fitness to practice examinations, including those established by any entity contracted by the Board to administer the Board-approved examination. No person who has failed on 6 or more occasions to achieve a passing score on the examination shall be eligible for licensure by examination.

These provisions are identical to provisions in SS/HB 2149 (2022) and SCS/SB 1153 (2022).

PHARMACISTS (Sections 338.010)

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 similar to provisions in HB 2331 (2022), SB 1126 (2022), and HB 2452 (2022).

DENTISTRY (Sections 376.427, 376.1575, and 376.1800)

This act adds prepaid dental plans to a statute requiring insurers to pay providers directly if a patient has assigned his or her insurance benefits to the provider.

This provision is identical to SCS/SB 1180 (2022) and similar to HB 2743 (2022).

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 1024 (2022), SB 484 (2021), HB 1002 (2021), and a provision in CCS#2/HCS/SS/SB 64 (2021).

Current law allows for physicians to enter into contracts for the provision of health care services to an individual for an agreed-upon fee and period of time. This act provides that dentists may enter into the contracts as well.

This provision is similar to SCS/SB 1097 (2022).

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 a quarter-mile of a school building, as well as the offense of unlawful manufacturing with intent to deliver drug paraphernalia.

These provisions are substantially similar to provisions in CCS#2/HCS/SS/SB 64 (2021), HB 1486 (2020), SB 668 (2020), HCS/SS/SB 580 (2020), and HCS/HB 168 (2019) and similar to SCS/HB 1620 (2019).

BEHAVIORAL CRISIS GRANT PROGRAM (Section 630.980)

Under this act and subject to appropriations, the Department of Mental Health shall establish a behavioral crisis grant program to assist non-profit organizations in the creation or maintenance of programs to support individuals experiencing behavioral crises.

REPEAL OF CERTAIN DEPARTMENT OF HEALTH AND SENIOR SERVICES STATUTES (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 provisions in HCS#2/SB 710 (2022), SCS/SB 1045 (2022), and SB 1100 (2022).

SARAH HASKINS