Missouri Senate

House Amendment

SICKLE CELL (Sections 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 SB 1145 (2022) and a provision in HB 2559 (2022), HCS/SS/SCS/SB 46 (2021), 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 act is similar to a provision in SB 1147 (2022) and HB 2559 (2022).

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. (Section 135.690)

This provision is substantially similar to 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).

WILL'S LAW (Sections 167.625 and 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 act contains an emergency clause.

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

ADMINISTRATION OF EPINEPHRINE AUTO SYRINGES (Section 167.630)

This act authorizes school contracted agents trained by a nurse to administer an epinephrine auto syringe on any student who is having a life-threatening anaphylactic reaction. This act also provides that trained contracted agents shall be immune from civil liability in the administration of a prefilled auto syringe.

This provision is identical to SB 1170 (2022), SB 1210 (2022), and provisions in SCS/HB 2151 (2022) and SS#2/SB 823 (2022).

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

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 January 1, 2023, and extends the task force expiration date from December 31, 2026, to December 31, 2027.

This provision is identical to a provision in SCS/SB 1045 (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 identical to SB 757 (2022) and provisions in SCS/SB 1045 (2022).

ABUSE AND NEGLECT (Sections 191.900, 191.905, 565.184, and 630.155)

This act modifies current law on abuse and neglect of certain vulnerable persons. This act contains provisions that prohibit a person from knowingly neglecting a person receiving health care, which shall be a Class D felony, unless the act involves no physical, sexual, or emotional harm or injury, in which case it shall be a Class A misdemeanor. This act also modifies the penalty of the existing offense of abuse of an elderly person, a person with a disability, or a vulnerable person from a Class A misdemeanor to a Class D felony. Finally, this act modifies the existing offense of patient, resident, or client abuse or neglect against a person admitted on a voluntary or involuntary basis to a mental health facility or mental health program from a Class E felony to a Class D felony.

These provisions are identical to provisions in SCS/SB 671 (2022) and SCS/HCS/HBs 2116, 2097, 1690, & 2221 (2022).

HEATH CARE FACILITY VISITATION (Section 191.1400)

This act establishes the "Compassionate Care Visitation Act". Under this act, a health care facility, defined as a hospital, hospice, or long-term care facility, shall allow a resident, patient, or guardian of such, to permit in-person contact with a compassionate care visitor during visiting hours. A compassionate care visitor may be the patient's or resident's friend, family member, clergy member or lay person offering religious or spiritual support, hairdresser or barber, or other person requested by the patient or resident. The compassionate care visitation is a visit necessary to meet the physical or mental needs of the patient or resident, including end-of-life care, assistance with hearing and speaking, emotional support, assistance with eating or drinking, or social support.

A health care facility shall allow a resident to permit at least 2 compassionate care visitors simultaneously to have in-person contact with the resident during visitation hours. Visitation hours shall include evenings, weekends, and holidays, and shall be no less than 6 hours daily. 24-hour visitation may be allowed when appropriate. Visitors may leave and return during visitor hours. Visitors may be restricted within the facility to the patient or resident's room or common areas and may be restricted entirely for reasons specified in the act.

By January 1, 2023, the Department of Health and Senior Services shall develop informational materials for patients, residents, and their legal guardians regarding the provisions of this act. Health care facilities shall make these informational materials accessible upon admission or registration and on the primary website of the facility.

No health care facility shall be held liable for damages in an action involving a liability claim against the facility arising from compliance with the provisions of this act; provided no recklessness or willful misconduct on the part of the facility, employees, or contractors has occurred.

The provisions of this act shall not be terminated, suspended, or waived except by a declaration by the Governor of a state of emergency, in which case the provisions of the "Essential Caregiver Program Act" shall apply.

These provisions are identical to provisions in SCS/HCS/HBs 2116, 2097, 1690, & 2221 (2022).

THE ESSENTIAL CAREGIVER PROGRAM ACT (Sections 191.2290 and 630.202)

This act establishes the "Essential Caregiver Program Act". During a governor-declared state of emergency, a hospital, long-term care facility, or facility operated, licensed, or certified by the Department of Mental Health shall allow a resident of such facility, or the resident's guardian or legal representative, to designate an essential caregiver for in-person contact with the resident in accordance with the standards and guidelines developed under this act. An "essential caregiver" is defined as a family member, friend, guardian, or other individual selected by a resident, or the guardian or legal representative of the resident. Essential caregivers shall be considered a part of the patient's care team, along with the resident's health care providers and facility staff.

The Department of Health and Senior Services and the Department of Mental Health shall develop the program's standards and guidelines, including: (1) allowing the resident to select at least two caregivers, although the facility may limit in-person contact to one at a time; (2) establishing an in-person contact schedule allowing for at least four hours each day; and (3) establishing procedures enabling physical contact between the caregiver and resident. The facility may require the caregiver to follow infection control and safety measures; provided that such measures are no more stringent than required for facility employees. Caregiver in-person contact may be restricted or revoked for caregivers who do not follow such measures.

A facility may request a suspension of in-person contact for a period not to extend seven days. The suspension may be extended, but not for more than fourteen consecutive days in a twelve-month period or more than forty-five days in a twelve-month period. The Department shall suspend in-person contact by essential caregivers under this act if it determines that doing so is required under federal law, including a determination that federal law requires a suspension of in-person contact by members of the resident's care team.

The provisions of this act shall not apply to those residents whose condition necessitates limited visitation for reasons unrelated to the stated reason for the declared state of emergency.

A facility, its employees, and its contractors shall be immune from civil liability for (1) an injury or harm caused by or resulting from exposure of a contagious disease or harmful agent or (2) acts or omissions by essential caregivers who are present in the facility, as a result of the implementation of the caregiver program. This immunity shall not apply to any act or omission of the facility, its employees, or its contractors that constitutes recklessness or willful misconduct.

This provisions are identical to provisions in SCS/HCS/HBs 2116, 2097, 1690, & 2221 (2022) and substantially similar to SCS/SB 671 (2022).

THE OLDER AMERICANS ACT (Sections 192.005, 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 identical to provisions in SCS/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 identical 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 2331 (2022), HB 1861 (2022), and HCS/HBs 2358 & 1485 (2022).

DRUG PARAPHERNALIA (Section 195.010)

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

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 act is similar to SB 1011 (2022) and SB 478 (2021).

CONSUMER-DIRECTED SERVICES (Section 208.909)

A vendor participating in the MO HealthNet consumer-directed services program shall ensure all payroll, employment, and other taxes are timely paid on behalf of the consumer and the vendor shall be liable to the consumer for any garnishment action occurring or that has occurred as a result of the vendor's failure to timely pay such taxes. The vendor shall also be subject to a $1,000 per occurrence penalty for failure to timely pay such taxes. The vendor shall notify the consumer of any communication or correspondence from any federal, state, or local tax authority of any overdue or unpaid tax obligations, as well as any notice of an impending garnishment.

This provision is identical to provisions in SCS/SB 671 (2022) and SCS/HCS/HBs 2116, 2097, 1690, & 2221 (2022).

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 SB 1100 (2022).

SARAH HASKINS

HA#1: MODIFIES HCS PROVISIONS RELATING TO THE ALZHEIMER'S STATE PLAN TASK FORCE AND THE ORGAN DONOR PROGRAM FUND; ADDS THE "KRATOM CONSUMER PROTECTION ACT"

HA#2: MODIFIES HCS PROVISIONS RELATING TO ABUSE AND NEGLECT AND THE "COMPASSIONATE CARE VISITATION ACT"; REMOVES THE "ESSENTIAL CAREGIVER ACT" FROM THE HCS

HA#3: ADDS LANGUAGE REQUIRING A COLLABORATIVE PROJECT BETWEEN THE DEPARTMENT OF MENTAL HEALTH AND THE DEPARTMENT OF SOCIAL SERVICES TO EXAMINE CONTINUED HOSPITALIZATION OF FOSTER CHILDREN AND DMH CLIENTS WITHOUT MEDICAL JUSTIFICATION

HA#4, AS AMENDED: ADDS LANGUAGE ESTABLISHING "MYASTHENIA GRAVIS AWARENESS MONTH" AND "CAREGIVER APPRECIATION DAY"

HA#1 TO HA#4: ADDS LANGUAGE ESTABLISHING "BILIARY ATRESIA AWARENESS DAY"

HA#5, AS AMENDED: MODIFIES HCS PROVISION RELATING TO COVID-19 VACCINATIONS AND ORGAN TRANSPLANTS

HA#1 TO HA#5: ADDS LANGUAGE RELATING TO PREPAID DENTAL PLANS

HA#6: ADDS LANGUAGE RELATING TO SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS

HA#7: ADDS THE "TRICIA LEANN THARP ACT" REGARDING SUICIDE AWARENESS AND PREVENTION AMONG PHARMACISTS

HA#8: ADDS LANGUAGE ESTABLISHING A TAX CREDIT FOR RURAL DENTISTS AND PRIMARY CARE PHYSICIANS

HA#9: ADDS LANGUAGE RELATING TO HOME HEALTH AGENCIES

HA#10: ADDS LANGUAGE RELATING TO PREPAID DENTAL PLANS

HA#11: ADDS LANGUAGE RELATING TO PATIENT EXAMINATIONS UPON ANESTHETIZED OR UNCONSCIOUS PATIENTS

HA#12: ADDS LANGUAGE RELATING TO THE AGE OF A MINOR PURCHASING TOBACCO PRODUCTS

HA#13: MODIFIES HCS PROVISIONS RELATING TO SUPPLEMENTAL HEALTH CARE SERVICES AGENCIES

HA#14, AS AMENDED: ADDS LANGUAGE ESTABLISHING "MISSOURI DONATE LIFE DAY"

HA#1 TO HA#14: ADDS LANGUAGE ESTABLISHING "BLACK MATERNAL HEALTH WEEK" AND "MINORITY HEALTH MONTH"

HA#15: ADDS LANGUAGE RELATING TO 340B DRUGS

HA#16: ADDS LANGUAGE RELATING TO PUBLIC HEALTH ORDERS, MASK REQUIREMENTS IN SCHOOLS, AND COVID-10 VACCINATIONS AND OTHER POLICIES IN SCHOOLS

HA#1 TO HA#16: AMENDS HA#16 BY REMOVING PROVISIONS RELATING TO SOVEREIGN AND OFFICIAL IMMUNITY

HA#17: ADDS LANGUAGE MODIFYING SUPPLEMENTAL WELFARE ASSISTANCE

HA#18: ADDS LANGUAGE EXTENDING THE MISSOURI RX PLAN

HA#19: ADDS LANGUAGE MODIFYING MEDICAL RETAINER AGREEMENTS TO PERMIT DENTISTS TO ENTER INTO SUCH AGREEMENTS

HA#20: ADDS LANGUAGE MODIFYING THE ABILITY OF PHARMACISTS TO DISPENSE CERTAIN CONTRACEPTIVES

HA#21, AS AMENDED: ADDS LANGUAGE GRANTING CERTAIN PREGNANT AND POSTPARTUM WOMEN MO HEALTHNET BENEFITS

HA#1 TO HA#21: ADDS THE "STOP THE BLEED ACT" RELATING TO TRAUMATIC BLOOD LOSS PROTOCOLS IN SCHOOLS

HA#3 TO HA#21: ADDS LANGUAGE RELATING TO TIME-CRITICAL DIAGNOSIS AND EMERGENCY MEDICAL SERVICES

HA#4 TO HA#21: ADDS LANGUAGE RELATING TO PHYSICAL THERAPIST EXAMINATIONS