Missouri Senate

Conference Committee Substitute

Missouri Dental Board pilot projects; (21) physical therapists; (22) audiologists and speech-language pathologists; (23) dentistry; (24) medical retainer agreements; (25) syringe access programs; (26) services for foster children and clients of the Department of Mental Health; (27) civil detentions; and (28) the repeal of certain Department of Health and Senior Services statutes.

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 a provision in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed SS/SCS/HCS/HB 2627 (2022), the truly agreed to and finally passed SS/SCS/HB 1738 (2022), SB 1145 (2022), HCS/HB 2462 (2022), HB 2559 (2022), HB 2653 (2022), HCS/HB 2658 (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 the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), HCS/HB 2658 (2022), and HB 2653 (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 a provision in the truly agreed to and finally passed SS/SCS/HB 1738 (2022), HCS/HB 2463 (2022), and 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".

This provision is identical to a provision in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022).

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 the truly agreed to and finally passed SS/SCS/HB 2331 (2022), SCS/SB 801 (2022), 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 provision contains an emergency clause.

This provision is identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed CCS#2/HCS/SS/SCS/SBs 681 & 662 (2022), SCS/SB 187 (2021), and provisions in HCS/SS/SCS 152 (2021) and is 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 provision in the truly agreed to and finally passed CCS#2/HCS/SS/SCS/SBs 681 & 662 (2022) and HCS/HB 2136 (2022) and substantially similar to SCS/SB 1142 (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 the truly agreed to and finally passed HCS/HB 718 (2022), SCS/SB 1142 (2022), and HCS/HB 2136 (2022) and similar to HB 2238 (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).

EMERGENCY HEALTH CARE SERVICES (Sections 190.100, 190.101, 190.103, 190.176, 190.200, 190.241, 190.243, 190.245, and 190.257)

Under this act, the state EMS medical director shall serve as an ex officio member of the State Advisory Council on Emergency Medical Services. The Council shall consult with the Time-Critical Diagnosis Advisory Committee established under this act regarding time-critical diagnosis, defined as trauma care, stroke care, and STEMI care occurring either outside of a hospital or in a designated center.

The State EMS Medical Director's Advisory Committee shall review and make recommendations regarding all proposed community and regional time-critical diagnosis plans.

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 of Health and Senior Services' uniform data collection system on all ambulance runs and injured patients.

The Department shall cooperate with hospitals to provide public and professional information related to emergency medical services systems. The Department may 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. 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 determined there has been a substantial failure to comply with certain regulations. Centers that are placed on probationary status shall show compliance with these regulations within 12 months, unless otherwise provided by a settlement agreement 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 designation. A hospital receiving a center designation under this provision may have such designation removed upon the request of the hospital or upon a determination by the Department that the organization certifying or verifying the alternative designation has suspended or revoked its designation. This act requires centers receiving alternative designations under this provision to submit to the Department proof of certification or verification and to participate in local and regional emergency services systems for training, sharing educational resources, and collaboration on improving patient outcomes.

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 meet certain standards.

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 board-eligible physicians, either through the American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine, 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 physicians, nurses, and other providers who provide care at the designated center shall equal, 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.

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.

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.

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

Finally, 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; 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 14 members to the committee, as specified in the act.

These provisions are identical to provisions in the truly agreed to and finally passed SS/SCS/HB 2331 (2022) and HB 2355 (2022), substantially similar to SB 1020 (2022), and similar to SB 541 (2021).

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 identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed SS/SCS/HB 2331 (2022), SCS/SB 1045 (2022), and SB 757 (2022) and substantially similar to provisions in HCS/HB 2133 (2022) and HB 2881 (2022).

HEALTH CARE FACILITY VISITATION (Sections 191.1400, 191.2290, and 630.202)

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, 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 reasonably 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.

A compassionate care visitor may report any violation of the Compassionate Care Visitation Act by a health care facility to the Department of Health and Senior Services, as specified in the act. The Department shall investigate any such complaint within thirty-six hours of receipt.

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.

Additionally, 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.

These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022) and substantially similar to provisions in the truly agreed to and finally passed SS/SCS/HCS/HBs 2116, 2097, 1690, & 2221 and SCS/SB 671 (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 provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed SS/SCS/HB 2331 (2022), SCS/SB 1045 (2022), HB 2848 (2022), and SB 1029 (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 provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed SS/SCS/HB 2331 (2022), SCS/SB 1045 (2022), and SB 1146 (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, except in cases of lung transplants.

This provision is identical to a provision in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed SS/SCS/HB 2331 (2022), HB 1861 (2022), and HCS/HBs 2358 & 1485 (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 provisions in the truly agreed to and finally passed SS/HB 2162 (2022), the truly agreed to and finally passed SS/SCS/HB 2331 (2022), SB 1037 (2022), and HB 2603 (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 the truly agreed to and finally passed SS/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).

HOME HEALTH LICENSING (Sections 197.400 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, nurse practitioners, clinical nurse specialists, or physician assistants, as specified in the act.

These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed SS/SCS/HB 2331 (2022), the truly agreed to and finally passed CCS#2/SS/HB 2149 (2022), and substantially similar to SCS/SB 830 (2022), provisions in HCS/HB 2434 (2022), HB 2382 (2022), HB 1565 (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.

These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022) and similar to SB 1011 (2022) and SB 478 (2021).

SUPPLEMENTAL WELFARE ASSISTANCE (Section 208.030)

Under current law, certain persons may be eligible for up to $156 a month in supplemental welfare assistance for home care in licensed residential care facilities. This act removes that monthly cap and makes such assistance and assistance for assisted living facilities subject to appropriations, while the amount of total state payment for care in licensed intermediate care or skilled nursing facilities shall not exceed $390 a month.

This provision is similar to SB 1192 (2022) and HCS/HB 2727 (2022).

MISSOURI 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 provisions in the truly agreed to and finally passed SS/HB 2400 (2022), the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), SB 1179 (2022), and HB 2820 (2022).

THE "CORRECTIONAL CENTER NURSERY PROGRAM" (Section 217.940, 217.941, 217.942, 217.943, 217.944, 217.945, 217.946, and 217.947)

This act establishes the "Correctional Center Nursery Program" which requires the Department of Corrections to establish a correctional center nursery in one or more of the correctional centers for women operated by the Department by July 1, 2025. The program allows eligible inmates and children born to them while in the custody of the Department to reside together in the institution for up to eighteen months post-delivery. Nothing in this act shall affect, modify, or interfere with the inmate's custodial rights to the child nor establish legal custody of the child with the Department.

An inmate is eligible for the program if:

• She delivers the child while in custody of the Department;

• She gives birth on or after the program is implemented;

• She has a presumptive release date of 18 months or less from the date she applies to participate in the program;

• She has no dangerous felony, sexual offense, or offenses against the family convictions; and

• She meets any other criteria established by the Department.

To participate in the program, the inmate must agree to abide by certain requirements set forth in the act. Any inmate's participation in the program can be terminated by the Department for reasons set forth in the act.

The Division of Child Support Enforcement shall collect support payments made under the assignment and such payments shall be deposited in the inmate's banking account. The Department may accept donations on behalf of the program, but no donations shall be made on behalf of one particular inmate or child. Any financial donations for a specific inmate shall be made through the inmate banking system.

This act also established the "Correctional Center Nursery Program Fund" which shall be used to maintain the program.

This act provides that neither the Department of Corrections, nor the program, shall be subject to regulation, licensing, or oversight by the Department of Health and Senior Services, Department of Social Services, Children's Division, juvenile officer of any jurisdiction, or Office of Childhood unless the Department of Corrections agrees to voluntary regulation, licensing, or oversight.

Finally, the operation of a correctional center nursery program under this act and the presence of inmates' children in the program shall not be considered a dangerous condition that would result in the waiver of sovereign immunity.

These provisions are identical to provisions in the truly agreed to and finally passed SS/SCS/SB 683 (2022), SS/SCS/HCS/HB 2151 (2022), and HCS/SS/SCS/SB 834 (2022).

MISSOURI DENTAL BOARD PILOT PROJECTS (Section 332.325)

This act authorizes the Missouri Dental Board, in collaboration with the Department of Health and Senior Services and the Office of Dental Health within the Department of Health and Senior Services, to approve pilot projects designed to examine new methods of extending care to under-served populations. Such projects may employ techniques or approaches to care that may necessitate a waiver of statute or regulation and shall follow the requirements of the act regarding scope, content, and reports.

The provisions of this act shall expire on August 28, 2026, and a report of the pilot projects approved by the Board shall be submitted to the General Assembly no later than December 1, 2025.

This provision is substantially similar to provisions in the truly agreed to and finally passed CCS#2/SS/HB 2149 (2022), SCS/SB 993 (2022), and provisions in SCS/SB 1153 (2022).

PHYSICAL THERAPISTS (Sections 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 truly agreed to and finally passed CCS#2/SS/HB 2149 (2022) and SCS/SB 1153 (2022).

AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS (Sections 345.015, 345.022, 345.050, 345.052, and 345.085)

This act modifies provisions relating to audiology and speech-language pathology. In order to be eligible for licensure by the State Board of Registration for the Healing Arts by examination under this act, each applicant shall present written evidence of completion of a clinical fellowship. Any person in a clinical fellowship shall hold a provisional license to practice speech-language pathology or audiology and shall be issued a license if the person meets requirements set forth in the act.

This act modifies provisions relating to license reciprocity. Currently, those applicants who are licensed in another country or hold a certificate of competence issued by the American Speech-Language-Hearing Association may receive a license without an examination. This act repeals this provision and implements a provision permitting any person who, for at least one year, has held a valid, current license issued by another state, a branch or unit of the military, a U.S. territory, or the District of Columbia, to apply for an equivalent Missouri license through the Board, subject to procedures and limitations as provided in the act.

This act also adopts the Audiology and Speech-Language Pathology Interstate Compact. The purpose of the compact is to increase access to audiology and speech-language pathology services by providing for the mutual recognition of other member state licenses. The compact sets forth requirements that must be met in order for a state to join the compact. Each member state shall require an applicant to obtain or retain a license in the home state and meet the home state's qualifications for licensure or renewal of licensure as well as all other applicable state laws.

The compact creates a joint public agency known as the Audiology and Speech-Language Pathology Compact Commission. The Commission has powers and duties as listed in the compact and shall enforce the provisions and rules of the compact. The Commission shall provide for the development, maintenance, and utilization of a coordinated database and reporting system containing licensure, adverse action, and investigative information on all licensed individuals in member states.

The compact shall come into effect on the date on which the compact is enacted into law in the 10th member state. Any member state may withdraw from the compact by enacting a statute repealing the same. The compact shall be binding upon member states and shall supersede any conflict with state law.

These provisions are identical to provisions in the truly agreed to and finally passed CCS#2/SS/HB 2149 (2022), SCS/SB 978 (2022), and provisions in SCS/SB 1153 (2022), and substantially similar to HCS/HB 2138 (2022).

DENTISTRY (Sections 376.427 and 376.1575)

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 provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022) and 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 provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), SB 1024 (2022), SB 484 (2021), HB 1002 (2021), and a provision in CCS#2/HCS/SS/SB 64 (2021).

MEDICAL RETAINER AGREEMENTS (Section 376.1800)

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 and chiropractors may enter into the contracts as well.

This provision is similar to provisions in the truly agreed to and finally passed CCS/SS/SCS/HCS/HB 2168 (2022) and 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).

SERVICES FOR FOSTER CHILDREN AND CLIENTS OF THE DEPARTMENT OF MENTAL HEALTH (Section 630.1150)

Under this act, the Department of Mental Health (DMH) and the Department of Social Services shall oversee and implement a collaborative project to assess the continued hospitalization without medical justification of foster children and DMH clients due to a lack of post-discharge placement options or because they are awaiting screening for appropriateness of residential treatment services, as well as to develop recommendations to ensure these patients receive treatment in the most cost-effective and efficacious settings consistent with federal and state standards for treatment in the least restrictive environment. The Departments shall solicit information from specified persons and entities and shall issue interim reports by December 31, 2022, and July 1, 2023, before issuing a final report by December 1, 2023. The provisions of this act shall expire on January 1, 2024.

This provision is identical to SCS/SB 1168 (2022).

CIVIL DETENTION (Section 632.305)

Currently, an application for civil detention for evaluation and treatment may be executed by any adult on a form provided by the court. Such form shall allege that the applicant has reason to believe that the respondent is suffering from a mental disorder and presents a likelihood of serious harm to themselves. Under this act, such form shall not be required to be notarized.

This provision is identical to provisions in the truly agreed to and finally passed CCS/HCS/SS/SCS/SBs 775 et al. (2022), SB 1109 (2022), and SCS/HBs 2088, et. al. (2022) and similar to HB 2110 (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 provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed SS/SCS/HB 2331 (2022), SCS/SB 1045 (2022), and SB 1100 (2022).

SARAH HASKINS