Relating to case managers offering pregnancy care options, with a penalty clause.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI,

AS FOLLOWS:

Section 1. As used in sections 1 to 22 of this act, the following terms mean:

(1) "Accredited educational institution", a public or private two or four year college, a university, an adult education program conducted by a public or private school accredited by an organization recognized by the department of elementary and secondary education or a licensed hospital;

(2) "Case Manager", a pregnancy caregiver trained and registered to perform services as provided by sections 1 to 22 of this act who has reached the age of twenty-five whose primary role is to outreach with human compassion to clients, to link them to appropriate services, programs and professionals and to advocate in the client's behalf;

(3) "Department", the department of health;

(4) "Departments", the departments of health, elementary and secondary education, mental health and social services;

(5) "Facility" or "Health facility", includes any licensed hospital, licensed ambulatory surgical center, clinic, or any licensed health professional performing services outside a licensed hospital or clinic;

(6) "Person", any individual, corporation or other business entity;

(7) "Pregnancy", during pregnancy or the perinatal period.

Section 2. Pregnancy care option services provided by case managers shall include, but not be limited to:

(1) Providing human care and compassion to persons needing special encouragement and support;

(2) Promoting early entry into prenatal care and discussing the socioeconomic factors which may induce the client to fail to pursue adequate prenatal care or to seek an abortion and refer her to or provide her with services which remove such factors;

(3) Assisting and advocating in behalf of persons to obtain support services such as prenatal care, adoption services, employment services, alternative education, housing, child care or similar services;

(4) Offering skills and support to cope with decision making during crisis;

(5) Promoting school attendance or alternative instruction for minors;

(6) Promoting adoption and removing obstacles to adoption;

(7) Assuring that a client who is considering abortion is fully informed of the consequences of abortion and that the person's choice is truly freely made;

(8) Promoting the avoidance of out-of-wedlock conception, including avoidance of repetition or reoccurrence of out-of-wedlock conception for unwed clients who are now or were pregnant, and referring the client to services to promote same;

(9) Involving the father or spouse and parents of minors, when appropriate, if approved by the client in writing;

(10) Referring and placing the client with professional counselors and other professional support services.

Section 3. The department shall contract for or purchase pregnancy care option services from local public or non-profit private agencies to meet the needs of clients pursuant to an appropriation made to the health initiative fund established in section 191.831, RSMo, and the department shall not have a duty to fund service beyond the limits of that appropriation. The moneys shall be used to supplement and not to supplant services available in the community. When identifying the most important needs in a community, the department shall consult with case managers serving the community and shall also consider such factors as prenatal care rates, abortion rates, unwed conception rates and local availability of pregnancy care option services.

Section 4. 1. The department shall define minimum standards for training of case managers which are consistent with sections 1 to 22 of this act.

2. Any accredited educational institution may offer training programs designed to meet or exceed the minimum standards. The expense of the training shall be paid by the applicant. The institution shall certify all applicants who successfully complete the training program and pass the examination. The certificate of training shall expire three years after it is issued.

Section 5. Subject to appropriation, state agencies may offer continuing education programs for case managers. These programs may be extended through local health departments, adult education programs, telecommunications education under section 170.250, RSMO, or other effective means selected by the agency providing the training. Continuing education programs may also be offered by accredited educational institutions.

Section 6. 1. Upon certification, case managers shall register with the department. The registration shall include the name, date of birth, address, county and telephone number where the case manager may be contacted for services. Registration shall include a verified statement that the registrant meets the qualifications established in this act. The case manager shall pay to the department a fee of ten dollars at the time of registration.

2. The department shall maintain a computerized directory of all registered case managers which shall included the identifying information required by subsection 1. The computerized directory shall be accessible through the Missouri Home Page of the Internet or other similar telecommunication service available to the public. The computerized directory shall also be accessible by the Tel-Link operators. Information on case managers shall be provided by Tel-Link operators to any person calling and requesting such information. Subject to appropriation, the department may make the directory of case managers available through any other means deemed appropriate by the department.

Section 7. The department may withhold registration of a case manager pending a criminal record review by the highway patrol. Upon written request from the department, with the consent of the applicant for registration, the highway patrol shall conduct a criminal record review of both the Missouri criminal record system and the National criminal history background check system. The highway patrol shall respond in writing the department as whether the applicant has been convicted of a felony or misdemeanor. If the applicant refuses to consent to the review or if the highway patrol reports the applicant has been convicted of a felony or misdemeanor, other than a traffic offense, the registration shall be denied. The report of the highway patrol shall be confidential and it shall be unlawful for any person to disclose the report other than as authorized in this section. If the department denies registration under this section, it shall notify the applicant in writing of the denial and the basis for such denial.

Section 8. Upon registration, each case manager shall be assigned by the department to a city or county public health department for supervision. The city or county public health department shall offer the case manager advice on effectively carrying out the responsibilities under sections 1 to 22 of this act. The local health department shall have the right to inspect the performance of the case manager but shall not have the right to any information made confidential by sections 1 to 22 of this act.

Section 9. 1. It shall be unlawful for anyone to issue or purport to issue proof of the offer of pregnancy care option services unless he or she has satisfactorily completed the training program and registration as provided in sections 1 to 22 of this act, except as authorized in section 17.

2. It shall be unlawful for a person to claim to be a case manager under sections 1 to 22 of this act without having been certified by an accredited educational institution and registered with the department.

Section 10. The department on its own initiative or upon filing of a citizen complaint may revoke the training certification and registration of any case manager who fails to comply with the terms of sections 1 to 22 of this act. Whenever any person has cause to believe a case manager has acted in a manner inconsistent with the provisions of sections 1 to 22, such person may make a complaint, orally or in writing, to the department.

Section 11. 1. The department shall inform all local public health departments and all relevant state agencies of pregnancy option care services and how to refer clients to case managers. Tel-Link operators shall be trained in making referrals to case managers. The department of social services shall develop and implement procedures for social workers and other personnel serving clients who may benefit from pregnancy option care services, especially personnel investigating claims of child abuse, to make referral to case managers where appropriate. The department of elementary and secondary education shall develop and disseminate to public and private school districts for implementation procedures for teachers, counselors and administrators with knowledge of students who may benefit from pregnancy option care services to make referral to case managers where appropriate. The department of mental health shall develop and implement procedures for its counselors, treatment personnel and others serving clients who may benefit from pregnancy option care services, especially those affected by drug or alcohol addiction, to make referral to case managers where appropriate. The circuit court by local rule shall develop and implement procedures within the family court to refer clients of the family court to case managers where appropriate. If a social worker, teacher, counselor, administrator, person providing treatment or other person knows of a client in need of prenatal care, contemplating an abortion or otherwise needing pregnancy care options services, he or she shall be urged to encourage such clients to seek these services.

2. A poster at least twenty-four inches by forty-eight inches shall be posted in all facilities which perform abortion where clients will see upon first entering. The poster shall include the statement, "Alternatives to abortion services and people who will help women in need are available by calling toll-free Tel-Link at (phone number)" and such other information as may be specified by the department.

Section 12. 1. The case manager shall use a system of identification codes for record keeping which protects the anonymity of the client. All information concerning an individual's need for case manager services and records containing any such information held or maintained by any agency, department, political subdivision, and employee thereof or any other person shall be strictly confidential. All such records shall be delivered to the client on demand of the client at any time. If the client makes no demand for the records, such records shall be destroyed within thirty days after a case manager completes services to the client.

2. Disclosure of information without the written consent of the client or failure to deliver or destroy records as required by subsection 1 of this section by any person in violation of this section shall be unlawful.

Section 13. 1. The department, with the cooperation of professional licensing boards of the state, shall notify all physicians, pharmacists and health facilities providing services to women who may be prospective clients of the case manager program and, subject to appropriation, provide sample literature for distribution to patients about the Tel-Link and case manager programs and how to locate case managers in each community.

2. Whenever the department publicly promotes the Tel-Link program, it shall include information that through Tel-Link women may be referred to case managers offering pregnancy care option services including alternatives to abortion.

3. From appropriations for the Family Health Initiatives program of the division of maternal, child and family health of the department, the department shall prepare and implement an education and awareness plan for the general public about the availability of the case manager program and services. The plan shall include the preparation and dissemination of public service announcements to radio and television stations broadcasting to audiences within this state and similar announcements to newspapers in this state.

Section 14. 1. The department, with the cooperation of all state agencies, shall identify pregnancy care options services which are available to pregnant women and infants which support the purposes of sections 1 to 22 of this act.

2. The department shall develop and maintain a directory of care options services. The department shall make this directory available to operators of the Tel-Link program. The department shall make copies of the directory for specific communities available to any person for a fee commensurate to the cost of publication.

3. Subject to appropriation, a computerized version of the directory of services shall be available to the public through the Missouri Home Page of the Internet or other similar telecommunication service available to the public.

Section 15. Each department shall designate an existing employee to serve as an ombudsman within such department who shall be readily accessible to case managers assisting clients. In the department of health, the ombudsman shall be the director of the Tel-Link program. This ombudsman shall promptly address removal of administrative barriers to delivery of services by his or her department such as the failure of subordinate agencies or staff to understand or implement department policy, regulations or law.

Section 16. 1. The acceptance of pregnancy option care services shall be wholly the voluntary choice of the client. Immediately on first contact the case manager shall give the client in writing the following statement: "The acceptance of pregnancy care options services is wholly your voluntary choice. All communications are strictly confidential. You rights under this program are protected by law. You can obtain more information on pregnancy care options services and your rights by calling the Missouri Department of Health at 1-800-TEL-LINK. Keep this document as proof that you have been offered pregnancy care option services by me." The statement shall be dated and signed by the case manager. Refusal of a case manager to provide the foregoing statement because the client chooses not to accept the offer of services or harassment by a case manager of the client after refusal of services shall be unlawful.

2. In the event a client has met with a case manager and services have been offered to and rejected by the client and the case manager has refused to immediately sign and deliver the statement required by this section, the client may attest subject to penalty for perjury, the name of the case manager and such case manager's refusal to sign and deliver the statement. The sworn statement of the client shall serve in lieu of the case manager statement required pursuant to sections 1 to 22.

Section 17. If a client has been offered information about pregnancy care options services and how to access case managers by her physician, an ordained minister of her faith preference or a nurse employed by a city or county public health department, she need not directly contact a case manager unless she so chooses. The written statement of her physician, minister or public health nurse confirming the offer of information shall be sufficient proof of the offer of pregnancy care option services as required by section 16, provided that the physician or minister does not have a conflict of interest as described in section 20.

Section 18. Case managers shall offer services at a site which is mutually agreeable to the client and the case manager and which is safe and confidential. Such sites shall include places provided by local, state or federal agencies such as public health, social services, or mental health offices, by an elementary or secondary school or an accredited educational institution, or by a hospital, physician or other licensed health professional. The department by regulation may specify other sites approved as safe and confidential. Any city, county or state public health, social services or mental health department or public educational institution may provide a place for case managers and clients to meet.

Section 19. 1. Except as provided in subsections 3 and 4 of this section, beginning January 1, 1997, before a facility can perform an induced abortion, it must receive from the client a copy of the written proof indicating that the client has been offered pregnancy care option services.

2. When the proof is required, a physician who performs an abortion shall acknowledge notice of the proof by signing the copy. The copy of the proof shall be made part of the medical record of the client. It is unlawful for any person to perform an induced abortion on a client who does not have this written proof.

3. Proof of access to pregnancy care option services shall not be required in the event of a medical emergency threatening the life or long-term physical health of the client as determined the physician treating the emergency condition. Nor shall it be required in a non-emergency situation, if the client's attending physician, other than the physician intending to perform the abortion, certifies with reasonable medical certitude that the abortion is medically indicated according to accepted medical standards for preservation of the life or the long-term physical health of the client. The certification shall set forth the medical facts upon which the physician's opinion is based.

4. If the pregnancy is a result of rape or incest as reported to a law enforcement agency, no written proof of the offering of pregnancy care option services shall be required before the facility performs an induced abortion.

Section 20. It shall be unlawful for a person to verify the offer of pregnancy care option services or act as a case manager who has any economic interest in an abortion facility or an organization which promotes a purpose contrary to sections 1 to 22, including but not limited to employment (including volunteer workers), investment or contractual relationships. It shall also be unlawful for a person to act as a case manager who advocates violence or who has been convicted of a misdemeanor, other than a traffic offense, or felony.

Section 21. The policy of this state is to reduce out-of-wedlock conception, inadequate prenatal care, infant mortality, abortion and violence associated with abortion protest activities, and to support childbirth and responsible family planning.

Section 22. 1. Any person who knowingly performs an act made unlawful by sections 1 to 22 of this act shall be guilty of a class C misdemeanor and, upon conviction, shall be punished as provided by law.

2. Any individual injured as a result of the knowing performance of an act declared unlawful by sections 1 to 22 of this act may bring a civil action for damages against the person committing the unlawful act.

3. Knowingly performing an unlawful act under sections 1 to 22 of this act shall be grounds for revocation or suspension of the certification of a case manager or of the license of the facility or the physician performing the unlawful act.