CCS/HCS/SB 635 - This act modifies provisions relating to health care, including: (1) investment of funds by municipal hospitals; (2) vaccinations; (3) dyslexia screening and support; (4) CPR curriculum; (5) EMT-P licensure testing; (6) alternative stroke center designations and collection of emergency care data; (7) medical helipad fences; (8) palliative care; (9) background checks for certain heath care providers; (10) administrative rules regulating the construction of hospitals; (11) certificates of need; (12) health care workforce data analysis; (13) the physical therapist compact; (14) the nurse licensure compact; (15) emergency supplies of medication; (16) pharmacy benefit managers; (17) insurance coverage for occupational therapy services; (18) prescription eye drops; and (19) the Legislative Task Force on Dyslexia. INVESTMENT OF FUNDS BY MUNICIPAL HOSPITALS (Section 96.192) This act allows the board of trustees of any authorized municipal hospital to invest up to 25% of the hospital's funds not required for immediate disbursement in any U.S. investment grade fixed income funds or diversified stock funds, or both. The provisions of this act shall only apply if the hospital: (1) receives less than 1% of its annual revenue from municipal, county, or state taxes and (2) receives less than 1% of its annual revenue from appropriated funds from the municipality in which such hospital is located. This provision is identical to a provision in SB 988 (2016) and SB 1039 (2016). VACCINATIONS (Sections 167.638 and 174.335) Under current law, the Department of Health and Senior Services must develop an informational brochure, available to students at institutions of higher education, relating to meningococcal disease. This act requires such brochure to state that immunizations against the disease are available and to include information on all vaccines receiving Category A or B recommendations from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. Additionally, the brochure shall include a recommendation that students receive meningococcal vaccines in accordance with the Advisory Committee's guidelines. This provision is identical to a provision in SB 608 (2016) and HB 2616 (2016). Under current law, every public institution of higher education in Missouri must require all students residing in on-campus housing to have received the meningococcal vaccine, unless an exemption applies. This act would require all such students to have received the vaccine not more than 5 years prior to enrollment and in accordance with the latest recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. Additionally, this act defines "on-campus" housing as including any fraternity or sorority residence, privately owned or not, on or near the campus of a public institution of higher education. This provision is identical to a provision in SB 608 (2016) and HB 2616 (2016) and substantially similar to SB 1005 (2016). DYSLEXIA SCREENING AND SUPPORT (Section 167.950) By December 31, 2017, this act requires the Department of Elementary and Secondary Education to develop guidelines for the appropriate screening of students for dyslexia and related disorders and to develop the necessary classroom support for such students. Beginning in the 2018-19 school year, each public school, including charter schools, shall conduct dyslexia screenings and provide reasonable classroom support consistent with the guidelines developed by the Department of Elementary and Secondary Education. Additionally, practicing teacher assistance programs shall include two hours of in-service training regarding dyslexia and related disorders provided by each school district for all practicing teachers. Such training shall count as two contact hours of professional development. This provision is similar to a provision HCS/HB 2379 (2016). CPR CURRICULUM (Section 170.310) Beginning with the 2017-18 school year, this act requires high school pupils in public schools and charter schools to have received thirty minutes of CPR instruction and training in the proper performance of the Heimlich maneuver or other first aid for choking prior to graduation. The act also requires the training to be included in the district's existing health or physical education curriculum. This provision is identical to SB 711 (2016) and is substantially similar to the perfected HCS/HB 457 (2015). EMT-P LICENSURE TESTING (Section 190.142) This act requires any rules or regulations promulgated by the Department of Health and Senior Services relating to initial EMT-P licensure testing to be through the national registry of EMTs or to be examinations developed and administered by the Department. This provision is identical to a provision in SB 732 (2016). ALTERNATIVE STROKE CENTER DESIGNATIONS AND COLLECTION OF EMERGENCY CARE DATA (Sections 190.241 and 192.737) This act provides for an alternative stroke center designation for a hospital. The Department of Health and Senior Services shall designate a hospital, upon receipt of an application, as follows: (1) a level I stroke center if the hospital has been certified as a comprehensive stroke center by the Joint Commission or another certifying organization; (2) a level II stroke center if the hospital has been certified as primary stroke center by the Joint Commission or other certifying organization; or (3) a level III stroke center if the hospital has been certified as a acute stroke-ready hospital by the Joint Commission or other certifying organization. The Department shall not require compliance with any additional standards for establishing or renewing stroke designations and the designation shall continue as long as the hospital remains certified. The Department may remove a hospital's designation if the hospital so requests or if the Department determines the certification has been suspended or revoked. Any hospital receiving this alternative designation shall submit annual proof of certification and other contact information, as well as the certification survey results and other specified documents. Sole authority to establish education requirements for physicians who practice in an emergency department of a facility designated as a trauma, STEMI, or stroke center by the Department of Health and Senior Services is given to the Board of Registration for the Healing Arts. Hospitals designated as STEMI or stroke centers shall submit data to the Department for use in the evaluation and improvement of hospital and emergency medical services' trauma, stroke, and STEMI care. The hospitals shall submit data to the Department as described in the act. The Department shall also use patient abstract data collected from hospital infection reporting, the trauma registry, motor vehicle crash and outcome data, and other publicly available data to provide information and create reports for the purpose of data analysis and needs assessment of traumatic brain and spinal cord-injured persons. These provisions are identical to provisions in SB 732 (2016) and SB 988 (2016) and substantially similar to SB 1060 (2016). MEDICAL HELIPAD FENCES (Section 190.265) Under this act, any rules and regulations promulgated by the Department of Health and Senior Services, or any interpretation of such rules, shall not require hospitals to have a fence or other barriers around a hospital helipad. Additionally, the Department shall not promulgate any rules and regulations with respect to the operation or construction of a helipad located at a hospital. Finally, hospitals shall ensure that helipads are free of obstruction and safe for use by a helicopter while on the ground, during approach, and takeoff. This provision is identical to a provision in SB 732 (2016) and SB 988 (2016). PALLIATIVE CARE (Sections 191.1075, 191.1080, and 191.1085) This act creates the "Missouri Palliative Care and Quality of Life Interdisciplinary Council," which shall consult with and advise the Department of Health and Senior Services on matters related to the establishment, maintenance, operation, and outcomes evaluation of palliative care initiatives in the state, as well as submit an annual report to the General Assembly assessing the availability of palliative care in the state for patients at early stages of serious disease and analyzing barriers to greater access to palliative care. This act also creates the "Palliative Care Consumer and Professional Information and Education Program," which shall be designed to maximize the effectiveness of palliative care in the state by ensuring the public availability of comprehensive and accurate information about palliative care. The program shall encourage hospitals to have a palliative care presence on their intranet or internet website and to develop and distribute information about palliative care to patients. These provisions expire on August 28, 2022. These provisions are identical to provisions in SB 635 (2016), SBs 865 & 866 (2016), HB 1682 (2016), and SCS/HB 808 (2015). BACKGROUND CHECKS FOR CERTAIN HEALTH CARE PROVIDERS (Sections 192.2490 and 192.2495) Currently, the Department of Health and Senior Services must provide the employee disqualification list upon request to any person, corporation, organization, or association who employs "nurses and nursing assistants" for temporary employment. This act changes this provision to "health care providers" for temporary employment. This act also requires an applicant for employment in certain positions to disclose if the applicant is listed on any of the background checks in the Family Care Safety Registry. A provider who is not otherwise prohibited from employing an individual listed on such background checks may deny employment to an individual listed on any of the background checks in the registry. ADMINISTRATIVE RULES REGULATING THE CONSTRUCTION OF HOSPITALS (Sections 197.065 and 536.031) This act requires the Department of Health and Senior Services to promulgate regulations for the construction and renovation of hospitals that will include standards that reflect the Life Safety Code standards imposed under Medicare. Hospitals shall not be required to meet the standards contained in the Facility Guidelines Institute for the Design and Construction of Health Care Facilities, but any hospital that complies with the 2010 or later version of such guidelines shall not be required to comply with any inconsistent or conflicting regulations. The Department may waive enforcement of these standards for licensed hospitals if the department determines that: (1) compliance with them would result in unreasonable hardship for the facility and the health and safety of hospital patients would not be compromised by such a waiver; or (2) the hospital used other equivalent standards. Any conflicting regulations promulgated by the Department that are currently in existence and that conflict with the standards promulgated pursuant to this act shall lapse on and after January 1, 2018. Regulations developed pursuant to this act may incorporate by reference later additions or amendments to such rules, regulations, standards, or guidelines as needed to consistently apply current standards of safety and practice. These provisions are identical to provisions in SB 608 (2016), SB 973 (2016), SCS/HCS/HB 2402 (2016), and SCS/HCS/HB 2376 (2016) and similar to SB 1052 (2016). CERTIFICATES OF NEED (Section 197.315) This act requires hospitals operated and licensed by the state, with the exception of Department of Mental Health-operated psychiatric hospitals, to obtain a certificate of need and to comply with statutes relating to certificates of need. However, no certificate of need shall be required for the purchase and operation of medical equipment used by an academic health center operated by the state in furtherance of research or instruction. This provision is identical to a provision in SB 608 (2016), SB 973 (2016), SB 988 (2016), and HCS/HB 2402 (2016). HEALTH CARE WORKFORCE DATA ANALYSIS (Section 324.001) This act provides that the State Board of Nursing, Board of Pharmacy, Missouri Dental Board, State Committee of Psychologists, State Board of Chiropractic Examiners, State Board of Optometry, State Board of Occupational Therapy, and State Board of Registration for the Healing Arts may enter into contractual agreements with the Department of Health and Senior Services, public institutions of higher education, and nonprofit entities in order to collect and analyze workforce data from its licensees for the purpose of future workforce planning and to assess the accessibility and availability of qualified health care services and practitioners in Missouri. Data collection is controlled by the applicable state board requesting the collection, and the boards may release identifying data to the contractor to facilitate data analysis of the health care workforce. The data collected is the property of the board requesting the data, and shall be maintained as provided in existing law. Data shall only be released in the aggregate form in a manner that cannot be used to identify a specific individual. A board cannot request or collect income or other financial earnings information. Contractors shall maintain the confidentiality of data received and shall not release any data without approval from the applicable board. This provision is identical to a provision in HB 1816 (2016) and HCS/HB 1850 (2016) and similar to HCS/HB 112 (2015), HCS/SCS/SB 197 (2015), HCS/SCS/SB 230 (2015), and HCS/SS/SCS/SB 354 (2015). PHYSICAL THERAPIST COMPACT (Sections 334.1200-334.1233) The act creates a physical therapist compact. To participate in the compact a state must 1) participate in the Physical Therapy Compact Commission's data system; 2) have a mechanism in place for receiving and investigating complaints; 3) notify the Commission of any adverse action regarding a licensee; 4) implement a criminal background check; 5) comply with the rules of the Commission; 6) use a recognized national examination as a requirement for licensure; and 7) have continuing education as a requirement for license renewal. A member state shall grant the compact privilege to a licensee holding a valid license in another member state. In order to have a compact privilege a licencee must 1) have an unencumbered license in his or her home state; 2) have not had any adverse action against the license in the previous 2 years; 3) notify the Commission that he or she is seeking compact privilege within a remote state; 4) pay a fee; 5) meet any jurisprudence requirements established by the remote state; and 6) report to the Commission adverse action taken by a nonmember state within 30 days from the date the adverse action is taken. The compact privilege is valid until the expiration date of the home license. The licensee providing physical therapy in a remote state is subject to the laws and regulations of the remote state. If a home state license is encumbered then the licensee shall lose the compact privilege until certain conditions are met as established in the act. A remote state has the authority to take adverse action against a licensee's compact privilege in that state, but only a home state may impose adverse action against a license issued by the home state. Additionally, any member state may investigate violations of physical therapy statutes and rules in any other member state in which a physical therapist holds a license or compact privilege. Member states may also participate in joint investigations of licensees. The act creates the Physical Therapy Compact Commission. Each member state shall have one delegate who shall be a current member of the member state's licensing board. The Commission shall establish bylaws and promulgate rules, which shall have the force and effect of law and shall be binding in all member states. Within the Commission, there is an executive board composed of 9 members with the authority to act on behalf of the Commission. The Commission may collect an annual assessment from each member state or impose fees on other parties to cover the cost of the operations and activities of the Commission and its staff. The Commission shall develop, maintain, and use a coordinated database and reporting system containing licensure, adverse action, and investigative information on all licensed individuals in member states. Member states are required to submit a uniform data set to the data system on all individuals to whom the compact is applicable. The data shall include 1) identifying information; 2) licensure data; 3) adverse actions against the licensee or compact privilege; 4) nonconfidential information related to alternative program participation; 5) denial of application for licensure; and 6) any other information that may facilitate the administration of the compact. If a member state defaults in its performance of its obligations under the compact or promulgated rules then the defaulting state may be terminated from the compact as provided in the act. The compact shall not become effective until ten states enact the compact into law. These provisions are identical to provisions in SB 608 (2016), SB 973 (2016), and HB 1816 (2016). NURSE LISCENSURE COMPACT (Sections 335.360-335.415) This act establishes a new nursing licensure compact in which states who are members of the compact, known as party states, may issue multistate nursing licenses for the practice of registered and licensed practical or vocational nursing. A multistate nursing license shall authorize a nurse to practice under a multistate licensure privilege in each party state. The act does not affect the requirements established by a party state for the issuance of a single-state license. This compact shall become effective and binding on the earlier of the date of legislative enactment of this compact by no less than twenty-six states or December 31, 2018. All party states to this compact that were also parties to the prior nurse licensure compact shall be deemed to have withdrawn from the prior compact within six months after the effective date of this compact. Under the act, a party state must adopt procedures for considering the criminal history of applicants for an initial multistate license, and require an applicant for multistate licensure to 1) meet certain educational requirements as specified in the act, 2) pass the NCLEX-RN or NCLEX-PN examination, 3) hold or be eligible for an active, unencumbered license, 4) submit fingerprints for a criminal background check, 5) not have been convicted of a felony or a misdemeanor related to the practice of nursing or be enrolled in an alternative licensure disciplinary program, and 6) have a valid Social Security number. A nurse practicing in a party state, not his or her home state, is subject to the jurisdiction of the licensing board, courts, and laws, of the party state in which the client is located at the time service is provided. A party state may take adverse action against a nurse's multistate licensure privilege, and shall notify the administrator of the coordinated licensure information system of any disciplinary action. The administrator shall then inform the licensee's home state of any such action by another state against the licensee. All party states shall participate in a coordinated licensure information system, which shall include information on the licensure and disciplinary history of each nurse, and shall be administered by a nonprofit organization composed of and controlled by the party states' licensing boards. Any personally identifiable information obtained from the coordinated licensure information system by a party state licensing board shall not be shared with non-party states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information. A nurse who holds a multistate license issued by his or her home state on the effective date the compact may retain and renew the multistate license issued by the current home state. However, a nurse who changes primary state of residence after the effective date of the compact shall meet the requirements to obtain a multistate license from a new home state. A nurse may hold a multistate license issued by the home state in only one party state at a time. If a nurse moves to a new party state, he or she must apply for licensure in the new home state, and the multistate license issued by the prior home state will be deactivated. If a nurse moves to a non-party state then the multistate license issued by the prior home state will convert to a single-state license, valid only in the prior home state. The licensing board of each state shall have the authority to take disciplinary action against a nurse's multistate licensure privilege to practice within the party state, but only the home state shall have the power to take adverse action against a nurse's license issued by the home state. The Interstate Commission of Nurse Licensure Compact Administrators, composed of one designee from each party state, shall have the authority to promulgate uniform rules to implement and administer the compact. Such rules shall be binding in all party states and have force and effect of law. The act sets forth procedures and requirements that the Commission must follow in order to exercise its rulemaking powers. The Commission shall meet at least once a year and the meetings shall be open to the public. The Commission shall establish bylaws or rules to govern its conduct, which shall be published on the Commission's website. If the Commission determines that a party state has defaulted in the performance of its responsibilities under the Compact and fails to cure such default, then the party state's membership in the Compact shall be terminated upon an affirmative vote of the members of the Commission. This act shall become effective upon notification to the Revisor of Statutes by the Commission that no less than twenty-six states have enacted the Compact, or December 31, 2018, whichever occurs earlier. These provisions are identical to provisions in SB 608 (2016) and HB 1816 (2016) and substantially similar to SB 985 (2016). EMERGENCY SUPPLIES OF MEDICATION (Section 338.200) This act provides that only a licensed pharmacist can make the determination to dispense an emergency supply of medication without the authorization from the prescriber. This provision is identical to a provision in SB 608 (2016), SB 864 (2016), and provisions contained in SB 457 (2015). PHARMACY BENEFIT MANAGERS (Section 376.388) This act also requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy's contracting representative to include sources utilized to determine maximum allowable cost and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the maximum allowable cost (MAC) list of drugs or modify MAC pricing within seven days if the drugs do not meet the standards as provided in the act. A PBM shall reimburse pharmacies for drugs subject to MAC pricing based upon pricing information which has been updated within seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from at least one manufacturer and is generally available for purchase from national or regional wholesalers. All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list. These provisions are identical to provisions in SB 608 (2016) and SBs 865 & 866 (2016), substantially similar to SCS/SB 908 (2016) and to provisions in HCS/SB 458 (2015), and similar to SB 325 (2015) and SB 895 (2014). INSURANCE COVERAGE FOR OCCUPATIONAL THERAPY SERVICES (Section 376.1235) This act adds services rendered by licensed occupational therapists to services that cannot require a higher co-payment or coinsurance than is required for the services of a primary care physician office visit. This act also requires health carriers to clearly state the availability of occupational therapy services. This act requires the Oversight Division of the Joint Committee on Legislative Research to perform an actuarial analysis of the cost impact to health carriers, insureds with a health benefit plan, and other payers for occupational therapy coverage beginning September 1, 2016, and submit a report by December 31, 2016. This provision is identical to a provision in SB 608 (2016) and SB 853 (2016). PRESCRIPTION EYE DROPS (Section 376.1237) This act extends the sunset provision for coverage of early refills of prescription eye drops from January 1, 2017, to January 1, 2020. This provision is identical to a provision in SB 635 (2016), SBs 865 & 866 (2016), SB 973 (2016), SB 868 (2016), HB 1682 (2016), HB 1816 (2016), and HB 1852 (2016). LEGISLATIVE TASK FORCE ON DYSLEXIA (Section 633.420) This act creates the Legislative Task Force on Dyslexia. The task force will advise and make recommendations to the Governor, the Joint Committee on Education, and relevant state agencies. The task force will consist of twenty members, as described in the act. The task force will make recommendations for a statewide system for identification, intervention, and delivery of supports for students with dyslexia, as described in the act. The task force will hire or contract for hire specialist services to support the work of the task force as necessary with appropriations or from other available funding. The task force will terminate on August 31, 2018. This provision is identical to a provision in HCS/SB 827 (2016). This act has an emergency clause for certain provisions and a contingent effective date for other provisions. SARAH HASKINS