CCS#2/HCS/SS/SB 608 - This act modifies provisions relating to health care, including: (1) vaccinations; (2) the "Health Care Cost Reduction and Transparency Act"; (3) palliative care; (4) administrative rules regulating the construction of hospitals; (5) certificates of need; (6) MO HealthNet co-payments; (7) MO HealthNet missed appointment fees; (8) MO HealthNet reimbursement for certain health care providers; (9) the Joint Committee on Public Assistance; (10) the physical therapy compact; (1) the nurse licensure compact; (12) emergency supplies of medication; (13) maintenance medication; (14) medication synchronization; (15) pharmacy benefit managers; (16) insurance coverage for occupational therapy services; (17) prescription eye drops; and (18) health care price transparency. VACCINATIONS (Sections 167.638, 174.335, and 198.054) 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 brochures 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 635 (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 635 (2016) and HB 2616 (2016) and substantially similar to SB 1005 (2016). Under this act, each year between October 1 and March 1, all licensed long-term care facilities shall assist their health care workers, volunteers, and other employees who have direct contact with residents in obtaining a vaccination for the influenza virus by either offering a vaccination in the facility or providing information as to how they may independently obtain a vaccination. Facilities are encouraged to document that each health care worker, volunteer, and employee has been offered assistance in obtaining a vaccination against the influenza virus and has either accepted or declined. This provision is identical to HB 2616 (2016) and substantially similar to SB 1089 (2016) and SB 558 (2015). HEALTH CARE COST AND TRANSPARENCY ACT (Section 191.875) This provision, known as the "Health Care Cost Reduction and Transparency Act," requires health care providers to provide, upon a patient's written request, including a medical treatment plan from the patient's health care provider, an estimate of cost of a particular health care service within 3 business days. This estimate shall be accompanied by specified language. If health care providers provide the patient with a link to the estimated costs or post such costs on a publicly available website, such entity shall not be required to provide cost estimates to patients upon written request. Beginning July 1, 2017, hospitals shall make available to the public the amount that would be charged without discounts for each of the 100 most prevalent diagnosis-related groups. No health care provider shall be required to report information under this provision if such reporting could reasonably lead to the identification of a person receiving health care services in violation of the Health Insurance Portability and Accountability Act of 1996 or other federal law. These provisions shall not apply to emergency departments that are required to comply with the Emergency Medical Treatment and Active Labor Act. Finally, this act requires health care providers located in certain Kansas border counties to comply with these provisions in order to become a MO HealthNet provider. This provision is substantially similar to SB 900 (2016) and HCS/HB 2269 (2016) and similar to SS/SB 806 (2016) and SB 46 (2015). 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). 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 635 (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 provisions in SB 635 (2016), SB 973 (2016), SB 988 (2016), and HCS/HB 2402 (2016). MO HEALTHNET CO-PAYMENTS (Section 208.142) Beginning October 1, 2016, the Department of Social Services shall require MO HealthNet participants to pay an eight dollar co-payment fee for use of a hospital emergency department for the treatment of a condition that is not an emergency medical condition. The Department shall promulgate rules for the implementation of this provision. This provision is identical to SB 118 (2015). MO HEALTHNET MISSED APPOINTMENT FEES (Section 208.148) This provision permits fee-for-service MO HealthNet health care providers, to the extent permitted by laws pertaining to the termination of patient care, to charge a missed appointment fee to MO HealthNet participants that such participants must pay before scheduling another appointment with that provider. The fee may be charged for missed appointments or for failing to cancel an appointment within 24 hours prior to the appointment. The permissible fees are as follows: No charge for the first missed appointment in a three-year period, $5 for the second missed appointment in a three-year period, $10 for the third missed appointment in a three-year period, and $20 for the fourth and each subsequent missed appointment in a three-year period. Health care providers shall waive the fee in cases of inclement weather. The health care provider shall not charge to nor shall the MO HealthNet participant be reimbursed by the MO HealthNet program for the missed appointment fee. MO HEALTHNET REIMBURSEMENT (Section 208.152) This act provides that, subject to appropriations, MO HealthNet providers of behavioral, social, and psychophysiological services, including psychologists, shall be reimbursed for the prevention, treatment, or management of physical health problems. This provision is identical to a provision in SB 607 (2016), SB 972 (2016), HB 1659 (2016), and SB 281 (2015). JOINT COMMITTEE ON PUBLIC ASSISTANCE (Section 208.952) This act modifies the Joint Committee on MO HealthNet to create a permanent Joint Committee on Public Assistance. The committee shall have the following purposes: (1) studying, monitoring, and reviewing the efficacy of public assistance programs within the state, (2) determining the level and adequacy of resources needed for the programs, and (3) developing recommendations on the public assistance programs and on promoting independence from safety-net programs among participants as may be appropriate. The committee shall receive and obtain information from the departments of Social Services, Mental Health, Health and Senior Services, Elementary and Secondary Education, and any other department as applicable, regarding projected enrollment growth, budgetary matters, trends in childhood poverty and hunger, and any other information deemed relevant to the committee's purpose. The directors of the departments of Social Services, Mental Health, and Health and Senior Services shall each submit an annual written report providing data and statistical information regarding the caseloads of the Department's employees involved in the administration of public assistance programs. The committee shall meet at least twice a year. A portion of the meeting shall be set aside for public testimony. The committee is authorized to hire staff and enter into employment contracts, including an executive director, to conduct special reviews or investigations of the state's public assistance programs. The committee shall conduct an annual rolling 5-year forecast of the state's public assistance programs and make recommendations to the General Assembly. This act also repeals a section of law relating to a rolling 5-year MO HealthNet forecast conducted by the Legislative Budget Office. This provision is identical to a provision in SB 607 (2016) and HCS/SCS/SBs 688 & 854 (2016), and similar to provisions in SB 854 (2016) and HCS/SCS/SB 38 (2015). PHYSICAL THERAPY COMPACT (Sections 334.1200-334.1233) This 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. This 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 635 (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 635 (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 635 (2016), SB 864 (2016), and provisions contained in SB 457 (2015). MAINTENANCE MEDICATION (Section 338.202) This act provides that a pharmacist may dispense varying quantities of maintenance medication per fill up to the total number of dosage units as authorized by the prescriber, unless the prescriber has specified that dispensing a prescription for maintenance medication in an initial amount is medically necessary. When the dispensing of the maintenance medication is based on refills then the pharmacist shall dispense no more than a 90 day supply and the patient must have already been prescribed the medication for 3 months. This provision is identical to a provision in SBs 865 & 866 (2016), SB 973 (2016), HB 1682 (2016), and HB 1816 (2016). MEDICATION SYNCHRONIZATION SERVICES (Section 376.379) This act requires a health carrier or managed care plan that provides prescription drug coverage in the state to offer medication synchronization services. A health carrier or managed care plan that provides prescription drug coverage shall not charge any amount in excess of the otherwise applicable co-payment for dispensing a prescription drug in a quantity that is less than the prescribed amount and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met. This provision is identical to a provision in SBs 865 & 866 (2016), substantially similar to SB 910 (2016), and is similar to SB 528 (2015), HB 198 (2015), and provisions in HCS/SB 458 (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 635 (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 635 (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). HEALTH CARE PRICE TRANSPARENCY (Section 376.2020) Under this provision, no contract provision between a health carrier and a health care provider shall be enforceable if such provision prohibits, conditions, or in any way restricts any party to such contract from disclosing to an enrollee the contractual payment amount for a health care service if such payment amount is less than the health care provider's usual charge for the health care service, and if such contractual provision prevents the determination of the potential out-of-pocket cost for the health care service by the enrollee. This provision is identical to SB 581 (2016), SCS/SB 8 (2015) and substantially similar to a provision in SCS/SB 167 (2015), SB 847 (2014), SCS/SB 739 (2014), and HB 1793 (2014). This provision is substantially similar to SB 307 (2013). Provisions of this act have a contingent effective date. SARAH HASKINS