HCS/SS/SB 580 - This act modifies several provisions relating to health care, including: (1) health awareness designations; (2) vouchers for veteran room and board at skilled nursing facilities; (3) medical preceptor tax credit; (4) the "Long-Term Dignity Act"; (5) academic performance standards and instruction; (6) automated external defibrillators; (7) staff on ambulances; (8) outside the hospital do-not-resuscitate orders; (9) the "Alzheimer's State Plan Task Force"; (10) medical marijuana patient information; (11) vapor products in public schools; (12) telehealth; (13) the "21st Century Missouri Patient Education Task Force"; (14) provision of certain senior services; (15) controlled substance registration; (16) administration of controlled substances; (17) medical marijuana background checks; (18) "Kratom Consumer Protection Act"; (19) certificate of need; (20) the "Authorized Electronic Monitoring in Long-Term Care Facilities Act"; (21) MO HealthNet drug utilization review board; (22) home and community-based care referrals; (23) medical alert notations on driver's licenses and identification cards; (24) continuing education for certain health care providers; (25) radiologic imaging; (26) pharmacy technicians; (27) pharmacist refill authorization; (28) health information exchanges; (29) overpayment of health insurance claims; (30) insurance for living organ donors; and (31) needle exchanges. HEALTH AWARENESS DESIGNATIONS (Sections 9.152, 9.166, 9.182, and 9.309) This act designates the months of April as "Limb Loss Awareness Month", May as "Mental Health Awareness Month", July as "Minority Mental Health Awareness Month", and September as "Deaf Awareness Month". These provisions are identical to provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020) and SCS/HB 1383 (2020). VOUCHERS FOR VETERAN ROOM AND BOARD AT SKILLED NURSING FACILITIES (Section 42.145) Under this act, an eligible veteran who is approved for admission to a Missouri veterans' home nearest his or her residence, but who has not been admitted due to a lack of vacancy or a lack of vacancy at a nearby facility that has contracted with the Department of Veterans Affairs for the care of veterans, may elect to receive a monthly voucher from the Missouri Veterans' Commission to pay for room and board costs at any skilled nursing facility in an amount equal to the average cost by the state of Missouri to house a veteran in a Missouri veterans' home for one month. The issuance of a voucher shall not effect any veteran's position in the queue for a veterans' home vacancy. This provision is identical to HCS/HB 1485 (2020). MEDICAL PRECEPTOR TAX CREDIT (Section 135.690) This act creates a medical preceptor state tax credit, beginning January 1, 2021, for any community-based faculty preceptor who serves as the faculty preceptor for a medical student core preceptorship or physician assistant core preceptorship in an amount equal to $1,000 dollars for each preceptorship, up to a maximum of $3,000 per tax year, if he or she completes up to three preceptorship rotations during the tax year and did not receive any direct compensation for the preceptorships. No more than 200 preceptorship tax credits in one calendar year shall be authorized by the Missouri Division of Professional Registration within the Department of Commerce and Insurance on a first-come, first-served basis. To the greatest extent possible, persons who provide preceptorships in rural areas shall be given first priority. The cumulative amount of tax credits awarded under this provision shall not exceed two hundred thousand dollars per year; provided, that the Division may exceed that cap in an amount not to exceed the funds remaining in the "Medical Preceptor Fund", established in this act for the tax credit program and funded through a license fee increase of $7 per license for physicians and surgeons and $3 per license for physician assistants. This provision is identical to HB 2036 (2020). LONG-TERM DIGNITY ACT (Sections 143.1160 and 191.1601 to 191.1607) This act establishes the "Long-Term Dignity Act". Beginning January 1, 2021, an individual may open a long-term dignity savings account and designate the account to be used to pay a designated qualified beneficiary's eligible long-term care expenses. This act creates an income tax deduction for contributions to a long-term dignity savings account in the amount of 100% of the contribution, not to exceed the taxpayer's Missouri adjusted gross income for the tax year the deduction is claimed and not to exceed $8,000 for an individual or $16,000 for married individuals filing jointly. Moneys withdrawn from the account shall be subject to recapture and the account holder subject to a penalty if it has been less than one year since the first deposit in the account or the moneys have been used for any purpose not specified in the act. The income tax deduction created by this act shall sunset December 31, 2026, unless reauthorized by the General Assembly. These provisions are identical to provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020). ACADEMIC PERFORMANCE STANDARDS AND INSTRUCTION (Sections 160.514 and 161.502) This act modifies membership and hearing requirements of work groups convened by the State Board of Education to develop academic performance or learning standards. Additionally, the State Board of Education shall amend the existing, and include in all future, health or physical education academic standards, learning standards, and curriculum frameworks to include evidence-based instruction on the use and effects of vapor products. This provision is identical to HCS/HB 1808 (2020). AUTOMATED EXTERNAL DEFIBRILLATORS (Sections 190.092 and 190.1005) This act modifies provisions of the "Public Access to Automated External Defibrillator Act". Under current law, persons or entities that have acquired an automated external defibrillator are required to ensure that: (1) expected users receive training from the American Red Cross, American Heart Association, or other equivalent training course; (2) the defibrillator is maintained and tested according to the manufacturer's operational guidelines; (3) the user activates the emergency medical services system as soon as possible; and (4) person or entity placing a defibrillator outside of a health care facility has a physician review and approve the protocol and training. This act repeals these provisions and requires that a person or entity who acquires an automated external defibrillator to do the following: (1) comply with all regulations governing placement of the defibrillator; (2) notify an agent of the local EMS agency of the existence, location, and type of all automated external defibrillators on the premises; (3) ensure that the defibrillator is maintained and tested to the manufacturer's guidelines; (4) ensure that testing of the defibrillator occurs at least twice a year and after each use; and (5) ensure that an inspection of all defibrillators on the premises is made every 90 days. Currently, a person who gratuitously and in good faith renders emergency care through the use or provision of an automated external defibrillator shall not be held liable for any civil damages, unless he or she acted in a willful and wanton or reckless manner. This act extends this immunity to criminal penalties. Additionally, a person who or entity that provides training, owns the defibrillator, or is responsible for the site where the defibrillator is located shall likewise not be held liable. This act repeals such immunity for the person or entity that provided the clinical protocol for the sites or programs and for the licensed physician who reviews and approved the clinical protocol. Finally, this act requires any training or course in cardiopulmonary resuscitation to include instruction in the proper use of an automated external defibrillator. These provisions are similar to provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020), SCS/SB 692 (2020), and SCS/HB 1383 (2020). STAFF ON AMBULANCES (Sections 190.094, 190.105, 190.143, and 190.196) Under this act, physician assistants and assistant physicians may serve as staff on an ambulance. When attending a patient on an ambulance, the physician assistant or assistant physician shall be exempt from any mileage limitations in any collaborative practice arrangement prescribed under law. These provisions are substantially similar to the perfected SB 866 (2020) and provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020) and the truly agreed to and finally passed CCS/SS/HCS/HB 2046 (2020). OUTSIDE THE HOSPITAL DO-NOT-RESUSCITATE ORDERS (Sections 190.606 and 190.612) Under this act, emergency medical services personnel shall comply with an outside the hospital do-not-resuscitate order from another state, the District of Columbia, or a U.S. territory if such order is on a standardized form, signed by the patient or the patient's representative and a licensed physician, and such form has been previously reviewed and approved by the Department of Health and Senior Services. Emergency medical services personnel shall not comply with the order if the patient or the patient's representative expresses to such personnel the desire to be resuscitated. Physicians, emergency medical service personnel, and health care facilities shall not be subject to civil, criminal, or administrative liability for complying with an outside the hospital do-not-resuscitate order from another state, the District of Columbia, or a U.S. territory. This provision is substantially similar to SB 1010 (2020) and provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020). ALZHEIMER'S STATE PLAN TASK FORCE (Sections 191.116 and 192.2000) This act establishes the "Alzheimer's State Plan Task Force" in the Department of Health and Senior Services, which shall consist of 19 members as specified in the act. The task force shall assess and maintain a state plan to overcome Alzheimer's disease, including assessing the existing services and resources available for persons with Alzheimer's disease and their families and identifying opportunities for Missouri to coordinate with federal entities. The task force shall deliver a report to the Governor and General Assembly by June 1, 2021, and shall supplement the report annually thereafter. The task force shall expire on December 31, 2026. This act also requires the Division of Aging within the Department of Health and Senior Services to provide information and support to persons with Alzheimer's disease and related dementias by establishing a family support group in every county. These provisions are identical to HCS/HB 1683 (2020) and substantially similar to SB 823 (2020) and provisions in SCS/HCS/HB 1683 (2020). MEDICAL MARIJUANA PATIENT INFORMATION (Section 191.255) Under this act, no state agency or employee thereof shall disclose to the federal government or an unauthorized third party the statewide list or any individual information of persons who have applied for or obtained a medical marijuana card. Any violation of this provision is a Class E felony. This provision is identical to a provision in HCS/HB 1896 (2020). VAPOR PRODUCTS IN PUBLIC SCHOOLS (Section 191.775) Under this act, no person shall use vapor products in any indoor area of a public elementary or secondary school building or on school buses. School boards may set policy on permissible uses of vapor products in any other nonclassroom or nonstudent occupant facility or outdoor school grounds. This provision is identical to provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020) and substantially similar to a provision in SCS/SB 829 (2020). TELEHEALTH (Section 191.1145) This act permits health care providers not licensed in Missouri, but licensed in another state or territory, to treat patients through telehealth in a state of emergency proclaimed by the Governor or General Assembly. THE "21ST CENTURY MISSOURI PATIENT EDUCATION TASK FORCE" (Section 191.1160) This act establishes the "21st Century Missouri Patient Education Task Force" consisting of 22 members who shall evaluate the condition of the state's patient education system and make recommendations to improve health care delivery and outcomes in Missouri. The task force shall submit a report of its activities and recommendations by August 28, 2021 and terminate on January 1, 2022. This provision is identical to HB 2288 (2020). PROVISION OF CERTAIN SENIOR SERVICES (Section 192.2150) Currently, the Department of Health and Senior Services shall use the services of community based, not-for-profit organizations for the provision of home delivered meals to seniors if the service is available at not more than 75% of the cost currently incurred by the Department to provide such services. This act removes the requirement that such services be made available at 75% of the Department's cost. CONTROLLED SUBSTANCE REGISTRATION (Section 195.030) Current law permits the Department of Health and Senior Services, by regulation, to waive registration requirements for the manufacture, distribution, or dispensation of controlled substances for certain manufacturers, distributors, or dispensers. This act permits the Department to waive the same requirements for temporary health care facilities established for the duration of any state emergency proclaimed by the Governor or General Assembly. ADMINISTRATION OF CONTROLLED SUBSTANCES (Section 195.070) Under current law, a health care practitioner shall not accept any portion of a controlled substance unused by a patient if the practitioner did not originally dispense the drug, unless as part of an authorized drug disposal program. This act permits a non-dispensing practitioner to accept the unused controlled substance when the controlled substance is prescribed to the patient and delivered to the practitioner to administer to the patient. Practitioners shall maintain records and secure the medication. This provision is substantially similar to a provision in in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020) and the perfected SB 928 (2020). MEDICAL MARIJUANA BACKGROUND CHECKS (Section 195.815) The Department shall require all officers, managers, contractors, employees, and other support staff of licensed or certified medical marijuana facilities, and all owners of such facilities who will have access to the facilities or the facilities' supply of medical marijuana, to submit fingerprints to the Highway Patrol for a state and federal criminal background check. The Highway Patrol shall notify the Department of any criminal history record information or lack thereof discovered on the individual. All such records shall be accessible and available to the Department. This provision is similar to a provision in the truly agreed to and finally passed SS/SCS/HCS#2/HB 1896 (2020), the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020), and SCS/SB 764 (2020). This provision has an emergency clause. THE "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 purporting 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 substances, 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 order, ordinance, or regulation of kratom by any political subdivision of this state. This provision is identical to HB 2061 (2020) and a provision in HCS/SCS/SB 662 (2020). CERTIFICATE OF NEED (Section 197.305 and 197.318) This act modifies several provisions relating to the occupancy rate of health care facilities for purposes of certificates of need. First, this act removes the phrase "nonapplicability review" from the definition of "new institutional health service" regarding changes in licensed bed capacity. Additionally, current law requires maintenance of a 90% average occupancy rate for the previous six quarters when determining whether a long-term care facility may increase its licensed bed capacity. This act changes that rate to 85%. Under current law, long-term care facilities may transfer or sell individual licensed beds to qualifying facilities. The selling facility shall not expand its licensed bed capacity in that licensure category for 5 years. Under this act, the licensed bed transferred or sold to qualifying facilities shall be "licensed and available". Additionally, the selling facility may not expand its bed capacity either for 5 years or until the average occupancy of licensed and available beds in that licensure category within a 15-mile radius is 85% for the previous six quarters. Any facility that transfers or sells licensed and available beds shall have an average occupancy rate of less than 70% for the previous six quarters. This act is identical to HB 2093 (2020) and substantially similar to SB 898 (2020). THE "AUTHORIZED ELECTRONIC MONITORING IN LONG-TERM CARE FACILITIES ACT" (Sections 198.610 to 198.632) This act establishes the "Authorized Electronic Monitoring in Long-Term Care Facilities Act". Under these provisions, a long-term care facility resident shall have the right to place in his or her room an authorized electronic monitoring device that is owned and operated by the resident or provided by the resident's guardian or legal representative. The device shall be open and obvious and the facility and the Department of Health and Senior Services shall be informed about the device. Each facility shall use an electronic monitoring device acknowledgment form developed by the Department, which shall be signed by or on behalf of the resident prior to the use of a monitoring device. The form shall also require any other resident of the room to consent to release the facility from liability for a violation of his or her privacy rights; provided, that the other resident may condition his or her consent on limitations on the use of the device. The facility shall require a resident using a device to post and maintain conspicuous notice regarding the device at the entrance to the resident's room. No facility shall be civilly or criminally liable for any activity or action arising out of the use of the monitoring device or be liable for a violation of the Health Insurance Portability and Accountability Act (HIPAA) or any resident's right of privacy. No person shall release any recording without the written permission of the resident or resident's guardian or legal representative, except for cases of abuse or neglect as specified in the act. Footage created through the use of the device may be admitted into evidence in civil or criminal actions or administrative proceedings. No facility shall refuse to admit or remove an individual to the facility because of his or her request to use a device. The facility shall make reasonable physical accommodations for the resident to use a device. The resident, or his or her guardian or legal representative, shall pay for all costs associated with the device, except for electricity. A facility shall not be required to provide Internet service or network access for the device. The Department may impose appropriate sanctions and administrative penalties on a facility knowingly violating provisions of this act. A person who, without the consent of the resident or his or her guardian or legal representative, intentionally hampers, obstructs, tampers with, or destroys an installed electronic monitoring device or who destroys or corrupts any data collected by the device is guilty of a Class B misdemeanor. Any person who places an unauthorized device in a resident's room, or who consents to the placement of such device, is guilty of a Class B misdemeanor if the person continues such conduct after a written warning to cease and desist. These provisions are identical to the truly agreed to and finally passed HCS/HBs 1387 & 1482 (2020), substantially similar SB 909 (2020), and similar to provisions in SCS/HB 758 (2019) and HCS/HB 1635 (2018). DRUG UTILIZATION REVIEW BOARD (Section 208.175) This act modifies the membership of the MO HealthNet Drug Utilization Review Board. This provision is identical to HCS/HB 2035 (2020). HOME AND COMMUNITY-BASED CARE REFERRALS (Section 208.895) This act remove that requirement that assessments for home and commmunity-based care services for MO HealthNet recipients be conducted face-to-face. MEDICAL ALERT NOTATIONS ON DRIVER'S LICENSE AND IDENTIFICATION CARDS (Section 302.205) This act allows for medical alert notations to be placed on driver's licenses and non-driver's identification cards for posttraumatic stress disorder, diabetes, heart conditions, epilepsy, drug allergies, Alzheimer's or dementia, schizophrenia, autism, or other conditions as approved by the Department of Revenue. Persons applying for a medical alert notation shall waive liability for the release of any medical information to the Department, anyone eligible for access to such medical information recorded on a driving record, and any other person who may view or receive notice of the medical information by virtue of having seen the license. The application shall include a space for applicants to obtain a sworn statement from a licensed physician or licensed psychologist verifying the diagnosis. Individuals who have been issued licenses or identification cards bearing medical alert information may be issued a replacement that does not bear the medical alert information upon payment of the fee applicable to lost licenses or cards. No medical alert information shall be printed on or removed from a license or identification card without the express consent of the licensee, or parent or guardian. These provisions have a delayed effective date of July 31, 2021. These provisions are identical to SS/SCS/HB 1963 (2020) and HCS/HB 1334 (2020) and similar to HCS/HB 207 (2019), provisions in HCS/SB 371 (2019), provisions in HB 1613 (2018), and provisions in SCS/HCS/HBs 2277 & 1983 (2018). CONTINUING EDUCATION FOR CERTAIN HEALTH CARE PROVIDERS (Sections 332.181, 332.261, 334.036, 334.075, 334.150, 334.507, 336.080, and 337.050) The professional licensing boards for dentists, dental hygienists, assistant physicians, physicians and surgeons, physical therapists, physical therapist assistants, optometrists, and psychologists shall give credit for continuing education hours performed by the health care provider on a volunteer basis working within his or her professional scope of practice at a nonprofit entity. These provisions are identical to HCS/HB 1995 (2020). RADIOLOGIC IMAGING (Sections 334.1000 and 334.1005) Under this act, after January 1, 2021, no person shall perform radiation therapy procedures on humans for diagnostic or therapeutic purposes, except for certain licensed professionals set forth in the act. This provision is identical to SB 1032 (2020) and HB 2431 (2020). PHARMACY TECHNICIANS (Section 338.013) Under this act, any pharmacy technician who holds an active license in any U.S. state or territory shall be authorized to practice in Missouri during a state of emergency proclaimed by the Governor or General Assembly if he or she has had no violations, suspensions, or license revocations. PHARMACIST REFILL AUTHORIZATION (Section 338.200) Under this act, a pharmacist may dispense or refill a prescription for an emergency supply of medication for a prescription not previously dispensed or refilled at his or her pharmacy when the pharmacy that originally dispensed or refilled the prescription is closed or unable to fill the prescription due to a state of emergency and the pharmacist has made a good faith effort to verify the medication to be dispensed and the authorized prescriber and dosage form. This provision shall only apply during a state of emergency declared by the Governor or General Assembly. HEALTH INFORMATION EXCHANGES (Section 376.455) Under this act, a participant of a health information exchange operated by a health information organization may disclose, access, or use individually identifiable information; provided, that an individual has the right to opt out of having his or her identifiable information accessible through the exchange. A health information organization shall implement policies governing privacy and security of individually identifiable information accessible through the exchange and shall maintain written notice of such policies on a publicly accessible website. A health information organization shall not be considered a health care provider under this act and shall not be subject to liability for damages or costs arising out a civil action against a health care provider. Participants and staff, officers, and members of the board of directors of a health information organization shall not be liable in actions for damages or costs, as described in the act. Individually identifiable information accessed through an exchange under this act shall not be subject to discovery or subpoena and no health information organization shall be compelled by a request for production, subpoena, court order, or otherwise, to disclose such information. This provision is substantially similar to SB 1049 (2020). OVERPAYMENT OF HEALTH INSURANCE CLAIMS (Section 376.1345) Under this act, a health carrier may only withhold or recoup an amount it overpaid to a provider or entity in receipt of the payment for the claim. The notice of withholding or recoupment shall inform the provider or entity of the health care service, date of service, and patient for which the withhold or recoupment is being made. This provision is similar to SB 935 (2020) and provisions in SCS/HB 1383 (2020). INSURANCE FOR LIVING ORGAN DONORS (Section 376.1590) This act specifies that a person's status as a living organ donor shall not be the sole factor in the offering, issuance, cancellation, price, or conditions of an insurance policy, nor in the amount of coverage provided. The Department of Commerce and Insurance shall provide information to the public on the access of a living organ donor to insurance as specified in the act. If the Department of Commerce and Insurance or the Department of Health and Senior Services receives materials related to live organ donation from a recognized live organ donation organization, the materials may be made available to the public. These departments may seek or accept gifts, grants, or donations from public or private sources for purposes of this act. These provisions are identical to provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020), the truly agreed to and finally passed CCS/HCS/SB 551 (2020), and HCS/HB 1709 (2020). NEEDLE EXCHANGES (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 and the offense of unlawful manufacturing with intent to deliver drug paraphernalia, if such entity is not located within 500 feet of a school building, unless such entity's premises were established prior to the school building. These provisions are substantially similar to HB 1486 (2020), SB 668 (2020), and HCS/HB 168 (2019) and similar to SCS/HB 1620 (2019). SARAH HASKINS HA #2: ESTABLISHES JUNE AS "MYASTHENIA GRAVIS AWARENESS MONTH" HA #3: MODIFIES MEMBERSHIP OF THE "ALZHEIMER'S STATE PLAN TASK FORCE" HA #4: REMOVES LIMITATIONS ON NUMBER OF MEDICAL MARIJUANA FACILITY LICENSES HA #5: REGULATES HEALTH INFORMATION EXCHANGE ACTIVITIES HA #1 TO HA#5: MODIFIES HEALTH INFORMATION EXCHANGE ACTIVITIES PROVISION HA #6: ESTABLISHES SEPTEMBER AS "INFANT AND MATERNAL MORTALITY AWARENESS MONTH" HA # : MODIFIES LIABILITY PROVISIONS FOR HEALTH CARE PROVIDERS PROVIDING CARE DURING THE COVID-19 PANDEMIC HA #1 TO HA # 7: MODIFIES PROVISIONS RELATING TO MO HEALTHNET PRESCRIPTIONS FOR INDIVIDUAL ANTIPSYCHOTIC MEDICATION; MODIFIES HEALTH CARE PROVIDER LIABILITY PROVISION HA #8: MODIFIES PROVISIONS RELATING TO SERVICE ANIMALS HA #9: MODIFIES PROVISION RELATING TO VOUCHERS FOR VETERANS IN NURSING HOMES HA #10: MODIFIES PROVISIONS RELATING TO CONTINUING EDUCATION FOR VOLUNTEERING PHYSICIANS HA #1 TO HA #10: MODIFIES PROVISIONS RELATING TO BIOLOGICAL TESTING RESULTS