CCS/HCS/SS#2/SB 754 - This act modifies provisions relating to health care. STATE LEGAL EXPENSE FUND (Section 105.711) Currently, for the purposes of the State Legal Expense Fund a free health clinic is defined as a nonprofit community health center, exempt from federal taxation, which provides primary care and preventative services to people without health insurance without charge. This amendment changes the term "free health clinic" to "community health clinic" and modifies its definition by removing the without charge qualification. The amendment also excludes federally funded community health centers and rural health clinics from the description of nonprofit community health centers for the purposes of the State Legal Expense Fund. This act is identical to SS/SCS/HB 1231(2014) and HCS/SS/SB 758 (2014). MENINGOCOCCAL VACCINE (Section 174.335) Under this act, each student attending a public institution of higher education who lives in on-campus housing must receive the meningococcal vaccine unless he or she has a medical or religious exemption. This provision is identical to CCS#2/HCS/SCS/SB 716 (2014); and similar to SCS/HCS/HB 2125 (2014) and SCS/SB 748 (2014). UMBILICAL CORD BLOOD BANK (Section 191.761) Beginning July 1, 2015, this act requires the Department of Health and Senior Services to transport collected, donated umbilical cord blood samples to a nonprofit umbilical cord blood bank located in St. Louis City in existence as of the effective date of the act. The collection sites shall only be those facilities designated and trained by the blood bank in the collection and handling of umbilical cord blood specimens. This provision is identical to a provision in CCS#2/HCS/SCS/SB 716 (2014); SCS/HCS/HB 2125 (2014) and HCS/HB 1193 (2014). DIABETES CARE AND CONTROL (Section 191.990) The MO HealthNet Division and the Department of Health and Senior Services shall collaborate to coordinate goals and benchmarks in each individual agency's plans to reduce the incidence of diabetes in Missouri, improve diabetes care, and control complications associated with diabetes. A report on such collaboration shall be submitted to the General Assembly by January 1 of each odd-numbered year. The act specifies the topics to be addressed in the report regarding diabetes. The requirement of this act shall be limited to diabetes information, data, initiatives, and programs within each agency prior to the effective date of this act, unless there is unobligated funding for diabetes in each agency that may be used for new research, data collection, reporting, or other requirements of this act. This provision is identical to a provision in CCS#2/HCS/SCS/SB 716 (2014); and SCS/HCS/HB 2125 (2014). SHOW-ME ECHO PROGRAM (Section 191.1140) Subject to appropriations, the University of Missouri shall manage the "Show-Me Extension for Community Health Care Outcomes (ECHO) Program". The Department of Health and Senior Services shall collaborate with the University of Missouri in utilizing the program to expand the capacity to safely and effectively treat chronic, common, and complex diseases in rural and underserved areas of the state and to monitor outcomes of such treatment. The program is designed to utilize current telehealth technology to disseminate knowledge of best practices for the treatment of chronic, common, and complex diseases from a multidisciplinary team of medical experts to local primary care providers who will deliver the treatment protocol to patients, which will alleviate the need of many patients to travel to see specialists and will allow patients to receive treatment more quickly. The program shall utilize local community health care workers with knowledge of local social determinants as a force multiplier to obtain better patient compliance and improved health outcomes. This provision is identical to HB 2154; and to a provision in CCS#2/HCS/SCS/SB 716 (2014); and SCS/HCS/HB 2125 (2014). BREAST DENSITY NOTIFICATION (Section 192.769) Beginning January 1, 2015, on completion of a mammogram, a mammography facility shall provide information to the patient stating that if the mammogram demonstrates that the patient has dense breast tissue, such tissue could hide abnormalities and the patient might benefit from supplemental screening that may be suggested by the ordering physician. The provisions of this amendment do not create a duty of care beyond the duty to provide the notice required under the amendment. Also, the information required by this amendment or evidence that a person violated this amendment is not admissible in a civil, judicial, or administrative proceeding. This provision is identical to SCS/SB 639 (2014) and HCS/HB 1510 (2014). COLLABORATIVE PRACTICE ARRANGEMENTS WITH ASSISTANT PHYSICIANS (Sections 195.070, 334.035, 334.036, 334.037, Section 1) This act allows certain medical school graduates to obtain a temporary assistant physician license in order to enter into "assistant physician collaborative practice arrangements" with a physician. An assistant physician collaborative practice arrangement shall limit the assistant physician to providing only primary care services and only in medically underserved rural or urban areas of this state or in any pilot project areas. An "assistant physician", is defined as any medical school graduate who has passed the prescribed medical examinations and who has not entered into postgraduate residency training prescribed by rule of the State Board of Registration for the Healing Arts. The act prescribes the other requirements to be licensed as an assistant physician and specifies certain practices an assistant physician cannot perform. The collaborating physician is responsible at all times for the oversight of the activities of, and accepts responsibility for primary care services rendered by the assistant physician. A licensed assistant physician shall enter into an assistant physician collaborative practice arrangement within six months of his or her initial licensure and shall not have more than a six-month time period between collaborative practice arrangements during his or her licensure period. These provisions are identical to provisions contained in CCS#2/HCS/SCS/SB 716 (2014); HCS/HB 1842 (2014) and HCS/HB 1793 (2014) and substantially similar to SB 847 (2014). OFFERS OF INFLUENZA IMMUNIZATIONS (Section 197.168) Each year between October 1st and March 1st and in accordance with Centers for Disease Control and Prevention recommendations, each hospital shall offer prior to discharge immunizations against influenza virus to all inpatients 65 years of age and older unless contraindicated for such patient so long as there is approval of the attending physician or other practitioners authorized to order vaccinations or as authorized by physician-approved hospital policies or protocols for influenza. This provision is identical to a provision in CCS#2/HCS/SCS/SB 716 (2014); SCS/HCS/HB 2125 (2014). HUMAN DONOR MILK (Section 208.141) This act requires the Department of Social Services to reimburse hospitals under the MO HealthNet program for donor human milk provided to critically ill infants under three months of age in the neonatal intensive care unit, if the physician orders the milk and the Department determines it is medically necessary. Such donor milk shall be obtained from a donor bank that meets the Department's guidelines. This provision is identical to SB 899 (2014). SCHIP (Sections 208.631 to 208.646) Currently, the State children's health insurance program (SCHIP) defines uninsured children as an individual up to 19 years of age who meets specified criteria and whose parent or guardian has not had access to affordable coverage for their children for six months prior to application for SCHIP. This act removes the requirement that they be uninsured for six months. The act also changes the requirements of a parent of such child eligible for SCHIP by removing the requirement that the parent or guardian demonstrate annually that their total net worth does not exceed $250,000 in total value. These provisions are in HCS/SB 508 (2014); HB 2080 (2014). SHOW-ME HEALTHY BABIES (Section 208.662) This act establishes the Show-Me Healthy Babies Program within the Department of Social Services as a separate children's health insurance program for any low-income unborn child. For an unborn child to be eligible for enrollment in the program, the mother of the child must not be eligible for coverage under the Medicaid Program as administered by the state and must not have access to affordable employer-subsidized health care insurance or other affordable health care coverage that includes coverage for the unborn child. The unborn child must be in a family with income eligibility of no more than 300% of the federal poverty level or the equivalent modified adjusted gross income unless the income eligibility is set lower by the General Assembly through appropriations. The act delineates all of the parameters of the program. This act is identical to CCS#2/HCS/SCS/SB 716 (2014); HB 1065 (2014) and to a provision in SCS/HCS/HB 2125 (2014). MO RX PRESCRIPTION DRUG PROGRAM ELIGIBILITY CHANGES(SECTION 208.790) This act provides that applicant household income limits for eligibility shall be subject to appropriations, but in no event shall applicants have household income that is greater than 185% of the federal poverty level for the applicable family size for the applicable year as converted to the MAGI equivalent net income standard. The Department of Social Services shall promulgate rules outlining standards for documenting proof of household income. MO RX PRESCRIPTION DRUG PROGRAM EXPIRATION DATE EXTENSION(SECTION 208.798) This act extends the expiration date of the MO RX Prescription Drug Program from 2014 to 2017. PHARMACIST PROVIDED VACCINATIONS (Section 338.010) The act adds to the description of the "practice of pharmacy" the administration of hepatitis A, hepatitis B, diphtheria, tetanus, and pertussis vaccines by written protocol authorized by a physician. Also, a pharmacist shall administer vaccines in accordance with the treatment guidelines established by the Centers for Disease Control and Prevention and rules jointly promulgated by the Board of Pharmacy and the State Board of Registration for the Healing Arts. A pharmacist shall receive additional training for the administration of vaccines as required by the Board of Pharmacy. Within fourteen days of administering a vaccine a pharmacist shall provide specified information to the patient's primary health care provider. This provision is identical to a provision contained in CCS#2/HCS/SCS/SB 716 (2014), HCS/SB 528 (2014), HCS/SCS/SB 808 (2014), HCS/HB 1683 (2014), and SCS/HCS/HB 2125 (2014). PHARMACY LICENSURE (SECTIONS 338.059; 338.165; and 338.220) This act provides that pharmacists may label prescription drugs using either a sequential number or a unique identifier. The act states that the Board of Pharmacy may inspect Class B hospital pharmacies that are not under the inspection authority of the Department of Health and Senior Services. The Board and the Department of Health and Senior Services may jointly promulgate rules governing medication services by a pharmacist at or within a hospital. A drug distributor license is not required to transfer medication from a Class B hospital pharmacy to a hospital clinic for patient care. Medication dispensed by a hospital to a patient for use outside of the hospital shall be labeled as provided by rules jointly promulgated by the Department and the Board, and shall be dispensed only by a prescription order from a physician. All pharmacists providing medication therapy services must obtain a certificate of medication therapeutic plan authority as provided by rule. There shall be an advisory committee, with members appointed by the Board, which will make recommendations to the Board and review all rules jointly promulgated by the Board and the Department. The act defines a "Class B Hospital Pharmacy," and provides that any hospital that holds a pharmacy license on the effective date of the act shall be eligible to obtain a Class B pharmacy license without the payment of a fee. These provisions are identical to CCS#2/HCS/SCS/SB 716 (2014); SCS/SB 942 (2014) and to a provision in SCS/HCS/HB 2125 (2014). JOINT COMMITTEE ON EATING DISORDERS (Section 2) This act establishes a Joint Committee on Eating Disorders to review issues pertaining to the regulation of insurance and other matters impacting the lives of those diagnosed with an eating disorder. The act delineates the list of members. By December 31, 2014, the committee shall provide a report to the members of the General Assembly and the Governor on such issues. ADRIANE CROUSE