CCS/HCS/SCS/SB 718 - This act modifies provisions relating to health care. The act designates the month of November as Diabetes Awareness Month. (Section 9.158) This provision is identical to HB 1247 (2018), and to a provision contained in the truly agreed CCS/HCS/SB 951 (2018). The years of 2018-2028 shall be designated as the Show-Me Freedom from Opioid Addiction Decade. (Section 9.192) This provision is identical to a provision contained in HCS/HB 2105 (2018), the truly agreed CCS/HCS/SB 951 (2018), and HCB 15 (2018). MEDICAL RECORDS: For the purposes of furnishing a copy of a patient's health history or health records upon request, such request may be satisfied if a statement or record is retained that no such health history or treatment record responsive to the request exists. (Section 191.227) This provision is identical to a provision contained in the truly agreed CCS/HCS/SS/SCS/SB 826 (2018) and substantially similar to a provision contained in the truly agreed CCS/HCS/SB 951 (2018). CAREGIVER, ADVISE, RECORD, AND ENABLE (CARE) ACT: This act creates the "Caregiver, Advise, Record, and Enable (CARE) Act," which requires a hospital or ambulatory surgical center to provide each patient or patient's legal guardian with an opportunity to designate a caregiver prior to the patient's discharge. Such caregiver designation, or lack thereof, shall be documented by the hospital or ambulatory surgical center. The hospital or ambulatory surgical center shall notify a patient's caregiver of the patient's discharge or transfer as soon as practicable. Hospitals, ambulatory surgical centers, or employees or contractors of such entities shall not be liable in any way for the actions of a caregiver. This act shall not interfere with the rights of an attorney-in-fact under a durable power of health care. The Department of Health and Senior Services shall provide a standard form that can be used to satisfy the requirements of the CARE Act. However, a hospital or ambulatory surgical center can continue to use their current forms to satisfy these requirements if the form is compliant with Centers for Medicare and Medicaid Services standards. This provision is identical to HCS/HB 2293 (2018). ADVERSE ACTIONS AGAINST CERTAIN INDIVIDUALS OR ENTITIES: The act specifies that no individual or health care entity shall be subject to adverse action by the state if the individual or health care entity, acting in its normal course of business, acts in good faith upon an order relating to the medical use of hemp extract. (Section 192.947) This provision is substantially similar to a provision contained in HCS/SCS/SB 953 (2018), HB 1440 (2018), and HB 1441 (2018). DRUG TAKE-BACK PROGRAM: The act allows unused controlled substances to be accepted from the public through collection receptacles, drug disposal boxes, and other means provided through drug take back programs by a drug enforcement agency authorized collector in accordance with federal regulations, regardless of whether or not the authorized collector originally dispensed the drug. The act requires the Department of Health and Senior Services to develop an education and awareness program about drug disposal by August 28, 2019. (Sections 195.070 and 195.265) These provisions are identical to HCS/HB 1618 (2018), to the truly agreed CCS/HCS/SB 951 (2018), to the truly agreed CCS/HCS/SS/SCS/SB 826 (2018), and similar to provisions contained in HCS/HB 2105 (2018). ADVISORY COUNCIL ON RARE DISEASES AND PERSONALIZED MEDICINE: The act establishes an "Advisory Council on Rare Diseases and Personalized Medicine" in the MO HealthNet Division to assist the Drug Utilization Review Board when making recommendations or determinations regarding prior authorization and reauthorization criteria for rare disease drugs and other topics relating to rare diseases. The act specifies the Council's membership and requires the Council to meet no later that February 28, 2019. The Council's recommendations to the Board shall be in writing. All members of the Council shall sign a conflict of interest statement each year and at least 20% of the members shall not have a conflict of interest with any insurer, pharmaceutical benefits manager, or pharmaceutical manufacturer. (Section 208.183) This provision is identical to a provision contained in the truly agreed CCS/HCS/SS/SCS/SB 826 (2018) and substantially similar to a provision contained in the truly agreed SS/HB 1953 (2018). EYE DROPS FOR NEWBORN INFANTS: The administration of eye drops to a newborn infant is not required if a parent or legal guardian objects to the treatment because it is against the religious beliefs of the parent or guardian. The act repeals a provision requiring the physician, nurse, or midwife to report in writing his or her compliance in administering the eye drops. (Section 210.070) This provision is identical to HB 2117 (2018), SB 960 (2018), to a provision contained in the truly agreed CCS/HCS/SS/SCS/SB 826 (2018), and similar to a provision contained in the truly agreed CCS/HCS/SB 951 (2018). ASSISTANT PHYSICIANS: This act changes the examination requirement for an assistant physician to require that an assistant physician complete Step 2 instead of Step 1 and Step 2, of the United States Medical Licensing Examination within a three-year period before applying for licensure but in no event more than three years after graduation from a medical college. An assistant physician licensure fee cannot be more than the licensure fee for a physician assistant. Additionally, no rules can require an assistant physician to complete more hours of continuing medical education than a licensed physician. The act repeals the requirement that an assistant physician has to enter into a collaborative practice agreement within six months of initial licensure. A health carrier shall reimburse an assistant physician on the same basis that it covers a service when it is provided by another comparable mid-level provider. No rule or regulation shall require the collaborating physician to review more than ten percent of the assistant physician's patient charts or records during the one-month period that the physician is continuously present while the assistant physician is practicing medicine. An assistant physician may prescribe buprenorphine for up to a 30-day supply without refill in certain circumstances. An assistant physician who is providing opioid addiction treatment can receive a certificate of prescriptive authority without having completed 120 hours of practice in a four month period with a collaborating physician. (Sections 334.036 & 334.037) These provisions are substantially similar to provisions contained in the truly agreed CCS/HCS/SB 951 (2018), and similar to provisions contained in SCS/HCS/HB 2127 (2018) and SCS/HCS/HB 1574 (2018). COLLABORATIVE PRACTICE AND SUPERVISORY AGREEMENTS: Current law authorizes physicians to enter into a collaborative practice agreement with 3 advanced practice registered nurses (APRN) and 3 assistant physicians, and a supervising agreement with 3 licensed physician assistants. This act authorizes physicians to enter into a collaborative practice agreement or a supervising agreement with 6 APRNs, assistant physicians, licensed physician assistants, or any combination thereof. The limitation on collaborative practice agreements and supervision agreements shall not apply to the supervision of certified registered nurse anesthetists in the provision of anesthesia services under the supervision of an anesthesiologist or other physician, dentist, or podiatrist who is immediately available if needed. Current law also states that a physician and a physician assistant in a supervisory agreement shall practice no further than 50 miles by road from each other. This act repeals the 50 mile limitation and states that the physician assistant shall practice within a geographic proximity to be determined by the Board of Registration for the Healing Arts. No supervision requirements in addition to the minimum federal law shall be required for a physician-physician assistant team working in a certified community behavioral health clinic or a federally qualified health center. Advanced practice registered nurses and physician assistants may prescribe buprenorphine for up to a 30-day supply without refill in certain circumstances. (Sections 334.037, 334.104, 334.735, & 334.747) These provisions are identical to provisions contained in the truly agreed CCS/HCS/SB 951 (2018), and similar to SCS/HCS/HB 2127 (2018), SCS/SB 745 (2018), SCS/HCS/HB 1574 (2018), HCS/HB 2233 (2018), and HB 244 (2017), and HB 1697 (2016). PSYCHOLOGISTS: The act provides that a doctoral degree in psychology from a program accredited, or provisionally accredited, by the Psychological Clinical Science Accreditation System is acceptable to meet various requirements for licensure as a psychologist if the degree program meets certain requirements as set forth in the act. (Sections 337.025, 337.029, & 337.033) These provisions are identical to provisions contained in: HCS/SB 796 (2018), the truly agreed CCS/HCS/SB 951 (2018), the truly agreed CCS/HCS/SB 660 (2018), the truly agreed CCS/SS/SCS/HB 1719 (2018), SCS/HB 1419 (2018), and SCS/HB 1629 (2018). MAINTENANCE MEDICATION: Current law provides that dispensing of maintenance medication based on refills authorized by the physician or prescriber on the prescription be limited to no more than a 90 day supply of the medication and the patient shall have already been prescribed the medication for 3 months. This act provides that the supply limitations shall not apply if the prescription is issued by a practitioner located in another state or dispensed to a patient who is a member of the United States Armed Forces serving outside the United States. (Section 338.202) This provision is identical to a provision contained in the truly agreed CCS/HCS/SS/SCS/SB 826 (2018) and similar to HB 1837 (2018). PATIENT SATISFACTION SCORES: The act specifies that patient scoring of pain control shall not be required when defining data standards for quality of care and patient satisfaction. Beginning August 28, 2018, the Director of the Department of Insurance, Financial Institutions and Professional Registration shall discontinue the use of patient satisfaction scores. (Section 374.426) This provision is identical to a provision contained in SCS/HCS/HB 2105 (2018), and in the truly agreed CCS/HCS/SB 951 (2018). HEALTH INSURANCE: The act requires every insurance company and health service corporation to offer, in all insurance policies, coverage for medication-assisted treatment for substance use disorders. (Section 376.811) This provision is identical to a provision contained in the truly agreed CCS/HCS/SB 951 (2018), and similar to a provision contained in HB 1636 (2018) and a provision contained in HCB 15 (2018). Current law that requires health carriers to provide coverage for early refills of an eye drop prescription is set to expire on January 1, 2020. This act repeals the expiration date. (Section 376.1237) This provision is identical to a provision contained in the truly agreed CCS/HCS/SS/SCS/SB 826 (2018). The act also modifies the definition of "mental health condition" for purposes of health insurance coverage by removing chemical dependency from the definition. (Section 376.1550) This provision is identical to a provision contained in the truly agreed CCS/HCS/SB 951 (2018), HB 2384 (2018), and SB 1098 (2018). IMPROVED ACCESS TO TREATMENT FOR OPIOID ADDICTIONS ACT: The act creates the "Improved Access to Treatment for Opioid Addictions Program," (IATOA), which shall disseminate information and best practices regarding opioid addiction, subject to appropriations. Assistant physicians who participate in the IATOA program shall complete the requirements to prescribe buprenorphine within 30 days of joining the program. The Department of Mental Health may develop curriculum, examinations, and certification on the subject of opioid addiction and treatment. An assistant physician in the IATOA program may serve several functions. When an overdose survivor comes to an emergency room, an assistant physician shall provide treatment options and support to the survivor, when reasonably practicable. (Section 630.875) This provision is identical to a provision contained in the truly agreed CCS/HCS/SB 951 (2018), and substantially similar to a provision in SCS/HCS/SB 2105 (2018) and HCB 15 (2018). MENTAL HEALTH PROFESSIONALS: The act adds psychiatric physician assistants, psychiatric advanced practice registered nurses, and psychiatric assistant physicians to the definition of mental health professionals for the purposes of provisions of law relating to alcohol and drug abuse and comprehensive psychiatric services and adds a definition for each term. (Section 632.005) This provision is identical to a provision contained in the truly agreed CCS/SS/SCS/HB 1719 (2018), the truly agreed CCS/HCS/SB 951 (2018), the truly agreed CCS/HCS/SB 660 (2018), and similar to HB 2295 (2018). This act contains an emergency clause for certain sections relating to opioids. JAMIE ANDREWS