CCS/SB 50 - This act modifies several provisions relating to health care, including: (1) STEMI and trauma center designations; (2) newborn screening; (3) neonatal and maternal levels of care; (4) x-ray inspections; (5) a health care directives registry; (6) hospital licensure; (7) hospital employment of dentists; (8) assistant physicians; and (9) speech-language pathologists and audiologists. STEMI AND TRAUMA CENTER DESIGNATIONS (Sections 190.241 and 190.242) Under this act, the Department shall promulgate rules for the designation of a trauma center and a STEMI center without site review if such hospital is certified by a national body. Additionally, a hospital may apply for STEMI center designation as follows: (1) a Level I STEMI center if such hospital has been certified as a Joint Commissions Comprehensive Cardiac Center or another approved nationally-recognized organization or (2) a Level II STEMI center if such hospital has been accredited as a Mission: Lifeline STEMI Receiving Center by the American Heart Association or another approved nationally-recognized organization. No rule or regulation promulgated by the Department of Health and Senior Services shall require hospitals, as a condition of trauma, STEMI, or stroke center designation, to obtain emergency medical services data, unless such data may be obtained from the state database for emergency medical services. Additionally, a hospital shall not be required to comply with an interpretation of a specific provision in a regulation concerning trauma, STEMI, or stroke centers if the hospital can demonstrate that the interpretation of such provision was different for a similarly-situated hospital, unless the Department has subsequently and consistently interpreted such provision for similarly-situated hospitals. The Department shall attend meetings with trauma, STEMI, and stroke centers for the benefit of improved communications, best-practice identification, and facilitation of improvements to the designation process. Finally, this act removes the requirement that the Department generate quarterly regional and state outcome data reports for trauma, stroke, and STEMI centers, the State Advisory Council on EMS, and regional EMS committees. These provisions are substantially similar to provisions in SCS/SB 495 (2017) and similar to HB 1153 (2017). NEWBORN SCREENING (Section 191.332) This act requires the Department of Health and Senior Services, beginning January 1, 2019, and subject to appropriations, to expand current newborn screening requirements to include spinal muscular atrophy and Hunter syndrome. This provision is identical to HCS/HB 66 (2017) and similar to SCS/HCS/HB 66 (2017). NEONATAL AND MATERNAL LEVELS OF CARE (Section 192.380) Under this act, the Department of Health and Senior Services shall hold public hearings and establish criteria for levels of maternal care designations and neonatal care designations for birthing facilities. Beginning January 1, 2019, any hospital with a birthing facility and any such hospital operated by a state university shall report to the Department its appropriate level of maternal care and neonatal care designations. The Department may partner with nationally-recognized nonprofit organizations with relevant expertise to administer the provisions of this act. This provision is identical to HB 58 (2017) and similar to provisions in HCS/HB 1875 (2016), SCS/SB 342 (2015), HCS/SCS/SB 146 (2015), HCS/SCS/SB 197 (2015), and HCS/SB 533 (2015). X-RAY INSPECTIONS (Section 192.500) This act provides that inspections of cone beam computed tomography systems and panoramic x-ray systems that cannot produce radiation intensity greater than thirty milligrays shall not be required to be inspected more frequently than every 3 years. Cone beam computed tomography systems that can produce radiation intensity greater than thirty milligrays shall be inspected annually. Additionally, all cone beam computed tomography systems and panoramic x-ray systems shall be inspected within thirty days of installation and whenever moved within an office. A cone beam computed tomography system is a medical imaging device which uses x-ray computed tomography to capture data using a cone-shaped x-ray beam. A panoramic x-ray system is an imaging device that captures the entire mouth in a single, 2-dimensional image that includes the teeth, upper and lower jaws, and surrounding structures and tissues. This act also provides that inspections of conventional x-ray equipment used exclusively on animals by a licensed veterinarian or veterinary facility shall not be required to be inspected more frequently than every 4 years. This provision is identical to a provision in HCS/SB 125 (2017) and SCS/HB 815 (2017) and similar to SB 212 (2017), SCS/HB 349 (2017), HB 1531 (2016), HB 832 (2015), and provisions in HCS/SCS/SB 38 (2015). HEALTH CARE DIRECTIVES REGISTRY (Section 194.600) This provision requires the Department of Health and Senior Services to contract with a third party for the establishment of a health care directives registry for the purpose of providing a place to securely store an advance health care directive online and to give authorized health care providers immediate access to the directive. The third party contractor shall be solely responsible for the administration and maintenance of the registry. All data and information contained in the registry shall remain confidential and shall be exempt from the Sunshine law. An "advance health care directive" is defined as either a power of attorney for health care or a declaration signed by an adult declarant containing the person's direction concerning a health care decision. All documents shall be submitted electronically to the registry at intake points, such as licensed health care providers and licensed attorneys, and signed electronically with a unique identifier, such as a Social Security number, a driver's license number, or another unique government-issued identifier. The electronic submission will be accompanied by a fee not to exceed ten dollars. The Department may promulgate rules to carry out theses provisions, which may include, but not be limited to, a determination of who may access the registry, including physicians, other licensed health care providers, the declarant, and his or her legal representative or designee. This provision is identical to a provision in CCS/HCS/SB 501 (2017) and SB 887 (2016) and substantially similar to SS/SCS/SB 122 (2015). HOSPITAL LICENSURE (Sections 197.005, 197.040, 197.050, 197.070, 197.071, 197.080, and 197.100) Under this act and beginning July 1, 2018, compliance with Medicare conditions of participation shall be deemed to constitute compliance with the standards for hospital licensure in this state. Nothing in this act shall preclude the Department of Health and Senior Services from promulgating regulations, with specific statutory authorization, to define separate regulatory standards that do not duplicate the Medicare conditions of participation. Regulations promulgated by the Department that duplicate or conflict with Medicare conditions of participation shall lapse and expire on and after July 1, 2018. This provision contains a delayed effective date of July 1, 2018. This provision is identical to a provision in CCS/HCS/SB 501 (2017) and SB 518 (2017) and substantially similar to HB 1069 (2017). HOSPITAL EMPLOYMENT OF DENTISTS (Section 332.081) Under this act, licensed hospitals shall be permitted to employ any of the following providers to treat certain conditions for hospital patients: (1) licensed dentists, (2) licensed oral and maxillofacial surgeons, and (3) licensed maxillofacial prosthodontists. This provision is identical to a provision in HCS/SB 125 (2017) and substantially similar to a provision in SCS/HB 815 (2017), SB 410 (2017), HB 762 (2017). ASSISTANT PHYSICIANS (Section 334.036) This act modifies the definition of "assistant physician" to allow any medical school graduate who has met the requirements to be an assistant physician between August 28, 2014, and August 28, 2017, to be deemed to be in compliance with the requirements of becoming an assistant physician. This provision is identical to a provision in CCS/HCS/SB 501 (2017) and HCS/HB 330 (2017). SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS (Section 345.051) This act provides that license renewal for speech-language pathologists and audiologists shall occur no less frequently than every three years. Additionally, the continued competence requirements for licensed speech-language pathologists and audiologists may include up to 30 hours triennially of continuing education, examination, self-evaluation, peer review, performance appraisal, or practical simulation. This provision is identical to a provision contained in HCS/SB 125 (2017), CCS/HCS/SB 501 (2017), and SCS/HB 815 (2017) and similar to a provision contained in HB 813 (2017). SARAH HASKINS