HCS/SB 1019 - This act modifies several provisions relating to health care. HOSPITAL INVESTMENTS AND SERVICE AREAS (Sections 96.192, 96.196, 206.110, and 206.158) This act modifies the investment authority of boards of trustees of municipal hospitals in third class cities and hospital district hospitals. Current law permits investment of up to 25% of funds not required for operations of the hospital or other obligations. This act permits investment of up to 50% of funds not required for operations or other obligations in a manner described in the act, with the remaining portion to be invested into any investment in which the Treasurer is allowed to invest. Under this act, municipal hospitals in third class cities may operate in areas where hospital district hospitals and county hospitals operate. Hospital district hospitals may operate in areas where municipal hospitals in third class cities and county hospitals operate. These provisions are identical to SB 244 (2025) and substantially similar to provisions in SS/SCS/SB 841 (2026), SCS/HCS/HB 2372 (2026), SCS/HCS/HB 943 (2025), SCS/SB 317 (2025), and HCS/SS/SB 7 (2025). TELEHEALTH (Sections 191.1146 and 334.108) Currently, the establishment of a physician-patient relationship for purposes of telehealth shall include an interview and a physical examination. Under this act, an evaluation is required, but a physical examination shall be required only if needed to meet the standard of care. Current law prohibits the use of an internet or telephone questionnaire completed by a patient from constituting an acceptable medical interview for the provision of treatment by telehealth. This act permits such questionnaires if the information provided is sufficient as though the medical evaluation was performed in person, with a report to be provided to the patient's primary health care provider within fourteen days of evaluation, as described in the act. Additionally, current law requires a physician-patient relationship for purposes of telehealth to include a sufficient dialogue with the patient regarding treatment. This act changes "dialogue" to "exchange" with the patient regarding treatment. Finally, current law prohibits a health care provider from prescribing any drug, controlled substance, or other treatment to a patient based solely on an internet request or questionnaire. Under this act, a health care provider shall not prescribe any drug, controlled substance, or other treatment to a patient in the absence of a proper provider-patient relationship. These provision are identical to provisions in SS/SCS/SB 841 (2026) and SCS/HCS/HB 2372 (2026), substantially similar to SB 108 (2025) and SB 851 (2024), and similar to SCS/SB 418 (2023) and HB 710 (2023). DEPARTMENT OF HEALTH AND SENIOR SERVICES CONTRACTS FOR PUBLIC HEALTH (Section 192.021) This act authorizes the Department of Health and Senior Services to contract with a Missouri affiliate of a national public health association or public health institute, or a similar or successor entity, in order to assist in carrying out its duties to promote the health and well-being of Missouri residents. Such contracts may include efforts to assist in the delivery of health services throughout the state and the administration of grant funds and related programs. The Department and the designated affiliate shall provide a report to the General Assembly as specified in the act. This provision is identical to a provision in SS/SCS/SB 841 (2026) SB 1525 and substantially similar to provisions in SB 1037 (2026), HCS/SB 94 (2025), and SB 549 (2025). HOSPITAL WORKPLACE VIOLENCE (Section 197.708) Under this act, each hospital shall prominently display a printed sign, in all capital letters, warning that assaulting a health care professional is a serious crime which may be punishable as a class A misdemeanor. This provision is identical to provisions in the perfected HCS/HB 2372 (2026), HCS/SB 94 (2025), and HCS/HB 1213 (2025) and substantially similar provisions in SS/SCS/SB 841 (2026) and SB 791 (2025). MO HEALTHNET COVERAGE OF CERTAIN CLINICAL PATHOLOGY SERVICES (Section 208.149) This act requires that the fee for the professional component of clinical pathology services shall be paid by MO HealthNet for professional services provided by a hospital-based pathologist for inpatient clinical pathology services rendered to MO HealthNet patients. The reimbursement shall be set at no less than thirty percent of the approved MO HealthNet Independent Lab-Technical Component fee schedule, as described in the act, as shall be made directly to the physician providing the services or the entity the physician has assigned the right to receive payment. This provision is identical to a provision in SS/SCS/SB 841 (2026) and the perfected HCS/HB 2376 (2026) and substantially similar to a provision in HCS/SB 94 (2025) and SCS/HCS/HB 943 (2025). LICENSE RECIPROCITY (Section 324.009) Those health care providers, who hold a current license issued by another jurisdiction and are licensed in Missouri with a waiver of examination, educational, or experience requirements, shall be deemed to be fully licensed to practice within the profession's scope of practice in Missouri and may provide telehealth services to the same extent and manner as health care providers who receive a license without a waiver. This provision is identical to a provision in SS/SCS/SB 841 (2026), SB 1691 (2026), a provision in the perfected HCS/HB 2372 (2026), and HCS/HB 2974 (2026). SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS (Section 345.050) This act modifies the requirements for licensure as a speech-language pathologist or audiologist by providing for completion of a clinical fellowship under the direct supervision of a licensed speech-language pathologist in good standing, rather than under the direct supervision of a person licensed by the state of Missouri in the profession in which the applicant seeks to be licensed. This provision is identical to a provision in SS/SCS/SB 841 (2026), SB 1405 (2026), the perfected HCS/HB 2372 (2026), in HCS/SS/SB 7 (2025), in the perfected SS/SB 61 (2025), in the perfected HCS/HB 268 (2025), SB 431 (2025), in the perfected HB 478 (2025), in HB 765 (2025), and in SCS/HB 834 (2025), and is substantially similar to the perfected HB 2591 (2026). 340B DRUGS (Section 376.417) Under this act, a health carrier, a pharmacy benefits manager, or an agent or affiliate of such, shall not discriminate against a covered entity, as defined in the act, including by reimbursing the covered entity for a quantity of a 340B drug in an amount less than it would pay similarly situated non-covered entities for such drugs, imposing different terms and conditions as compared to similarly situated entities, refusing to cover 340B drugs or discriminating in reimbursement for 340B drugs, and other situations described under this act. The Director of the Department of Commerce and Insurance shall impose a civil penalty on any health carrier, pharmacy benefits manager, or agent or affiliate of such, that violates this provision, not to exceed $5,000 per violation per day. This provision is identical to a provision in SS/SCS/SB 841 (2026), SCS/HCS/HB 943 (2025) and HB 784 (2025). MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (Sections 376.1000-376.1017) This act modifies the definition of "multiple employer-self insure health plan" by including two or more self-employed individuals, each with at least one common-law employee, and their dependents. Currently, funds collected from the participating employers under the health plans are held in trust and trustees are required to file an annual report with the director of the Department of Commerce and Insurance showing the condition and affairs of the plan as of the preceding thirty first day of December. This act requires the annual report be filed with the National Association of Insurance Commissioners and comply with current law. This act requires plans to establish a surplus account equal to the greater of six hundred thousand dollars or an amount equal to two times the authorized control level risk-based capital, as defined by current law. These provisions are identical to provisions in SS/SCS/SB 841 (2026) and the perfected HCS/HB 2596 (2026) and similar to SB 1464 (2026). INSURANCE COVERAGE OF ALTERNATIVES TO OPIOID DRUGS (Section 376.1280) This act provides that an enrollee's health benefit plan shall not deny coverage of a non-opioid prescription drug in favor of an opioid drug, require the enrollee to try an opioid drug before covering the non-opioid prescription drug, or require a higher level of cost-sharing for a non-opioid prescription drug than for an opioid drug. This act shall apply to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027. These provisions shall only be applicable when multiple nonopioid medications are approved by the U.S. Food and Drug Administration for the treatment of chronic or acute pain. This provision is identical in the perfected HCS/HB 2372 (2026) and substantially similar to a provision in SS/SCS/SB 841 (2026) and SB 158 (2025). ARTIFICIAL INTELLIGENCE IN MENTAL HEALTH (Section 407.3007) The act provides that no person or entity that develops or deploys artificial intelligence (AI) shall advertise or represent to the public that the AI is or is able to act as a mental health professional, as defined in the act, or is capable of providing therapy services, psychotherapy services, or a mental health diagnosis. A violation under the act shall be considered an unlawful practice under the Missouri Merchandising Practices Act. The Attorney General shall enforce the provisions of the act. Any individual may report violations of the act to the Attorney General. If the Attorney General finds that a violation occurred, the Attorney General shall commence a civil action. If the court finds that a violation occurred, the court may grant relief as described in the act. This provision is identical to a provision in SS/SCS/SB 841 (2026), the perfected HCS/HB 2372 (2026), and SCS/SB 1444 (2026) and similar to HB 2368 (2026). NOTARIZATION REQUIREMENTS FOR MENTAL HEALTH FACILITY DETENTION (Section 632.305) This act modifies notarization requirements for applications for detention for evaluation and treatment at a mental health facility. Under this act, no notarization shall be required for the application or any affidavits, declarations, or other supporting documents filed under certain provisions of law, including when filed in court by an adult, when a peace officer takes a person into custody for detention at the facility for a period of 96 hours, when a person presents themselves at the facility and the health care provider completes the application, or if the person executing the application is an employee acting on behalf of a hospital. This provision is identical to provisions in SS/SCS/SB 841 (2026), the perfected SS/SCS/SB 1015 (2026), the perfected HB 1977 (2026), a provision in the perfected HCS/HB 2372 (2026), and provisions in SCS/HCS/HB 1259 (2025) and substantially similar to SB 1274 (2026) and SB 436 (2025). SEXUALLY VIOLENT PREDATOR CIVIL COMMITMENT (Sections 632.489, 632.492, 632.495, 632.504, and 632.520) Under this act, if a person is ordered to the Department of Mental Health for evaluation as to whether the person is a sexually violent predator, the Director of the Department of Mental Health shall determine the appropriate secure facility, which may include the Department of Corrections. The Department of Mental Health and the Department of Corrections may enter into an interagency agreement, which may permit the Department of Corrections to enter into a contract agreement with one or more licensed professionals or providers of health care services to provide health care services to such persons. Persons in the control and care of the Department of Corrections under this provision shall be housed and managed separately from other offenders. These provisions are identical to provisions in the truly agreed and finally passed HCS/SB 982 (2026). ASSISTED OUTPATIENT TREATMENT (Sections 632.580-632.610) This act establishes procedures for authorizing or continuing an individual's assisted outpatient treatment. A petition in court for such treatment may be filed by individuals specified in the act. A court may issue an order requiring the individual to participate in assisted outpatient treatment if the individual is at least 18 years of age, is suffering from a mental disorder, will not obtain treatment in the community voluntarily, and is unable to make an informed decision to see or comply with voluntary treatment. Additional grounds for ordering treatment shall consider the necessity of treatment to prevent a deterioration in the individual's mental illness likely to result in harm to the individual or others or the individual's history of lack of compliance with treatment for the illness, as described in the act. The act sets forth the procedures for the hearing process, including the option for a jury trial. If the court or jury finds, by clear and convincing evidence, that the individual meets the criteria for assisted outpatient treatment and that an appropriate mental health program has agreed to accept the individual, the court shall issue an order requiring the individual to participate in treatment for a period not to exceed two years, unless extended by the court as described in the act. Current provisions of law exempting certain professionals from civil liability for investigating, detaining, transporting, conditionally releasing, or discharging a person shall apply to assisted outpatient treatment under this act. The court shall assign a case manager from a certified community behavioral health clinic to each individual ordered to participate in assisted outpatient treatment. The case manager and individual shall report to the court at least once every ninety days. If a court determines that the individual is not complying with an order of assisted outpatient treatment, the court may order, without a hearing, that the individual be evaluated at a community mental health center, be hospitalized in a psychiatric hospital for a period of not more than ten days, and potentially be hospitalized for longer upon the recommendation of the community mental health center; provided such extended hospitalization does not exceed the duration of the order for assisted outpatient treatment or ninety days, whichever is less. If the individual objects to such hospitalization, the court shall schedule a hearing as described in the act. Beginning December 1, 2028, the Office of State Courts Administrator shall submit an annual report to the General Assembly regarding certain statistics of individuals receiving treatment under this act and the impact of such treatment on hospitalization and incarceration rates. These provisions are identical to provisions in the perfected SS/SCS/SB 1015 (2026) and substantially similar to HB 1154 (2025). SARAH HASKINS HA#1: MODIFIES SECTIONS 96.192 AND 206.158 RELATING TO HOSPITAL INVESTMENTS AND SERVICE AREAS FROM THE SENATE PERFECTED BILL; ADDS SECTION 192.026 RELATING TO LYME DISEASE REPORTING; AND REPEALS ALL PROVISIONS ADDED IN THE HOUSE COMMITTEE SUBSTITUTE