MASCA Legislative Report 5/17
Attachments
Top News of the Week
63% Fewer Bills Passed
A total of 55 policy bills were passed in the 2017 legislative session, which is a 63% decrease in the annual average. While some of Greitens major policy initiatives were passed (Right to Work, Expert Witness, Collateral Source, Uber/Ridesharing, Real ID, and a few others), there are other priority items that never made it across the finish line. Based off our recent conversations with the administration and House/Senate leadership, we are expecting Greitens to call a Special Session as early as next week to address one or more of the following (Venue – Lawsuit Reform, Prevailing Wage Repeal, Paycheck Protection – Labor Reform, and an energy bill to address the issue outlined below with an aluminum smelter in southeast Missouri). We will be with Greitens this week at the Republican Governor’s Association meeting and may get a better idea on the timing of a special session.
FULL BILL SUMMARIES FOR ALL HEALTH CARE BILLS PASSED IN 2017
HB 153 – Tort Reform
EXPERT WITNESS
This bill specifies that a witness who is qualified as an expert may testify in the form of an opinion or otherwise if the expert's specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue, the testimony is based on sufficient facts or data, the testimony is the product of reliable principles and methods, and the expert has reliably applied the principles and methods to the facts of the case.
An expert may base an opinion on facts or data in the case that the expert has been made aware of or personally observed. If experts in the particular field would reasonably rely on those kinds of facts or data in forming an opinion on the subject, such facts or data need not be admissible for the opinion to be admitted.
However, if the facts or data would otherwise be inadmissible, the proponent of the opinion may disclose them to the jury only if their probative value in helping the jury evaluate the opinion substantially outweighs their prejudicial effect.
An expert opinion is not objectionable just because it embraces an ultimate issue. In a criminal case, an expert witness must not state an opinion about whether the defendant did or did not have a mental state or condition that constitutes an element of the crime charged or of a defense.
The bill specifies the provisions do not prevent a landowner from testifying as to the value of their land.
Unless the court orders otherwise, an expert may state an opinion and give the reasons for it without first testifying to the underlying facts or data. However, the expert may be required to disclose those facts or data on cross-examination.
SS/SB 31 – Tort Reform
COLLATERAL SOURCE RULE – HEALTH CARE COSTS
Under the act, special damages claimed by the plaintiff at trial that have been satisfied by a payment from a defendant, the defendant's insurer, or authorized representative prior to trial are not recoverable. The defendant is entitled to deduct such payments towards special damages from any judgement as provided in current law.
Parties may introduce evidence of the actual cost, rather than the value, of the medical care or treatment to the plaintiff, and the act repeals a provision of law which provides that there is a rebuttable presumption that the value of the medical treatment provided is represented by the dollar amount necessary to satisfy the financial obligation to the health care provider. The actual cost of the medical care or treatment shall not exceed the dollar amounts paid by or on behalf of a patient whose care is at issue plus any remaining amount necessary to satisfy the financial obligation for medical care by a health care provided after adjustment for any contractual discounts, or price reduction.
This act is identical to the truly agreed to and finally passed version of SB 847 (2016) and similar to SB 227 (2015).
SS SCS HCS HBs 339 & 714 – Tort Reform
SETTLEMENT OF TORT CLAIMS
This bill provides that a time-limited demand to settle any claim for personal injury, bodily injury, or wrongful death must be in writing and sent by certified mail to the tortfeasor's liability insurer, and it must include various material terms specified in the bill. Additional information, as provided in the bill, must accompany the demand including authorizations to allow the party to obtain records from all employers and medical care providers. Upon receipt of a time-limited demand, a recipient may ask for clarification of the terms without it being considered a counteroffer or rejection of the demand. After acceptance of the time-limited demand, the defendant may provide payment to the claimant in the form of cash, money order, wire transfer, cashier's check, draft or bank check, or electronic funds transfer. A claimant may require payment within a specified period of time, but cannot be less than 10 days after written acceptance of the time-limited demand. This bill does not apply to offers made within 90 days of the trial (Section 537.058, RSMo).
TORT CLAIMS
This bill specifies that if a person who has a claim for damages against a tort-feasor enters into a contract with a tort-feasor's insurer, such person will, in consideration for payment of a specified amount of money and in case of judgment against the tortfeasor, levy execution only up to the applicable monetary limits of the insurance contract. The bill also specifies that execution or garnishment proceedings as to the insurer or insurers depend on whether the insurer or insurers have been notified in writing of the contract and have been given the opportunity to intervene within 30 days in any lawsuit relating to the un-liquidated claim for damages (Section 537.065).
SS HCS HB 452 – Tort Reform
ACTION AGAINST HEALTH CARE PROVIDERS
This bill creates a definition for the term "employee" and repeals the definition for the term "physician employee" in provisions relating to causes of action for damages against a health care provider for personal injury or death. With certain exceptions, no health care provider shall be liable to any plaintiff for the negligence of another entity or person who is not an employee of the health care provider.
CCS/SB 50 – Health Care
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 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 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 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), HCS/SB 501 (2017), and SCS/HB 815 (2017) and similar to a provision contained in HB 813 (2017)
SCS/SB 52 – Suicide Prevention
SHOW-ME COMPASSIONATE MEDICAL EDUCATION ACT
This act requires each public institution of higher education to develop and implement a policy to advise students and staff on suicide prevention programs available on and off campus that includes, but is not limited to crisis intervention access, mental health program access, multimedia application access, student communication plans, and post intervention plans. Such policy shall also advise students, faculty, and staff of the proper procedures for identifying and addressing the needs of students exhibiting suicidal tendencies or behavior, and shall require training where appropriate.
Each public institution of higher education shall provide all incoming students with information about depression and suicide prevention resources available to students. The information contained in such policy, in addition to any applicable free-of-cost prevention materials or programs, shall be posted on the websites of each public institution of higher education.
Each public institution shall establish and maintain methods of anonymous reporting of unsafe, potentially harmful, dangerous, violent, or criminal activities, or the threat of such activities. Such methods shall ensure the anonymity of the reporting party.
This act designates August 28, 2017, and thereafter a date designated by specified committees, as "Show-Me Compassionate Medical Education Day".
Under this act, no medical school in the state shall prohibit, discourage, or otherwise restrict a medical student organization or a medical organization from undertaking or conducting a study of the prevalence of depression or other mental health issues among medical students. Any medical school in this state is prohibited from penalizing, disciplining, or otherwise taking any adverse action against a student or medical student organization in connection with the student's or medical student organization's participation in, planning, or conducting a study of the prevalence of depression or other mental health issues among medical students.
This act permits medical schools in this state to conduct an ongoing multicenter study or studies in order to facilitate the collection of data and implement practices and protocols to minimize stress and reduce the risk for depression among medical students in Missouri. The act establishes the "Show-Me Compassionate Medical Education Research Project Committee". The multicenter study shall, among other specified objectives, collect relevant data and examine the culture of medical schools that may contribute to the risk of depression among students, as well as identify best practices to address the root causes of depression among students.
Any medical school which conducts a study under this act shall prepare an annual report concerning the specified objectives of the study. The reports must be made available annually on each medical school's website and to the Missouri General Assembly.
The sections relating to the "Show Me Compassionate Medical Education Act" contain an emergency clause.
HCS/SS/SCS/SB 66 – Workers’ Compensation
S CORPORATIONS
This act authorizes, beginning January 1, 2018, a shareholder of an S corporation with at least 40% or more interest in the S corporation to individually elect to reject coverage under the workers' compensation laws by providing a written notice of the rejection to the S corporation and its insurer. Failure to provide notice to the S corporation shall not be grounds for any shareholder to claim that the rejection is not legally effective. The shareholder may rescind the rejection in writing to the S corporation and its insurer. The rescission shall entitle the shareholder only to the benefits which accrue on or after the date of the notice of rescission is received by the insurance company.
This provision is identical to a provision in SCS/HB 289 (2017) and HB 148 (2015), and substantially similar to HB 1867 (2016).
MAXIMUM MEDICAL IMPROVEMENT
Under this act, for the purposes of workers' compensation laws, the term "maximum medical improvement" is defined as the point at which the injured employee's medical condition has stabilized and can no longer reasonably improve with additional medical care, within a reasonable degree of medical certainty.
Furthermore, in the case of temporary total and temporary partial disability benefits, such benefits shall only continue until the employee reaches maximum medical improvement unless such benefits are terminated by the employee's return to work or are otherwise terminated under law. In the case of permanent total disability, compensation shall be paid during the continuance of such disability from the date of maximum medical improvement for the lifetime of the employee at the appropriate weekly rate.
The act modifies provisions relating to compromise settlements under workers' compensation laws. For all compromise settlements offered after a claimant has reached maximum medical improvement, such claimants have 12 months after receiving an initial permanent disability rating from the employer's physician to acquire a rating from a second physician of his or her own choosing. Absent extenuating circumstances, if after 12 months the claimant has not acquired a second rating then any compromise settlement entered into shall be based upon the initial rating. Employers may waive these provisions with or without stating a reason.
These provisions are substantially similar to certain provisions in SCS/HB 289 (2017) and similar to SB 1027 (2016).
REDUCTION OF WORKERS' COMPENSATION AWARD BASED ON USE OF DRUGS
Under current law, if an employee fails to obey any rule or policy of an employer relating to the use of alcohol or nonprescribed controlled drugs in the workplace, the compensation or death benefit available under workers' compensation laws shall be reduced by 50% if the injury was sustained in conjunction with the use of alcohol or nonprescribed controlled drugs.
This act provides that any positive test for a nonprescribed controlled drug or the metabolites of such drug from an employee shall give rise to a rebuttable presumption that the tested nonprescribed controlled drug was in the employee's system at the time of an accident or injury and that the injury was sustained in conjunction with such drug if:
The initial testing was administered within 24 hours of the accident or injury;
Notice was given to the employee of the test results within 14 calendar days of the insurer receiving actual notice of the results;
The employee was given an opportunity to perform a second test; and
The initial or any subsequent testing which forms the basis of the presumption was confirmed by mass spectrometry using generally accepted medical or forensic testing procedures.
This provision is identical to a provision in SCS/HB 289 (2017) and HCS/HB 1100 (2017) and similar to a provision in SS/SCS/SB 113 (2017) and SCS/SB 290 (2017).
TERMINATION OF DISABILITY PAYMENTS - VOLUNTARY SEPARATION
If an employee voluntarily separates from employment at a time when the employer made work available for the employee which was in compliance with any medical restriction imposed upon the employee as a result of an injury that is the subject of a claim for benefits under workers' compensation, neither temporary total disability nor temporary partial disability benefits shall be payable to the employee.
This provision is identical to a provision in SS/SCS/SB 113 (2017) and SCS/SB 290 (2017), and substantially similar to a provision in HCS/HB 1100 (2017).
HEARINGS FOLLOWING TERMINATION OF WORKERS' COMPENSATION BENEFITS
Under current law, the Division of Workers' Compensation is required to set a hearing for any dispute over the termination of workers' compensation benefits within 60 days of an employee making a request for a hearing. This act requires a hearing to be set within 30 days.
DEATH BENEFITS AND BURIAL EXPENSES
This act modifies the definition of "dependent" for purposes death benefits and burial expenses available under workers' compensation laws. The term "dependent" is modified to mean only the claimant's spouse or the claimant's natural, posthumous, or adopted child or children, including any stepchild claimable by the deceased on his or her federal tax return at the time of injury, who are under the age of 18 years or over that age but physically or mentally incapacitated from wage earning. The act additionally eliminates partial dependents from the definition of "dependent."
This provision is identical to HCS/HB 725 (2017).
LINE OF DUTY COMPENSATION
Under current law, the estate of a deceased law enforcement officer, emergency medical technician, air ambulance pilot, air ambulance registered professional nurse, or firefighter who is killed in the line of duty is eligible to receive $25,000 in compensation. Under this act, such compensation shall be awarded as follows:
If there are no children, the surviving spouse shall be awarded the compensation;
If there is at least one eligible child and a surviving spouse, the child shall receive 50% and the surviving spouse shall receive 50%, provided that if there are multiple children, the children shall receive equal shares of 50% of the compensation;
If there is no surviving spouse, any eligible surviving children shall receive equal shares of the compensation;
If there is no surviving spouse or qualified surviving child, compensation shall be awarded to the individual who has been designated by the deceased in the most recent designation of beneficiary that is on file with the public safety organization; provided that if there is no such designation, compensation shall be awarded to the individual designated as beneficiary under the most recently executed life insurance policy of the deceased;
If there is no beneficiary of a life insurance policy of the deceased, compensation shall be awarded to the surviving parent or parents, in equal shares;
If there are no surviving parents of the deceased, compensation shall be awarded to the children of the deceased who are over 18 years of age, in equal shares.
These provisions are identical to SB 282 (2017) and certain provisions in SCS/HB 289 (2017) and
SS/SCS/SB 113 (2017). They are substantially similar to HB 426 (2017).
TRUST SELF-INSURERS
The act requires new applicants to specified self-insured trusts to submit proof of payment of 25% of the estimated annual premium to the Division of Workers' Compensation. Self-insured trusts are further permitted to invest surplus moneys from a prior trust year not needed for current obligations.
This provision is identical to a provision in SCS/HB 289 (2017) and HCS/HB 1100 (2017).
DISCHARGE AND DISCRIMINATION
Under current law, no employer or agent shall discharge or in any way discriminate against any employee for exercising any of his or her rights under workers' compensation statutes. This act modifies that provision so that no employer or agent shall discharge or discriminate against any employee when the exercising of such rights is the motivating factor in the discharge or discrimination.
This provision is identical to a provision in SS/SCS/SB 113 (2017), SCS/HB 289 (2017), and HCS/HB 1100 (2017), and similar to a provision in SCS/SB 290 (2017).
CCS/HCS/SCS/SB 139 – Health Care (Omnibus)
EMERGENCY ADMINISTRATION EPINEPHRINE (Section 196.990)
This act allows a physician to prescribe epinephrine (EPI) auto-injectors in the name of an authorized entity for use in certain emergency situations. Pharmacists, physicians, and other persons authorized to dispense prescription medications may dispense EPI auto-injectors under a prescription issued in the name of an authorized entity. An "authorized entity" is defined as any entity or organization at or in connection with locations where allergens capable of causing anaphylaxis may be present, including but not limited to restaurants, recreation camps, youth sports leagues, amusement parks, and sports arenas.
This act also allows such authorized entities to acquire and stock a supply of EPI auto-injectors under a prescription issued in accordance with the provisions of the act. An employee or agent of an authorized entity or any other person who has completed the required training shall be allowed to use the EPI auto-injector on the premises of or in connection with the authorized entity to provide it to any individual who the employee, agent or other person believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for the EPI auto-injector or has been previously diagnosed with an allergy. The employee or agent shall not administer or provide the auto-injector to a person who is eighteen years of age or younger without the verbal consent of a parent or guardian who is present at the time, unless the child will be in imminent danger without the use of the auto-injector.
The act specifies the required training and the procedures for making the EPI auto-injectors available to individuals other than trained persons, as long as the auto-injectors are secured and properly stored. The act also requires all basic life support ambulances and stretcher vans to be equipped with EPI auto-injectors and staffed by at least one person trained in the use of the auto-injectors.
This act exempts certain persons and entities from liability for any injuries or related damages that result from the administration or self-administration of an EPI auto-injector in accordance with the provisions of the act that may constitute ordinary negligence. The immunity shall not apply to acts or omissions constituting reckless disregard for the safety of others, or willful or wanton conduct, and shall be in addition to and not in lieu of the protections provided under the Good Samaritan emergency law. No trained person who is in compliance with this law and who in good faith and with reasonable care fails to administer the EPI auto-injector shall be liable for that failure.
These provisions are identical to HB 761 (2017) and SB 677 (2016), substantially similar to SS/SCS/SB 26 (2015) and HB 96 (2015), and similar to SB 868 (2014) and HB 1568 (2014).
POLYPHARMACY & ANTIPSYCHOTIC MEDICATIONS (Section 208.227)
This act repeals existing language relating to psychotrophic medications and adds new language relating to the establishment of a polypharmacy program and the prescribing of antipsychotic medications. The MO HealthNet Division shall establish a polypharmacy program for high-risk MO HealthNet participants with numerous or multiple prescribed drugs. The Division shall also establish a behavioral health pharmacy and opioid surveillance program to encourage the use of best medical evidence-supported prescription practices. The Division shall issue provider updates to enumerate specified treatment and utilization principles for MO HealthNet providers, including treatment principles relating to antipsychotic drugs.
If the Division implements any new policy or clinical edit for an antipsychotic drug, the Division shall continue to allow MO HealthNet participants access to any antipsychotic drug that they use and on which they are stable or that they have successfully used in the past. Additionally, the following shall apply to the prescribing of antipsychotics:
If an antipsychotic drug is listed as "non-preferred" by the Division and is considered clinically appropriate for an individual patient, prior authorization shall be simple and flexible;
If an antipsychotic drug is listed as "non-preferred" and is known or found to be safe and effective for a patient, the Division shall not restrict the patient's access to the drug and such drug shall be considered "preferred" for that patient;
A patient shall not be required to change antipsychotic drugs due to changes in medication management policy, prior authorization, or a change in the payor responsible for the benefit; and
Patients transferring from state psychiatric hospitals to community-based settings shall be permitted to continue their medication regimens.
The Division's medication policy and clinical edits shall provide MO HealthNet participants initial access to multiple FDA-approved antipsychotic drugs that have substantially the same clinical differences and adverse effects that are predictable across patients and whose manufacturers have entered into rebate agreements with the federal Department of Health and Human Services. The act specifies the categories of available drugs that shall be made available to participants.
These provisions are identical to provisions in HCS/HB 986 (2017), substantially similar to provisions in SCS/SB 433 (2017), and similar to provisions in HB 1159 (2017).
PRESCRIPTION DRUG REBATES (Section 208.229)
Under this act, pharmaceutical manufacturers shall pay to the state of Missouri, in accordance with federal law, rebates on eligible utilization of covered outpatient drugs dispensed to MO HealthNet participants as follows: (1) for single source drugs and innovator multiple source drugs, rebates shall reflect the manufacturer's best price; and (2) for single source drugs and innovator and noninnovator multiple source drugs, any additional rebates as necessary to account for certain price increases in excess of inflation.
These provisions are identical to provisions in HCS/HB 986 (2017), substantially similar to provisions in SCS/SB 433 (2017), and similar to provisions in HB 1159 (2017).
MISSOURI RX PROGRAM (Sections 208.790 & 208.798)
The act modifies provisions relating to the Missouri Rx Prescription Drug Program by requiring applicants' household income limits for eligibility to only apply to Medicaid dual eligible individuals.
The provisions of the Missouri Rx Program are extended and shall sunset on August 28, 2022.
These provisions are identical to provisions in HCS/HB 986 (2017).
DELEGATION OF PHYSICAL THERAPY TREATMENT (Section 334.506)
Currently, a physical therapist may delegate physical therapy treatment to a person in an entry level of a professional education program approved by the Commission for Accreditation of Physical Therapists and Physical Therapist Assistant Education. This act modifies the name of the relevant commission to the Commission on Accreditation in Physical Therapy Education (CAPTE).
RX CARES FOR MISSOURI PROGRAM (Sections 338.700 & 338.710)
This act also creates the Rx Cares for Missouri Program to be administered by the Board of Pharmacy in consultation with the Department of Health and Senior Services. The goals of the program are to promote medication safety and prevent prescription drug abuse. The Board may expend funds appropriated to the Board to private and public entities for the development of programs and education in order to meet these goals. Funds shall not be used for any state prescription drug monitoring program.
The Board of Pharmacy may enter into interagency agreements with the Department of Health and Senior Services so that the Department may assist in the operation of the program. The program shall expire on August 28, 2019.
These provisions are substantially similar to SB 1136 (2016).
CCS/HCS/SB 501 – Health Care (Omnibus)
This act modifies several provisions relating to health care, including: (1) health care records; (2) a health care directives registry; (3) drug or alcohol overdoses; (4) epinephrine auto-injectors; (5) hospital licensure; (6) immunization education; (7) sports medicine; (8) assistant physicians; (9) physician assistants; (10) psychologist internships; (11) vaccine protocols; (12) speech-language pathologists and audiologists; (13) medication-assisted treatment; and (14) a drug take-back program.
HEALTH CARE RECORDS (Section 191.227)
This act changes the fees for the search, retrieval, and copying of a patient's health care records by a health care provider. Additionally, a health care provider may disclose a deceased patient's health care records or payment records to specified persons in the act.
This provision is identical to a provision in SCS/HCS/HB 381 (2017) and HCS/HB 144 (2017).
HEALTH CARE DIRECTIVES REGISTRY (Section 194.600)
This act 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 shall be accompanied by a fee not to exceed ten dollars.
The Department may promulgate rules to carry out these 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/SB 50 (2017) and SB 887 (2016) and substantially similar to SS/SCS/SB 122 (2015).
DRUG OR ALCOHOL OVERDOSES (Sections 195.205 and 195.206)
Under this act, a person who, in good faith, seeks or obtains medical assistance for himself or herself or someone else who is experiencing a drug or alcohol overdose or other medical emergency shall not be arrested, charged, prosecuted, convicted, or have his or her property subject to civil forfeiture or otherwise penalized for offenses specified in the act if the evidence, charge, prosecution, conviction, seizure, or penalty was gained as a result of seeking or obtaining medical assistance.
This act shall not prevent a police officer from arresting a person for an outstanding warrant or prevent a person from being arrested, charged, or prosecuted based on an offense other than the specified offenses in the act, whether the offense arises from the same circumstances as the seeking of medical assistance. Additionally, the protection from prosecution under this act for possession offenses shall not be grounds for suppression of evidence or dismissal in charges unrelated to this act.
Finally, any police officer who is in contact with any person or persons in need of emergency medical assistance under this act shall provide appropriate information and resources for substance-related assistance.
This provision is identical to HB 294 (2017).
Additionally, this act gives the Director of the Department of Health and Senior Services, or a licensed physician with the express written consent of the Director if the Director is not a licensed physician, the authority to issue a statewide standing order for an opioid antagonist. A physician issuing such an order shall not be subject to any criminal or civil liability or professional disciplinary action associated with the order.
This provision is identical to a provision in HCS/HB 1197 (2017).
EPINEPHRINE AUTO-INJECTORS (Section 196.990)
This act allows a physician to prescribe epinephrine (EPI) auto-injectors in the name of an authorized entity for use in certain emergency situations. Pharmacists, physicians, and other persons authorized to dispense prescription medications may dispense EPI auto-injectors under a prescription issued in the name of an authorized entity. An "authorized entity" is defined as any entity or organization at or in connection with locations where allergens capable of causing anaphylaxis may be present, including but not limited to restaurants, recreation camps, youth sports leagues, amusement parks, and sports arenas.
This act also allows such authorized entities to acquire and stock a supply of EPI auto-injectors under a prescription issued in accordance with the provisions of the act. An employee or agent of an authorized entity or any other person who has completed the required training shall be allowed to use the EPI auto-injector on the premises of or in connection with the authorized entity to provide it to any individual who the employee, agent or other person believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for the EPI auto-injector or has been previously diagnosed with an allergy. The employee or agent shall not administer or provide the auto-injector to a person who is eighteen years of age or younger without the verbal consent of a parent or guardian who is present at the time, unless the child will be in imminent danger without the use of the auto-injector.
The act specifies the required training and the procedures for making the EPI auto-injectors available to individuals other than trained persons, as long as the auto-injectors are secured and properly stored. The act also requires all basic life support ambulances and stretcher vans to be equipped with EPI auto-injectors and staffed by at least one person trained in the use of the auto-injectors.
This act exempts certain persons and entities from liability for any injuries or related damages that result from the administration or self-administration of an EPI auto-injector in accordance with the provisions of the act that may constitute ordinary negligence. The immunity shall not apply to acts or omissions constituting reckless disregard for the safety of others, or willful or wanton conduct, and shall be in addition to and not in lieu of the protections provided under the Good Samaritan emergency law. No trained person who is in compliance with this law and who in good faith and with reasonable care fails to administer the EPI auto-injector shall be liable for that failure.
This provision is identical to HB 761 (2017) and SB 677 (2016), substantially similar to SS/SCS/SB 26 (2015) and HB 96 (2015), and similar to SB 868 (2014) and HB 1568 (2014).
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.
These provisions contain a delayed effective date of July 1, 2018.
These provisions are identical to provisions in CCS/SB 50 (2017) and SB 518 (2017) and substantially similar to HB 1069 (2017).
IMMUNIZATION EDUCATION (Section 198.053)
Under this act, all Missouri assisted living facilities shall, no later than October 1 each year, notify residents and staff where in the facility the latest edition of the Vaccine Informational Sheet published by the Centers for Disease Control and Prevention has been posted. Nothing in this act shall be construed to require any assisted living facility to pay for an influenza vaccination, allow the Department of Health and Senior Services to promulgate any rules to implement this provision, or cite any facility for acting in good faith to post the Vaccine Informational Sheet.
This provision is identical to a provision in HCS/SCS/SB 334 (2017) and HCS/SB 363 (2017) and similar to HB 778 (2017).
PROFESSIONAL REGISTRATION (Section 324.003)
This act provides the acceptable ways in which a professional licensee may submit payment, application, requests for educational time extensions, or notify his or her licensing board for changes to items required as part of licensure to the Division of Professional Registration or its component boards, committees, offices, and commissions.
This provision is substantially similar to a provision in HCS/SB 125 (2017).
SPORTS MEDICINE (Section 334.010)
This act permits a physician to travel into Missouri with an athletic team and provide sports-related medical services to specified individuals related to the athletic team, band, dance team, or cheerleading squad, so long as the physician is currently licensed to practice medicine in another state and has a written agreement with an athletic team located in the state where the physician is licensed. The act prohibits such physician from providing medical services at a health care facility in Missouri.
This provision is identical to SB 494 (2017), SCS/HCS/HB 122 (2017), and SCS/HB 815 (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/SB 50 (2017) and HCS/HB 330 (2017).
PHYSICIAN ASSISTANTS (Section 334.735)
Under current law, physician assistants may only dispense drugs, medicines, devices, or therapies pursuant to a physician supervision agreement. This act removes this requirement.
This provision is identical to SB 455 (2017) and substantially similar to a provision in SCS/HB 815 (2017).
PSYCHOLOGIST INTERNSHIPS (Sections 337.010 and 337.025)
This act changes the experience requirements for initial licensure as a psychologist. Under the provisions of the act, supervised professional experience may be accrued through preinternship, internship, predoctoral postinternship, or postdoctoral experiences. Each applicant shall complete 1,500 hours or supervised professional experience as part of his or her required internship, along with an additional 2,000 hours through preinternship, predoctoral postinternship, internship, or postdoctoral experiences.
These provisions are identical to SB 397 (2017) and substantially similar to provisions in SCS/HCS/HB 316 (2017).
VACCINE PROTOCOLS (Section 338.010)
This act requires pharmacists to administer vaccines by protocol in accordance with treatment guidelines established by the Centers for Disease Control and Prevention.
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 CCS/SB 50 (2017), HCS/SB 125 (2017), and SCS/HB 815 (2017) and similar to a provision contained in HB 813 (2017).
MEDICATION-ASSISTED TREATMENT (Sections 478.004 and 487.200)
This act allows participants in drug courts, family courts, and veterans courts to receive medication-assisted treatment under the care of a licensed physician if the participant requires such treatment for substance abuse dependence. A participant assigned to a substance abuse treatment program for substance abuse or dependence shall not be in violation of the terms or conditions of the program on the basis of his or her participation in medication-assisted treatment.
These provisions are identical to provisions contained in HCB 1 (2017), HCS/HB 219 (2017), and HCS/HB 1197 (2017) and similar to HB 710 (2017).
DRUG TAKE-BACK PROGRAM (Section 1)
This act gives the Missouri Board of Pharmacy the ability to allocate funds to develop a drug take-back program to collect and dispose of Schedule II and III controlled substances.
This provision is substantially similar to a provision in HCS/HB 1197 (2017).
CCS/SB 503 – Emergency Services
EMS MEDICAL DIRECTORS - 190.103
The act modifies the designations and duties of state and regional EMS medical directors, including that regional EMS directors shall be considered public officials for certain purposes, the state EMS medical director's advisory committee shall be considered a peer review committee and eligible to participate in certain programs, allowing regional medical directors to provide medical direction by telecommunication, and provisions allowing regional medical directors to promulgate treatment protocols for patients with special needs and requiring EMS agencies to follow those protocols.
These provisions are identical to provisions of SCS/SB 418 (2017).
EMT LIABILITY - 190.144
The act provides that no emergency medical technician shall be liable, if acting in good faith and without gross negligence, for the administration of a patient's personal medication when deemed necessary.
This provision is identical to provisions of HCS/SS/SB 124 (2017), HCS/HB 226 (2017), and HCS/HB 1044 (2017).
ANSWERING POINTS STUDY - 190.450
The act requires that the Department of Public Safety shall conduct a study by December 31, 2017, relating to 911 answering points and issue a state public safety answering point consolidation plan based upon the study.
MISSOURI 911 SERVICE BOARD - Sec. 650.320, 650.325, & 630.330
The act changes the name of the Advisory Committee for 911 Service Oversight to the Missouri 911 Service Board.
The number of Board members is reduced from 16 to 15, and the composition of the Board is changed. The Board shall have no authority over certain emergency communications services providers. No corporation or its affiliate shall have more than one member on the Board, subject to the exception that all members appointed as of August 28, 2017, shall continue to serve the remainder of their terms. Additional new powers and responsibilities of the Board are specified including compliance with federal standards, coordinating services, planning and implementing improvements to technological systems, and collaborating with other bodies of state government.
The Board is required to designate a coordinator who shall be responsible for overseeing state 911 operations.
A deadline relating to rulemaking authority is modified and extended to August 28, 2017.
The section modifying the Missouri 911 Service Board contains an emergency clause.
These provisions are similar to HB 1009 (2017).
STATE AUDITOR'S AUTHORITY TO CONDUCT PERFORMANCE AND FISCAL AUDITS
The act authorizes the State Auditor to conduct performance and fiscal audits of any board, dispatch center, joint emergency communications entity, or trust fund involving emergency 911 service.
This provision is identical to a provision of SCS/HCS/HB 334 (2017).
