Health/Hospital Law
HCS HB 98 — Transportation Services for the Elderly. (See Elder Law)
HCS HB 182 — Outside the Hospital Do-Not-Resuscitate Act. Establishes the Outside the Hospital Do-not-resuscitate Act which requires that a copy of a do-not-resuscitate order must be included as the first page of a patient’s medical record. A patient or patient’s representative and the patient’s attending physician may execute an outside the hospital do-not-resuscitate order. The Department of Health and Senior Services must develop and approve uniform forms and personal identifiers. The identifiers must alert any emergency medical technician, paramedic, first responder, or other health care provider of the existence of the order for the patient.
Specifies that the outside the hospital do-not-resuscitate order will only be effective when the patient has not been admitted to or is not being treated within a hospital. These orders and protocols will not authorize the withholding or withdrawal of other medical interventions such as intravenous fluids, oxygen, or therapies other than cardiopulmonary resuscitation. An outside the hospital do-not-resuscitate order will not be in effect when a patient is pregnant or when believing in good faith that a patient is pregnant.
Emergency medical technicians, paramedics, first responders, and other health care providers are required to comply with an outside the hospital do-not-resuscitate order or identifier unless the patient or patient’s representative expresses to the personnel in any manner, before or after the onset of a cardiac or respiratory arrest, the desire to be resuscitated. A physician or a health care facility other than a hospital that is unwilling or unable to comply with this order must take all reasonable steps to transfer the patient to another physician or facility where the order will be followed.
Specifies the individuals and entities that are exempt from civil or criminal liability for withholding or withdrawing resuscitation pursuant to an order or identifier if the actions were performed in good faith and without gross negligence. Anyone who knowingly conceals, cancels, defaces, or obliterates an order or identifier without the individual’s consent or knowingly falsifies or forges a revocation will be guilty of a class A misdemeanor. Anyone who knowingly executes, falsifies, or forges an order without the individual’s consent or knowingly conceals or withholds the knowledge of a revocation of an order will be guilty of a class D felony. (Signed 7/13/07)
HCS HB 497 — Physician Assistants. Expands the definition of “supervision” of physician assistants to allow supervising physicians to be available via telecommunication for consultation, assistance, or intervention. Supervising physicians must be present a minimum of 66% of the clinic’s hours for practice supervision and collaboration when utilizing physician assistants, and physician assistants must practice within 30 miles of the supervising physician.
The Advisory Commission on Physician Assistants is authorized to create a waiver mechanism by which an individual physician and a physician assistant together may apply to the State Board of Registration for the Healing Arts for alternate amounts of on-site supervision. After receiving a waiver, the physician assistant will be allowed to conduct unsupervised practice up to 50 miles from the supervising physician in a designated health professional shortage area.
Prior to allowing a physician assistant to practice without the physician being physically present, the physician assistant must practice for one month with continuous physician supervision. After January 1, 2008, a physician assistant applicant will be required to have a master’s degree in a health or medical science related field.
The bill also voids and makes it against public policy to require any physician to enter into any contract or other agreement to act as a supervising physician for any physician assistant. A physician has the right to refuse to act as a supervising physician, and no contract will limit the supervising physician’s ultimate authority over any protocols or standing orders. A physician cannot supervise more than three full-time physician assistants except in a hospital setting. (Signed 6/30/07)
HB 554 — Discrimination Against Licensed Professional Counselors. Prohibits state and local agencies, including school districts, from discriminating between licensed professional counselors when establishing rules or when requiring or recommending services that may be legally performed by licensed professional counselors. (Signed 6/30/07)
HB 686 — Nursing Home Administrators’ Rule-Making Authority. (See Administrative Law)
CCS SS SCS HCS HB 780 — Professional Registration. (See Licensing Law)
SCS HB 791 — Health Carrier Claims Information. (See Insurance Law)
SS#2 SCS HCS HB 818 — Health Insurance. Establishes the Missouri Health Insurance Portability and Accountability Act including provisions to make Missouri compliant with federal law and changes the laws regarding health care insurance. Includes provisions relating to:
(1) Missouri Consolidated Health Care Plan;
(2) Missouri Health Insurance Portability and Accountability Act;
(3) Missouri Health Insurance Pool;
(4) Small Employer Health Insurance Act;
(5) Health Care Sharing Ministry;
(6) Health Insurance Tax Credits and Income Tax Deductions; and
(7) Delinquent Medical Bills.
Currently, state agencies are allowed to submit an agency debt to the Department of Revenue in order to set off the debt by the person’s tax refund. The bill establishes a process for hospitals and other health care providers to intercept a person’s tax refund or lottery winnings.
Down Syndrome Prenatal Information. A health care provider is required to give certain information to a patient who receives a positive result from a prenatal test for Down syndrome or other condition, including current information about the tested conditions, accuracy of the tests, resources for obtaining support services, and referrals to support service providers, including the Missouri Alternatives to Abortion Services Program.
Dependent Health Insurance Coverage. If a health maintenance organization, a group health insurance, or an accident and sickness insurance plan provides coverage for an enrollee’s dependent, the insurer must offer coverage until the dependent’s twenty-fifth birthday. In addition to being younger than 25 years of age, the dependent must be unmarried, a state resident, and not be covered under a health benefit plan or government program.
Prescription Drug Coverage. Any health carrier or health benefit plan that provides prescription drug coverage must notify enrollees in writing or electronically of all additions or deletions in its prescription drug formularies at least 30 days prior to the immediately preceding plan year and for each calendar quarter.
Discount Medical Plan Organizations. Establishes regulations for discount medical plan organizations and specifies that a discount medical plan cannot allow discounts or prices to be sold, rented, or otherwise provided to another carrier, a self-insured or self-funded employer-sponsored plan, or a Taft-Hartley trust.
Tocologists. Specifies that any person who holds a current certification for a minister of religion or a certification in the science of childbirth, midwifery, or obstetrics by an organization accredited by the National Organization for Competency Assurance may provide services related to pregnancy, including prenatal, delivery, and postpartum services.
The provisions regarding the Missouri Health Insurance Portability and Accountability Act, delinquent medical bills, prescription drug coverage, dependent health insurance coverage, and certain sections regarding the Missouri Health Insurance Pool become effective January 1, 2008. (Signed 6/1/07)
HCS HB 948 — Genetic and Metabolic Screening Programs. (See State Government Law)
SS SCS HCS HB 952 & 674 — Long-Term Care Facilities. Allows any intermediate care facility that provides the services of an assisted living facility to advertise itself as an assisted living facility without obtaining a license to operate as an assisted living facility from the Department of Health and Senior Services.
Requires certain long-term care facilities; assisted living facilities; and facilities completing a major renovation that are licensed by the department are required to install and maintain an approved sprinkler system in accordance with the standards of the National Fire Protection Association (NFPA).
Facilities that make a substantial effort to install an approved sprinkler system prior to December 31, 2012, may apply to the department for a loan for the costs to install the system. All long-term care facilities must be equipped with a complete fire alarm system by December 31, 2008; and each floor accessed by residents must be divided into at least two sections separated by a one-hour rated smoke partition.
The Fire Mitigation System Installer Statewide Qualification Commission is established. (Signed 6/1/07)
HCS HB 1055 — Sexual Education and Abortions. (See Education/School Law)
CCS HCS#2 SS SCS SB 3 — Vulnerable Person Abuse. (See Criminal Law)
SCS SB 4 — Health Care Provider Tax. (See Taxation Law)
SCS SB 16 — Children’s Vision Examinations. (See Education/School Law)
SS SB 195 — Practice of Pharmacy. Revises the definition of “practice of pharmacy” to include the implementation of medical prescription orders and authorizes the design and implementation of a medication therapeutic plan defined by a specific prescription order. Physician protocols referring to the patient are required and cannot come from a nurse under a collaborative agreement with a physician.
Health carriers are prohibited from requiring any physician with whom they contract to enter into a written protocol with a pharmacist for medication therapeutic services.
Prohibits any person other than the patient or the patient’s authorized representative from accepting a dispensed prescription order unless that person is on the premises of a pharmacy.
The State Board of Pharmacy may establish the Well-being Committee to aid pharmacists who suffer from illness, substance abuse, mental illness, or physical impairments. All communications involving the licensee and the committee are confidential and not considered a public record.
The committee may disclose information about an impaired licensee when it is necessary to further the intervention, treatment, or rehabilitation of the licensee; the release is authorized by the licensee; the committee must make a report to the board; or the information is subject to a court order. (Signed 7/13/07)
SB 298 — Hospital District Directors in Iron County. (See Local Government Law)
SCS SB 397 — Long-Term Care Facilities Licensure Requirements. (See Elder Law)
SCS SB 418 — Supplemental Nursing Care Program. (See Elder Law)
SB 513 — Nursing Student Loan Program. (See Education/School Law)
CCS HCS SS SCS SB 577 — Mo HealthNet Program. Changes the laws regarding the state medical assistance program, known as the Missouri Medicaid Program, including changing its name to the Mo HealthNet Program.
State Legal Expense Fund. Physicians, dentists, podiatrists, chiropractors, nurses, optometrists, psychologists, professional counselors, social workers, and pharmacists who provide specialty care without compensation and who were referred by their city or county health department, city health department operating under a city charter, combined city-county health department, a nonprofit community health center, or any social welfare board established under Section 205.770, RSMo, are included in the list for whom the State Legal Expense Fund is available. The fund is not available to a physician who performs an abortion procedure.
Any claim or judgment arising from these provisions is limited to a maximum of $1 million based upon the same act or acts in a single cause of action and $1 million for any one claimant. Liability or malpractice insurance will not be considered available to pay any portion of the judgment when the fund is liable.
Health Professional Shortage Areas. The Missouri Healthcare Access Fund is created to expand health care services in state and federally designated areas with health care shortages. Beginning January 1, 2007, individuals making a donation in excess of $100 to the fund will be eligible for an income tax credit.
Health Access Incentive Fund. Psychiatrists, psychologists, professional counselors, and social workers are added to the list of providers who are allowed to receive enhanced payments from the Health Access Incentive Fund in designated shortage areas.
Mo HealthNet Fraud and Abuse. The bill:
(1) Expands the definition of “health care provider” to include any employee, representative, or subcontractor of the state;
(2) Increases the penalty for making a false statement to a class C felony for a first conviction and a class B felony for a subsequent conviction. A person who attempts to or willfully prevents, obstructs, misleads, or delays the communication of information relating to a violation will be guilty of a class D felony;
(3) Specifies that any person who is the original source of information regarding a violation will be compensated unless he or she participated in the fraud or abuse;
(4) Prevents an employer from discriminating against an employee for participating in a court action relating to a violation unless the employee filed a frivolous claim, participated in the violation, or is convicted of criminal conduct related to the violation;
(5) Requires the Office of the Attorney General and the Department of Social Services to report information regarding violations of the fraud statutes to the Governor and General Assembly by January 1, 2008, and annually thereafter;
(6) Requires the State Auditor to complete a financial audit of the Mo HealthNet fraud unit within the Office of the Attorney General and the program integrity unit within the Department of Social Services;
(7) Creates a penalty for destroying or concealing records of claims submitted or payments received and for filing false reports or claims of alleged violations and receiving compensation for failure to report violations; and
(8) Creates a fund for the deposit of moneys recovered through restitution to be used for increasing Mo HealthNet provider reimbursements until the average provider reimbursement equals the average federal Medicare Program provider reimbursement.
Chronic Kidney Disease Task Force. The Chronic Kidney Disease Task Force is established. The Task Force will develop a plan to educate the public and health care professionals about early screening, diagnosis, treatment, and complications of chronic kidney disease; make recommendations regarding the implementation of the plan; and identify barriers to the adoption of best practices.
Assisted Living Facilities. Assisted living facilities are required to immediately implement any physician order and, with 24 hours, review and update a resident’s care plan when the resident returns from a hospital or skilled nursing facility.
Misappropriation of Funds. Specifies that a person assuming the responsibility of managing the financial affairs of an elderly person is guilty of misappropriation of funds for failure to pay for the care of an elderly or disabled person.
Medical Assistance for Employed Persons with Disabilities. The Department of Social Services is required to determine the eligibility of an employed disabled person requesting medical assistance whose family gross income is less than 250% of the federal poverty level. The bill sets out various requirements and exception.
Missouri Continuing Health Improvement Act. The bill:
(1) Establishes the Missouri Continuing Health Improvement Act and changes the name of the Division of Medical Services within the Department of Social Services to the MO HealthNet Division;
(2) Extends the eligibility for health insurance for a drug court participant to 60 days from the time his or her dependent child is removed from his or her custody, subject to the approval of the federal Centers for Medicare and Medicaid Services;
(3) Expands coverage to include independent foster care adolescents younger than 21 years of age;
(4) Adds hospice services to the list of covered services and adds durable medical equipment, dental services, and optometry to the list of covered benefits when it is based on a medical necessity;
(5) Requires the division to establish a four-year plan to increase the MO HealthNet provider reimbursement rate to the federal Medicare Program rates;
(6) Requires the division to develop pay-for-performance program guidelines;
(7) Specifies that any Social Security cost-of-living increase will be disregarded as income until the federal poverty level for the year is implemented;
(8) Specifies if a MO HealthNet recipient prepays his or her spenddown in cash to the division and subsequently pays a valid out-of-pocket medical bill, that the expense will be allowed as a deduction to future required spenddown for up to three months;
(9) Establishes the Professional Services Payment Committee to monitor the performance program;
(10) Establishes a premium offset program pilot project in one urban and one rural area of the state;
(11) Allows income from annuity investments to be excluded when determining MO HealthNet eligibility;
(12) Establishes rules for personal care contracts;
(13) Requires health benefit plans to pay all properly submitted claims for a period of three years from the date of service;
(14) Specifies the department’s rights to third-party benefits;
(15) Requires compliance with the federal Health Insurance Portability and Accountability Act;
(16) Changes the eligibility requirement for the State Children’s Health Insurance Program and specifies that the program will remain in effect only if the federal government appropriates funds;
(17) Changes affordability requirements for uninsured children without access to affordable health care. Health insurance plans that do not cover a child’s pre-existing condition are not considered affordable employer-sponsored health care insurance. A child is also considered uninsured under these provisions when the child exceeds the annual coverage limits for all health care services;
(18) Changes the eligibility requirements for the Uninsured Women’s Health Program;
(19) Allows the use of telehealth services in the MO HealthNet Program;
(20) Establishes the Long-Term Care Partnership Program that provides incentives for individuals to purchase insurance for their long-term care needs;
(21) Extends the expiration date for consumer-directed personal care services from June 30, 2008 to June 30, 2019;
(22) Requires the Department of Social Services to establish health improvement plans for all participants with the advice and approval of the MO HealthNet Oversight Committee. The health improvement plans will include, but not be limited to, risk-bearing coordinated care plans, administrative services organizations, and coordinated fee-for-service plans;
(23) Requires the development of and enrollment into the health improvement plans to begin July 1, 2008, and be completed by July 1, 2011;
(24) Requires that contracts for risk-bearing coordinated care plans and administrative services organization plans have a financial penalty if quality targets are not met;
(25) Specifies that every program participant will be enrolled in a health improvement plan and be provided a health care home;
(26) Specifies that no aged, blind, or disabled program participant will be required to enroll in a risk-bearing coordination plan;
(27) Requires the department to commission an independent survey to evaluate health and wellness outcomes of program participants and report the results of the survey to the Governor, General Assembly, and the Joint Committee on Legislative Research, Oversight Division, within six months;
(28) Requires the department to engage in a public process for the design, development, and implementation of health improvement plans;
(29) Requires all health improvement plans to complete a health risk assessment and develop a plan of care for enrolled participants by July 1, 2008;
(30) Specifies the products or services necessary to administer the program;
(31) Establishes the Joint Committee on MO HealthNet to study the resources needed to continue improvements to the program;
(32) Establishes the MO HealthNet Oversight Committee to advise the department and study various aspects of the program including, but not limited to, satisfaction reports, pilot project results, and health risk assessment results;
(33) Establishes a subcommittee within the oversight committee to advise the department on the development of a comprehensive entry-point system. The subcommittee is required to report its findings to the Governor and General Assembly by October 1, 2008;
(34) Creates the Health Care Technology Fund to promote technological advances in health care delivery;
(35) Requires the Legislative Budget Office to conduct a five-year rolling MO HealthNet budget forecast;
(36) Specifies that fee-for-service-policies which prescribe psychotropic medications will not include any new limits to the initial access requirements; and
(37) Specifies that there will not be a single, statewide contract for any health improvement plan.
The provisions of the bill regarding the tax credit for donations to the Missouri Healthcare Access Fund and medical assistance for employed persons with a disability will expire six years from the effective date. The provisions regarding the Chronic Kidney Disease Task Force will expire August 30, 2008. The provisions regarding the premium offset program pilot project will expire June 30, 2011.
The provisions of the bill regarding the eligibility of certain foster care participants in the MO HealthNet Program contain an emergency clause. (Signed 7/2/07)