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SECOND REGULAR SESSION
HOUSE BILL NO. 2514
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE BYRNES.
6050H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 191, RSMo, by adding thereto six new sections relating to medical
documentation, with penalty provisions.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 191, RSMo, is amended by adding thereto six new sections, to be
2 known as sections 191.1870, 191.1873, 191.1876, 191.1879, 191.1882, and 191.1885, to read
3 as follows:
191.1870. 1. Sections 191.1870 to 191.1885 shall be known and may be cited as
2 the "Missouri Medical Documentation and Patient Recording Accountability Act".
3 2. As used in sections 191.1870 to 191.1885, the following terms mean:
4 (1) "Advocate":
5 (a) For a patient eighteen years of age or older , any individual designated by the
6 patient to assist in communication or oversight of the patient's care; or
7 (b) For a minor patient under eighteen years of age, any paren t, guardian, or
8 other person having control or custody of the minor patient;
9 (2) "Auto-purge", the deletion of a record by an automated technological system
10 without intervention by the user;
11 (3) "Clinical communication", any oral, written, electr onic, or other act of
12 communication rela ting to the diagnosis, symptoms, assessment, tr eatment, discharge,
13 psychiatric attribution, or plan of car e for a patient;
14 (4) "Health care facility", any facility , as the term "facility" is defined in section
15 376.1350;
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
16 (5) "Health care pr ofessional", the same meaning given to the term in section
17 376.1350;
18 (6) "Health car e pr ovider", the same meaning given to the term in section
19 376.1350;
20 (7) "Medical r ecord", the official r ecord of a patient's health history and
21 tr eatment ren dered to the patient.
191.1873. 1. All clinical communications influencing patient care shall be
2 documented within the same calendar day or within twenty-four hours if occurring
3 outside the r egular business hours of the health care prov ider .
4 2. No clinical decision, diagnosis, exclusion, refu sal of testing, psychiatric
5 attribution, or change in car e plan for a patient shall be valid unless documented.
6 3. A health care pro fessional shall not attribute a patient's symptoms to
7 psychiatric or psychosomatic causes or make any diagnosis of functional neur ological
8 disorder , conversion disorder , or somatic symptom disorder unless the health car e
9 pr ofessional:
10 (1) Performs a differen tial diagnosis;
11 (2) Orders testing to rule out other conditions;
12 (3) Performs a physical examination and documents the findings; and
13 (4) Documents the rationale for the attribution or diagnosis in the patient's
14 medical record.
15 4. Any electr onic communication rela ted to patient care shall be automatically
16 r etained and incorporated into the patient's medical reco rd. No such communication
17 shall be stor ed or r etained outside the patient's medical record .
18 5. A patient or the patient's family may r equest documentation or clarification of
19 any clinical communication. A health car e prov ider shall prov ide the documentation or
20 clarification within seventy-two hours of the requ est.
191.1876. 1. A health car e pr ovider shall not:
2 (1) Make or r ely on undocumented clinical decisions;
3 (2) Delay care based on undocumented psychiatric assumptions;
4 (3) Use internal messaging as a substitute for documentation in the patient's
5 medical record;
6 (4) Delete, auto-purge, or conceal internal communications; or
7 (5) Creat e systems bypassing documentation r equir ements.
8 2. Any undocumented communication shall be tre ated as though the
9 communication did not occur .
10 3. Except as otherwise pro vided in this section, any health care pr ovider that
11 violates this section shall be punished as follows:
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12 (1) For the first violation, the health car e pr ovider shall be guilty of a class D
13 misdemeanor;
14 (2) For the second violation, the health care pr ovider shall be guilty of a class A
15 misdemeanor; and
16 (3) For the third or subsequent violation or any violation that res ults in harm to
17 a patient, the health care pro vider shall be guilty of a class E felony .
18 4. A health care pro vider that intentionally deletes internal communications in
19 violation of this section shall be guilty of a class D felony .
20 5. A health care facility that enables undocumented communication in violation
21 of this section shall be subject to a civil penalty of up to fifty thousand dollars for each
22 violation.
191.1879. 1. A patient or the patient's advocate may audio reco rd, video reco rd,
2 or live str eam any part of the patient's medical encounter .
3 2. A health care pr ovider shall not interfer e with any record ing or live strea ming
4 allowed under subsection 1 of this section except to pr otect the privacy of other patients,
5 pr event obstruction of a pr ocedur e, or maintain sterile envir onments. Any such
6 interfer ence shall use the least res trictive means to achieve the permitted purpose.
7 3. Unless the patient ref used rec ording or live str eaming in writing, the patient's
8 advocate may recor d even if the patient is unconscious, sedated, mentally impair ed, or
9 under psychiatric evaluation.
10 4. A health care facility shall not ret aliate or take any of the following actions
11 based on a patient's or advocate's exercise of the right to reco rd or live stream the
12 patient's medical encounter:
13 (1) Confiscate a device;
14 (2) Demand deletion of a recordi ng;
15 (3) Interrupt care to block r ecording or live strea ming; or
16 (4) Deny tre atment.
17 5. A health care prov ider that interfer es with any record ing or live strea ming in
18 violation of subsection 2 of this section shall be guilty of a class A misdemeanor unless
19 the health care prov ider interfer ed for the purpose of concealing the medical encounter ,
20 in which case the health car e pr ovider shall be guilty of a class E felony .
21 6. Notwithstanding any court rule or any other pr ovision of law , any r ecording
22 made in accordance with this section shall be admissible in civil, criminal,
2 3 administrative, licensing, and wron gful death pr oceedings.
24 7. Each health car e facility shall post a printed sign with the following text:
25 "Patients have the right to re cord communications and care involving their tr eatment.".
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191.1882. Any health car e pr ovider that ret aliates against an employee for
2 r eporting a violation of sections 191.1870 to 191.1885 shall be guilty of a class D felony .
191.1885. The department of health and senior services shall promul gate rules to
2 implement sections 191.1870 to 191.1885. Any rule or portion of a rule, as that term is
3 defined in section 536.010, that is cr eated under the authority delegated in this section
4 shall become effective only if it complies with and is subject to all of the provi sions of
5 chapter 536 and, if applicable, section 536.028. This section and chapter 536 are
6 nonseverable and if any of the powers vested with the general assembly pursuant to
7 chapter 536 to review , to delay the effective date, or to disappr ove and annul a rule ar e
8 subsequently held unconstitutional, then the grant of rulemaking authority and any rule
9 pr oposed or adopted after August 28, 2026, shall be invalid and void.
✔
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