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SECOND REGULAR SESSION
HOUSE BILL NO. 3255
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE TERR Y .
6979H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 354, RSMo, by adding thereto twenty-one new sections relating to the
Missouri universal health assurance program, with a contingent ef fective date for
certain sections.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 354, RSMo, is amended by adding thereto twenty-one new
2 sections, to be known as sections 354.750, 354.753, 354.756, 354.759, 354.762, 354.765,
3 354.768, 354.769, 354.770, 354.771, 354.774, 354.777, 354.780, 354.783, 354.786, 354.789,
4 354.792, 354.795, 354.807, 354.810, and 354.813, to read as follows:
354.750. 1. Sections 354.750 to 354.813 shall be known and may be cited as the
2 "Missouri Universal Health Assurance Pr ogram".
3 2. The Missouri universal health assurance pr ogram is hereb y cr eated for the
4 purpose of pr oviding a publicly financed statewide prog ram to pr ovide compreh ensive
5 necessary health, mental health, and dental health car e services, including pr eventive
6 scr eenings, for all res idents of this state. The pro gram shall have as its goals:
7 (1) T imely access to health car e services of the highest quality for every res ident
8 of the state so that all may benefit;
9 (2) The pr ovision of adequate funding for health care ; and
10 (3) Lower health car e spending thr ough streamlin ed administration, a single bill,
11 and uniform payments.
12 3. As used in sections 354.750 to 354.813, the following terms mean:
13 (1) "Board", the board of governors of the Missouri universal health assurance
14 pr ogram;
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.
15 (2) "Eligible person", any person who qualifies for benefits under section
16 354.783;
17 (3) "Fund", the Missouri health care trust fund;
18 (4) "Participating pr ovider", any person who is authorized to furnish services
19 under the pr ovisions of sections 354.750 to 354.813 and under rules adopted by the
20 board of governors of the Missouri universal health assurance prog ram;
21 (5) "Progra m", the Missouri universal health assurance prog ram.
354.753. The Missouri universal health assurance progra m shall be a body
2 corporate and an instrumentality of the state. In the pr ogram shall be vested the powers
3 and duties specified in sections 354.750 to 354.813 and those powers necessary to enable
4 the pr ogram and the progra m's officers, employees, and agents to carry out the
5 purposes of sections 354.750 to 354.813.
354.756. 1. The director of the department of health and senior services shall
2 divide the population of the state into six r egional health planning and policy
3 development districts of roug hly equal population. An advisory council in each district
4 shall:
5 (1) Assist the board in the development of a compreh ensive state health care
6 plan under section 354.765 and in the development of budgetary allocations for health
7 car e services and of operating policies and pro cedure s for the pr ogram; and
8 (2) Develop a transportation plan to enable indigents, elderly persons, and
9 persons with disabilities to have access to nonemergency health care services.
10 2. Not later than thirty days after the first meeting of the board of governors
11 appointed under section 354.759, the board shall submit to the governor a list of names
12 of qualified persons who r eside in each of the six re gional health planning and policy
13 development districts. Fr om such list, the governor shall appoint to each district an
14 advisory council composed of the following nine members:
15 (1) T wo physicians;
16 (2) One regist ered nurse;
17 (3) One licensed health car e pr ovider who is neither a physician nor a r egister ed
18 nurse;
19 (4) One dentist;
20 (5) One medical dir ector of a mental health facility;
21 (6) One municipal or county public health administrator;
22 (7) One person with a physical disability; and
23 (8) One profes sional consumer advocate.
24 3. The terms of the initial appointees to each of the district advisory councils
25 shall be as follows: four shall be appointed for a term of four years, thr ee for a term of
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26 thr ee years, and two for a term of two years. Ther eafter , all terms shall be for four
27 years, but any member appointed to fill a vacancy in an unexpir ed term shall serve only
28 for the rem ainder of that term. No member shall be appointed to serve mor e than two
29 consecutive terms.
354.759. 1. The Missouri universal health assurance prog ram shall be
2 administer ed by a board of governors composed of twenty-three members:
3 (1) Fourteen of whom shall be appointed by the governor with the advice and
4 consent of the senate as follows:
5 (a) One repr esentative of a hospital;
6 (b) T wo physicians;
7 (c) One registe red nurse;
8 (d) One epidemiologist;
9 (e) One repr esentative of a community health center;
10 (f) One mental health car e pr ovider;
11 (g) One profes sional consumer advocate;
12 (h) T wo persons whose annual income does not exceed twice the federal poverty
13 level;
14 (i) One person sixty-five years of age or older;
15 (j) One person who is a licensed health car e pr ofessional other than a physician
16 or a nurse;
17 (k) One person trained in bioethics; and
18 (l) One dentist;
19 (2) Six of whom shall rep res ent the r egional health planning and policy
20 development districts established under section 354.756, appointed by the dir ector of the
21 department of health and senior services; and
22 (3) Three of whom shall be the following ex officio members:
23 (a) The dir ector of the department of health and senior services;
24 (b) The dir ector of the department of social services; and
25 (c) The dir ector of the department of mental health.
26 2. The terms of the initial members who are appointed under subdivision (1) of
27 subsection 1 of this section shall be stagger ed as follows: five shall be appointed for a
28 term of four years, five for a term of thr ee years, and four for a term of two years. The
29 initial terms of the members selected under subdivision (2) of subsection 1 of this section
30 shall be stagger ed so that the members selected fr om even-number ed districts shall
31 serve an initial term of thr ee years and those fr om odd-number ed districts shall serve
32 four years. Thereaf ter , all terms shall be for four years, but a member appointed to fill
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33 a vacancy in an unexpired term shall serve only for the rem ainder of that term. No
34 member shall be appointed to serve mor e than two consecutive terms.
35 3. Members of the board shall at all times include:
36 (1) Sufficient repr esentatives of racial, ethnic, and gender diversity so that the
37 makeup of the board shall accurately r eflect the racial, ethnic, and gender diversity of
38 the state population; and
39 (2) At least two members who ar e defined as disabled under the Americans with
40 Disabilities Act, 42 U.S.C. Section 12101 et seq.
41 4. The board shall elect a chair and vice chair .
42 5. Meetings shall be called by the chair or by any thirteen members. The board
43 shall meet at least six times per year . All meetings of the board shall be announced in
44 advance and open to the public, except as provi ded by chapter 610.
45 6. Thirteen members of the board constitute a quorum, and an affirmative vote
46 of at least thirteen members shall be necessary for any action to be taken by the board.
47 7. The members of the board shall be r eimbursed fr om the Missouri health car e
48 trust fund for mileage and any necessary and actual expenses incurr ed while engaged in
49 the business of the board.
354.762. 1. The board of governors of the Missouri universal health assurance
2 pr ogram shall be r esponsible for:
3 (1) Establishing budget and policy guidelines for the prog ram thr ough the
4 development of a compr ehensive state health car e plan under section 354.765;
5 (2) Establishing fee schedules using the last available calendar year as a base
6 year;
7 (3) Determining aggr egate capital expenditures in keeping with the goals
8 established under subdivision (2) of subsection 1 of section 354.765;
9 (4) Appr oving additions to services offered by the pr ogram;
10 (5) Administering and implementing the pr ogram and administering the
11 Missouri health car e trust fund creat ed under section 354.770;
12 (6) Adopting rules under chapter 536;
13 (7) Monitoring the operation of the pr ogram;
14 (8) Studying means of incorporating institutional long-term care benefits into
15 the pr ogram, studying immigration into the state for the purpose of r eceiving health
16 car e services under the prog ram, and r eporting on the pr ogress of such studies to the
17 speaker of the house of repr esentatives, the pr esident pr o tempor e of the senate, and the
18 governor;
19 (9) Reporting annually to the speaker of the house of repr esentatives, the
20 pr esident pr o tempor e of the senate, and the governor on the pr ogram's activities and
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21 r ecommending any changes to insurance and health care laws to impr ove access to
22 health car e for res idents of this state;
23 (10) Disseminating to pr oviders of services and to the public information
24 concerning the pr ogram and the persons eligible to recei ve the benefits of the prog ram;
25 (1 1) Conducting necessary investigations and inquiries and compelling the
26 submission of information, documents, and record s the board considers necessary to
27 carry out its duties under the prov isions of sections 354.750 to 354.813;
28 (12) Conducting utilization reviews of patients and prov iders to identify abuses
29 of the pro gram and r eporting abuses to state agencies;
30 (13) Employing and supervising staff;
31 (14) Conducting other activities the board considers necessary to carry out the
32 purposes of sections 354.750 to 354.813;
33 (15) Establishing standards and pro cedure s for negotiating and entering into
34 contracts with participating pr oviders; and
35 (16) Initiating and respondi ng to lawsuits.
36 2. The board, after pr oviding notice to consumers, pr oviders, the dir ector of the
37 department of health and senior services, and other interes ted parties, may hold
38 hearings in connection with any action that it pr oposes to take under subsection 1 of this
39 section. Nothing in this section shall be construed as authorizing the board to adopt
40 rules under subdivision (6) or (15) of subsection 1 of this section or to conduct
41 evaluations or investigations under subdivision (1 1) of subsection 1 of this section
42 without holding public hearings.
354.765. 1. The board, in cooperation with the district advisory councils
2 established under section 354.756, shall annually develop a compr ehensive state health
3 car e plan. The plan shall include the following:
4 (1) A compreh ensive budget for the pr ogram within the limits of funds made
5 available thr ough the measur es instituted in sections 354.750 to 354.813. The budget
6 shall include specific amounts to be allocated res pectively to:
7 (a) The health services account established under section 354.774;
8 (b) The pr escribed medications and durable and nondurable medical equipment
9 account established under section 354.774;
10 (c) The re gional capital improvement account established under section 354.774;
11 (d) The health pr ofessional education and training fund established under
12 section 354.777; and
13 (e) Administration of the pr ogram in an amount not to exceed four per cent of
14 the total funds available to the prog ram;
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15 (2) Specific goals for the total portion of funds in the health services account to
16 be expended for the capital needs of provi ders under section 354.792;
17 (3) An evaluation of the health care and mental health needs of the state and of
18 each regi onal health planning and policy development district including, but not limited
19 to, assessments of:
20 (a) Regional needs and other investments in health care equipment and capital
21 impr ovements;
22 (b) The effectiveness of state and local efforts to coordinate the activities of the
23 health car e delivery system; and
24 (c) Any other unmet local health car e or mental health needs;
25 (4) Goals for geographic distribution of health care pro viders and personnel,
26 with strategies for using the authority over rei mbursements under section 354.792 and
27 r esources fr om the health pr ofessional education and training fund established in
28 section 354.777 to achieve such goals;
29 (5) Quantitative goals for the use of health and mental health services by eligible
30 persons;
31 (6) Specific goals for the physical and mental health status of Missourians and
32 for quality of car e r endere d under the pro gram; and
33 (7) An evaluation of the adequacy of total funds available to the progra m.
34 2. Prior to pro mulgation of the compr ehensive state health car e plan, the board
35 shall:
36 (1) Appoint a subcommittee of experts in medical and health car e ethics to
37 advise the board on the ethical issues r elating to the allocation of health care res our ces;
38 (2) Appoint a subcommittee of licensed physicians, regi stered nurses, and
39 r egister ed pharmacists to establish an evidence-based system formulary for all
40 pr escription drugs and durable and nondurable medical equipment used by the
41 Missouri health car e system;
42 (3) Instruct each district advisory council to conduct at least one public hearing
43 in at least two ar eas of its region to gather public comment on the pro posed plan. The
44 board shall pr ovide the district advisory councils with staff assistance in conducting
45 such hearings; and
46 (4) Hold at least two public hearings to gather public comment on the pro posed
47 plan.
48 3. The compreh ensive state health car e plan shall, to the extent practicable, seek
49 to assur e the most cost-effective delivery of health car e by ref lecting the following
50 priorities:
51 (1) Quality of car e to be achieved thr ough the following:
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52 (a) Primary and pr eventive services;
53 (b) Accountability of pr oviders to payers and consumers for both the outcomes
54 and consumer acceptability of the car e they render ;
55 (c) Continuity of car e, as embodied in coordination of services to individuals and
56 the community; and
57 (d) Maintenance of high levels of profes sional competence and expertise among
58 health car e pr oviders according to pr ofessional practice standards;
59 (2) Access to car e thr ough the equitable distribution of res our ces within the
60 health car e delivery system on the basis of community need; and
61 (3) Efficient use of res ource s thr ough:
62 (a) Elimination of unnecessary administrative and overhead expenses;
63 (b) Elimination of means testing;
64 (c) Establishment of cost-containment pricing for r eimbursements to
6 5 manufactur ers of pharmaceuticals and manufactur ers of durable and nondurable
66 medical equipment; and
67 (d) Innovative and cost-effective models of car e including, but not limited to:
68 a. Community , nonmedical, or in-home services that prov ide alternatives to
69 institutional long-term car e;
70 b. Community health nursing;
71 c. Services pr ovided by nurse practitioners; and
72 d. Psychiatric and other mental health services pr ovided on an outpatient basis.
354.768. The board of governors of the Missouri universal health assurance
2 pr ogram shall appoint the executive dir ector of the pro gram.
354.769. 1. The executive dir ector of the pro gram shall serve as secr etary to the
2 board and shall perform such duties in the administration of the pro gram as the board
3 may assign.
4 2. The board may delegate to the executive dir ector any of the board's functions
5 or duties under sections 354.750 to 354.813, except the issuance of rules and the
6 determination of the pro gram.
354.770. The board shall administer the "Missouri Health Care T rust Fund",
2 which is hereb y creat ed in the state tr easury , into which shall be placed all federal
3 payments recei ved as a res ult of any waiver of requ irem ents granted by the United
4 States Secr etary of Health and Human Services under health car e pr ograms established
5 under T itle XVIII and T itle XIX of the Social Security Act, as amended, and all moneys
6 appr opriated by the general assembly to the pr ogram under sections 354.750 to 354.813.
7 Moneys in the fund shall be used for compreh ensive necessary health care services and
8 to support construction, ren ovation, and equipping of health care institutions based on
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9 r egional needs in accordance with sections 354.750 to 354.813 and rules established by
10 the board of governors of the pro gram and for no other purpose. The board shall have
11 power , in the name and on behalf of the pr ogram, to pur chase, acquire, hold, lend, lease,
12 sell, assign, transfer , and dispose of all pro perty and rights, and enter into written
13 contracts, all as may be necessary or prop er to carry out the purposes of sections
14 354.750 to 354.813.
354.771. 1. All moneys receiv ed by or belonging to the pr ogram shall be
2 deposited in the state tr easury to the cred it of the Missouri health care trust fund. No
3 such moneys shall be deposited in, or be ret ained by , any bank or trust company that
4 does not have on deposit at the time the kind and value of collateral r equir ed by sections
5 30.240 and 30.270 for depositories of the state tr easurer . The executive dir ector shall be
6 r esponsible for all prop erty belonging to the progra m and shall give such corporate
7 sur ety bonds for the faithful handling of the pr operty as the board shall r equir e.
8 2. The board of governors shall administer the fund and shall conduct a
9 quarterly review of the expenditur es fr om and r evenues r eceived by the fund.
10 3. The board shall submit each quarterly review to the state auditor for
11 oversight.
12 4. The state trea sur er may invest funds of the pr ogram as permitted by law .
13 5. The amount of res erves in the fund at any time shall equal at least the amount
14 of expenditures fr om the fund during the thr ee pr eceding months.
354.774. 1. The "Health Services Account" is hereb y cr eated within the
2 Missouri health care trust fund. Moneys in the health services account shall be used
3 solely to pay participating pr oviders in accordance with section 354.792.
4 2. The "Pres cribed Medications and Durable and Nondurable Medical
5 Equipment Account" is her eby cr eated within the Missouri health car e trust fund.
6 Moneys in the account shall be used solely for medications and durable and nondurable
7 medical equipment prescribed by participating physicians in accordance with section
8 354.792.
9 3. The "Regional Capital Impr ovement Account" is hereb y crea ted within the
10 Missouri health care trust fund. Moneys in the account shall be used solely to pay for
11 medical technology and capital impro vements needed in regi ons to improve access to
12 health car e r esources in accordance with section 354.792.
354.777. 1. Ther e is her eby cr eated within the state tr easury the "Health
2 Pr ofessional Education and T raining Fund", which shall consist of all moneys receiv ed
3 fr om federal health profession al training moneys and any other funds so allocated by
4 the board under section 354.765. Upon appr opriation by the general assembly , moneys
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5 in the health profes sional education and training fund shall be used by the board solely
6 to pay for the education and training of health pr ofessionals.
7 2. During the five-year period commencing on January first following the
8 effective date of this section, the annual amount of state expenditures for the education
9 and training of health pr ofessionals shall not be redu ced below the level of such
10 expenditur es in the pr evious calendar year .
354.780. Notwithstanding the pr ovisions of section 33.080 to the contrary , the
2 moneys in the health care trust fund at the end of any biennium shall not be transferr ed
3 and placed to the credit of the general r evenue fund.
354.783. 1. Every person, r egardless of pree xisting conditions, who is a res ident
2 of this state is eligible to r eceive services under the Missouri universal health assurance
3 pr ogram. No person eligible for services under the Missouri universal health assurance
4 pr ogram who receives services from a participating pro vider shall be charged an
5 additional amount for such services.
6 2. If a person who is not a res ident of the state of Missouri r eceives medical
7 tr eatment in Missouri, the state of Missouri is subr ogated to the right to reim bursement
8 fr om any third-party payer for such medical tr eatment.
354.786. 1. Every person who is eligible to receiv e services under the pr ogram
2 under section 354.783 is entitled to receiv e benefits for any cover ed service furnished
3 within this state by a participating provi der if the service is deemed by the patient and
4 participating pr ovider to be necessary or appr opriate for the maintenance of physical or
5 mental health or for the diagnosis or tr eatment of, or r ehabilitation following, injury ,
6 disability , or disease.
7 2. Health car e services include, but ar e not limited to, all services pr ovided under
8 section 208.152 and those community , nonmedical, or in-home services that pr ovide an
9 alternative to institutional long-term car e, except for:
10 (1) Surgery for cosmetic purposes other than for reconst ructive surgery;
11 (2) Medical examinations conducted and medical repo rts prep ared for either of
12 the following purposes:
13 (a) Purchasing or renew ing life insurance; or
14 (b) Participating as a plaintiff or defendant in a civil action for the reco very or
15 settlement of damages; and
16 (3) Custodial care r ender ed in a nursing home. As used in this subdivision, the
17 term "custodial car e" means nonmedical services pro vided in a res idential car e facility ,
18 as defined in section 198.006.
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354.789. 1. No participating pr ovider shall ref use to furnish services under the
2 pr ogram to an eligible person on the basis of race, color , income level, national origin,
3 r eligion, sex, sexual orientation, or other nonmedical criteria.
4 2. An eligible person may choose any participating pr ovider .
5 3. Every participating pr ovider shall furnish such information as may be
6 r easonably req uired by the board of governors of the progr am for utilization rev iew , for
7 the making of payments, and for statistical or other studies of the operation of the
8 pr ogram.
9 4. Every participating pr ovider shall permit the board of governors to examine
10 the pro vider's records as may be necessary for verification of payment.
11 5. Physicians and other participating prov iders shall practice according to state
12 and federal laws and according to their accepted profes sional standards.
13 6. The Missouri universal health assurance prog ram shall reim burse health car e
14 pr oviders that ar e located outside this state at reas onable rates for requi red emergency
15 medical care render ed to eligible persons.
354.792. 1. The Missouri universal health assurance progra m shall pay the
2 expenses of institutional prov iders of inpatient services on the basis of global budgets
3 that are appr oved by the board of governors of the prog ram. Such global budgets shall
4 include necessary construction, ren ovation, or equipment so long as the board has
5 determined that such construction, reno vation, or equipment will direc tly enhance
6 public access to quality health care.
7 2. Each institutional pr ovider shall negotiate an annual budget with the pr ogram
8 to cover its anticipated services for the next year based on past performance and
9 pr ojected changes in prices and service levels and pr ovide a reas onable margin above
10 operating expenses in order to provi de for capital depr eciation and other long-term
11 needs of the institution.
12 3. Every physician or other provi der employed by a globally budgeted
13 institutional prov ider shall be paid thr ough and in a manner determined by the
14 institutional pr ovider .
15 4. The pr ogram shall reim burse independent pr oviders of health care services on
16 a fee-for -service basis using the federal Medicare reim bursement fees as a guideline.
17 The prog ram shall annually negotiate the fee schedule with the appr opriate pr ofessional
18 gr oup. The fee schedule shall be applied to health car e services ren dered by
19 independent prov iders thr oughout the state. The appr opriate pr ofessional group to
20 negotiate the fee schedule shall be the pr ofessional association chosen by election of
21 members of each health car e pr ofession.
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22 5. A pro vider shall not charge rates that ar e higher than the negotiated
23 r eimbursement level and shall not charge separately for services under section 354.786.
24 6. In any instance in which the health car e pr ovider or the profes sional grou p
25 negotiating for the pr ovider is unable to negotiate an annual budget or a fee schedule
26 with the prog ram, the annual budget or the fee schedule set by the board shall be
27 pr esumed to be corre ct and a final administrative decision, which may be appealed in
28 the circu it court of Cole County .
29 7. Policies and rules of institutional pro viders shall be consistent with state and
30 federal laws and with accepted medical and pro fessional standards of car e.
354.795. 1. It is unlawful for a private health insur er to sell health insurance
2 coverage that duplicates the benefits pro vided under sections 354.750 to 354.813.
3 Nothing in sections 354.750 to 354.813 shall be construed as pro hibiting insurers,
4 employers, or other plans fr om offering benefits that do not duplicate services that are
5 offer ed by the Missouri universal health assurance pr ogram.
6 2. Investor -ownership of health delivery facilities, including but not limited to
7 hospitals, health maintenance organizations, nursing homes, and clinics, is unlawful.
8 Investor -owners of health delivery facilities at the time of the effective date of this
9 section shall be compensated for the loss of their facilities but not for loss of business
10 opportunities or for administrative capacity not used by the pr ogram.
354.807. Not later than thirty days after the effective date of this section, the
2 department of social services shall:
3 (1) Apply to the United States Secr etary of Health and Human Services for all
4 waivers of re quir ements under health car e pro grams established under T itle XVIII and
5 T itle XIX of the Social Security Act, as amended, that are necessary to enable this state
6 to deposit all federal payments under such pr ograms to the cr edit of the Missouri health
7 car e trust fund creat ed in section 354.770; and
8 (2) Identify any other federal pr ograms that pr ovide federal funds for payment
9 of health care services to individuals. The department shall comply with any
10 r equir ements under those prog rams and apply for any waivers of those r equir ements
11 that are necessary to enable this state to deposit such federal funds to the cr edit of the
12 Missouri health car e trust fund.
354.810. Not later than thirty days after the effective date of this section, the
2 governor and the dir ector of the department of health and senior services shall make the
3 initial appointments to the board of governors of the Missouri universal health
4 assurance pr ogram under section 354.759.
354.813. The board of governors of the Missouri universal health assurance
2 pr ogram shall requ est that the pro gram established under the pro visions of sections
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3 354.750 to 354.813 be appr oved for federal employees and reti rees while they are
4 r esidents of the state of Missouri.
Section B. The enactment of sections 354.750 and 354.753 and sections 354.762 to
2 354.795 of this act shall be ef fective April first of the year following the notice to the revisor
3 of statutes that a waiver has been obtained from the Secretary of the Department of Health
4 and Human Services by the director of the department of social services based on a request
5 filed under section 354.807 of this act.
✔
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