Repeals provisions relating to the Infection Control Advisory Panel

EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1527
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BURGER.
6223S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 192.131, 192.665, 192.667, 197.165, 197.293, and 197.294, RSMo, and to enact
in lieu thereof five new sections relating to the infection control advisory panel, with
penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 192.131, 192.665, 192.667, 197.165, 1
197.293, and 197.294, RSMo, are repealed and five new sections 2
enacted in lieu thereof, to be known as sections 192.131, 3
192.665, 192.667, 197.293, and 197.294, to read as follows:4
192.131. 1. As used in this section, the following 1
terms shall mean: 2
(1) ["Advisory panel", the infection control advisory 3
panel created by section 197.165; 4
(2)] "Antibiogram", a record of the resistance of 5
microbes to various antibiotics; 6
[(3)] (2) "Antimicrobial", the ability of an agent to 7
destroy or prevent the development of pathogenic action of a 8
microorganism; 9
[(4)] (3) "Department", the department of health and 10
senior services. 11
2. Every laboratory performing culture and sensitivity 12
testing on humans in Missouri shall submit data on health 13
care associated infections to the department in accordance 14
with this section. The data to be reported shall be defined 15
SB 1527 2
by regulation of the department [after considering the 16
recommendations of the advisory panel]. Such data may 17
include antibiograms and, not later than July 1, 2005, shall 18
include but not be limited to the number of patients or 19
isolates by hospital, ambulatory surgical center, and other 20
facility or practice setting with methicillin-resistant 21
staphylococcus aureus (MRSA) or vancomycin-resistant 22
enterococcus (VRE). 23
3. Information on infections collected pursuant to 24
this section shall be subject to the confidentiality 25
protections of this chapter but shall be available in 26
provider-specific form to appropriate facility and 27
professional licensure authorities. 28
4. The [advisory panel] department shall [develop a 29
recommended plan to] use laboratory and health care provider 30
data provided pursuant to this chapter to create a system to: 31
(1) Enhance the ability of health care providers and 32
the department to track the incidence and distribution of 33
preventable infections, with emphasis on those infections 34
that are most susceptible to interventions and that pose the 35
greatest risk of harm to Missouri residents; 36
(2) Monitor trends in the development of antibiotic- 37
resistant microbes, including but not limited to methicillin- 38
resistant staphylococcus aureus (MRSA) and vancomycin- 39
resistant enterococcus (VRE) infections. 40
5. In implementing this section, the [advisory panel 41
and the] department shall conform to guidelines and 42
standards adopted by the federal Centers for Disease Control 43
and Prevention. [The advisory panel's plan may provide for 44
demonstration projects to assess the viability of the 45
recommended initiatives.] 46
SB 1527 3
192.665. As used in this section, section 192.667, and 1
sections 197.150 to [197.165] 197.162, the following terms 2
mean: 3
(1) "Charge data", information submitted by health 4
care providers on current charges for leading procedures and 5
diagnoses; 6
(2) "Charges by payer", information submitted by 7
hospitals on amount billed to Medicare, Medicaid, other 8
government sources and all nongovernment sources combined as 9
one data element; 10
(3) "Department", the department of health and senior 11
services; 12
(4) "Financial data", information submitted by 13
hospitals drawn from financial statements which includes the 14
balance sheet, income statement, charity care and bad debt 15
and charges by payer, prepared in accordance with generally 16
accepted accounting principles; 17
(5) "Health care provider", hospitals as defined in 18
section 197.020 and ambulatory surgical centers and abortion 19
facilities as defined in section 197.200; 20
(6) "Nosocomial infection", as defined by the federal 21
Centers for Disease Control and Prevention and applied to 22
infections within hospitals, ambulatory surgical centers, 23
abortion facilities, and other facilities; 24
(7) "Nosocomial infection incidence rate", a risk- 25
adjusted measurement of new cases of nosocomial infections 26
by procedure or device within a population over a given 27
period of time, with such measurements defined by rule of 28
the department pursuant to subsection 3 of section 192.667 29
for use by all hospitals, ambulatory surgical centers, 30
abortion facilities, and other facilities in complying with 31
SB 1527 4
the requirements of the Missouri nosocomial infection 32
control act of 2004; 33
(8) "Other facility", a type of facility determined to 34
be a source of infections and designated by rule of the 35
department pursuant to subsection 11 of section 192.667; 36
(9) "Patient abstract data", data submitted by 37
hospitals which includes but is not limited to date of 38
birth, sex, race, zip code, county of residence, admission 39
date, discharge date, principal and other diagnoses, 40
including external causes, principal and other procedures, 41
procedure dates, total billed charges, disposition of the 42
patient and expected source of payment with sources 43
categorized according to Medicare, Medicaid, other 44
government, workers' compensation, all commercial payors 45
coded with a common code, self-pay, no charge and other. 46
192.667. 1. All health care providers shall at least 1
annually provide to the department charge data as required 2
by the department. All hospitals shall at least annually 3
provide patient abstract data and financial data as required 4
by the department. Hospitals as defined in section 197.020 5
shall report patient abstract data for outpatients and 6
inpatients. Ambulatory surgical centers and abortion 7
facilities as defined in section 197.200 shall provide 8
patient abstract data to the department. The department 9
shall specify by rule the types of information which shall 10
be submitted and the method of submission. 11
2. The department shall collect data on the incidence 12
of health care-associated infections from hospitals, 13
ambulatory surgical centers, abortion facilities, and other 14
facilities as necessary to generate the reports required by 15
this section. Hospitals, ambulatory surgical centers, 16
abortion facilities, and other facilities shall provide such 17
SB 1527 5
data in compliance with this section. In order to 18
streamline government and to eliminate duplicative reporting 19
requirements, if the Centers for Medicare and Medicaid 20
Services, or its successor entity, requires hospitals to 21
submit health care-associated infection data, then hospitals 22
and the department shall not be required to comply with the 23
health care-associated infection data reporting requirements 24
of subsections 2 to 17 of this section applicable to 25
hospitals, except that the department shall post a link on 26
its website to publicly reported data by hospitals on the 27
Centers for Medicare and Medicaid Services' Hospital Compare 28
website, or its successor. 29
3. The department shall promulgate rules specifying 30
the standards and procedures for the collection, analysis, 31
risk adjustment, and reporting of the incidence of health 32
care-associated infections and the types of infections and 33
procedures to be monitored pursuant to subsection 13 of this 34
section. In promulgating such rules, the department shall[: 35
(1)] use methodologies and systems for data collection 36
established by the federal Centers for Disease Control and 37
Prevention's National Healthcare Safety Network, or its 38
successor[; and 39
(2) Consider the findings and recommendations of the 40
infection control advisory panel established pursuant to 41
section 197.165]. 42
4. [By January 1, 2017, the infection control advisory 43
panel created by section 197.165 shall make recommendations 44
to] The department [regarding] shall assess the Centers for 45
Medicare and Medicaid Services' health care-associated 46
infection data collection, analysis, and public reporting 47
requirements for hospitals, ambulatory surgical centers, and 48
other facilities in the federal Centers for Disease Control 49
SB 1527 6
and Prevention's National Healthcare Safety Network, or its 50
successor, in lieu of all or part of the data collection, 51
analysis, and public reporting requirements of this 52
section. The [advisory panel recommendations] department 53
shall address which hospitals shall be required as a 54
condition of licensure to use the National Healthcare Safety 55
Network for data collection; the use of the National 56
Healthcare Safety Network for risk adjustment and analysis 57
of hospital submitted data; and the use of the Centers for 58
Medicare and Medicaid Services' Hospital Compare website, or 59
its successor, for public reporting of the incidence of 60
health care-associated infection metrics. [The advisory 61
panel shall consider the following factors in developing its 62
recommendation: 63
(1) Whether the public is afforded the same or greater 64
access to facility-specific infection control indicators and 65
metrics; 66
(2) Whether the data provided to the public is subject 67
to the same or greater accuracy of risk adjustment; 68
(3) Whether the public is provided with the same or 69
greater specificity of reporting of infections by type of 70
facility infections and procedures; 71
(4) Whether the data is subject to the same or greater 72
level of confidentiality of the identity of an individual 73
patient; 74
(5) Whether the National Healthcare Safety Network, or 75
its successor, has the capacity to receive, analyze, and 76
report the required data for all facilities; 77
(6) Whether the cost to implement the National 78
Healthcare Safety Network infection data collection and 79
reporting system is the same or less.] 80
SB 1527 7
5. [After considering the recommendations of the 81
infection control advisory panel, and provided that the 82
requirements of subsection 13 of this section can be met,] 83
The department shall implement guidelines from the federal 84
Centers for Disease Control and Prevention's National 85
Healthcare Safety Network, or its successor. It shall be a 86
condition of licensure for hospitals that meet the minimum 87
public reporting requirements of the National Healthcare 88
Safety Network and the Centers for Medicare and Medicaid 89
Services to participate in the National Healthcare Safety 90
Network, or its successor. Such hospitals shall permit the 91
National Healthcare Safety Network, or its successor, to 92
disclose facility-specific infection data to the department 93
as required under this section, and as necessary to provide 94
the public reports required by the department. It shall be 95
a condition of licensure for any ambulatory surgical center 96
or abortion facility which does not voluntarily participate 97
in the National Healthcare Safety Network, or its successor, 98
to submit facility-specific data to the department as 99
required under this section, and as necessary to provide the 100
public reports required by the department. 101
6. The department shall not require the resubmission 102
of data which has been submitted to the department of health 103
and senior services or the department of social services 104
under any other provision of law. The department of health 105
and senior services shall accept data submitted by 106
associations or related organizations on behalf of health 107
care providers by entering into binding agreements 108
negotiated with such associations or related organizations 109
to obtain data required pursuant to section 192.665 and this 110
section. A health care provider shall submit the required 111
information to the department of health and senior services: 112
SB 1527 8
(1) If the provider does not submit the required data 113
through such associations or related organizations; 114
(2) If no binding agreement has been reached within 115
ninety days of August 28, 1992, between the department of 116
health and senior services and such associations or related 117
organizations; or 118
(3) If a binding agreement has expired for more than 119
ninety days. 120
7. Information obtained by the department under the 121
provisions of section 192.665 and this section shall not be 122
public information. Reports and studies prepared by the 123
department based upon such information shall be public 124
information and may identify individual health care 125
providers. The department of health and senior services may 126
authorize the use of the data by other research 127
organizations pursuant to the provisions of section 128
192.067. The department shall not use or release any 129
information provided under section 192.665 and this section 130
which would enable any person to determine any health care 131
provider's negotiated discounts with specific preferred 132
provider organizations or other managed care organizations. 133
The department shall not release data in a form which could 134
be used to identify a patient. Any violation of this 135
subsection is a class A misdemeanor. 136
8. The department shall undertake a reasonable number 137
of studies and publish information, including at least an 138
annual consumer guide, in collaboration with health care 139
providers, business coalitions and consumers based upon the 140
information obtained pursuant to the provisions of section 141
192.665 and this section. The department shall allow all 142
health care providers and associations and related 143
organizations who have submitted data which will be used in 144
SB 1527 9
any publication to review and comment on the publication 145
prior to its publication or release for general use. The 146
publication shall be made available to the public for a 147
reasonable charge. 148
9. Any health care provider which continually and 149
substantially, as these terms are defined by rule, fails to 150
comply with the provisions of this section shall not be 151
allowed to participate in any program administered by the 152
state or to receive any moneys from the state. 153
10. A hospital, as defined in section 197.020, 154
aggrieved by the department's determination of ineligibility 155
for state moneys pursuant to subsection 9 of this section 156
may appeal as provided in section 197.071. An ambulatory 157
surgical center or abortion facility as defined in section 158
197.200 aggrieved by the department's determination of 159
ineligibility for state moneys pursuant to subsection 9 of 160
this section may appeal as provided in section 197.221. 161
11. The department of health may promulgate rules 162
providing for collection of data and publication of the 163
incidence of health care-associated infections for other 164
types of health facilities determined to be sources of 165
infections; except that, physicians' offices shall be exempt 166
from reporting and disclosure of such infections. 167
12. [By January 1, 2017, the advisory panel shall 168
recommend and] The department shall adopt in regulation 169
[with an effective date of no later than January 1, 2018,] 170
the requirements for the reporting of the following types of 171
infections as specified in this subsection: 172
(1) Infections associated with a minimum of four 173
surgical procedures for hospitals and a minimum of two 174
surgical procedures for ambulatory surgical centers that 175
meet the following criteria: 176
SB 1527 10
(a) Are usually associated with an elective surgical 177
procedure. An "elective surgical procedure" is a planned, 178
nonemergency surgical procedure that may be either medically 179
required such as a hip replacement or optional such as 180
breast augmentation; 181
(b) Demonstrate a high priority aspect such as 182
affecting a large number of patients, having a substantial 183
impact for a smaller population, or being associated with 184
substantial cost, morbidity, or mortality; or 185
(c) Are infections for which reports are collected by 186
the National Healthcare Safety Network or its successor; 187
(2) Central line-related bloodstream infections; 188
(3) Health care-associated infections specified for 189
reporting by hospitals, ambulatory surgical centers, and 190
other health care facilities by the rules of the Centers for 191
Medicare and Medicaid Services to the federal Centers for 192
Disease Control and Prevention's National Healthcare Safety 193
Network, or its successor; and 194
(4) Other categories of infections that may be 195
established by rule by the department. 196
The department[, in consultation with the advisory panel,] 197
shall be authorized to collect and report data on subsets of 198
each type of infection described in this subsection. 199
13. [In consultation with the infection control 200
advisory panel established pursuant to section 197.165,] The 201
department shall develop and disseminate to the public 202
reports based on data compiled for a period of twelve 203
months. Such reports shall be updated [quarterly] at least 204
annually and shall show for each hospital, ambulatory 205
surgical center, abortion facility, and other facility 206
SB 1527 11
metrics on risk-adjusted health care-associated infections 207
under this section. 208
14. The types of infections under subsection 12 of 209
this section to be publicly reported shall be determined by 210
the department by rule and shall be consistent with the 211
infections tracked by the National Healthcare Safety 212
Network, or its successor. 213
15. Reports published pursuant to subsection 13 of 214
this section shall be published and readily accessible on 215
the department's internet website. The reports shall be 216
distributed at least annually to the governor and members of 217
the general assembly. The department shall make such 218
reports available to the public for a period of at least two 219
years. 220
16. [The Hospital Industry Data Institute shall 221
publish a report of Missouri hospitals', ambulatory surgical 222
centers', and abortion facilities' compliance with 223
standardized quality of care measures established by the 224
federal Centers for Medicare and Medicaid Services for 225
prevention of infections related to surgical procedures. If 226
the Hospital Industry Data Institute fails to do so by July 227
31, 2008, and annually thereafter, the department shall be 228
authorized to collect information from the Centers for 229
Medicare and Medicaid Services or from hospitals, ambulatory 230
surgical centers, and abortion facilities and publish such 231
information in accordance with this section. 232
17.] The data collected or published pursuant to this 233
section shall be available to the department for purposes of 234
licensing hospitals, ambulatory surgical centers, and 235
abortion facilities pursuant to chapter 197. 236
[18.] 17. The department shall promulgate rules to 237
implement the provisions of section 192.131 and sections 238
SB 1527 12
197.150 to 197.160. Any rule or portion of a rule, as that 239
term is defined in section 536.010, that is created under 240
the authority delegated in this section shall become 241
effective only if it complies with and is subject to all of 242
the provisions of chapter 536 and, if applicable, section 243
536.028. This section and chapter 536 are nonseverable and 244
if any of the powers vested with the general assembly 245
pursuant to chapter 536 to review, to delay the effective 246
date, or to disapprove and annul a rule are subsequently 247
held unconstitutional, then the grant of rulemaking 248
authority and any rule proposed or adopted after August 28, 249
2004, shall be invalid and void. 250
[19. No later than August 28, 2017,] 18. Each 251
hospital, excluding mental health facilities as defined in 252
section 632.005, and each ambulatory surgical center and 253
abortion facility as defined in section 197.200, shall in 254
consultation with its medical staff establish an 255
antimicrobial stewardship program for evaluating the 256
judicious use of antimicrobials, especially antibiotics that 257
are the last line of defense against resistant infections. 258
The hospital's stewardship program and the results of the 259
program shall be monitored and evaluated by hospital quality 260
improvement departments and shall be available upon 261
inspection to the department. At a minimum, the 262
antimicrobial stewardship program shall be designed to 263
evaluate that hospitalized patients receive, in accordance 264
with accepted medical standards of practice, the appropriate 265
antimicrobial, at the appropriate dose, at the appropriate 266
time, and for the appropriate duration. 267
[20.] 19. Hospitals described in subsection [19] 18 of 268
this section shall meet the National Healthcare Safety 269
Network requirements for reporting antimicrobial usage or 270
SB 1527 13
resistance by using the Centers for Disease Control and 271
Prevention's Antimicrobial Use and Resistance (AUR) Module 272
when conditions of participation promulgated by the Centers 273
for Medicare and Medicaid Services requiring the electronic 274
reporting of antibiotic use or antibiotic resistance by 275
hospitals become effective. When such antimicrobial usage 276
or resistance reporting takes effect, hospitals shall 277
authorize the National Healthcare Safety Network, or its 278
successor, to disclose to the department facility-specific 279
information reported to the AUR Module. Facility-specific 280
data on antibiotic usage and resistance collected under this 281
subsection shall not be disclosed to the public, but the 282
department may release case-specific information to other 283
facilities, physicians, and the public if the department 284
determines on a case-by-case basis that the release of such 285
information is necessary to protect persons in a public 286
health emergency. Nothing in this section shall prohibit a 287
hospital from voluntarily reporting antibiotic use or 288
antibiotic resistance data through the National Healthcare 289
Safety Network, or its successor, prior to the effective 290
date of the conditions of participation requiring the 291
reporting. 292
[21.] 20. The department shall make a report to the 293
general assembly beginning January 1, 2018, and on every 294
January first thereafter on the incidence, type, and 295
distribution of antimicrobial-resistant infections 296
identified in the state and within regions of the state. 297
197.293. 1. In addition to the powers established in 1
sections 197.070 and 197.220, the department of health and 2
senior services shall use the following standards for 3
enforcing hospital, ambulatory surgical center, and abortion 4
facility licensure regulations promulgated to enforce the 5
SB 1527 14
provisions of sections 197.010 to 197.120, sections 197.150 6
to [197.165] 197.162, and sections 197.200 to 197.240: 7
(1) Upon notification of a deficiency in meeting 8
regulatory standards, the hospital, ambulatory surgical 9
center, or abortion facility shall develop and implement a 10
plan of correction approved by the department which 11
includes, but is not limited to, the specific type of 12
corrective action to be taken and an estimated time to 13
complete such action; 14
(2) If the plan as implemented does not correct the 15
deficiency, the department may either: 16
(a) Direct the hospital, ambulatory surgical center, 17
or abortion facility to develop and implement a plan of 18
correction pursuant to subdivision (1) of this subsection; or 19
(b) Require the hospital, ambulatory surgical center, 20
or abortion facility to implement a plan of correction 21
developed by the department; 22
(3) If there is a continuing deficiency after 23
implementation of the plan of correction pursuant to 24
subdivision (2) of this subsection and the hospital, 25
ambulatory surgical center, or abortion facility has had an 26
opportunity to correct such deficiency, the department may 27
restrict new inpatient admissions or outpatient entrants to 28
the service or services affected by such deficiency; 29
(4) If there is a continuing deficiency after the 30
department restricts new inpatient admissions or outpatient 31
entrants to the service or services pursuant to subdivision 32
(3) of this subsection and the hospital, ambulatory surgical 33
center, or abortion facility has had an opportunity to 34
correct such deficiency, the department may suspend 35
operations in all or part of the service or services 36
affected by such deficiency; 37
SB 1527 15
(5) If there is a continuing deficiency after 38
suspension of operations pursuant to subdivision (4) of this 39
subsection, the department may deny, suspend or revoke the 40
hospital's, ambulatory surgical center's, or abortion 41
facility's license pursuant to section 197.070 or section 42
197.220. 43
2. Notwithstanding the provisions of subsection 1 of 44
this section to the contrary, if a deficiency in meeting 45
licensure standards presents an immediate and serious threat 46
to the patients' health and safety, the department may, 47
based on the scope and severity of the deficiency, restrict 48
access to the service or services affected by the deficiency 49
until the hospital, ambulatory surgical center, or abortion 50
facility has developed and implemented an approved plan of 51
correction. Decisions as to whether a deficiency 52
constitutes an immediate and serious threat to the patients' 53
health and safety shall be made in accordance with 54
guidelines established pursuant to regulation of the 55
department of health and senior services and such decisions 56
shall be approved by the bureau of health facility licensing 57
in the department of health and senior services, or its 58
successor agency, or by a person authorized by the 59
regulations to approve such decisions in the absence of the 60
director. 61
197.294. No information disclosed by the department to 1
the public pursuant to sections 192.019, 192.020, 192.067, 2
192.131, 192.138, 192.665, and 192.667, and sections 3
197.150, 197.152, 197.154, 197.156, 197.158, 197.160, 4
197.162, [197.165,] and 197.293 shall be used to establish a 5
standard of care in a private civil action. 6
[197.165. 1. The department shall appoint 1
an "Infection Control Advisory Panel" for the 2
SB 1527 16
purposes of implementing sections 192.131 and 3
192.667. 4
2. Members of the infection control 5
advisory panel shall include: 6
(1) Two public members; 7
(2) Three board-certified or board- 8
eligible physicians licensed pursuant to chapter 9
334 who are affiliated with a Missouri hospital 10
or medical school, active members of the Society 11
for Health Care Epidemiology of America, and 12
have demonstrated interest and expertise in 13
health facility infection control; 14
(3) One physician licensed pursuant to 15
chapter 334 who is active in the practice of 16
medicine in Missouri and who holds medical staff 17
privileges at a Missouri hospital; 18
(4) Four infection control practitioners 19
certified by the certification board of 20
infection control and epidemiology, at least two 21
of whom shall be practicing in a rural hospital 22
or setting and at least two of whom shall be 23
registered professional nurses licensed under 24
chapter 335; 25
(5) A medical statistician with an 26
advanced degree in such specialty; 27
(6) A clinical microbiologist with an 28
advanced degree in such specialty; 29
(7) Three employees of the department, 30
representing the functions of hospital, 31
ambulatory surgical center, and abortion 32
facility licensure, epidemiology and health data 33
analysis, who shall serve as ex officio 34
nonvoting members of the panel. 35
3. Reasonable expenses of the panel shall 36
be paid from private donations made specifically 37
for that purpose to the "Infection Control 38
Advisory Panel Fund", which is hereby created in 39
the state treasury. If such donations are not 40
received from private sources, then the 41
provisions of this act shall be implemented 42
without the advisory panel.] 43
✓