Modifies provisions relating to health care

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 COMMITTEE SUBSTITUTE FOR
SENATE BILL NO. 841
103RD GENERAL ASSEMBLY
4822S.02C KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 96.192, 96.196, 167.627, 167.630, 190.098, 190.246, 191.1146, 195.417,
196.990, 198.022, 198.070, 206.110, 208.662, 321.621, 332.081, 334.108, 335.081,
338.010, 338.333, 338.710, and 579.060, RSMo, and to enact in lieu thereof thirty -
seven new sections relating to health care, with penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 96.192, 96.196, 167.627, 167.630, 1
190.098, 190.246, 191.1146, 195.417, 196.990, 198.022, 198.070, 2
206.110, 208.662, 321.621, 332.081, 334.108, 335.081, 338.010, 3
338.333, 338.710, and 579.060, RSMo, are repealed and thirty -4
seven new sections enacted in lieu thereof, to be known as 5
sections 9.412, 9.418, 96.192, 96.196, 167.627, 167.630, 6
190.098, 190.246, 191.708, 191.1146, 192.021, 195.417, 196.990, 7
197.708, 198.022, 198.070, 206.110, 206.158, 208.149, 208.662, 8
208.1400, 208.1405, 208.1410, 208.1415, 208.1420, 208.1425, 9
210.225, 321.621, 332.081, 334.108, 335.081, 338.010, 338.333, 10
338.710, 376.1245, 376.1280, and 579.060, to read as follows:11
9.412. The month of September each year is hereby 1
designated as "Brain Aneurysm Awareness Month" in Missouri. 2
The citizens of this state are encouraged to participate in 3
appropriate events and activities to raise awareness about 4
the causes of and treatments for brain aneurysms, which 5
affect nearly two hundred thousand people each year. 6
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9.418. The last full week of April each year shall be 1
known as "Infertility Awareness Week" in Missouri. 2
Infertility is a medical condition defined by the inability 3
to achieve pregnancy after twelve months or more of regular, 4
unprotected sexual activity, or the inability to carry a 5
pregnancy to live birth, affecting millions of individuals 6
and couples worldwide. It is estimated that approximately 7
one in eight couples in the United States experience 8
infertility, impacting people across all racial, ethnic, 9
socioeconomic, and cultural backgrounds. The citizens of 10
this state are encouraged to participate in appropriate 11
events and activities to raise awareness about infertility 12
to help reduce stigma, foster understanding, and promote 13
equitable access to fertility treatments and family-building 14
options, including assisted reproductive technologies, 15
adoption, and surrogacy. 16
96.192. 1. The board of trustees of any hospital 1
authorized under subsection 2 of this section, and 2
established and organized under the provisions of sections 3
96.150 to 96.229[,]: 4
(1) May invest up to [twenty-five] fifty percent of 5
the hospital's "available funds", defined in this section as 6
funds not required for immediate disbursement in obligations 7
or for the operation of the hospital [in any United States 8
investment grade fixed income funds or any diversified stock 9
funds, or both.], into: 10
(a) Any mutual funds that invest in stocks, bonds, or 11
real estate, or any combination thereof; 12
(b) Bonds that have: 13
a. One of the five highest long-term ratings or the 14
highest short-term rating issued by a nationally recognized 15
rating agency; and 16
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b. A final maturity of ten years or less; 17
(c) Money market investments; or 18
(d) Any combination of investments described in 19
paragraphs (a) to (c) of this subdivision; and 20
(2) Shall invest the remaining percentage of any 21
available funds not invested as allowed under subdivision 22
(1) of this subsection into any investment in which the 23
state treasurer is allowed to invest. 24
2. The provisions of this section shall only apply if 25
the hospital: 26
(1) Receives less than [one] three percent of its 27
annual revenues from municipal, county, or state taxes; and 28
(2) Receives less than [one] three percent of its 29
annual revenue from appropriated funds from the municipality 30
in which such hospital is located. 31
96.196. 1. A hospital organized under this chapter 1
may purchase, operate or lease, as lessor or lessee, related 2
facilities or engage in health care activities, except in 3
counties of the third or fourth classification (other than 4
the county in which the hospital is located) where there 5
already exists a hospital organized pursuant to this chapter 6
[and chapter 205 or 206]; provided, however, that this 7
exception shall not prohibit the continuation of existing 8
activities otherwise allowed by law. 9
2. If a hospital organized pursuant to this chapter 10
accepts appropriated funds from the city during the twelve 11
months immediately preceding the date that the hospital 12
purchases, operates or leases its first related facility 13
outside the city boundaries or engages in its first health 14
care activity outside the city boundaries, the governing 15
body of the city shall approve the hospital's plan for such 16
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purchase, operation or lease prior to implementation of the 17
plan. 18
167.627. 1. For purposes of this section, the 1
following terms shall mean: 2
(1) "Epinephrine delivery device", a single-use device 3
used for the delivery of a premeasured dose of epinephrine 4
into the human body; 5
(2) "Medication", any medicine prescribed or ordered 6
by a physician for the treatment of asthma or anaphylaxis, 7
including without limitation inhaled bronchodilators and 8
[auto-injectible] epinephrine delivery devices; 9
[(2)] (3) "Self-administration", a pupil's 10
discretionary use of medication prescribed by a physician or 11
under a written treatment plan from a physician. 12
2. Each board of education and its employees and 13
agents in this state shall grant any pupil in the school 14
authorization for the possession and self-administration of 15
medication to treat such pupil's chronic health condition, 16
including but not limited to asthma or anaphylaxis if: 17
(1) A licensed physician prescribed or ordered such 18
medication for use by the pupil and instructed such pupil in 19
the correct and responsible use of such medication; 20
(2) The pupil has demonstrated to the pupil's licensed 21
physician or the licensed physician's designee, and the 22
school nurse, if available, the skill level necessary to use 23
the medication and any device necessary to administer such 24
medication prescribed or ordered; 25
(3) The pupil's physician has approved and signed a 26
written treatment plan for managing the pupil's chronic 27
health condition, including asthma or anaphylaxis episodes 28
and for medication for use by the pupil. Such plan shall 29
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include a statement that the pupil is capable of self- 30
administering the medication under the treatment plan; 31
(4) The pupil's parent or guardian has completed and 32
submitted to the school any written documentation required 33
by the school, including the treatment plan required under 34
subdivision (3) of this subsection and the liability 35
statement required under subdivision (5) of this subsection; 36
and 37
(5) The pupil's parent or guardian has signed a 38
statement acknowledging that the school district and its 39
employees or agents shall incur no liability as a result of 40
any injury arising from the self-administration of 41
medication by the pupil or the administration of such 42
medication by school staff. Such statement shall not be 43
construed to release the school district and its employees 44
or agents from liability for negligence. 45
3. An authorization granted under subsection 2 of this 46
section shall: 47
(1) Permit such pupil to possess and self-administer 48
such pupil's medication while in school, at a school- 49
sponsored activity, and in transit to or from school or 50
school-sponsored activity; and 51
(2) Be effective only for the same school and school 52
year for which it is granted. Such authorization shall be 53
renewed by the pupil's parent or guardian each subsequent 54
school year in accordance with this section. 55
4. Any current duplicate prescription medication, if 56
provided by a pupil's parent or guardian or by the school, 57
shall be kept at a pupil's school in a location at which the 58
pupil or school staff has immediate access in the event of 59
an asthma or anaphylaxis emergency. 60
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5. The information described in subdivisions (3) and 61
(4) of subsection 2 of this section shall be kept on file at 62
the pupil's school in a location easily accessible in the 63
event of an emergency. 64
167.630. 1. As used in this section, the term 1
"epinephrine delivery device" has the same meaning given to 2
the term in section 167.627. 3
2. Each school board may authorize a school nurse 4
licensed under chapter 335 who is employed by the school 5
district and for whom the board is responsible for to 6
maintain an adequate supply of [prefilled auto syringes of] 7
epinephrine [with fifteen-hundredths milligram or three- 8
tenths milligram] delivery devices at the school. The nurse 9
shall recommend to the school board the number of 10
[prefilled] epinephrine [auto syringes] delivery devices 11
that the school should maintain. 12
[2.] 3. To obtain [prefilled] epinephrine [auto 13
syringes] delivery devices for a school district, a 14
prescription written by a licensed physician, a physician's 15
assistant, or nurse practitioner is required. For such 16
prescriptions, the school district shall be designated as 17
the patient, the nurse's name shall be required, and the 18
prescription shall be filled at a licensed pharmacy. 19
[3.] 4. A school nurse, contracted agent trained by a 20
nurse, or other school employee trained by and supervised by 21
the nurse shall have the discretion to use an epinephrine 22
[auto syringe] delivery device on any student the school 23
nurse, trained employee, or trained contracted agent 24
believes is having a life-threatening anaphylactic reaction 25
based on the training in recognizing an acute episode of an 26
anaphylactic reaction. The provisions of section 167.624 27
concerning immunity from civil liability for trained 28
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employees administering lifesaving methods shall apply to 29
trained employees administering [a prefilled auto syringe] 30
an epinephrine delivery device under this section. Trained 31
contracted agents shall have immunity from civil liability 32
for administering [a prefilled auto syringe] an epinephrine 33
delivery device under this section. 34
190.098. 1. As used in this section, the term 1
"community paramedic services" means services that are: 2
(1) Provided by any entity that: 3
(a) Employs licensed paramedics who are certified as 4
community paramedics by the department; and 5
(b) Has received an endorsement by the department as a 6
community paramedic service entity; 7
(2) Provided in a nonemergent setting, independent of 8
a 911 system or emergency summons; 9
(3) Consistent with the training and education, as 10
well as within the scope of skill and practice, of the 11
personnel and with the supervisory standard approved by the 12
medical director; and 13
(4) Reflected and documented in the entity's patient 14
care plans or protocols approved by the medical director in 15
accordance with section 190.142. 16
2. In order for a person to be eligible for 17
certification by the department as a community paramedic, an 18
individual shall: 19
(1) Be currently [certified] licensed as a paramedic; 20
(2) Successfully complete or have successfully 21
completed a community paramedic certification program from a 22
college, university, or educational institution that has 23
been approved by the department or accredited by a national 24
accreditation organization approved by the department; and 25
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(3) Complete an application form approved by the 26
department. 27
[2.] 3. A community paramedic shall practice in 28
accordance with protocols and supervisory standards 29
established by the medical director[. A community paramedic 30
shall provide services of a health care plan if the plan has 31
been developed by the patient's physician or by an advanced 32
practice registered nurse through a collaborative practice 33
arrangement with a physician or a physician assistant 34
through a collaborative practice arrangement with a 35
physician and there is no duplication of services to the 36
patient from another provider] in collaboration with the 37
ambulance service administrator. Patient care plans that 38
are developed by the patient's physician, advanced practice 39
nurse practitioner, or physician assistant shall be 40
implemented through a collaboration with the medical 41
director and agency. 42
[3.] 4. (1) Any ambulance service [shall enter into a 43
written contract to provide community paramedic services in 44
another ambulance service area, as that term is defined in 45
section 190.100. The contract that is agreed upon may be 46
for an indefinite period of time, as long as it includes at 47
least a sixty-day cancellation notice by either ambulance 48
service] that seeks to provide community paramedic services 49
outside of its ambulance service area, as described in 50
section 190.105 and administered by the department, and in 51
the service area of another ambulance service that currently 52
provides community paramedic services shall be required to 53
have a memorandum of understanding with that ambulance 54
service regarding the provision of such community paramedic 55
services. An ambulance service that provides community 56
paramedic services may provide community paramedic services 57
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without a memorandum of understanding in the ambulance 58
service area of an ambulance service that is not providing 59
community paramedic services, but the ambulance service 60
providing community paramedic services shall provide 61
notification to the ambulance service with emergency service 62
responsibilities in the service area of the general 63
community paramedic activities being performed. 64
(2) An ambulance service that provides community 65
paramedic services and that has executed formal contracts or 66
agreements with health care institutions, hospitals, health 67
clinics, or insurance companies for the provision of 68
community paramedic services shall be permitted to honor 69
those agreements. 70
(3) For sustained services provided outside the county 71
of the ambulance services primary 911 response territory 72
where another licensed ambulance service also offers 73
community paramedic services, the community paramedic 74
program shall coordinate with the local ambulance service. 75
(4) Any emergency medical response agency seeking to 76
provide community paramedic services within its designated 77
response service area may do so if the ground ambulance 78
service covering the area within which the emergency medical 79
response agency is located does not provide community 80
paramedic services. If such ground ambulance service does 81
provide community paramedic services, the ground ambulance 82
service may establish, at its sole discretion, a memorandum 83
of understanding with the emergency medical response agency 84
planning to offer community paramedic services in order to 85
coordinate programs and avoid service duplication. If an 86
emergency medical response agency is providing community 87
paramedic services in a service area before the ground 88
ambulance service in that service area begins offering 89
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community paramedic services, the emergency medical response 90
agency and the ground ambulance service shall establish a 91
memorandum of understanding for the coordination of services. 92
(5) A community paramedic program shall notify the 93
appropriate local ambulance service when providing services 94
within the service area of an ambulance service. 95
(6) The department shall establish regulations for the 96
purpose of recognizing community paramedic service entities 97
that have met the standards necessary to provide community 98
paramedic services, including physician medical oversight, 99
training, patient record keeping, formal relationships with 100
primary care services where necessary, and quality 101
improvement policies. The department shall issue an 102
endorsement to any community paramedic service entity that 103
meets such standards that allows the entity to provide 104
community paramedic services for a period of five years. 105
[4.] 5. A community paramedic is subject to the 106
provisions of sections 190.001 to 190.245 and rules 107
promulgated under sections 190.001 to 190.245. 108
[5.] 6. No person shall hold himself or herself out as 109
a community paramedic or provide the services of a community 110
paramedic unless such person is certified by the department. 111
[6.] 7. The medical director shall approve the 112
implementation of the community paramedic program. 113
[7.] 8. Any rule or portion of a rule, as that term is 114
defined in section 536.010, that is created under the 115
authority delegated in this section shall become effective 116
only if it complies with and is subject to all of the 117
provisions of chapter 536 and, if applicable, section 118
536.028. This section and chapter 536 are nonseverable and 119
if any of the powers vested with the general assembly 120
pursuant to chapter 536 to review, to delay the effective 121
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date, or to disapprove and annul a rule are subsequently 122
held unconstitutional, then the grant of rulemaking 123
authority and any rule proposed or adopted after August 28, 124
2013, shall be invalid and void. 125
190.246. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Eligible person, firm, organization or other 3
entity", an ambulance service or emergency medical response 4
agency, an emergency medical responder, or an emergency 5
medical technician who is employed by, or an enrolled 6
member, person, firm, organization or entity designated by, 7
rule of the department of health and senior services in 8
consultation with other appropriate agencies. All such 9
eligible persons, firms, organizations or other entities 10
shall be subject to the rules promulgated by the director of 11
the department of health and senior services; 12
(2) "Emergency health care provider": 13
(a) A physician licensed pursuant to chapter 334 with 14
knowledge and experience in the delivery of emergency care; 15
or 16
(b) A hospital licensed pursuant to chapter 197 that 17
provides emergency care; 18
(3) "Epinephrine delivery device", a single-use device 19
used for the delivery of a premeasured dose of epinephrine 20
into the human body. 21
2. Possession and use of epinephrine [auto-injector] 22
delivery devices shall be limited as follows: 23
(1) No person shall use an epinephrine [auto-injector] 24
delivery device unless such person has successfully 25
completed a training course in the use of epinephrine [auto- 26
injector] delivery devices approved by the director of the 27
department of health and senior services. Nothing in this 28
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section shall prohibit the use of an epinephrine [auto- 29
injector] delivery device: 30
(a) By a health care professional licensed or 31
certified by this state who is acting within the scope of 32
his or her practice; or 33
(b) By a person acting pursuant to a lawful 34
prescription; 35
(2) Every person, firm, organization and entity 36
authorized to possess and use epinephrine [auto-injector] 37
delivery devices pursuant to this section shall use, 38
maintain and dispose of such devices in accordance with the 39
rules of the department; and 40
(3) Every use of an epinephrine [auto-injector] 41
delivery device pursuant to this section shall immediately 42
be reported to the emergency health care provider. 43
3. (1) Use of an epinephrine [auto-injector] delivery 44
device pursuant to this section shall be considered first 45
aid or emergency treatment for the purpose of any law 46
relating to liability. 47
(2) Purchase, acquisition, possession or use of an 48
epinephrine [auto-injector] delivery device pursuant to this 49
section shall not constitute the unlawful practice of 50
medicine or the unlawful practice of a profession. 51
(3) Any person otherwise authorized to sell or provide 52
an epinephrine [auto-injector] delivery device may sell or 53
provide it to a person authorized to possess it pursuant to 54
this section. 55
4. Any person, firm, organization or entity that 56
violates the provisions of this section is guilty of a class 57
B misdemeanor. 58
191.708. 1. The chief medical officer or chief 1
medical director of the department of health and senior 2
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services, the department of mental health, or the MO 3
HealthNet division of the department of social services, or 4
any licensed physician acting with the express written 5
consent of the director of any such department or division, 6
may, within his or her scope of practice, issue: 7
(1) Nonspecific recommendations for doula services; 8
(2) A medical standing order for prenatal vitamins; or 9
(3) A medical standing order for any other purpose, 10
other than for controlled substances, that is promulgated by 11
rule in compliance with chapter 536. 12
2. Any standing order issued under this section shall: 13
(1) Be made available on the relevant department's 14
website while in effect; 15
(2) Terminate upon removal of the issuing medical 16
professional's authority under this section by vacancy of 17
his or her position or otherwise; and 18
(3) If not terminated sooner under subdivision (2) of 19
this subsection, expire within one year of issuance unless 20
renewed. 21
3. The chief medical officer, chief medical director, 22
or other authorized and licensed physician described in 23
subsection 1 of this section shall be immune from criminal 24
prosecution, disciplinary action from his or her 25
professional licensing board, and civil liability for 26
issuing a medical standing order or recommendation in 27
accordance with this section, including for any outcome 28
related to the standing order or recommendation. 29
191.1146. 1. Physicians licensed under chapter 334 1
who use telemedicine shall ensure that a properly 2
established physician-patient relationship exists with the 3
person who receives the telemedicine services. The 4
physician-patient relationship may be established by: 5
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(1) An in-person encounter through a medical 6
[interview] evaluation and physical examination; 7
(2) Consultation with another physician, or that 8
physician's delegate, who has an established relationship 9
with the patient and an agreement with the physician to 10
participate in the patient's care; or 11
(3) A telemedicine encounter, if the standard of care 12
does not require an in-person encounter, and in accordance 13
with evidence-based standards of practice and telemedicine 14
practice guidelines that address the clinical and 15
technological aspects of telemedicine. 16
2. In order to establish a physician-patient 17
relationship through telemedicine: 18
(1) The technology utilized shall be sufficient to 19
establish an informed diagnosis as though the medical 20
[interview] evaluation and, if required to meet the standard 21
of care, the physical examination has been performed in 22
person; [and] 23
(2) Prior to providing treatment, including issuing 24
prescriptions or physician certifications under Article XIV 25
of the Missouri Constitution, a physician who uses 26
telemedicine shall [interview] evaluate the patient, collect 27
or review the patient's relevant medical history, and 28
perform an examination sufficient for the diagnosis and 29
treatment of the patient. [A] Any questionnaire completed 30
by the patient, whether via the internet or telephone, shall 31
be reviewed by the treating health care professional, as 32
defined in section 376.1350, and shall include such 33
information sufficient to provide the information as though 34
the medical evaluation has been performed in person, 35
otherwise such questionnaire does not constitute an 36
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acceptable medical [interview] evaluation and examination 37
for the provision of treatment by telehealth; and 38
(3) Any provider that uses a questionnaire to 39
establish a physician-patient relationship through 40
telemedicine shall be employed or contracted with a business 41
entity that is licensed to provide health care in this state. 42
3. A health care provider, utilizing a medical 43
evaluation questionnaire completed by the patient by way of 44
the internet or telephone, shall provide a written report to 45
the patient's primary health care provider within fourteen 46
days of evaluation, if provided by the patient, that 47
contains: 48
(1) The identity of the patient; 49
(2) The date of the evaluation; 50
(3) The diagnosis and treatment provided, if any; and 51
(4) Any further instructions provided to the patient. 52
192.021. 1. The department of health and senior 1
services shall be authorized to contract directly with an 2
entity on a qualified vendor list composed of Missouri 3
affiliates of national public health associations or public 4
health institutes in order to assist in carrying out its 5
duties to promote the health and wellbeing of the residents 6
of this state. Such contracts may include, but not be 7
limited to, efforts to assist in the delivery of health 8
services to residents throughout the state and the 9
administration of grant funds and related programs. 10
2. Within sixty days after the end of each fiscal 11
year, the department and the designated affiliate shall 12
provide the general assembly with an annual report and 13
accounting of any appropriations and grant funds received 14
and expended by the designated affiliate pursuant to this 15
section during the immediate prior fiscal year and may 16
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provide recommendations and suggestions for improvement in 17
services provided. 18
195.417. 1. The limits specified in this section 1
shall not apply to any quantity of such product, mixture, or 2
preparation which must be dispensed, sold, or distributed in 3
a pharmacy pursuant to a valid prescription. 4
2. Within any thirty-day period, no person shall sell, 5
dispense, or otherwise provide to the same individual, and 6
no person shall purchase, receive, or otherwise acquire more 7
than the following amount: any number of packages of any 8
drug product containing any detectable amount of ephedrine, 9
phenylpropanolamine, or pseudoephedrine, or any of their 10
salts or optical isomers, or salts of optical isomers, 11
either as: 12
(1) The sole active ingredient; or 13
(2) One of the active ingredients of a combination 14
drug; or 15
(3) A combination of any of the products specified in 16
subdivisions (1) and (2) of this subsection; 17
in any total amount greater than seven and two-tenths grams, 18
without regard to the number of transactions. 19
3. Within any twenty-four-hour period, no pharmacist, 20
intern pharmacist, or registered pharmacy technician shall 21
sell, dispense, or otherwise provide to the same individual, 22
and no person shall purchase, receive, or otherwise acquire 23
more than the following amount: any number of packages of 24
any drug product containing any detectable amount of 25
ephedrine, phenylpropanolamine, or pseudoephedrine, or any 26
of their salts or optical isomers, or salts of optical 27
isomers, either as: 28
(1) The sole active ingredient; or 29
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(2) One of the active ingredients of a combination 30
drug; or 31
(3) A combination of any of the products specified in 32
subdivisions (1) and (2) of this subsection; 33
in any total amount greater than three and six-tenths grams 34
without regard to the number of transactions. 35
4. Within any twelve-month period, no person shall 36
sell, dispense, or otherwise provide to the same individual, 37
and no person shall purchase, receive, or otherwise acquire 38
more than the following amount: any number of packages of 39
any drug product containing any detectable amount of 40
ephedrine, phenylpropanolamine, or pseudoephedrine, or any 41
of their salts or optical isomers, or salts of optical 42
isomers, either as: 43
(1) The sole active ingredient; or 44
(2) One of the active ingredients of a combination 45
drug; or 46
(3) A combination of any of the products specified in 47
subdivisions (1) and (2) of this subsection; 48
in any total amount greater than [forty-three] sixty-one and 49
two-tenths grams, without regard to the number of 50
transactions. 51
5. All packages of any compound, mixture, or 52
preparation containing any detectable quantity of ephedrine, 53
phenylpropanolamine, or pseudoephedrine, or any of their 54
salts or optical isomers, or salts of optical isomers, 55
except those that are excluded from Schedule V in subsection 56
17 or 18 of section 195.017, shall be offered for sale only 57
from behind a pharmacy counter where the public is not 58
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permitted, and only by a registered pharmacist or registered 59
pharmacy technician under section 195.017. 60
6. Each pharmacy shall submit information regarding 61
sales of any compound, mixture, or preparation as specified 62
in this section in accordance with transmission methods and 63
frequency established by the department by regulation. 64
7. (1) As used in this subsection, "administrator of 65
the real-time electronic pseudoephedrine tracking system" 66
means the entity responsible for developing, implementing, 67
and maintaining the data collection system described in 19 68
CSR 30-1.074 or any successor regulation. 69
(2) Beginning October 1, 2026, and continuing 70
thereafter, any manufacturer of any compound, mixture, or 71
preparation specified in this section that is sold in or 72
into the state shall, on a monthly basis, pay fees to the 73
administrator of the real-time electronic pseudoephedrine 74
tracking system. 75
(3) The administrator of the real-time electronic 76
pseudoephedrine tracking system shall be responsible for 77
setting the fee levels required under this subsection. 78
(4) Upon the request of the department of health and 79
senior services, any manufacturer required to pay fees under 80
this subsection shall provide written documentation 81
demonstrating that the manufacturer has paid such fees. 82
8. No prescription shall be required for the 83
dispensation, sale, or distribution of any drug product 84
containing any detectable amount of ephedrine, 85
phenylpropanolamine, or pseudoephedrine, or any of their 86
salts or optical isomers, or salts of optical isomers, in an 87
amount within the limits described in subsections 2, 3, and 88
4 of this section. The superintendent of the Missouri state 89
highway patrol shall report to the revisor of statutes and 90
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the general assembly by February first when the statewide 91
number of methamphetamine laboratory seizure incidents 92
exceeds three hundred incidents in the previous calendar 93
year. The provisions of this subsection shall expire on 94
April first of the calendar year in which the revisor of 95
statutes receives such notification. 96
[8.] 9. This section shall supersede and preempt any 97
local ordinances or regulations, including any ordinances or 98
regulations enacted by any political subdivision of the 99
state. This section shall not apply to the sale of any 100
animal feed products containing ephedrine or any naturally 101
occurring or herbal ephedra or extract of ephedra. 102
[9.] 10. Any local ordinances or regulations enacted 103
by any political subdivision of the state prior to August 104
28, 2020, requiring a prescription for the dispensation, 105
sale, or distribution of any drug product containing any 106
detectable amount of ephedrine, phenylpropanolamine, or 107
pseudoephedrine, or any of their salts or optical isomers, 108
or salts of optical isomers, in an amount within the limits 109
described in subsections 2, 3, and 4 of this section shall 110
be void and of no effect and no such political subdivision 111
shall maintain or enforce such ordinance or regulation. 112
[10.] 11. All logs, records, documents, and electronic 113
information maintained for the dispensing of these products 114
shall be open for inspection and copying by municipal, 115
county, and state or federal law enforcement officers whose 116
duty it is to enforce the controlled substances laws of this 117
state or the United States. 118
[11.] 12. All persons who dispense or offer for sale 119
pseudoephedrine and ephedrine products, except those that 120
are excluded from Schedule V in subsection 17 or 18 of 121
section 195.017, shall ensure that all such products are 122
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located only behind a pharmacy counter where the public is 123
not permitted. 124
[12.] 13. The penalty for a knowing or reckless 125
violation of this section is found in section 579.060. 126
196.990. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Administer", the direct application of an 3
epinephrine [auto-injector] delivery device to the body of 4
an individual; 5
(2) "Authorized entity", any entity or organization at 6
or in connection with which allergens capable of causing 7
anaphylaxis may be present including, but not limited to, 8
qualified first responders, as such term is defined in 9
section 321.621, facilities licensed under chapter 198, 10
restaurants, recreation camps, youth sports leagues, child 11
care facilities, amusement parks, and sports arenas. 12
"Authorized entity" shall not include any public school or 13
public charter school; 14
(3) "Epinephrine [auto-injector] delivery device", a 15
single-use device used for the [automatic injection] 16
delivery of a premeasured dose of epinephrine into the human 17
body; 18
(4) "Physician", a physician licensed in this state 19
under chapter 334; 20
(5) "Provide", the supply of one or more epinephrine 21
[auto-injectors] delivery devices to an individual; 22
(6) "Self-administration", a person's discretionary 23
use of an epinephrine [auto-injector] delivery device. 24
2. A physician may prescribe epinephrine [auto- 25
injectors] delivery devices in the name of an authorized 26
entity for use in accordance with this section, and 27
pharmacists, physicians, and other persons authorized to 28
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dispense prescription medications may dispense epinephrine 29
[auto-injectors] delivery devices under a prescription 30
issued in the name of an authorized entity. 31
3. An authorized entity may acquire and stock a supply 32
of epinephrine [auto-injectors] delivery devices under a 33
prescription issued in accordance with this section. Such 34
epinephrine [auto-injectors] delivery devices shall be 35
stored in a location readily accessible in an emergency and 36
in accordance with the epinephrine [auto-injector's] 37
delivery device's instructions for use and any additional 38
requirements established by the department of health and 39
senior services by rule. An authorized entity shall 40
designate employees or agents who have completed the 41
training required under this section to be responsible for 42
the storage, maintenance, and general oversight of 43
epinephrine [auto-injectors] delivery devices acquired by 44
the authorized entity. 45
4. An authorized entity that acquires a supply of 46
epinephrine [auto-injectors] delivery devices under a 47
prescription issued in accordance with this section shall 48
ensure that: 49
(1) Expected epinephrine [auto-injector] delivery 50
device users receive training in recognizing symptoms of 51
severe allergic reactions including anaphylaxis and the use 52
of epinephrine [auto-injectors] delivery devices from a 53
nationally recognized organization experienced in training 54
laypersons in emergency health treatment or another entity 55
or person approved by the department of health and senior 56
services; 57
(2) All epinephrine [auto-injectors] delivery devices 58
are maintained and stored according to the epinephrine [auto- 59
injector's] delivery device's instructions for use; 60
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(3) Any person who provides or administers an 61
epinephrine [auto-injector] delivery device to an individual 62
who the person believes in good faith is experiencing 63
anaphylaxis activates the emergency medical services system 64
as soon as possible; and 65
(4) A proper review of all situations in which an 66
epinephrine [auto-injector] delivery device is used to 67
render emergency care is conducted. 68
5. Any authorized entity that acquires a supply of 69
epinephrine [auto-injectors] delivery devices under a 70
prescription issued in accordance with this section shall 71
notify the emergency communications district or the 72
ambulance dispatch center of the primary provider of 73
emergency medical services where the epinephrine [auto- 74
injectors] delivery devices are to be located within the 75
entity's facility. 76
6. No person shall provide or administer an 77
epinephrine [auto-injector] delivery device to any 78
individual who is under eighteen years of age without the 79
verbal consent of a parent or guardian who is present at the 80
time when provision or administration of the epinephrine 81
[auto-injector] delivery device is needed. Provided, 82
however, that a person may provide or administer an 83
epinephrine [auto-injector] delivery device to such an 84
individual without the consent of a parent or guardian if 85
the parent or guardian is not physically present and the 86
person reasonably believes the individual shall be in 87
imminent danger without the provision or administration of 88
the epinephrine [auto-injector] delivery device. 89
7. The following persons and entities shall not be 90
liable for any injuries or related damages that result from 91
the administration or self-administration of an epinephrine 92
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[auto-injector] delivery device in accordance with this 93
section that may constitute ordinary negligence: 94
(1) An authorized entity that possesses and makes 95
available epinephrine [auto-injectors] delivery devices and 96
its employees, agents, and other trained persons; 97
(2) Any person who uses an epinephrine [auto-injector] 98
delivery device made available under this section; 99
(3) A physician that prescribes epinephrine [auto- 100
injectors] delivery devices to an authorized entity; or 101
(4) Any person or entity that conducts the training 102
described in this section. 103
Such immunity does not apply to acts or omissions 104
constituting a reckless disregard for the safety of others 105
or willful or wanton conduct. The administration of an 106
epinephrine [auto-injector] delivery device in accordance 107
with this section shall not be considered the practice of 108
medicine. The immunity from liability provided under this 109
subsection is in addition to and not in lieu of that 110
provided under section 537.037. An authorized entity 111
located in this state shall not be liable for any injuries 112
or related damages that result from the provision or 113
administration of an epinephrine [auto-injector] delivery 114
device by its employees or agents outside of this state if 115
the entity or its employee or agent is not liable for such 116
injuries or related damages under the laws of the state in 117
which such provision or administration occurred. No trained 118
person who is in compliance with this section and who in 119
good faith and exercising reasonable care fails to 120
administer an epinephrine [auto-injector] delivery device 121
shall be liable for such failure. 122
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8. All basic life support ambulances and stretcher 123
vans operated in the state shall be equipped with 124
epinephrine [auto-injectors] delivery devices and be staffed 125
by at least one individual trained in the use of epinephrine 126
[auto-injectors] delivery devices. 127
9. The provisions of this section shall apply in all 128
counties within the state and any city not within a county. 129
10. Nothing in this section shall be construed as 130
superseding the provisions of section 167.630. 131
197.708. Each hospital shall display in a prominent 1
place within the waiting rooms of the emergency department 2
and the labor and delivery department a printed sign with 3
the following text in all capital letters: "WARNING: 4
ASSAULTING A HEALTH CARE PROFESSIONAL WHO IS ENGAGED IN THE 5
PERFORMANCE OF HIS OR HER OFFICIAL DUTIES, INCLUDING 6
STRIKING A HEALTH CARE PROFESSIONAL WITH ANY BODILY FLUID, 7
IS A SERIOUS CRIME AND WILL BE PROSECUTED TO THE FULLEST 8
EXTENT OF THE LAW.". 9
198.022. 1. Upon receipt of an application for a 1
license to operate a facility, the department shall review 2
the application, investigate the applicant and the 3
statements sworn to in the application for license and 4
conduct any necessary inspections. A license shall be 5
issued if the following requirements are met: 6
(1) The statements in the application are true and 7
correct; 8
(2) The facility and the operator are in substantial 9
compliance with the provisions of sections 198.003 to 10
198.096 and the standards established thereunder; 11
(3) The applicant has the financial capacity to 12
operate the facility; 13
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(4) The administrator of an assisted living facility, 14
a skilled nursing facility, or an intermediate care facility 15
is currently licensed under the provisions of chapter 344; 16
(5) Neither the operator nor any principals in the 17
operation of the facility have ever been convicted of a 18
felony offense concerning the operation of a long-term 19
health care facility or other health care facility or ever 20
knowingly acted or knowingly failed to perform any duty 21
which materially and adversely affected the health, safety, 22
welfare or property of a resident, while acting in a 23
management capacity. The operator of the facility or any 24
principal in the operation of the facility shall not be 25
under exclusion from participation in the Title XVIII 26
(Medicare) or Title XIX (Medicaid) program of any state or 27
territory; 28
(6) Neither the operator nor any principals involved 29
in the operation of the facility have ever been convicted of 30
a felony in any state or federal court arising out of 31
conduct involving either management of a long-term care 32
facility or the provision or receipt of health care; 33
(7) All fees due to the state have been paid. 34
2. Upon denial of any application for a license, the 35
department shall so notify the applicant in writing, setting 36
forth therein the reasons and grounds for denial. 37
3. The department may inspect any facility and any 38
records and may make copies of records, at the facility, at 39
the department's own expense, required to be maintained by 40
sections 198.003 to 198.096 or by the rules and regulations 41
promulgated thereunder at any time if a license has been 42
issued to or an application for a license has been filed by 43
the operator of such facility. Copies of any records 44
requested by the department shall be prepared by the staff 45
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of such facility within two business days or as determined 46
by the department. The department shall not remove or 47
disassemble any medical record during any inspection of the 48
facility, but may observe the photocopying or may make its 49
own copies if the facility does not have the technology to 50
make the copies. In accordance with the provisions of 51
section 198.525, the department shall make at least one 52
inspection per year, which shall be unannounced to the 53
operator. The department may make such other inspections, 54
announced or unannounced, as it deems necessary to carry out 55
the provisions of sections 198.003 to 198.136. 56
4. Whenever the department has reasonable grounds to 57
believe that a facility required to be licensed under 58
sections 198.003 to 198.096 is operating without a license, 59
and the department is not permitted access to inspect the 60
facility, or when a licensed operator refuses to permit 61
access to the department to inspect the facility, the 62
department shall apply to the circuit court of the county in 63
which the premises is located for an order authorizing entry 64
for such inspection, and the court shall issue the order if 65
it finds reasonable grounds for inspection or if it finds 66
that a licensed operator has refused to permit the 67
department access to inspect the facility. 68
5. Whenever the department is inspecting a facility in 69
response to an application from an operator located outside 70
of Missouri not previously licensed by the department, the 71
department may request from the applicant the past five 72
years compliance history of all facilities owned by the 73
applicant located outside of this state. 74
6. (1) In lieu of any inspection required by sections 75
198.003 to 198.186, the department may accept, in whole or 76
in part, written reports of the survey of any state or 77
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federal agency, or of any professional accrediting agency, 78
if such survey is: 79
(a) Comparable in scope and method to the department's 80
surveys; and 81
(b) Conducted in accordance with Title XVIII of the 82
Social Security Act. 83
(2) Failure by a residential care facility or assisted 84
living facility to maintain an accredited status by a 85
recognized accrediting entity shall result in the assisted 86
living facility or residential care facility being subject 87
to an inspection pursuant to section 198.525. 88
(3) The residential care facility or the assisted 89
living facility shall provide to the department the 90
accreditation report verifying accreditation status to be 91
published on the department's website and made publicly 92
available pursuant to section 198.030. 93
(4) The residential care facility or the assisted 94
living facility shall immediately forward any complaint or 95
report of suspected abuse or neglect that is reported to the 96
accrediting entity to the department in the same manner as 97
provided under section 198.070. 98
198.070. 1. When any adult day care worker; 1
chiropractor; Christian Science practitioner; coroner; 2
dentist; embalmer; employee of the departments of social 3
services, mental health, or health and senior services; 4
employee of a local area agency on aging or an organized 5
area agency on aging program; funeral director; home health 6
agency or home health agency employee; hospital and clinic 7
personnel engaged in examination, care, or treatment of 8
persons; in-home services owner, provider, operator, or 9
employee; law enforcement officer; long-term care facility 10
administrator or employee; medical examiner; medical 11
SCS SB 841 28
resident or intern; mental health professional; minister; 12
nurse; nurse practitioner; optometrist; other health 13
practitioner; peace officer; pharmacist; physical therapist; 14
physician; physician's assistant; podiatrist; probation or 15
parole officer; psychologist; social worker; or other person 16
with the care of a person sixty years of age or older or an 17
eligible adult, as defined in section 192.2400, has 18
reasonable cause to believe that a resident of a facility 19
has been abused or neglected, he or she shall immediately 20
report or cause a report to be made to the department. 21
2. (1) The report shall contain the name and address 22
of the facility, the name of the resident, information 23
regarding the nature of the abuse or neglect, the name of 24
the complainant, and any other information which might be 25
helpful in an investigation. 26
(2) In the event of suspected sexual assault of the 27
resident, in addition to the report to be made to the 28
department, a report shall be made to the appropriate local 29
law enforcement agency in accordance with federal law under 30
the provisions of 42 U.S.C. Section 1320b-25. 31
3. Any person required in subsection 1 of this section 32
to report or cause a report to be made to the department who 33
knowingly fails to make a report within a reasonable time 34
after the act of abuse or neglect as required in this 35
subsection is guilty of a class A misdemeanor. 36
4. In addition to the penalties imposed by this 37
section, any administrator who knowingly conceals any act of 38
abuse or neglect resulting in death or serious physical 39
injury, as defined in section 556.061, is guilty of a class 40
E felony. 41
5. In addition to those persons required to report 42
pursuant to subsection 1 of this section, any other person 43
SCS SB 841 29
having reasonable cause to believe that a resident has been 44
abused or neglected may report such information to the 45
department. 46
6. Upon receipt of a report, the department shall 47
initiate an investigation within twenty-four hours and, as 48
soon as possible during the course of the investigation, 49
shall notify the resident's next of kin or responsible party 50
of the report and the investigation and further notify them 51
whether the report was substantiated or unsubstantiated 52
unless such person is the alleged perpetrator of the abuse 53
or neglect. As provided in section 192.2425, substantiated 54
reports of elder abuse shall be promptly reported by the 55
department to the appropriate law enforcement agency and 56
prosecutor. 57
7. If the investigation indicates possible abuse or 58
neglect of a resident, the investigator shall refer the 59
complaint together with the investigator's report to the 60
department director or the director's designee for 61
appropriate action. If, during the investigation or at its 62
completion, the department has reasonable cause to believe 63
that immediate removal is necessary to protect the resident 64
from abuse or neglect, the department or the local 65
prosecuting attorney may, or the attorney general upon 66
request of the department shall, file a petition for 67
temporary care and protection of the resident in a circuit 68
court of competent jurisdiction. The circuit court in which 69
the petition is filed shall have equitable jurisdiction to 70
issue an ex parte order granting the department authority 71
for the temporary care and protection of the resident, for a 72
period not to exceed thirty days. 73
8. Reports shall be confidential, as provided pursuant 74
to section 192.2500. 75
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9. Anyone, except any person who has abused or 76
neglected a resident in a facility, who makes a report 77
pursuant to this section or who testifies in any 78
administrative or judicial proceeding arising from the 79
report shall be immune from any civil or criminal liability 80
for making such a report or for testifying except for 81
liability for perjury, unless such person acted negligently, 82
recklessly, in bad faith or with malicious purpose. It is a 83
crime under section 565.189 for any person to knowingly file 84
a false report of elder abuse or neglect. 85
10. Within five working days after a report required 86
to be made pursuant to this section is received, the person 87
making the report shall be notified in writing of its 88
receipt and of the initiation of the investigation. 89
11. No person who directs or exercises any authority 90
in a facility shall evict, harass, dismiss or retaliate 91
against a resident or employee because such resident or 92
employee or any member of such resident's or employee's 93
family has made a report of any violation or suspected 94
violation of laws, ordinances or regulations applying to the 95
facility which the resident, the resident's family or an 96
employee has reasonable cause to believe has been committed 97
or has occurred. Through the existing department 98
information and referral telephone contact line, residents, 99
their families and employees of a facility shall be able to 100
obtain information about their rights, protections and 101
options in cases of eviction, harassment, dismissal or 102
retaliation due to a report being made pursuant to this 103
section. 104
12. Any person who abuses or neglects a resident of a 105
facility is subject to criminal prosecution under section 106
565.184. 107
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13. The department shall maintain the employee 108
disqualification list and place on the employee 109
disqualification list the names of any persons who are or 110
have been employed in any facility and who have been finally 111
determined by the department pursuant to section 192.2490 to 112
have knowingly or recklessly abused or neglected a 113
resident. For purposes of this section only, "knowingly" 114
and "recklessly" shall have the meanings that are ascribed 115
to them in this section. A person acts "knowingly" with 116
respect to the person's conduct when a reasonable person 117
should be aware of the result caused by his or her conduct. 118
A person acts "recklessly" when the person consciously 119
disregards a substantial and unjustifiable risk that the 120
person's conduct will result in serious physical injury and 121
such disregard constitutes a gross deviation from the 122
standard of care that a reasonable person would exercise in 123
the situation. 124
14. The timely self-reporting of incidents to the 125
central registry by a facility shall continue to be 126
investigated in accordance with department policy, and shall 127
not be counted or reported by the department as a hot-line 128
call but rather a self-reported incident. If the self- 129
reported incident results in a regulatory violation, such 130
incident shall be reported as a substantiated report. 131
15. If a facility that is exempted from an annual 132
inspection under subsection 6 of section 198.022 has one or 133
more violations of a class I standard, as described in 134
section 198.085, then such facility shall be subject to a 135
full survey by the state under section 198.022. 136
206.110. 1. A hospital district, both within and 1
outside such district, except in counties of the third or 2
fourth classification (other than within the district 3
SCS SB 841 32
boundaries) where there already exists a hospital organized 4
pursuant to [chapters 96, 205 or] this chapter; provided, 5
however, that this exception shall not prohibit the 6
continuation or expansion of existing activities otherwise 7
allowed by law, shall have and exercise the following 8
governmental powers, and all other powers incidental, 9
necessary, convenient or desirable to carry out and 10
effectuate the express powers: 11
(1) To establish and maintain a hospital or hospitals 12
and hospital facilities, and to construct, acquire, develop, 13
expand, extend and improve any such hospital or hospital 14
facility including medical office buildings to provide 15
offices for rental to physicians and dentists on the 16
district hospital's medical or dental staff, and the 17
providing of sites therefor, including offstreet parking 18
space for motor vehicles; 19
(2) To acquire land in fee simple, rights in land and 20
easements upon, over or across land and leasehold interest 21
in land and tangible and intangible personal property used 22
or useful for the location, establishment, maintenance, 23
development, expansion, extension or improvement of any 24
hospital or hospital facility. The acquisition may be by 25
dedication, purchase, gift, agreement, lease, use or adverse 26
possession or by condemnation; 27
(3) To operate, maintain and manage a hospital and 28
hospital facilities, and to make and enter into contracts, 29
for the use, operation or management of a hospital or 30
hospital facilities; to engage in health care activities; 31
and to make and enter into leases of equipment and real 32
property, a hospital or hospital facilities, as lessor or 33
lessee, regardless of the duration of such lease; and to 34
provide rules and regulations for the operation, management 35
SCS SB 841 33
or use of a hospital or hospital facilities. Any agreement 36
entered into pursuant to this subsection pertaining to the 37
lease of the hospital shall have a definite termination date 38
as negotiated by the parties, but this shall not preclude 39
the trustees from entering into a renewal of the agreement 40
with the same or other parties pertaining to the same or 41
other subjects upon such terms and conditions as the parties 42
may agree; 43
(4) To fix, charge and collect reasonable fees and 44
compensation for the use or occupancy of the hospital or any 45
part thereof, or any hospital facility, and for nursing 46
care, medicine, attendance, or other services furnished by 47
the hospital or hospital facilities, according to the rules 48
and regulations prescribed by the board from time to time; 49
(5) To borrow money and to issue bonds, notes, 50
certificates, or other evidences of indebtedness for the 51
purpose of accomplishing any of its corporate purposes, 52
subject to compliance with any condition or limitation set 53
forth in this chapter or otherwise provided by the 54
Constitution of the state of Missouri; 55
(6) To employ or enter into contracts for the 56
employment of any person, firm, or corporation, and for 57
professional services, necessary or desirable for the 58
accomplishment of the corporate objects of the district or 59
the proper administration, management, protection or control 60
of its property; 61
(7) To maintain the hospital for the benefit of the 62
inhabitants of the area comprising the district who are 63
sick, injured, or maimed regardless of race, creed or color, 64
and to adopt such reasonable rules and regulations as may be 65
necessary to render the use of the hospital of the greatest 66
benefit to the greatest number; to exclude from the use of 67
SCS SB 841 34
the hospital all persons who willfully disregard any of the 68
rules and regulations so established; to extend the 69
privileges and use of the hospital to persons residing 70
outside the area of the district upon such terms and 71
conditions as the board of directors prescribes by its rules 72
and regulations; 73
(8) To police its property and to exercise police 74
powers in respect thereto or in respect to the enforcement 75
of any rule or regulation provided by the ordinances of the 76
district and to employ and commission police officers and 77
other qualified persons to enforce the same; 78
(9) To lease to or allow for any institution of higher 79
education to use or occupy the hospital, any real estate or 80
facility owned or leased by the district or any part thereof 81
for the purpose of health care-related and general education 82
or training. 83
2. The use of any hospital or hospital facility of a 84
district shall be subject to the reasonable regulation and 85
control of the district and upon such reasonable terms and 86
conditions as shall be established by its board of directors. 87
3. A regulatory ordinance of a district adopted under 88
any provision of this section may provide for a suspension 89
or revocation of any rights or privileges within the control 90
of the district for a violation of any such regulatory 91
ordinance. 92
4. Nothing in this section or in other provisions of 93
this chapter shall be construed to authorize the district or 94
board to establish or enforce any regulation or rule in 95
respect to hospitalization or the operation or maintenance 96
of such hospital or any hospital facilities within its 97
jurisdiction which is in conflict with any federal or state 98
law or regulation applicable to the same subject matter. 99
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206.158. 1. The board of directors of any hospital 1
district authorized under subsection 2 of this section, and 2
established and organized under the provisions of this 3
chapter: 4
(1) May invest up to fifty percent of its "available 5
funds", defined in this section as funds not required for 6
immediate disbursement in obligations or for the operation 7
of the hospital district, into: 8
(a) Any mutual funds that invest in stocks, bonds, or 9
real estate, or any combination thereof; 10
(b) Bonds that have: 11
a. One of the five highest long-term ratings or the 12
highest short-term rating issued by a nationally recognized 13
rating agency; and 14
b. A final maturity of ten years or less; 15
(c) Money market investments; or 16
(d) Any combination of investments described in 17
paragraphs (a) to (c) of this subdivision; and 18
(2) Shall invest the remaining percentage of any 19
available funds not invested as allowed under subdivision 20
(1) of this subsection into any investment in which the 21
state treasurer is allowed to invest. 22
2. The provisions of this section shall apply only if 23
the hospital district receives less than three percent of 24
its annual revenues from hospital district or state taxes. 25
208.149. 1. As used in this section, the following 1
terms mean: 2
(1) "Clinical pathology services", professional 3
medical services provided by a pathologist for the 4
examination, diagnosis, and interpretation of laboratory 5
tests performed on patient specimens to aid in the diagnosis 6
and treatment of disease. Clinical pathology services 7
SCS SB 841 36
include, but are not limited to, hematology, microbiology, 8
immunology, clinical chemistry, molecular pathology, and 9
other laboratory-based diagnostic procedures; 10
(2) "Hospital-based pathologist", a licensed physician 11
specializing in pathology who provides clinical pathology 12
services within a hospital setting; 13
(3) "Professional component of clinical pathology 14
services", the portion of clinical pathology services that 15
involves the pathologist's professional expertise in 16
interpreting and supervising laboratory tests, excluding the 17
technical component of performing the laboratory tests. 18
2. The fee for the professional component of clinical 19
pathology services shall be paid by MO HealthNet for 20
professional services provided by a hospital-based 21
pathologist for inpatient clinical pathology services 22
rendered to patients covered by the MO HealthNet program. 23
3. The reimbursement amount for the professional 24
component of clinical pathology services shall be set at 25
thirty percent of the approved outpatient simplified fee 26
schedule based on Medicare's clinical laboratory fee 27
schedule for the corresponding clinical pathology services 28
payable by MO HealthNet. 29
4. (1) If the fee for the professional component of 30
clinical pathology services is paid for professional 31
services provided by a pathologist employed by the hospital 32
where the clinical pathology services are rendered to 33
covered MO HealthNet patients, the professional fee shall be 34
paid directly to the hospital. 35
(2) If the fee for the professional component of 36
clinical pathology services is paid for professional 37
services provided by a pathologist who is not employed by 38
the hospital where clinical pathology services are rendered 39
SCS SB 841 37
to covered MO HealthNet patients, the professional fee shall 40
be paid directly to the third party providing the services. 41
5. The department of social services shall promulgate 42
all necessary rules and regulations for the administration 43
of this section. Any rule or portion of a rule, as that 44
term is defined in section 536.010, that is created under 45
the authority delegated in this section shall become 46
effective only if it complies with and is subject to all of 47
the provisions of chapter 536 and, if applicable, section 48
536.028. This section and chapter 536 are nonseverable and 49
if any of the powers vested with the general assembly 50
pursuant to chapter 536 to review, to delay the effective 51
date, or to disapprove and annul a rule are subsequently 52
held unconstitutional, then the grant of rulemaking 53
authority and any rule proposed or adopted after August 28, 54
2026, shall be invalid and void. 55
208.662. 1. There is hereby established within the 1
department of social services the "Show-Me Healthy Babies 2
Program" as a separate children's health insurance program 3
(CHIP) for any low-income unborn child. The program shall 4
be established under the authority of Title XXI of the 5
federal Social Security Act, the State Children's Health 6
Insurance Program, as amended, and 42 CFR 457.1. 7
2. For an unborn child to be enrolled in the show-me 8
healthy babies program, his or her mother shall not be 9
eligible for coverage under Title XIX of the federal Social 10
Security Act, the Medicaid program, as it is administered by 11
the state, and shall not have access to affordable employer- 12
subsidized health care insurance or other affordable health 13
care coverage that includes coverage for the unborn child. 14
In addition, the unborn child shall be in a family with 15
income eligibility of no more than three hundred percent of 16
SCS SB 841 38
the federal poverty level, or the equivalent modified 17
adjusted gross income, unless the income eligibility is set 18
lower by the general assembly through appropriations. In 19
calculating family size as it relates to income eligibility, 20
the family shall include, in addition to other family 21
members, the unborn child, or in the case of a mother with a 22
multiple pregnancy, all unborn children. 23
3. Coverage for an unborn child enrolled in the show- 24
me healthy babies program shall include all prenatal care 25
and pregnancy-related services that benefit the health of 26
the unborn child and that promote healthy labor, delivery, 27
and birth, including childbirth education classes. Coverage 28
need not include services that are solely for the benefit of 29
the pregnant mother, that are unrelated to maintaining or 30
promoting a healthy pregnancy, and that provide no benefit 31
to the unborn child. However, the department may include 32
pregnancy-related assistance as defined in 42 U.S.C. Section 33
1397ll. 34
4. There shall be no waiting period before an unborn 35
child may be enrolled in the show-me healthy babies 36
program. In accordance with the definition of child in 42 37
CFR 457.10, coverage shall include the period from 38
conception to birth. The department shall develop a 39
presumptive eligibility procedure for enrolling an unborn 40
child. There shall be verification of the pregnancy. 41
5. Coverage for the child shall continue for up to one 42
year after birth, unless otherwise prohibited by law or 43
unless otherwise limited by the general assembly through 44
appropriations. 45
6. (1) Pregnancy-related and postpartum coverage for 46
the mother shall begin on the day the pregnancy ends and 47
extend through the last day of the month that includes the 48
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sixtieth day after the pregnancy ends, unless otherwise 49
prohibited by law or unless otherwise limited by the general 50
assembly through appropriations. The department may include 51
pregnancy-related assistance as defined in 42 U.S.C. Section 52
1397ll. 53
(2) (a) Subject to approval of any necessary state 54
plan amendments or waivers, beginning on July 6, 2023, 55
mothers eligible to receive coverage under this section 56
shall receive medical assistance benefits during the 57
pregnancy and during the twelve-month period that begins on 58
the last day of the woman's pregnancy and ends on the last 59
day of the month in which such twelve-month period ends, 60
consistent with the provisions of 42 U.S.C. Section 61
1397gg(e)(1)(J). The department shall seek any necessary 62
state plan amendments or waivers to implement the provisions 63
of this subdivision when the number of ineligible MO 64
HealthNet participants removed from the program in 2023 65
pursuant to section 208.239 exceeds the projected number of 66
beneficiaries likely to enroll in benefits in 2023 under 67
this subdivision and subdivision (28) of subsection 1 of 68
section 208.151, as determined by the department, by at 69
least one hundred individuals. 70
(b) The provisions of this subdivision shall remain in 71
effect for any period of time during which the federal 72
authority under 42 U.S.C. Section 1397gg(e)(1)(J), as 73
amended, or any successor statutes or implementing 74
regulations, is in effect. 75
7. The department shall provide coverage for an unborn 76
child enrolled in the show-me healthy babies program in the 77
same manner in which the department provides coverage for 78
the children's health insurance program (CHIP) in the county 79
of the primary residence of the mother. 80
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8. The department shall provide information about the 81
show-me healthy babies program to maternity homes as defined 82
in section 135.600, pregnancy resource centers as defined in 83
section 135.630, and other similar agencies and programs in 84
the state that assist unborn children and their mothers. 85
The department shall consider allowing such agencies and 86
programs to assist in the enrollment of unborn children in 87
the program, and in making determinations about presumptive 88
eligibility and verification of the pregnancy. 89
9. Within sixty days after August 28, 2014, the 90
department shall submit a state plan amendment or seek any 91
necessary waivers from the federal Department of Health and 92
Human Services requesting approval for the show-me healthy 93
babies program. 94
10. At least annually, the department shall prepare 95
and submit a report to the governor, the speaker of the 96
house of representatives, and the president pro tempore of 97
the senate analyzing and projecting the cost savings and 98
benefits, if any, to the state, counties, local communities, 99
school districts, law enforcement agencies, correctional 100
centers, health care providers, employers, other public and 101
private entities, and persons by enrolling unborn children 102
in the show-me healthy babies program. The analysis and 103
projection of cost savings and benefits, if any, may include 104
but need not be limited to: 105
(1) The higher federal matching rate for having an 106
unborn child enrolled in the show-me healthy babies program 107
versus the lower federal matching rate for a pregnant woman 108
being enrolled in MO HealthNet or other federal programs; 109
(2) The efficacy in providing services to unborn 110
children through managed care organizations, group or 111
individual health insurance providers or premium assistance, 112
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or through other nontraditional arrangements of providing 113
health care; 114
(3) The change in the proportion of unborn children 115
who receive care in the first trimester of pregnancy due to 116
a lack of waiting periods, by allowing presumptive 117
eligibility, or by removal of other barriers, and any 118
resulting or projected decrease in health problems and other 119
problems for unborn children and women throughout pregnancy; 120
at labor, delivery, and birth; and during infancy and 121
childhood; 122
(4) The change in healthy behaviors by pregnant women, 123
such as the cessation of the use of tobacco, alcohol, 124
illicit drugs, or other harmful practices, and any resulting 125
or projected short-term and long-term decrease in birth 126
defects; poor motor skills; vision, speech, and hearing 127
problems; breathing and respiratory problems; feeding and 128
digestive problems; and other physical, mental, educational, 129
and behavioral problems; and 130
(5) The change in infant and maternal mortality, 131
preterm births and low birth weight babies and any resulting 132
or projected decrease in short-term and long-term medical 133
and other interventions. 134
11. The show-me healthy babies program shall not be 135
deemed an entitlement program, but instead shall be subject 136
to a federal allotment or other federal appropriations and 137
matching state appropriations. 138
12. Nothing in this section shall be construed as 139
obligating the state to continue the show-me healthy babies 140
program if the allotment or payments from the federal 141
government end or are not sufficient for the program to 142
operate, or if the general assembly does not appropriate 143
funds for the program. 144
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13. Nothing in this section shall be construed as 145
expanding MO HealthNet or fulfilling a mandate imposed by 146
the federal government on the state. 147
208.1400. Sections 208.1400 to 208.1425 shall be known 1
and may be cited as the "Missouri Doula Reimbursement Act". 2
208.1405. For purposes of sections 208.1400 to 1
208.1425, the following terms mean: 2
(1) "Community-based network", a network that is 3
representative of a community or significant segments of a 4
community and engaged in meeting that community's needs in 5
the area of social, human, or health services; 6
(2) "Community navigation services", services that 7
connect pregnant individuals and their families with 8
available resources using a community-based approach 9
including, but not limited to, an approach that understands 10
the services and supports available to pregnant and 11
postpartum individuals receiving MO HealthNet benefits and 12
facilitates access to those resources based upon an 13
assessment of social service needs; 14
(3) "Doula", a trained professional providing 15
continuous physical, emotional, and informational support to 16
a pregnant individual, from the prenatal, the intrapartum, 17
and up to the first twelve months of the postpartum 18
periods. Doulas also provide assistance by referring 19
pregnant individuals to community-based networks and 20
certified and licensed perinatal professionals in multiple 21
disciplines; 22
(4) "Doula services", services provided by a doula; 23
(5) "Fee-for-service", a payment model where services 24
are unbundled and paid for separately; 25
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(6) "Intrapartum", the period of pregnancy during 26
labor and delivery or childbirth. Services provided during 27
this period are rendered to the pregnant individual; 28
(7) "Managed care", the delivery of Medicaid health 29
benefits and additional services through contracted 30
arrangements between state Medicaid agencies and managed 31
care organizations that accept a set per member per month 32
(capitation) payment for these services; 33
(8) "Postpartum", the one-year period after a 34
pregnancy ends; 35
(9) "Prenatal", the period of pregnancy before labor 36
or childbirth. Services provided during this period are 37
rendered to the pregnant individual. 38
208.1410. The following doula services shall be 1
covered by the MO HealthNet program: 2
(1) A combined total of six prenatal and postpartum 3
support sessions; 4
(2) One birth attendance; 5
(3) Up to two visits for general consultation on 6
lactation at any time during the prenatal and postpartum 7
periods; and 8
(4) Community navigation services, except that any 9
community navigation services provided outside any visit or 10
session billed under subdivisions (1) to (3) of this section 11
shall be billed only up to ten times total over the course 12
of the pregnancy and postpartum period. 13
208.1415. A doula shall be eligible for participation 1
as a provider of doula services covered by the MO HealthNet 2
program only if the doula: 3
(1) Is enrolled as a MO HealthNet provider; 4
(2) Is eighteen years of age or older; 5
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(3) Holds liability insurance as an individual or 6
through a supervising organization; and 7
(4) Either: 8
(a) Possesses a current certificate issued by a 9
national or Missouri-based doula training organization whose 10
curriculum meets guidelines established by the MO HealthNet 11
division by rule; or 12
(b) Received training from a source not described in 13
paragraph (a) of this subdivision, or from multiple sources, 14
whose curriculum meets the guidelines established under 15
paragraph (a) of this subdivision as verified by a public 16
roster maintained by a statewide organization composed of 17
doula trainers from three or more independent, well- 18
established doula training organizations located in Missouri 19
whose purpose includes the validation of core competencies 20
of training. 21
208.1420. 1. Once enrolled as a MO HealthNet 1
provider, a doula shall be eligible to enroll as a provider 2
with fee-for-service and managed care payers affiliated with 3
the MO HealthNet program. 4
2. Doula services shall be reimbursed on a fee-for- 5
service schedule. 6
208.1425. The MO HealthNet division shall promulgate 1
all necessary rules and regulations for the administration 2
of sections 208.1400 to 208.1425. Any rule or portion of a 3
rule, as that term is defined in section 536.010, that is 4
created under the authority delegated in this section shall 5
become effective only if it complies with and is subject to 6
all of the provisions of chapter 536 and, if applicable, 7
section 536.028. This section and chapter 536 are 8
nonseverable and if any of the powers vested with the 9
general assembly pursuant to chapter 536 to review, to delay 10
SCS SB 841 45
the effective date, or to disapprove and annul a rule are 11
subsequently held unconstitutional, then the grant of 12
rulemaking authority and any rule proposed or adopted after 13
August 28, 2026, shall be invalid and void. 14
210.225. 1. This section shall be known and may be 1
cited as "Elijah's Law". 2
2. (1) Before July 1, 2028, each licensed child care 3
provider shall adopt a policy on allergy prevention and 4
response with priority given to addressing potentially 5
deadly food-borne allergies. Such policy shall contain, but 6
shall not be limited to, the following elements: 7
(a) Distinguishing between building-wide, room-level, 8
and individual approaches to allergy prevention and 9
management; 10
(b) Providing an age-appropriate response to building- 11
level and room-level allergy education and prevention; 12
(c) Describing the role of child care facility staff 13
in determining how to manage an allergy problem, whether 14
through a plan prepared for a child under Section 504 of the 15
Rehabilitation Act of 1973, as amended, for a child with an 16
allergy that has been determined to be a disability, an 17
individualized health plan for a child who has an allergy 18
that is not disabling, or another allergy management plan; 19
(d) Describing the role of other children and parents 20
in cooperating to prevent and mitigate allergies; 21
(e) Addressing confidentiality issues involved with 22
sharing medical information, including specifying when 23
parental permission is required to make medical information 24
available; and 25
(f) Coordinating with the department of elementary and 26
secondary education, local health authorities, and other 27
appropriate entities to ensure efficient promulgation of 28
SCS SB 841 46
accurate information and to ensure that existing child care 29
facility safety and environmental policies do not conflict. 30
(2) Such policies may contain information from or 31
links to child care facility allergy prevention information 32
furnished by the Food Allergy Research & Education 33
organization or equivalent organization with a medical 34
advisory board that has allergy specialists. 35
3. The department of elementary and secondary 36
education shall, in cooperation with any appropriate 37
professional association, develop a model policy or policies 38
before July 1, 2027. 39
321.621. 1. For the purposes of this section, the 1
following terms mean: 2
(1) "Epinephrine delivery device", a single-use device 3
used for the delivery of a premeasured dose of epinephrine 4
into the human body; 5
(2) "Qualified first responder" [shall mean], any 6
state and local law enforcement agency staff, fire 7
department personnel, fire district personnel, or licensed 8
emergency medical technician who is acting under the 9
directives and established protocols of a medical director 10
who comes in contact with a person suffering from an 11
anaphylactic reaction and who has received training in 12
recognizing and responding to anaphylactic reactions and the 13
administration of epinephrine [auto-injector] delivery 14
devices to a person suffering from an apparent anaphylactic 15
reaction[.]; 16
(3) "Qualified first responder agencies" [shall mean], 17
any state or local law enforcement agency, fire department, 18
or ambulance service that provides documented training to 19
its staff related to the administration of epinephrine [auto- 20
SCS SB 841 47
injector] delivery devices in an apparent anaphylactic 21
reaction. 22
2. The director of the department of health and senior 23
services, if a licensed physician, may issue a statewide 24
standing order for epinephrine [auto-injector] delivery 25
devices for adult patients to fire protection districts in 26
nonmetropolitan areas in Missouri as such areas are 27
determined according to the United States Census Bureau's 28
American Community Survey, based on the most recent of five- 29
year period estimate data in which the final year of the 30
estimate ends in either zero or five. If the director of 31
the department of health and senior services is not a 32
licensed physician, the department of health and senior 33
services may employ or contract with a licensed physician 34
who may issue such a statewide order with the express 35
consent of the director. 36
3. Possession and use of epinephrine [auto-injector] 37
delivery devices for adult patients shall be limited as 38
follows: 39
(1) No person shall use an epinephrine [auto-injector] 40
delivery device pursuant to this section unless such person 41
has successfully completed a training course in the use of 42
epinephrine [auto-injector] delivery devices for adult 43
patients approved by the director of the department of 44
health and senior services. Nothing in this section shall 45
prohibit the use of an epinephrine [auto-injector] delivery 46
device: 47
(a) By a health care professional licensed or 48
certified by this state who is acting within the scope of 49
his or her practice; or 50
(b) By a person acting pursuant to a lawful 51
prescription; 52
SCS SB 841 48
(2) Every person, firm, organization and entity 53
authorized to possess and use epinephrine [auto-injector] 54
delivery devices for adult patients pursuant to this section 55
shall use, maintain and dispose of such devices for adult 56
patients in accordance with the rules of the department; and 57
(3) Every use of an epinephrine [auto-injector] 58
delivery device pursuant to this section shall immediately 59
be reported to the emergency health care provider as defined 60
in section 190.246. 61
4. (1) Use of an epinephrine [auto-injector] delivery 62
device pursuant to this section shall be considered first 63
aid or emergency treatment for the purpose of any law 64
relating to liability. 65
(2) Purchase, acquisition, possession or use of an 66
epinephrine [auto-injector] delivery device pursuant to this 67
section shall not constitute the unlawful practice of 68
medicine or the unlawful practice of a profession. 69
(3) Any person otherwise authorized to sell or provide 70
an epinephrine [auto-injector] delivery device may sell or 71
provide it to a person authorized to possess it pursuant to 72
this section. 73
5. (1) There is hereby created in the state treasury 74
the "Epinephrine [Auto-injector] Delivery Devices for Fire 75
Personnel Fund", which shall consist of [money collected 76
under this section] moneys appropriated to the fund. The 77
state treasurer shall be custodian of the fund. In 78
accordance with sections 30.170 and 30.180, the state 79
treasurer may approve disbursements. The moneys in the fund 80
as set forth in this section shall be subject to 81
appropriation by the general assembly for the particular 82
purpose for which collected. The fund shall be a dedicated 83
fund and money in the fund shall be used solely by the 84
SCS SB 841 49
department of health and senior services for the purposes of 85
providing epinephrine [auto-injector] delivery devices for 86
adult patients to qualified first responder agencies as used 87
in this section. 88
(2) Notwithstanding the provisions of section 33.080 89
to the contrary, any moneys remaining in the fund at the end 90
of the biennium shall not revert to the credit of the 91
general revenue fund. 92
(3) The state treasurer shall invest moneys in the 93
fund in the same manner as other funds are invested. Any 94
interest and moneys earned on such investments shall be 95
credited to the fund. 96
332.081. 1. Notwithstanding any other provision of 1
law to the contrary, hospitals licensed under chapter 197 2
shall be authorized to employ any or all of the following 3
oral health providers: 4
(1) A dentist licensed under this chapter for the 5
purpose of treating on hospital premises those patients who 6
present with a dental condition and such treatment is 7
necessary to ameliorate the condition for which they 8
presented such as severe pain or tooth abscesses; 9
(2) An oral and maxillofacial surgeon licensed under 10
this chapter for the purpose of treating oral conditions 11
that need to be ameliorated as part of treating the 12
underlying cause of the patient's medical needs including, 13
but not limited to, head and neck cancer, HIV or AIDS, 14
severe trauma resulting in admission to the hospital, organ 15
transplant, diabetes, or seizure disorders. It shall be a 16
condition of treatment that such patients are admitted to 17
the hospital on either an in- or out-patient basis; and 18
(3) A maxillofacial prosthodontist licensed under this 19
chapter for the purpose of treating and supporting patients 20
SCS SB 841 50
of a head and neck cancer team or other complex care or 21
surgical team for the fabrication of appliances following 22
ablative surgery, surgery to correct birth anomalies, 23
extensive radiation treatment of the head or neck, or trauma- 24
related surgery. 25
2. No person or other entity shall practice dentistry 26
in Missouri or provide dental services as [defined] 27
described in section 332.071 unless and until the board has 28
issued to the person a certificate certifying that the 29
person has been duly registered as a dentist in Missouri or 30
the board has issued such certificate to an entity that has 31
been duly registered to provide dental services by licensed 32
dentists and dental hygienists and unless and until the 33
board has issued to the person a license, to be renewed each 34
period, as provided in this chapter, to practice dentistry 35
or as a dental hygienist, or has issued to the person or 36
entity a permit, to be renewed each period, to provide 37
dental services in Missouri. Nothing in this chapter shall 38
be so construed as to make it unlawful for: 39
(1) A legally qualified physician or surgeon, who does 40
not practice dentistry as a specialty, from extracting teeth; 41
(2) A dentist licensed in a state other than Missouri 42
from making a clinical demonstration before a meeting of 43
dentists in Missouri; 44
(3) Dental students in any accredited dental school to 45
practice dentistry under the personal direction of 46
instructors; 47
(4) Dental hygiene students in any accredited dental 48
hygiene school to practice dental hygiene under the personal 49
direction of instructors; 50
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(5) A duly registered and licensed dental hygienist in 51
Missouri to practice dental hygiene as defined in section 52
332.091; 53
(6) A dental assistant, certified dental assistant, or 54
expanded functions dental assistant to be delegated duties 55
as defined in section 332.093; 56
(7) A duly registered dentist or dental hygienist to 57
teach in an accredited dental or dental hygiene school; 58
(8) A person who has been granted a dental faculty 59
permit under section 332.183 to practice dentistry in the 60
scope of his or her employment at an accredited dental 61
school, college, or program in Missouri; 62
(9) A duly qualified anesthesiologist or nurse 63
anesthetist to administer an anesthetic in connection with 64
dental services or dental surgery; 65
(10) A person to practice dentistry in or for: 66
(a) The United States Armed Forces; 67
(b) The United States Public Health Service; 68
(c) Migrant, community, or health care for the 69
homeless health centers provided in Section 330 of the 70
Public Health Service Act (42 U.S.C. Section 254b); 71
(d) Federally qualified health centers as defined in 72
Section 1905(l) (42 U.S.C. Section 1396d(l)) of the Social 73
Security Act; 74
(e) Governmental entities, including county health 75
departments; or 76
(f) The United States Veterans Bureau; or 77
(11) A dentist licensed in a state other than Missouri 78
to evaluate a patient or render an oral, written, or 79
otherwise documented dental opinion when providing testimony 80
or records for the purpose of a civil or criminal action 81
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before any judicial or administrative proceeding of this 82
state or other forum in this state. 83
3. No corporation shall practice dentistry as defined 84
in section 332.071 unless that corporation is organized 85
under the provisions of chapter 355 or 356 provided that a 86
corporation organized under the provisions of chapter 355 87
and qualifying as an organization under 26 U.S.C. Section 88
501(c)(3) may only employ dentists and dental hygienists 89
licensed in this state to render dental services to Medicaid 90
recipients, low-income individuals who have available income 91
below two hundred percent of the federal poverty level, and 92
all participants in the SCHIP program, unless such 93
limitation is contrary to or inconsistent with federal or 94
state law or regulation. This subsection shall not apply to: 95
(1) A hospital licensed under chapter 197 that 96
provides care and treatment only to children under the age 97
of eighteen at which a person regulated under this chapter 98
provides dental care within the scope of his or her license 99
or registration; 100
(2) A federally qualified health center as defined in 101
Section 1905(l) of the Social Security Act (42 U.S.C. 102
Section 1396d(l)), or a migrant, community, or health care 103
for the homeless health center provided for in Section 330 104
of the Public Health Services Act (42 U.S.C. Section 254b) 105
at which a person regulated under this chapter provides 106
dental care within the scope of his or her license or 107
registration; 108
(3) A city or county health department organized under 109
chapter 192 or chapter 205 at which a person regulated under 110
this chapter provides dental care within the scope of his or 111
her license or registration; 112
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(4) A social welfare board organized under section 113
205.770, a city health department operating under a city 114
charter, or a city-county health department at which a 115
person regulated under this chapter provides dental care 116
within the scope of his or her license or registration; 117
(5) Any entity that has received a permit from the 118
dental board and does not receive compensation from the 119
patient or from any third party on the patient's behalf at 120
which a person regulated under this chapter provides dental 121
care within the scope of his or her license or registration; 122
or 123
(6) Any hospital nonprofit corporation exempt from 124
taxation under Section 501(c)(3) of the Internal Revenue 125
Code, as amended, that engages in its operations and 126
provides dental services at facilities owned by a city, 127
county, or other political subdivision of the state, or any 128
entity contracted with the state to provide care in a 129
correctional center, as such term is defined in section 130
217.010, at which a person regulated under this chapter 131
provides dental care within the scope of his or her license 132
or registration. 133
If any of the entities exempted from the requirements of 134
this subsection are unable to provide services to a patient 135
due to the lack of a qualified provider and a referral to 136
another entity is made, the exemption shall extend to the 137
person or entity that subsequently provides services to the 138
patient. 139
4. No unincorporated organization shall practice 140
dentistry as defined in section 332.071 unless such 141
organization is exempt from federal taxation under Section 142
501(c)(3) of the Internal Revenue Code of 1986, as amended, 143
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and provides dental treatment without compensation from the 144
patient or any third party on their behalf as a part of a 145
broader program of social services including food 146
distribution. Nothing in this chapter shall prohibit 147
organizations under this subsection from employing any 148
person regulated by this chapter. 149
5. A dentist shall not enter into a contract that 150
allows a person who is not a dentist to influence or 151
interfere with the exercise of the dentist's independent 152
professional judgment. 153
6. A not-for-profit corporation organized under the 154
provisions of chapter 355 and qualifying as an organization 155
under 26 U.S.C. Section 501(c)(3), an unincorporated 156
organization operating pursuant to subsection 4 of this 157
section, or any other person should not direct or interfere 158
or attempt to direct or interfere with a licensed dentist's 159
professional judgment and competent practice of dentistry. 160
Nothing in this subsection shall be so construed as to make 161
it unlawful for not-for-profit organizations to enforce 162
employment contracts, corporate policy and procedure 163
manuals, or quality improvement or assurance requirements. 164
7. All entities defined in subsection 3 of this 165
section and those exempted under subsection 4 of this 166
section shall apply for a permit to employ dentists and 167
dental hygienists licensed in this state to render dental 168
services, and the entity shall apply for the permit in 169
writing on forms provided by the Missouri dental board. The 170
board shall not charge a fee of any kind for the issuance or 171
renewal of such permit. The provisions of this subsection 172
shall not apply to a federally qualified health center as 173
defined in Section 1905(l) of the Social Security Act (42 174
U.S.C. Section 1396d(l)). 175
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8. Any entity that obtains a permit to render dental 176
services in this state is subject to discipline pursuant to 177
section 332.321. If the board concludes that the person or 178
entity has committed an act or is engaging in a course of 179
conduct that would be grounds for disciplinary action, the 180
board may file a complaint before the administrative hearing 181
commission. The board may refuse to issue or renew the 182
permit of any entity for one or any combination of causes 183
stated in subsection 2 of section 332.321. The board shall 184
notify the applicant in writing of the reasons for the 185
refusal and shall advise the applicant of his or her right 186
to file a complaint with the administrative hearing 187
commission as provided by chapter 621. 188
9. A federally qualified health center as defined in 189
Section 1905(l) of the Social Security Act (42 U.S.C. 190
Section 1396d(l)) shall register with the board. The 191
information provided to the board as part of the 192
registration shall include the name of the health center, 193
the nonprofit status of the health center, sites where 194
dental services will be provided, and the names of all 195
persons employed by, or contracting with, the health center 196
who are required to hold a license pursuant to this 197
chapter. The registration shall be renewed every twenty- 198
four months. The board shall not charge a fee of any kind 199
for the issuance or renewal of the registration. The 200
registration of the health center shall not be subject to 201
discipline pursuant to section 332.321. Nothing in this 202
subsection shall prohibit disciplinary action against a 203
licensee of this chapter who is employed by, or contracts 204
with, such health center for the actions of the licensee in 205
connection with such employment or contract. 206
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10. The board may promulgate rules and regulations to 207
ensure not-for-profit corporations are rendering care to the 208
patient populations as set forth herein, including 209
requirements for covered not-for-profit corporations to 210
report patient census data to the board. The provisions of 211
this subsection shall not apply to a federally qualified 212
health center as defined in Section 1905(l) of the Social 213
Security Act (42 U.S.C. Section 1396d(l)). 214
11. All not-for-profit corporations organized or 215
operated pursuant to the provisions of chapter 355 and 216
qualifying as an organization under 26 U.S.C. Section 217
501(c)(3), or the requirements relating to migrant, 218
community, or health care for the homeless health centers 219
provided in Section 330 of the Public Health Service Act (42 220
U.S.C. Section 254b) and federally qualified health centers 221
as defined in Section 1905(l) (42 U.S.C. Section 1396d(l)) 222
of the Social Security Act, that employ persons who practice 223
dentistry or dental hygiene in this state shall do so in 224
accordance with the relevant laws of this state except to 225
the extent that such laws are contrary to, or inconsistent 226
with, federal statute or regulation. 227
334.108. 1. Prior to prescribing any drug, controlled 1
substance, or other treatment through telemedicine, as 2
defined in section 191.1145, or the internet, a physician 3
shall establish a valid physician-patient relationship as 4
described in section 191.1146. This relationship shall 5
include: 6
(1) Obtaining a reliable medical history and, if 7
required to meet the standard of care, performing a physical 8
examination of the patient, adequate to establish the 9
diagnosis for which the drug is being prescribed and to 10
SCS SB 841 57
identify underlying conditions or contraindications to the 11
treatment recommended or provided; 12
(2) Having sufficient [dialogue] exchange with the 13
patient regarding treatment options and the risks and 14
benefits of treatment or treatments; 15
(3) If appropriate, following up with the patient to 16
assess the therapeutic outcome; 17
(4) Maintaining a contemporaneous medical record that 18
is readily available to the patient and, subject to the 19
patient's consent, to the patient's other health care 20
professionals; and 21
(5) Maintaining the electronic prescription 22
information as part of the patient's medical record. 23
2. The requirements of subsection 1 of this section 24
may be satisfied by the prescribing physician's designee 25
when treatment is provided in: 26
(1) A hospital as defined in section 197.020; 27
(2) A hospice program as defined in section 197.250; 28
(3) Home health services provided by a home health 29
agency as defined in section 197.400; 30
(4) Accordance with a collaborative practice agreement 31
as [defined] described in section 334.104; 32
(5) Conjunction with a physician assistant licensed 33
pursuant to section 334.738; 34
(6) Conjunction with an assistant physician licensed 35
under section 334.036; 36
(7) Consultation with another physician who has an 37
ongoing physician-patient relationship with the patient, and 38
who has agreed to supervise the patient's treatment, 39
including use of any prescribed medications; or 40
(8) On-call or cross-coverage situations. 41
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3. No health care provider, as defined in section 42
376.1350, shall prescribe any drug, controlled substance, or 43
other treatment to a patient based solely on an evaluation 44
[over the telephone] through telemedicine; except that, a 45
physician or such physician's on-call designee, or an 46
advanced practice registered nurse, a physician assistant, 47
or an assistant physician in a collaborative practice 48
arrangement with such physician, may prescribe any drug, 49
controlled substance, or other treatment that is within his 50
or her scope of practice to a patient based solely on a 51
[telephone] telemedicine evaluation if a previously 52
established and ongoing physician-patient relationship 53
exists between such physician and the patient being treated. 54
4. No health care provider shall prescribe any drug, 55
controlled substance, or other treatment to a patient [based 56
solely on an internet request or an internet questionnaire] 57
in the absence of a proper provider-patient relationship, as 58
described in section 191.1146. 59
5. Medical records of any drug, controlled substance, 60
or other treatment prescribed through telemedicine, as 61
defined in section 191.1145, shall be collected, stored, and 62
maintained in accordance with the Health Insurance 63
Portability and Accountability Act of 1996, which allows for 64
the sharing of protected health information for continuity 65
of care between health care providers for treatment, 66
payment, and health care operations. 67
335.081. So long as the person involved does not 1
represent or hold himself or herself out as a nurse licensed 2
to practice in this state, no provision of sections 335.011 3
to 335.096 shall be construed as prohibiting: 4
SCS SB 841 59
(1) The practice of any profession for which a license 5
is required and issued pursuant to the laws of this state by 6
a person duly licensed to practice that profession; 7
(2) The services rendered by technicians, nurses' 8
aides or their equivalent trained and employed in public or 9
private hospitals and licensed long-term care facilities 10
except the services rendered in licensed long-term care 11
facilities shall be limited to administering medication, 12
excluding injectable medications other than: 13
(a) Insulin; 14
(b) Subcutaneous injectable medications to treat 15
diabetes as ordered by an individual legally authorized to 16
prescribe such medications; and 17
(c) Epinephrine delivery devices ordered for stock 18
supply in accordance with section 196.990 or prescribed for 19
a resident's individual use by an individual legally 20
authorized to prescribe such epinephrine delivery devices. 21
Expected epinephrine delivery device users shall receive 22
training set forth in section 196.990. As used in this 23
paragraph, the term "epinephrine delivery device" means a 24
single-use device used for the delivery of a premeasured 25
dose of epinephrine into the human body; 26
(3) The providing of nursing care by friends or 27
members of the family of the person receiving such care; 28
(4) The incidental care of the sick, aged, or infirm 29
by domestic servants or persons primarily employed as 30
housekeepers; 31
(5) The furnishing of nursing assistance in the case 32
of an emergency situation; 33
(6) The practice of nursing under proper supervision: 34
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(a) As a part of the course of study by students 35
enrolled in approved schools of professional nursing or in 36
schools of practical nursing; 37
(b) By graduates of accredited nursing programs 38
pending the results of the first licensing examination or 39
ninety days after graduation, whichever first occurs; 40
(c) A graduate nurse who is prevented from attending 41
the first licensing examination following graduation by 42
reason of active duty in the military may practice as a 43
graduate nurse pending the results of the first licensing 44
examination scheduled by the board following the release of 45
such graduate nurse from active military duty or pending the 46
results of the first licensing examination taken by the 47
graduate nurse while involved in active military service 48
whichever comes first; 49
(7) The practice of nursing in this state by any 50
legally qualified nurse duly licensed to practice in another 51
state whose engagement requires such nurse to accompany and 52
care for a patient temporarily residing in this state for a 53
period not to exceed six months; 54
(8) The practice of any legally qualified nurse who is 55
employed by the government of the United States or any 56
bureau, division or agency thereof, while in the discharge 57
of his or her official duties or to the practice of any 58
legally qualified nurse serving in the Armed Forces of the 59
United States while stationed within this state; 60
(9) Nonmedical nursing care of the sick with or 61
without compensation when done in connection with the 62
practice of the religious tenets of any church by adherents 63
thereof, as long as they do not engage in the practice of 64
nursing as defined in sections 335.011 to 335.096; 65
SCS SB 841 61
(10) The practice of any legally qualified and 66
licensed nurse of another state, territory, or foreign 67
country whose responsibilities include transporting patients 68
into, out of, or through this state while actively engaged 69
in patient transport that does not exceed forty-eight hours 70
in this state. 71
338.010. 1. The "practice of pharmacy" includes: 1
(1) The interpretation, implementation, and evaluation 2
of medical prescription orders, including any legend drugs 3
under 21 U.S.C. Section 353, and the receipt, transmission, 4
or handling of such orders or facilitating the dispensing of 5
such orders; 6
(2) The designing, initiating, implementing, and 7
monitoring of a medication therapeutic plan in accordance 8
with the provisions of this section; 9
(3) The compounding, dispensing, labeling, and 10
administration of drugs and devices pursuant to medical 11
prescription orders; 12
(4) The ordering and administration of vaccines 13
approved or authorized by the U.S. Food and Drug 14
Administration, excluding vaccines for cholera, monkeypox, 15
Japanese encephalitis, typhoid, rabies, yellow fever, tick- 16
borne encephalitis, anthrax, tuberculosis, dengue, Hib, 17
polio, rotavirus, smallpox, chikungunya, and any vaccine 18
approved after January 1, [2023] 2026, to persons at least 19
seven years of age or the age recommended by the Centers for 20
Disease Control and Prevention, whichever is older, pursuant 21
to joint promulgation of rules established by the board of 22
pharmacy and the state board of registration for the healing 23
arts unless rules are established under a state of emergency 24
as described in section 44.100; 25
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(5) The participation in drug selection according to 26
state law and participation in drug utilization reviews; 27
(6) The proper and safe storage of drugs and devices 28
and the maintenance of proper records thereof; 29
(7) Consultation with patients and other health care 30
practitioners, and veterinarians and their clients about 31
legend drugs, about the safe and effective use of drugs and 32
devices; 33
(8) The prescribing and dispensing of any nicotine 34
replacement therapy product under section 338.665; 35
(9) The dispensing of HIV postexposure prophylaxis 36
pursuant to section 338.730; and 37
(10) The offering or performing of those acts, 38
services, operations, or transactions necessary in the 39
conduct, operation, management and control of a pharmacy. 40
2. No person shall engage in the practice of pharmacy 41
unless he or she is licensed under the provisions of this 42
chapter. 43
3. This chapter shall not be construed to prohibit the 44
use of auxiliary personnel under the direct supervision of a 45
pharmacist from assisting the pharmacist in any of his or 46
her duties. This assistance in no way is intended to 47
relieve the pharmacist from his or her responsibilities for 48
compliance with this chapter and he or she will be 49
responsible for the actions of the auxiliary personnel 50
acting in his or her assistance. 51
4. This chapter shall not be construed to prohibit or 52
interfere with any legally registered practitioner of 53
medicine, dentistry, or podiatry, or veterinary medicine 54
only for use in animals, or the practice of optometry in 55
accordance with and as provided in sections 195.070 and 56
SCS SB 841 63
336.220 in the compounding, administering, prescribing, or 57
dispensing of his or her own prescriptions. 58
5. A pharmacist with a certificate of medication 59
therapeutic plan authority may provide medication therapy 60
services pursuant to a written protocol from a physician 61
licensed under chapter 334 to patients who have established 62
a physician-patient relationship, as described in 63
subdivision (1) of subsection 1 of section 191.1146, with 64
the protocol physician. The written protocol authorized by 65
this section shall come only from the physician and shall 66
not come from a nurse engaged in a collaborative practice 67
arrangement under section 334.104, or from a physician 68
assistant engaged in a collaborative practice arrangement 69
under section 334.735. 70
6. Nothing in this section shall be construed as to 71
prevent any person, firm or corporation from owning a 72
pharmacy regulated by sections 338.210 to 338.315, provided 73
that a licensed pharmacist is in charge of such pharmacy. 74
7. Nothing in this section shall be construed to apply 75
to or interfere with the sale of nonprescription drugs and 76
the ordinary household remedies and such drugs or medicines 77
as are normally sold by those engaged in the sale of general 78
merchandise. 79
8. No health carrier as defined in chapter 376 shall 80
require any physician with which they contract to enter into 81
a written protocol with a pharmacist for medication 82
therapeutic services. 83
9. This section shall not be construed to allow a 84
pharmacist to diagnose or independently prescribe 85
pharmaceuticals. 86
10. The state board of registration for the healing 87
arts, under section 334.125, and the state board of 88
SCS SB 841 64
pharmacy, under section 338.140, shall jointly promulgate 89
rules regulating the use of protocols for medication therapy 90
services. Such rules shall require protocols to include 91
provisions allowing for timely communication between the 92
pharmacist and the protocol physician or similar body 93
authorized by this section, and any other patient protection 94
provisions deemed appropriate by both boards. In order to 95
take effect, such rules shall be approved by a majority vote 96
of a quorum of each board. Neither board shall separately 97
promulgate rules regulating the use of protocols for 98
medication therapy services. Any rule or portion of a rule, 99
as that term is defined in section 536.010, that is created 100
under the authority delegated in this section shall become 101
effective only if it complies with and is subject to all of 102
the provisions of chapter 536 and, if applicable, section 103
536.028. This section and chapter 536 are nonseverable and 104
if any of the powers vested with the general assembly 105
pursuant to chapter 536 to review, to delay the effective 106
date, or to disapprove and annul a rule are subsequently 107
held unconstitutional, then the grant of rulemaking 108
authority and any rule proposed or adopted after August 28, 109
2007, shall be invalid and void. 110
11. The state board of pharmacy may grant a 111
certificate of medication therapeutic plan authority to a 112
licensed pharmacist who submits proof of successful 113
completion of a board-approved course of academic clinical 114
study beyond a bachelor of science in pharmacy, including 115
but not limited to clinical assessment skills, from a 116
nationally accredited college or university, or a 117
certification of equivalence issued by a nationally 118
recognized professional organization and approved by the 119
board of pharmacy. 120
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12. Any pharmacist who has received a certificate of 121
medication therapeutic plan authority may engage in the 122
designing, initiating, implementing, and monitoring of a 123
medication therapeutic plan as defined by a written protocol 124
from a physician that may be specific to each patient for 125
care by a pharmacist. 126
13. Nothing in this section shall be construed to 127
allow a pharmacist to make a therapeutic substitution of a 128
pharmaceutical prescribed by a physician unless authorized 129
by the written protocol or the physician's prescription 130
order. 131
14. "Veterinarian", "doctor of veterinary medicine", 132
"practitioner of veterinary medicine", "DVM", "VMD", "BVSe", 133
"BVMS", "BSe (Vet Science)", "VMB", "MRCVS", or an 134
equivalent title means a person who has received a doctor's 135
degree in veterinary medicine from an accredited school of 136
veterinary medicine or holds an Educational Commission for 137
Foreign Veterinary Graduates (EDFVG) certificate issued by 138
the American Veterinary Medical Association (AVMA). 139
15. In addition to other requirements established by 140
the joint promulgation of rules by the board of pharmacy and 141
the state board of registration for the healing arts: 142
(1) A pharmacist shall administer vaccines by protocol 143
in accordance with treatment guidelines established by the 144
Centers for Disease Control and Prevention (CDC); 145
(2) A pharmacist who is administering a vaccine shall 146
request a patient to remain in the pharmacy a safe amount of 147
time after administering the vaccine to observe any adverse 148
reactions. Such pharmacist shall have adopted emergency 149
treatment protocols. 150
16. In addition to other requirements by the board, a 151
pharmacist shall receive additional training as required by 152
SCS SB 841 66
the board and evidenced by receiving a certificate from the 153
board upon completion, and shall display the certification 154
in his or her pharmacy where vaccines are delivered. 155
17. A pharmacist shall inform the patient that the 156
administration of a vaccine will be entered into the 157
ShowMeVax system, as administered by the department of 158
health and senior services. The patient shall attest to the 159
inclusion of such information in the system by signing a 160
form provided by the pharmacist. If the patient indicates 161
that he or she does not want such information entered into 162
the ShowMeVax system, the pharmacist shall provide a written 163
report within fourteen days of administration of a vaccine 164
to the patient's health care provider, if provided by the 165
patient, containing: 166
(1) The identity of the patient; 167
(2) The identity of the vaccine or vaccines 168
administered; 169
(3) The route of administration; 170
(4) The anatomic site of the administration; 171
(5) The dose administered; and 172
(6) The date of administration. 173
18. A pharmacist licensed under this chapter may order 174
and administer vaccines approved or authorized by the U.S. 175
Food and Drug Administration to address a public health 176
need, as lawfully authorized by the state or federal 177
government, or a department or agency thereof, during a 178
state or federally declared public health emergency. 179
338.333. 1. Except as otherwise provided by the board 1
of pharmacy by rule in the event of an emergency or to 2
alleviate a supply shortage, no person or distribution 3
outlet shall act as a wholesale drug distributor, pharmacy 4
distributor, drug outsourcer, or third-party logistics 5
SCS SB 841 67
provider without first obtaining license to do so from the 6
Missouri board of pharmacy and paying the required fee. The 7
board may grant temporary licenses when the wholesale drug 8
distributor, pharmacy distributor, drug outsourcer, or third- 9
party logistics provider first applies for a license to 10
operate within the state. Temporary licenses shall remain 11
valid until such time as the board shall find that the 12
applicant meets or fails to meet the requirements for 13
regular licensure. No license shall be issued or renewed 14
for a wholesale drug distributor, pharmacy distributor, drug 15
outsourcer, or third-party logistics provider to operate 16
unless the same shall be operated in a manner prescribed by 17
law and according to the rules and regulations promulgated 18
by the board of pharmacy with respect thereto. Separate 19
licenses shall be required for each distribution site owned 20
or operated by a wholesale drug distributor, pharmacy 21
distributor, drug outsourcer, or third-party logistics 22
provider, unless such drug distributor, pharmacy 23
distributor, drug outsourcer, or third-party logistics 24
provider meets the requirements of section 338.335. 25
2. An agent or employee of any licensed or registered 26
wholesale drug distributor, pharmacy distributor, drug 27
outsourcer, or third-party logistics provider need not seek 28
licensure under this section and may lawfully possess 29
pharmaceutical drugs, if the agent or employee is acting in 30
the usual course of his or her business or employment. 31
3. The board may permit out-of-state wholesale drug 32
distributors, drug outsourcers, third-party logistics 33
[provider] providers, or out-of-state pharmacy distributors 34
to be licensed as required by sections 338.210 to 338.370 on 35
the basis of reciprocity to the extent that the entity both: 36
SCS SB 841 68
(1) Possesses a valid license granted by another state 37
pursuant to legal standards comparable to those which must 38
be met by a wholesale drug distributor, pharmacy 39
distributor, drug [outsourcers] outsourcer, or third-party 40
logistics provider of this state as prerequisites for 41
obtaining a license under the laws of this state. If a 42
state license is not issued by their resident state, out-of- 43
state wholesale drug distributors and third-party logistics 44
providers with a current and valid drug distributor 45
accreditation from the National Association of Boards of 46
Pharmacy or its successor may be eligible for licensure as 47
provided by the board by rule; and 48
(2) Distributes into Missouri from a state which would 49
extend reciprocal treatment under its own laws to a 50
wholesale drug distributor, pharmacy distributor, drug 51
outsourcers, or third-party logistics provider of this state. 52
338.710. 1. There is hereby created in the Missouri 1
board of pharmacy the "RX Cares for Missouri Program". The 2
goal of the program shall be to promote medication safety 3
and to prevent prescription drug abuse, misuse, and 4
diversion in Missouri. 5
2. The board, in consultation with the department, 6
shall be authorized to expend, allocate, or award funds 7
appropriated to the board to private or public entities to 8
develop or provide programs or education to promote 9
medication safety or to suppress or prevent prescription 10
drug abuse, misuse, and diversion in the state of Missouri. 11
In no case shall the authorization include, nor the funds be 12
expended for, any state prescription drug monitoring program 13
including, but not limited to, such as are defined in 38 CFR 14
1.515. Funds disbursed to a state agency under this section 15
SCS SB 841 69
may enhance, but shall not supplant, funds otherwise 16
appropriated to such state agency. 17
3. The board shall be the administrative agency 18
responsible for implementing the program in consultation 19
with the department. The board and the department may enter 20
into interagency agreements between themselves to allow the 21
department to assist in the management or operation of the 22
program. The board may award funds directly to the 23
department to implement, manage, develop, or provide 24
programs or education pursuant to the program. 25
4. After a full year of program operation, the board 26
shall prepare and submit an evaluation report to the 27
governor and the general assembly describing the operation 28
of the program and the funds allocated. [Unless otherwise 29
authorized by the general assembly, the program shall expire 30
on August 28, 2026.] 31
376.1245. 1. As used in this section, the following 1
terms mean: 2
(1) "Anesthesia time", the period during which an 3
anesthesia practitioner is present with the patient, 4
starting when the anesthesia practitioner begins to prepare 5
the patient for anesthesia services in the operating room or 6
an equivalent area and ending when the anesthesia 7
practitioner is no longer furnishing anesthesia services to 8
the patient because the patient may be placed safely under 9
postoperative or postanesthesia care. The term "anesthesia 10
time" includes, if counted by the anesthesia practitioner, 11
blocks of time around an interruption in anesthesia time 12
provided the anesthesia practitioner is furnishing 13
continuous anesthesia care within the time periods around 14
the interruption; 15
SCS SB 841 70
(2) "Anesthesia time units", time units recognized 16
with appropriate time intervals that do not exceed fifteen 17
minutes in length for each interval and that, taken 18
together, represent the total anesthesia time for a 19
particular anesthesia service; 20
(3) "Excepted benefit plan", the same meaning given to 21
the term in section 376.998; 22
(4) "Health benefit plan", the same meaning given to 23
the term in section 376.1350. The term "health benefit 24
plan" shall also include MO HealthNet, the children's health 25
insurance program authorized under chapter 208, the Missouri 26
consolidated health care plan established under chapter 103, 27
and any other state-sponsored health insurance program; 28
(5) "Health carrier", the same meaning given to the 29
term in section 376.1350. The term "health carrier" shall 30
also include the MO HealthNet division and any Medicaid 31
managed care organization as defined in section 208.431; 32
(6) "Payment of anesthesia services", an amount paid 33
for anesthesia services: 34
(a) Determined by using prevailing medical coding and 35
billing standards in the professional medical billing 36
community, such as the Current Procedural Terminology code 37
book published by the American Medical Association, the 38
Medicare Claims Processing Manual, or guidance from 39
nationally recognized anesthesia organizations; and 40
(b) Calculated as the product obtained by multiplying 41
the following together: 42
a. The sum of the base units for the appropriate 43
medical code plus anesthesia time units; and 44
b. An anesthesia conversion factor that is defined in 45
the individual contract between the health carrier or health 46
benefit plan and the anesthesia practitioner or group. 47
SCS SB 841 71
2. No health carrier or health benefit plan shall 48
establish, implement, or enforce any policy, practice, or 49
procedure that imposes a time limit for the payment of 50
anesthesia services provided during a medical or surgical 51
procedure. 52
3. No health carrier or health benefit plan shall 53
establish, implement, or enforce any policy, practice, or 54
procedure that restricts or excludes all anesthesia time in 55
calculating the payment of anesthesia services. 56
4. Excepted benefit plans shall be subject to the 57
requirements of this section. 58
376.1280. 1. As used in this section, the following 1
terms mean: 2
(1) "Acute pain", pain that results from disease, 3
accidental or intentional trauma, or other causes, that a 4
health care provider reasonably expects to last thirty days 5
or fewer; 6
(2) "Enrollee", the same meaning given to the term in 7
section 376.1350; 8
(3) "Health benefit plan", the same meaning given to 9
the term in section 376.1350; 10
(4) "Health care professional", the same meaning given 11
to the term in section 376.1350. 12
2. Notwithstanding any provision of law to the 13
contrary, when a licensed health care professional acting 14
within the scope of his or her license prescribes a 15
nonopioid medication for the treatment of acute pain to a 16
patient, it shall be unlawful for a health benefit plan to: 17
(1) Deny coverage of the nonopioid prescription drug 18
in favor of an opioid prescription drug; 19
SCS SB 841 72
(2) Require the patient to try an opioid prescription 20
drug before providing coverage of the nonopioid prescription 21
drug; or 22
(3) Require a higher level of cost-sharing for the 23
nonopioid prescription drug than for an opioid prescription 24
drug. 25
3. This section shall apply to health benefit plans 26
delivered, issued for delivery, continued, or renewed on or 27
after January 1, 2027. 28
579.060. 1. A person commits the offense of unlawful 1
sale, distribution, or purchase of over-the-counter 2
methamphetamine precursor drugs if he or she knowingly: 3
(1) Sells, distributes, dispenses, or otherwise 4
provides any number of packages of any drug product 5
containing detectable amounts of ephedrine, 6
phenylpropanolamine, or pseudoephedrine, or any of their 7
salts, optical isomers, or salts of optical isomers, in a 8
total amount greater than seven and two-tenths grams to the 9
same individual within a thirty-day period, unless the 10
amount is dispensed, sold, or distributed pursuant to a 11
valid prescription; or 12
(2) Purchases, receives, or otherwise acquires within 13
a thirty-day period any number of packages of any drug 14
product containing any detectable amount of ephedrine, 15
phenylpropanolamine, or pseudoephedrine, or any of their 16
salts or optical isomers, or salts of optical isomers in a 17
total amount greater than seven and two-tenths grams, 18
without regard to the number of transactions, unless the 19
amount is purchased, received, or acquired pursuant to a 20
valid prescription; or 21
(3) Purchases, receives, or otherwise acquires within 22
a twenty-four-hour period any number of packages of any drug 23
SCS SB 841 73
product containing any detectable amount of ephedrine, 24
phenylpropanolamine, or pseudoephedrine, or any of their 25
salts or optical isomers, or salts of optical isomers in a 26
total amount greater than three and six-tenths grams, 27
without regard to the number of transactions, unless the 28
amount is purchased, received, or acquired pursuant to a 29
valid prescription; or 30
(4) Sells, distributes, dispenses, or otherwise 31
provides any number of packages of any drug product 32
containing detectable amounts of ephedrine, 33
phenylpropanolamine, or pseudoephedrine, or any of their 34
salts, optical isomers, or salts of optical isomers, in a 35
total amount greater than [forty-three] sixty-one and two- 36
tenths grams to the same individual within a twelve-month 37
period, unless the amount is dispensed, sold, or distributed 38
pursuant to a valid prescription; or 39
(5) Purchases, receives, or otherwise acquires within 40
a twelve-month period any number of packages of any drug 41
product containing any detectable amount of ephedrine, 42
phenylpropanolamine, or pseudoephedrine, or any of their 43
salts or optical isomers, or salts of optical isomers in a 44
total amount greater than [forty-three] sixty-one and two- 45
tenths grams, without regard to the number of transactions, 46
unless the amount is purchased, received, or acquired 47
pursuant to a valid prescription; or 48
(6) Dispenses or offers drug products that are not 49
excluded from Schedule V in subsection 17 or 18 of section 50
195.017 and that contain detectable amounts of ephedrine, 51
phenylpropanolamine, or pseudoephedrine, or any of their 52
salts, optical isomers, or salts of optical isomers, without 53
ensuring that such products are located behind a pharmacy 54
counter where the public is not permitted and that such 55
SCS SB 841 74
products are dispensed by a registered pharmacist or 56
pharmacy technician under subsection 11 of section 195.017; 57
or 58
(7) Holds a retail sales license issued under chapter 59
144 and knowingly sells or dispenses packages that do not 60
conform to the packaging requirements of section 195.418. 61
2. A pharmacist, intern pharmacist, or registered 62
pharmacy technician commits the offense of unlawful sale, 63
distribution, or purchase of over-the-counter 64
methamphetamine precursor drugs if he or she knowingly: 65
(1) Sells, distributes, dispenses, or otherwise 66
provides any number of packages of any drug product 67
containing detectable amounts of ephedrine, 68
phenylpropanolamine, or pseudoephedrine, or any of their 69
salts or optical isomers, or salts of optical isomers, in a 70
total amount greater than three and six-tenth grams to the 71
same individual within a twenty-four hour period, unless the 72
amount is dispensed, sold, or distributed pursuant to a 73
valid prescription; or 74
(2) Fails to submit information under subsection 13 of 75
section 195.017 and subsection 6 of section 195.417 about 76
the sales of any compound, mixture, or preparation of 77
products containing detectable amounts of ephedrine, 78
phenylpropanolamine, or pseudoephedrine, or any of their 79
salts, optical isomers, or salts of optical isomers, in 80
accordance with transmission methods and frequency 81
established by the department of health and senior services; 82
or 83
(3) Fails to implement and maintain an electronic log, 84
as required by subsection 12 of section 195.017, of each 85
transaction involving any detectable quantity of 86
pseudoephedrine, its salts, isomers, or salts of optical 87
SCS SB 841 75
isomers or ephedrine, its salts, optical isomers, or salts 88
of optical isomers; or 89
(4) Sells, distributes, dispenses or otherwise 90
provides to an individual under eighteen years of age 91
without a valid prescription any number of packages of any 92
drug product containing any detectable quantity of 93
pseudoephedrine, its salts, isomers, or salts of optical 94
isomers, or ephedrine, its salts or optical isomers, or 95
salts of optical isomers. 96
3. Any person who violates the packaging requirements 97
of section 195.418 and is considered the general owner or 98
operator of the outlet where ephedrine, pseudoephedrine, or 99
phenylpropanolamine products are available for sale shall 100
not be penalized if he or she documents that an employee 101
training program was in place to provide the employee who 102
made the unlawful retail sale with information on the state 103
and federal regulations regarding ephedrine, 104
pseudoephedrine, or phenylpropanolamine. 105
4. A manufacturer commits the offense of unlawful 106
sale, distribution, or purchase of over-the-counter 107
methamphetamine precursor drugs if he or she knowingly fails 108
to pay the fees required under subsection 7 of section 109
195.417. 110
5. The offense of unlawful sale, distribution, or 111
purchase of over-the-counter methamphetamine precursor drugs 112
is a class A misdemeanor. 113
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