HCS/SS/SCS/SBs 70 & 128 - This act modifies several provisions relating to the administration of health care services, including: (1) medication-assisted treatment; (2) qualifications of the Director of the Department of Health and Senior Services; (3) infection control data reporting; (4) opioid prescriptions for sickle cell patients; (5) hospital inspections; (6) certified nursing assistant training requirements; (7) personal care assistance vendors; (8) an interactive assessment tool for certain home and community-based services; (9) the suspension of MO HealthNet benefits for certain offenders; (10) telehealth; (11) nursing home administrator licenses; and (12) unanticipated out-of-network health care services.MEDICATION-ASSISTED TREATMENT (Sections 191.1164, 191.1165, 191.1167, and 191.1168)
This act establishes the "Ensuring Access to High Quality Care for the Treatment of Substance Use Disorders Act". These provisions specify that medication-assisted treatment (MAT) services shall include, but not be limited to, pharmacologic and behavioral therapies. Formularies used by a health insurer or managed by a pharmacy benefits manager, and medical benefit coverage in the case of medications dispensed through an opioid treatment program, shall include all certain specified medications. All MAT medications required for compliance with these provisions shall be placed on the lowest cost-sharing tier of the formulary.
MAT services provided for under these provisions shall not be subject to: annual or lifetime dollar limits; limits to predesignated facilities, specific numbers of visits, days of coverage, days in a waiting period, scope or duration of treatment, or other similar limits; financial requirements and quantitative treatment limitations that do not comply with the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA); step therapy or other similar strategies when it interferes with a prescribed or recommended course of treatment from a licensed health care professional; or prior authorization.
These provisions shall apply to all health insurance plans delivered in the state.
These provisions are identical to provisions in the truly agreed to and finally passed CCS/SS/SCS/HCS/HB 399 (2019), the truly agreed to and finally passed SB 514 (2019), SS#2/HB 219 (2019), as amended, SCS/SB 507 (2019), and SCS/HB 758 (2019) and similar to provisions in HCS/SB 275 (2019) and HCS/HB 904 (2019)
QUALIFICATIONS OF THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND SENIOR SERVICES (Section 192.007)
This act requires the Director of the Department of Health and Senior Services to have specified qualifications regarding education and experience.
This provision is similar to provisions in SB 177 (2019).
INFECTION DATA REPORTING (Section 192.667)
Under this act, hospitals and the Department of Health and Senior Services shall not be required to comply with infection data reporting requirements of current law applying to hospitals if the Centers for Medicare and Medicaid Services (CMS) also requires the submission of such data, except that the Department shall post a link on its website to the publicly reported data on CMS's website. Additionally, hospitals that have established antimicrobial stewardship programs, as required under current law, shall meet the National Healthcare Safety Network requirements for reporting antimicrobial usage or resistance when CMS's conditions of participation requiring such reporting become effective. Nothing shall prohibit a hospital from voluntarily reporting the data prior to the effective date of the conditions of participation.
This provision is identical to SB 435 (2019) and a provision in the perfected SS/SCS/SBs 70 & 128 (2019) and substantially similar to HB 1057 (2019).
OPIOID PRESCRIPTIONS FOR SICKLE CELL PATIENTS (Section 195.080)
This act excludes patients undergoing treatment for sickle cell disease from the initial opioid prescription limitations in current law.
This provision is identical to provisions in SS#2/HB 219 (2019), as amended, SCS/HB 758 (2019), SB 450 (2018), HCS/SCS/SB 6 (2019), the truly agreed to and finally passed SB 514 (2019), HCS/SB 275 (2019), and HB 986 (2019).
HOSPITAL INSPECTIONS(Section 197.108)
This act prohibits the Department of Health and Senior Services from assigning an individual to inspect or survey a hospital if the inspector or surveyor was an employee of such hospital or another hospital within its organization or a competing hospital within 50 miles of the hospital to be surveyed within the previous 2 years. The Department shall require inspectors or surveyors to disclose the name of every hospital in which he or she was employed in the previous 10 years, the length of service, and the job title held, as well as the same information for any immediate family member employed at a hospital. Such information shall be considered a public record.
If any person has reason to believe that an inspector or surveyor has any personal or business affiliation that would result in a conflict of interest, he or she may notify the Department. If the Department has reason to believe the information to be true, the Department shall not assign the inspector or surveyor to the hospital or any hospital within its organization.
This provision is identical to provisions in SS#2/HB 219 (2019), as amended, SCS/HB 758 (2019), SCS/SB 415 (2019), and the truly agreed and finally passed SB 514 (2019).
CERTIFIED NURSING ASSISTANT TRAINING REQUIREMENTS (Section 198.082)
This act requires certified nursing assistant training programs to be offered at skilled nursing or intermediate care facility units in Missouri veterans homes and hospitals. Certified nursing assistants shall include certain employees at such units and hospitals who have completed the training and passed the certification examination. Training shall include on-the-job training at certain locations and the act repeals language pertaining to continuing in-service training. Persons who have completed the required hours of classroom instruction and clinical practicum for unlicensed assistive personnel under state regulations shall be allowed to take the certified nursing assistant examination and shall be deemed to have fulfilled the classroom and clinical standards requirements for designation as a certified nursing assistant. Finally, the Department of Health and Senior Services may offer additional training programs and certifications to students already certified as nursing assistants as specified in the act.
This provision is substantially similar to provisions in the truly agreed to and finally passed SB 514 (2019), SS#2/HB 219 (2019), as amended, SCS/HB 758 (2019), SB 490 (2019), and HB 817 (2019) and similar to SB 1062 (2018) and HB 2597 (2018).
PERSONAL CARE ASSISTANCE VENDORS (Sections 208.909, 208.918, and 208.924)
Under current law, vendors of consumer-directed services shall monitor the performance of personal care assistance service plans. This act requires the consumer to permit the vendor to comply with its quality assurance and supervision process, including bi-annual face-to-face home visits and monthly case management activities. During the home visits, the vendor shall document if the attendant was present and providing services as set forth in the plan of care and report the Department if the attendant is not present or providing services, which may result in a suspension of services to the consumer.
This act repeals language permitting the Department of Health and Senior Services to establish certain pilot projects for telephone tracking systems.
This act also requires vendors to notify consumers during orientation that falsification of personal care attendant time sheets shall be considered and reported to the Department as fraud.
Under this act, a vendor shall submit an annual financial statement audit or annual financial statement review performed by a certified public accountant to the Department upon request. Additionally, this act requires the Department to create a consumer-directed services division provider certification manager course. No state or federal funds shall be authorized or expended if the person providing the personal care services is the same person conducting the biannual face-to-face home visits.
Currently, a consumer's services may be discontinued if the consumer has falsified records. This act adds language to include providing false information of his or her condition, functional capacity, or level of care needs.
These provisions are substantially similar to provisions in HCS/HB 1885 (2018) and HB 2500 (2018) and similar to SB 969 (2018) and provisions of SB 526 (2017).
INTERACTIVE ASSESSMENT TOOL FOR CERTAIN HOME AND COMMUNITY-BASED SERVICES (Section 208.935)
Finally, the Department shall, subject to appropriations, develop an interactive assessment tool for utilization by the Division of Senior and Disability Services when implementing the assessment and authorization process for home and community-based services authorized by the Division.
This provision is substantially similar to language in SB 441 (2019).
SUSPENSION OF MO HEALTHNET BENEFITS FOR CERTAIN OFFENDERS (Sections 217.930 and 221.125)
Under this act, MO HealthNet benefits shall be suspended, rather than cancelled or terminated, for offenders entering into a correctional facility or jail if the Department of Social Services is notified of the person's entry into the correctional center or jail, the person was currently enrolled in MO HealthNet, and the person is otherwise eligible for MO HealthNet benefits but for his or her incarcerated status. Upon release from incarceration, the suspension shall end and the person shall continue to be eligible for MO HealthNet benefits until such time as he or she is otherwise ineligible.
The Department of Corrections shall notify the Department of Social Services within 20 days of receiving information that person receiving MO HealthNet benefits is or will become an offender in a correctional center or jail and within 45 days prior to the release of such person whose benefits have been suspended under this act. City, county, and private jails shall notify the Department of Social Services within 10 days of receiving information that person receiving MO HealthNet benefits is or will become an offender in the jail.
These provisions are identical to provisions in SS#2/HB 219 (2019), as amended, HCS/HB 189 (2019), the truly agreed to and finally passed CCS/SS/SCS/HCS/HB 399 (2019), SCS/HCS/HB 466 (2019), HB 1102 (2019), SB 393 (2019), and the truly agreed to and finally passed SB 514 (2019).
TELEHEALTH (Section 335.175)
This act removes the sunset provision on the utilization of telehealth for advanced practice registered nurses in rural areas of need.
This provision is identical to provisions in SS#2/HB 219 (2019), as amended, SCS/HB 758 (2019), HB 226 (2019), HCS/HB 301 (2019), HB 420 (2019), and the truly agreed to and finally passed SB 514 (2019).
NURSING HOME ADMINISTRATOR LICENSES (Section 344.030)
Under current law, an applicant for a nursing home administrator license must have a minimum of three years of experience or two years of postsecondary education in health care administration or have satisfactorily completed a course of instruction prescribed by the Missouri Board or Nursing Home Administrators and passed the examination administered by the Board. Under this act, such applicant may meet this requirement if he or she has an associate degree or higher from an accredited academic institution.
Currently law allows the Board to issue a temporary emergency license for a period of 90 days to a person 21 years of age or older. This act permits the Board to issue such license for a period of 120 days to a person 18 years of age or older. Additionally, this act repeals the provisions relating to the renewal of a temporary emergency license.
This provision is substantially similar to SB 375 (2019).
UNANTICIPATED OUT-OF-NETWORK HEALTH CARE SERVICES (Section 376.690)
This act specifies that health care professionals shall, rather than may, utilize the process outlined in statute for claims for unanticipated out-of-network care.
This provision is identical to provisions in SS#2/HB 219 (2019), as amended, HB 83 (2019), the truly agreed to and finally passed CCS/SS/SCS/HCS/HB 399 (2019), HB 756 (2019), HCS/HB 1235 (2019), the truly agreed to and finally passed SB 514 (2019), SB 103 (2019), and HCS/SB 275 (2019).
SARAH HASKINS