SS/SCS/HB 2331 - This act modifies several provisions relating to programs administered by the Department of Health and Senior Services, including: (1) medical preceptorship tax credit; (2) the Alzheimer's State Plan Task Force; (3) emergency medical services; (4) medical student loan programs; (5) the Older Americans Act; (6) oversight of health care facilities; (7) naltrexone hydrochloride; (8) organ donation; (9) medical marijuana facility background checks; (10) home health licensing; and (11) the repeal of certain statutes relating to the duties of the Department of Health and Senior Services.MEDICAL PRECEPTORSHIP TAX CREDIT (Section 135.690)
For all tax years beginning on or after January 1, 2023, this act authorizes a taxpayer to claim a tax credit for serving as a community-based faculty preceptor for a medical student core preceptorship or a physician assistant student core preceptorship, as such terms are defined in the act. The tax credit shall be equal to $1,000 for each preceptorship, but not to exceed $3,000 in any tax year. Tax credits authorized by the act shall not be refundable or transferable, and shall not be carried forward or backward to any other tax year. The total amount of tax credits authorized in a given year shall not exceed $200,000. Additional tax credits may be authorized provided in amount not to exceed the excess funds available in the Medical Preceptor Fund, as created by the act.
Beginning January 1, 2023, the Division of Professional Registration of the Missouri Department of Commerce and Insurance shall increase the license fees for physicians and surgeons by $7 and for physician assistants by $3, with such revenues to be deposited in the Medical Preceptor Fund. At the end of each tax year, an amount equal to the total dollar amount of tax credits claimed during the tax year shall be transferred to the General Revenue Fund.
This provision is substantially similar to CCS/HCS/SS/SB 690 (2022), SCS/SB 801 (2022), SS/HB 502 (2021), HCS/SCS/SB 403 (2021), HCS/SS/SB 580 (2020), and HB 2036 (2020).
ALZHEIMER'S STATE PLAN TASK FORCE (Sections 172.800 and 191.116)
This act repeals an obsolete reference to the Alzheimer's Disease and Related Disorders Task Force. Additionally, the act changes the date that the Alzheimer's State Plan Task Force shall submit a report of recommendations from June 1, 2022, to January 1, 2023, and extends the task force expiration date from December 31, 2026, to December 31, 2027.
These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), SCS/SB 1045 (2022), and CCS/HCS/SS/SB 690 (2022).
EMERGENCY HEALTH CARE SERVICES (Sections 190.100, 190.101, 190.103, 190.176, 190.200, 190.241, 190.243, 190.245, and 190.257)
Under this act, the state EMS medical director shall serve as an ex officio member of the State Advisory Council on Emergency Medical Services. The Council shall consult with the Time-Critical Diagnosis Advisory Committee established under this act regarding time-critical diagnosis, defined as trauma care, stroke care, and STEMI care occurring either outside of a hospital or in a designated center.
The State EMS Medical Director's Advisory Committee shall review and make recommendations regarding all proposed community and regional time-critical diagnosis plans.
This act repeals the requirement under current law that hospitals disclose data elements under the Missouri Brain and Spinal Cord Injury Registry to the Department of Health and Senior Services' uniform data collection system on all ambulance runs and injured patients.
The Department shall cooperate with hospitals to provide public and professional information related to emergency medical services systems. The Department may provide public information of hospital designations as trauma, stroke, or STEMI centers. The Department shall make publicly available research and guidelines recommended by the Time-Critical Diagnosis Advisory Committee for recommended treatment standards. Currently, the Department makes recommendations for treatment standards, establishes protocols for transport of patients, and approves the development of regional or community-based plans for transporting STEMI or stroke patients. This act includes trauma patients.
Currently, the Department shall conduct a site review of a hospital to determine the applicable level of trauma center, STEMI, or stroke center criteria. Under this act, the site review may occur onsite or by any reasonable means of communication or combination thereof. In developing trauma, STEMI, or stroke center designation criteria, the Department shall use, as practicable, peer-reviewed and evidence-based clinical research and guidelines.
Currently, the Department shall conduct an onsite review of every trauma, STEMI, or stroke center every 5 years. Under this act, a site review shall be conducted every 3 years. The Department may deny, place on probation, suspend, or revoke a center's designation if it has determined there has been a substantial failure to comply with certain regulations. Centers that are placed on probationary status shall show compliance with these regulations within 12 months, unless otherwise provided by a settlement agreement with a maximum duration of 18 months.
This act modifies provisions governing alternative trauma, stroke, and STEMI center designations by repealing current law establishing various designation levels and requiring the Department to designate hospitals seeking alternative designation in manner that corresponds to a similar national designation. A hospital receiving a center designation under this provision may have such designation removed upon the request of the hospital or upon a determination by the Department that the organization certifying or verifying the alternative designation has suspended or revoked its designation. This act requires centers receiving alternative designations under this provision to submit to the Department proof of certification or verification and to participate in local and regional emergency services systems for training, sharing educational resources, and collaboration on improving patient outcomes.
This act modifies data submission requirements for designated centers to require submission to either a state or national registry. Additionally, this act repeals requirements that the data collections system meet certain standards.
This act repeals provisions of current law granting the Board of Registration for the Healing Arts the sole authority to establish education requirements for physicians practicing in an emergency department in a trauma, STEMI, or stroke center. Instead, the Department shall not have authority to establish additional education requirements for emergency medicine board-certified or board-eligible physicians, either through the American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine, who are practicing in the emergency department of a designated center. The Department shall deem the education requirements of such entities to meet the standards for designation. Education requirements for other physicians, nurses, and other providers who provide care at the designated center shall equal, but not exceed, those established by national designating or verifying bodies of trauma, stroke, or STEMI centers.
Under this act, the Department may only establish appropriate fees to offset the costs of center surveys.
This act adds physician assistants to the list of providers who shall instruct ambulance personnel to transport a severely ill patient to a trauma, STEMI, or stroke center.
Failure of a hospital to provide all medical records and quality improvement documentation necessary for the Department to implement the provisions of this act shall result in the revocation of the hospital's designation as a trauma, STEMI, or stroke center.
This act repeals a provision of law relating to peer review systems for trauma, STEMI, and stroke cases.
Finally, this act establishes the "Time-Critical Diagnosis Advisory Committee" within the Department for the purpose of advising and making recommendations to the Department on improving public and professional education related to time-critical diagnosis; cooperative research endeavors; developing standards and policies relating to time-critical diagnosis; and reviewing and recommending community and regional time-critical diagnosis plans. The Director of the Department shall appoint 14 members to the committee, as specified in the act.
These provisions are identical to provisions in HB 2355 (2022) and CCS/HCS/SS/SB 690 (2022), substantially similar to SB 1020 (2022), and similar to SB 541 (2021).
MEDICAL STUDENT LOAN PROGRAMS (Sections 191.500, 191.515, 191.520, 191.525, 335.230, and 335.257)
This act modifies provisions of current law relating to the medical student loan program administered by the Department of Health and Senior Services by adding psychiatry, dental surgery, dental medicine, or dental hygiene students to the list of eligible students in the program, as well as adding psychiatric care, dental practice, and dental hygienists to the definition of "primary care". Additionally, this act modifies the loan amount students may be eligible to receive from $7,500 each academic year to $25,000 each academic year.
This act also modifies the Nursing Student Loan Program by modifying the amount of financial assistance available to students from $5,000 each academic year for professional nursing programs to $10,000 each academic year and from $2,500 each academic year for practical nursing programs to $5,000 each academic year.
Finally, this act modifies the Nursing Student Loan Repayment Program by removing the June and December deadlines for qualified employment verification while retaining the requirement that such employment be verified twice each year.
These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), CCS/HCS/SS/SB 690 (2022), SCS/SB 1045 (2022), and SB 757 (2022) and substantially similar to provisions in HCS/HB 2133 (2022) and HB 2881 (2022).
THE OLDER AMERICANS ACT (Sections 192.005, 251.070, and 660.010) This act transfers authority for the implementation of the federal Older Americans Act of 1965 from the Department of Social Services to the Department of Health and Senior Services.
These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022) and SCS/SB 1045 (2022) and similar to provisions in HB 2377 (2022).
OVERSIGHT OF HEALTH CARE FACILITIES (Sections 192.2225, 197.100, 197.256, 197.258, 197.415, 198.006, 198.022, 198.026, 198.036, 198.525, 198.526, and 198.545)
Currently, the Department of Health and Senior Services conducts at least two inspections per year for licensed adult day care programs, at least one of which is unannounced. Under this act, the Department shall be required to conduct at least one unannounced inspection per year.
Currently, the Department conducts an annual inspection of licensed hospitals. Under this act, such inspections shall instead be performed in accordance with the schedule set forth under federal Medicare law.
A hospice currently seeking annual renewal of its certification shall be inspected by the Department of Health and Senior Services. Under this act, the Department may conduct a survey to evaluate the quality of services rendered by the applicant. Additionally, current law requires annual inspections of a certified hospice and this act instead requires such inspections to be performed in accordance with the schedule set forth under federal Medicare law.
Currently, the Department conducts an inspection of licensed home health agencies at least every 1 to 3 years, depending on the number of months the agency has been in operation following the initial inspection. Under this act, such inspections shall instead be performed in accordance with the schedule set forth under federal Medicare law.
This act updates a reference to a Missouri regulation regarding long-term care facility orientation training.
Current law requires the Department to inspect long-term care facilities at least twice a year, one of which shall be unannounced. Under this act, the Department shall be required to conduct at least one unannounced inspection per year. Additionally, current law requires that the Department issue a notice of noncompliance or revocation of a license by certified mail to each person disclosed to be an owner or operator of a long-term care facility. This act instead requires that such notice be sent by a delivery service to the operator or administrator of the facility.
Finally, this act modifies the "Missouri Informal Dispute Resolution Act" relating to informal dispute resolutions between the Department of Health and Senior Services and licensed long-term care facilities. Current law requires the Department to send to a facility by certified mail a statement of deficiencies following an inspection. This act requires that such notice be sent by a delivery service that provides dated receipt of delivery. Additionally, current law provides a facility ten calendar days following receipt of notice to return a plan of correction to the Department. This act changes the ten calendar days to ten working days.
These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), CCS/HCS/SS/SB 690 (2022), SCS/SB 1045 (2022), HB 2848 (2022), and SB 1029 (2022) and substantially similar to provisions of SB 342 (2021).
ORGAN DONATION (Sections 194.210, 194.255, 194.265, 194.285, 194.290, 194.297, 194.299, 194.304, 194.321, 301.020, and 302.171)
This act modifies the "Revised Uniform Anatomical Gift Act". Currently, moneys in the Organ Donor Program Fund are limited to use for grants by the Department of Health and Senior Services to certified organ procurement organizations for the development and implementation of organ donation programs, publication of informational booklets, maintenance of an organ donor registry, and implementation of organ donation awareness programs in schools. This act modifies the fund to be used by the Department for educational initiatives, donor family recognition efforts, training, and other initiatives, as well as reimbursement for expenses incurred by the Organ Donation Advisory Committee. The Department shall no longer be required to disperse grants to organ procurement organizations, but shall have the authority to enter into contracts with such organizations or other organizations and individuals for the development and implementation of awareness programs. The fund may seek other sources of moneys, including grants, bequests, and federal funds.
Currently, applicants for motor vehicle registrations and driver's licenses may make a one dollar donation to the Organ Donor Program Fund. This act changes that to a donation of not less than one dollar.
These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), CCS/HCS/SS/SB 690 (2022), SCS/SB 1045 (2022), and SB 1146 (2022).
This act prohibits hospitals, physicians, procurement organizations, or other person from considering COVID-19 vaccination status of a potential organ transplant recipient or potential organ donor in any part of the organ transplant process, except in cases of lung transplants.
This provision is identical to a provision in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), CCS/HCS/SS/SB 690 (2022), HB 1861 (2022), and HCS/HBs 2358 & 1485 (2022).
NALTREXONE HYDROCHLORIDE (Section 195.206)
Under this act, the Director of the Department of Health and Senior Services, if a licensed physician, or a licensed physician on behalf of the Director, may issue a statewide standing order for an addiction mitigation medication, defined as naltrexone hydrochloride administered in a manner approved by the U.S. Food and Drug Administration or any accepted medical practice method of administering.
Any licensed pharmacist may sell and dispense an addiction mitigation medication under a physician protocol or a statewide standing order. A pharmacist who, acting in good faith and with reasonable care, sells or dispenses the addiction mitigation medication and an appropriate device to administer the drug, and the protocol physician, shall not be subject to any criminal or civil liability or professional disciplinary action for prescribing or dispensing the medication and any outcome resulting from the administration of the medication. A physician issuing the statewide standing order shall likewise face no liability or professional discipline relating to the order or administration of the medication.
It shall be permissible for any person to possess an addiction mitigation medication.
This provision is identical to provisions in the truly agreed to and finally passed SS/HB 2162 (2022), CCS/HCS/SS/SB 690 (2022), SB 1037 (2022), and HB 2603 (2022).
MEDICAL MARIJUANA FACILITY BACKGROUND CHECKS (Section 195.815)
Under current law, the Department of Health and Senior Services requires all officers, managers, contractors, employees and support staff of licensed or certified medical marijuana facilities to submit fingerprints for background checks. Under this act, only employees, contractors, owners, and volunteers shall be required to submit fingerprints.
This provision is identical to HB 1736 (2022), SB 939 (2022), and a provision in SCS/HB 2623 (2022).
HOME HEALTH LICENSING (Sections 197.400 and 197.445)
Current law limits licensed home health agencies to those that provide two or more home health services at the residence of a patient according to a physician's written and signed plan of treatment. This act permits such licensed entities to provide treatment according to written plans signed by physicians, nurse practitioners, clinical nurse specialists, or physician assistants, as specified in the act.
These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), the truly agreed to and finally passed CCS#2/SS/HB 2149 (2022), and substantially similar to SCS/SB 830 (2022), provisions in HCS/HB 2434 (2022), HB 2382 (2022), HB 1565 (2022), and SB 177 (2021).
REPEAL OF CERTAIN STATUTES RELATING TO THE DUTIES OF THE DEPARTMENT OF HEALTH AND SENIOR SERVICES (Sections 191.743, 196.866, and 196.868)
Currently, physicians or health care providers who are providing services to women with high-risk pregnancies are required to identify such women and report them to the Department of Health and Senior Services within 72 hours for referral for services. The provision authorizing Department services for such women has previously been repealed and this act repeals the reporting requirements for the physicians and health care providers.
Additionally, producers of ice cream, mellorine, or other frozen dessert products are required to be licensed by the Department and pay an associated license fee. This act repeals such requirement and fee.
These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS#2/SB 710 (2022), CCS/HCS/SS/SB 690 (2022), SCS/SB 1045 (2022), and SB 1100 (2022).
SARAH HASKINS