SB 45
Modifies provisions relating to health care
Sponsor:
LR Number:
0453S.10T
Committee:
Last Action:
7/6/2023 - Signed by Governor
Journal Page:
S2815
Title:
CCS HCS SS SCS SBs 45 & 90
Effective Date:
Varies
House Handler:

Current Bill Summary

CCS/HCS/SS/SCS/SBs 45 & 90 - This act modifies several provisions relating to health care, including: (1) health awareness days; (2) the Office of Child Advocate; (3) the "Missouri as a Model Employer" initiative; (4) opioid overdoses; (5) outside the hospital do-not-resuscitate orders; (6) patient examinations; (7) health care professional loans and grants; (8) pharmacy settlements; (9) rural emergency hospitals; (10) transitional benefits for TANF, SNAP, and child care; (11) public assistance applications; (12) Ticket to Work Health Assurance program; (13) MO HealthNet postpartum benefits; (14) out of state MO HealthNet payments; (15) MO HealthNet eligibility redeterminations; (16) the "Missouri Employment First Act"; (17) confidentiality of information of certain children; (18) APRN geographic proximity; (19) administration of medications by pharmacists; (20) access to dental provider networks; and (21) fentanyl testing.

HEALTH AWARENESS DAYS (Sections 9.371, 9.381, and 9.388)

This act establishes the first Saturday of October each year as "Breast Cancer Awareness Day" in Missouri.

This provision is identical to a provision in CCS/SS/SB 139 (2023) and similar to HB 436 (2023).

This act established October 2 of each year as "Premenstrual Dysphoric Disorder (PMDD) Awareness Day" in Missouri.

This provision is identical to a provision in HCS/HBs 1082 & 1094 (2023) and HCS/HB 885 (2023).

This act establishes March of each year as "Rare Kidney Disease" in Missouri.

This provision is identical to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023) and substantially similar to a provision in the truly agreed to and finally passed SS/HB 402 (2023).

OFFICE OF CHILD ADVOCATE (Section 37.725)

Currently, the identity of a complainant or recipient shall not be disclosed by the Office of Child Advocate unless they or their legal representative consents or a court orders the disclosure. This act permits disclosure of such identities if the Child Advocate determines that disclosure to law enforcement is necessary to ensure immediate child safety.

This provision is identical to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023) and SCS/HB 677 (2023) and substantially similar to a provision in the truly agreed to and finally passed CCS/HCS/SB 186 (2023), the truly agreed to and finally passed CCS/SB 28 (2023), HCS/SS#3/SB 22 (2023), HCS/HB 776 (2023), HS/HCS/HBs 1108 & 1181 (2023), and SB 249 (2023).

"MISSOURI AS A MODEL EMPLOYER" INITIATIVE (Section 37.980)

The act requires the Office of Administration to submit a report to the General Assembly each year before December 31 regarding the progress made by the state with regards to the "Missouri as a Model Employer" initiative created by Executive Order 19-16.

This provision is identical to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), the perfected HCS/HB 971 (2023), the perfected HCS/HB 719 (2023), and HB 674 (2023) and substantially similar to HB 616 (2023), SB 978 (2020), and HB 2358 (2020).

OPIOID OVERDOSES (Sections 190.255 and 195.206)

Currently, qualified first responders may obtain and administer naloxone to a person suffering from an apparent narcotic or opiate-related overdose. This act allows first responders to obtain and administer any drug or device approved by the FDA to block the effects of an opioid overdose. Licensed drug distributors or pharmacies may sell such drugs or devices to first responders for this purpose.

Under current law, state or local law enforcement agency staff members are required to act under the directives and protocols of a medical director of a local licensed ground ambulance service in order to administer naloxone or similar drugs or devices to a person suffering from an apparent narcotic or opiate-related overdose. Under this act, state or local law enforcement agency staff members would not need to act under such directives and protocols to administer naloxone or similar drugs or devices.

This act modifies the definition of "opioid antagonist" in a statute relating to standing orders for opioid antagonists. Currently, opioid antagonists are defined as naloxone hydrochloride and this act adds any other drug or device approved by the FDA that blocks the effect of an opioid overdose.

These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023) and SCS/HCS/HBs 117, 343, & 1091 (2023) and substantially similar to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), the truly agreed to and finally passed HCS/SS/SB 24 (2023), and the truly agreed to and finally passed CCS/HCS/SB 186 (2023).

OUTSIDE THE HOSPITAL DO-NOT-RESUSCITATE ORDERS (Sections 190.600-190.613)

This act modifies the "Outside the Hospital Do-Not-Resuscitate Act" by expanding the provisions to cover persons under 18 years of age who have do-not-resuscitate orders issued on their behalf by a parent or legal guardian or by a juvenile or family court under a current provision of law. Such orders shall function as outside the hospital do-not-resuscitate orders unless specifically stated otherwise. Persons who are not subject to civil, criminal, or administrative liability for certain actions taken upon the discovery of an adult outside the hospital do-no-resuscitate orders shall not be subject to such liability in the case of a minor child's do-not-resuscitate order. Emergency services personnel shall be authorized to comply with the minor child's do-not-resuscitate order, except when the minor child, either parent, the legal guardian, or the juvenile or family court expresses to such emergency services personnel in any manner, before or after the onset of a cardiac or respiratory arrest, the desire for the patient to be resuscitated.

Under this act, do-not-resuscitate orders from other states or territories, or Transportable Physician Orders for Patient Preferences/Physician Orders for Life-Sustaining Treatment (TPOPP/POLST) forms containing specific do-not-resuscitate provisions, as described in the act, shall be accepted under this provision and may be revoked by the patient or patient's representative at any time and by any means.

These provisions are identical to provisions in the truly agreed and finally passed HCS/SS/SCS/SB 106 (2023) and substantially similar to provisions in the truly agreed to and finally passed SS/HB 402 (2023), HCS/HB 594 (2023), SCS/HCS/HB 1015 (2023), HCS/SS/SB 198 (2023, HCS/SS/SB 213 (2023), and SS/SCS/SB 228 (2023), and similar to HB 2741 (2022).

PATIENT EXAMINATIONS (Section 191.240)

Under this act, no health care provider, or any student or trainee under the supervision of a health care provider, shall perform a patient examination, defined as a prostate, anal, or pelvic examination, upon an anesthetized or unconscious patient in a health care facility, unless: (1) the patient or person authorized to make health care decisions for the patient gives specific informed consent for nonmedical purposes, (2) the patient examination is necessary for diagnostic or treatment purposes, (3) the collection of evidence through a forensic examination for a suspected sexual assault is necessary because the evidence will be lost or the patient is unable to give informed consent due to a medical condition, or (4) emergency implied consent, as described in the act, is present. A health care provider shall notify a patient of certain examinations performed.

A health care provider who violates the provisions of this act, or who supervises a student or trainee who violates the provisions of this act, shall be subject to disciplinary action by the provider's licensing board.

This provision is identical to a provision in the truly agreed to and finally passed SS/HB 402 (2023) and substantially similar to provisions in HCS/SS/SB 198 (2023), SCS/HB 283 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), HB 406 (2023), HB 1031 (2023), HCS/HB 1742 (2022), and SB 746 (2022).

HEALTH PROFESSIONAL LOANS AND GRANTS (Sections 191.430-191.450, 191.500-191.550, 191.592, 191.600, 191.828, 191.831, and 335.203-335.257)

This act repeals current law relating to student loans for certain health professional students and establishes the "Health Professional Loan Repayment Program". Under this program, the Department of Health and Senior Services shall provide forgivable loans in order to repay existing loans for eligible educational expenses for health professional students.

The Director of the Department shall have the discretion to select the health professionals who are eligible for the forgivable loans in accordance with the greatest need in the best interest of the public. Individuals receiving loans under this program shall agree to serve at least 2 years in an area of defined need as a condition of receipt of the funds, among other criteria that must be met as delineated in the act. An individual who fails to uphold the loan agreement shall be liable for the amount paid to the individual by the Department under this program. Furthermore, if an individual breaches a written contract executed pursuant to this provision by failing to begin or complete his or her service obligation, the state shall be entitled to recover from such person an amount equal to:

The total amount of the loan awarded by the Department or, if the Department had already awarded partial forgiveness at the time of the breach, the amount of the loan not yet forgiven;

The interest on the amount that would be payable if at the time the loan was awarded it was a loan bearing interest at the maximum prevailing rate as determined by the Treasurer of the United States;

An amount equal to any damages incurred by the Department as a result of the breach; and

Any legal fees or associated costs incurred by the Department or the state of Missouri in the collection of damages.

The act additionally creates the Health Professional Loan Incentive Fund for the purpose of allowing the Department to provide loans under this provision. The fund will consist of funds appropriated to it by the General Assembly.

These provisions are identical to provisions in the truly agreed to and finally passed SS/HB 402 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), and HB 542 (2023) and substantially similar to SB 555 (2023).

This act establishes a medical residency grant program to award grants, subject to appropriation, for eligible entities for the purpose of establishing and funding new general primary care and psychiatry medical residency positions in Missouri and continuing the funding of the new positions for the duration of the residency. Funding shall be available for 3 years for residency positions in family medicine, general internal medicine, and general pediatrics. The Department of Health and Senior Services shall establish criteria for the grants as described in the act and report on the program to the General Assembly.

This provision expires on January 1, 2038.

This provision has an emergency clause.

This provision is identical to a provision in the truly agreed to and finally passed SS/SCS/HCS/HB 417 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), and the perfected HCS/HB 1162 (2023) and similar to HB 1179 (2023).

The act modifies the Nursing Education Incentive Program. Under current law, grant awards made under the program are limited to $150,000. This act repeals that limit. Additionally, the State Board of Nursing is required to collect, at the time of any license application or license renewal application, a Nursing Education Incentive Program surcharge from each person licensed or relicensed as a nurse under Missouri law. Such surcharge shall be equal to $1 for practical nurses and $5 for registered professional nurses.

The act repeals the Nursing Student Loan Program and the Nursing Student Loan Repayment Program.

These provisions are identical to provisions in the truly agreed to and finally passed SS/HB 402 (2023), the truly agreed to and finally passed SS/SCS/HCS/HB 417 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), HB 775 (2023), and SB 552 (2023).

PHARMACY SETTLEMENTS (Section 196.1050)

This act adds proceeds from opioid settlements with pharmacies to the Opioid Addiction Treatment and Recovery Fund.

This provision is identical to a provision in the truly agreed to and finally passed SS/HB 402 (2023) and SCS/HCS/HBs 117, 343, & 1091 (2023) and substantially similar to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023).

RURAL EMERGENCY HOSPITALS (Section 197.020)

This act modifies the term "hospital" for purposes of licensure to include facilities designated as rural emergency hospitals by the Centers for Medicare and Medicaid Services.

This provision is identical to a provision in the truly agreed to and finally passed SS/HB 402 (2023), the truly agreed to and finally passed HCS/SS/SB 24 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), and SB 420 (2023).

TRANSITIONAL BENEFITS FOR TANF, SNAP, AND CHILD CARE (Sections 208.035 and 208.053)

This act establishes, subject to appropriations, a transitional benefits program for Temporary Assistance for Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP). Such transitional benefits shall be designed to assist recipients of such programs whose monthly income has exceeded the maximum allowable income for program eligibility to continue receiving reduced benefits, as described in the act. Recipients of transitional benefits shall comply with all requirements of each program for which they are eligible, including work requirements. Transitional benefits received under this act shall not be included in the lifetime limit for TANF benefits.

This act modifies provisions relating to transitional child care benefits by expanding the Hand-Up pilot program statewide for individuals whose incomes exceed the maximum allowable amount for the full child care subsidy benefit. Transitional child care benefits shall be reduced benefits determined on a sliding scale as the recipient's income increases, with the recipient paying the remainder of the fee to the child care provider. Additionally, this act removes the expiration date of the Hand-Up program.

These provisions are identical to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023) and substantially similar to provisions in HCS/SS/SB 82 (2023) and the perfected HCS/HB 719 (2023).

PUBLIC ASSISTANCE APPLICATIONS (Section 208.066 and 208.072)

Under this act, the Department of Social Services, subject to federal approval, shall limit any initial application for SNAP, TANF, child care assistance, or any medical assistance or health insurance program to a concise, non-duplicative, and easily accessible form on the Department's website. Program participants who are required to complete a periodic eligibility review form may submit such form as an attachment to their Missouri state individual income tax return if the eligibility review form is due at the same time as the tax return. Such eligibility forms shall also be made accessible on the Department of Revenue's website.

This provision is identical to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023) and substantially similar to a provision in HCS/SS/SB 82 (2023), the perfected HCS/HB 719 (2023), and HB 1960 (2020) and similar to HB 2048 (2022).

Under this act, the application of a minor or incapacitated applicant for MO HealthNet benefits shall by accepted from someone acting responsibly for the applicant.

This provision is identical to a provision in HCS/SS/SB 198 (2023), HCS/SS/SB 213 (2023), and HB 1288 (2023).

TICKET TO WORK HEALTH ASSURANCE PROGRAM (SECTION 208.146)

The Ticket to Work Health Assurance Program provides medical assistance through MO HealthNet for employed disabled persons who meet certain qualifications, including asset limits and earned, net, and gross income calculations. Under current law, disabled individuals whose income exceeds one hundred percent of the federal poverty level (FPL) pay a premium for participation in the program. If an eligible person's employer offers employer-sponsored health insurance and the Department of Social Services determines the employer-sponsored insurance is more cost effective, the Department will instead pay that person's costs for the employer-sponsored health insurance.

This act changes the program in the following ways: (1) excludes retirement accounts from asset limit calculations; (2) modifies the income calculation from a net/gross calculation to a broader definition that would consider income for those disabled persons with incomes up to 250% FPL, with earned income of the disabled worker from 250 to 300% FPL disregarded, and retaining the requirement that persons with incomes over 100% FPL pay a premium; (3) removes all earned income of the disabled worker from the list of disregards in income determinations; (4) adds to the list of disregards the first $50,000 of earned income of a spouse; (5) if the Department elects to pay the person's costs of employer-sponsored health insurance, MO HealthNet assistance shall be provided as a secondary or supplemental policy for only personal care assistance services and non-emergency medical transportation; and (6) the Department shall provide an annual report to the General Assembly concerning the number of participants and outreach and education efforts.

This provision is identical to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), the perfected HCS/HBs 971 & 970 (2023), the perfected HCS/HB 719 (2023), and HB 194 (2023), substantially similar to SB 773 (2022), HB 1927 (2022), SB 607 (2021), SB 629 (2020), SB 432 (2019), and the perfected SS/SB 699 (2018), and similar to HB 1527 (2018), SCS/SB 203 (2017), and SB 925 (2016).

MO HEALTHNET POSTPARTUM BENEFITS (Sections 208.151 and 208.662)

Currently, low-income pregnant and postpartum women receiving benefits through MO HealthNet for Pregnant Women or Show-Me Healthy Babies are eligible for pregnancy-related coverage throughout the pregnancy and for 60 days following the end of the pregnancy. Under this act, MO HealthNet coverage for these low-income women will include full Medicaid benefits for the duration of the pregnancy and for one year following the end of the pregnancy. The Department shall submit any necessary state plan amendments or waivers, as described in the act.

This provision has an emergency clause.

These provisions are identical to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), and the perfected HCS/HB 719 (2023), substantially similar to provisions in SB 193 (2023), HB 91 (2023), HB 286 (2023), HB 328 (2023), HB 1186 (2023), and HCS/HBs 354, 965, 254, & 957 (2023), and similar to SCS/SBs 698 & 639 (2022) and provisions in HCS/SS#2/SB 823 (2022) and SCS/HCS/HB 2012 (2022).

OUT OF STATE MO HEALTHNET PAYMENTS (Section 208.186)

Under this act, the state shall not provide any payments, add-ons, or reimbursements to health care providers through MO HealthNet for medical assistance services to persons who are not considered Missouri residents under federal regulations.

This provision has an emergency clause.

This provision is identical to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), SB 282 (2023), the perfected HCS/HB 719 (2023), SB 933 (2022), and SB 895 (2020).

MO HEALTHNET ELIGIBILITY REDETERMINATIONS (Section 208.239)

Finally, within 30 days of the effective date of this act, the Department of Social Services shall resume annual MO HealthNet eligibility redeterminations, renewals, and post-enrollment verifications.

This provision has an emergency clause.

This provision is identical to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023) and the perfected HCS/HB 719 (2023).

"MISSOURI EMPLOYMENT FIRST ACT" (Section 209.700)

The act also creates the Missouri Employment First Act, which requires state agencies that provide employment-related services or that provide services or support to persons with disabilities to:

Develop collaborative relationships with each other, confirmed by a written memorandum of understanding signed by each such state agency;

Implement coordinated strategies to promote competitive integrated employment including, but not limited to, coordinated service planning, job exploration, increased job training, and internship opportunities;

Implement an employment first policy by considering competitive integrated employment as the first and preferred outcome when planning or providing services or supports to persons with disabilities who are of working age;

Offer information on competitive integrated employment to all working-age persons with disabilities. The information offered shall include an explanation of the relationship between a person's earned income and his or her public benefits, information on Achieving a Better Life Experience (ABLE) accounts, and information on accessing assistive technology;

Ensure that persons with disabilities receive the opportunity to understand and explore education and training as pathways to employment, including postsecondary, graduate, and postgraduate education; vocational and technical training; and other training. State agencies shall not be required to fund any education or training unless otherwise required by law;

Promote the availability and accessibility of individualized training designed to prepare a person with a disability for the person's preferred employment;

Promote partnerships with private agencies that offer supported employment services, if appropriate;

Promote partnerships with employers to overcome barriers to meeting workforce needs with the creative use of technology and innovation;

Ensure that staff members of public schools, vocational service programs, and community providers receive the support, guidance, and training that they need to contribute to attainment of the goal of competitive integrated employment for all persons with disabilities;

Ensure that competitive integrated employment, while the first and preferred outcome when planning or providing services or supports to persons with disabilities who are of working age, is not required of a person with a disability to secure or maintain public benefits for which the person is otherwise eligible; and

At least once each year, discuss basic information about competitive integrated employment with the parents or guardians of a youth with a disability. If the youth with a disability has been emancipated, state agencies shall discuss this information with the youth with a disability. The information offered shall include an explanation of the relationship between a person's earned income and his or her public benefits, information about ABLE accounts, and information about accessing assistive technology.

These provisions are identical to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), the perfected HCS/HBs 971 & 970 (2023), the perfected HCS/HB 719 (2023), and HB 674 (2023).

CONFIDENTIALITY OF INFORMATION OF CERTAIN CHILDREN (Section 210.1360)

Under this act, any personally identifiable information regarding any child receiving child care from a provider or applying for or receiving any services through a state program shall not be subject to disclosure, except as described in the act.

This provision is identical to a provision in the truly agreed to and finally passed CCS/SB 28 (2023), the truly agreed to and finally passed HCS/SCS/SB 103 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), and the truly agreed to and finally passed SS/HB 447 (2023), substantially similar to HCS/SS/SB 198 (2023), HCS/SS/SB 213 (2023), SB 628 (2023), the perfected HB 1010 (2023), and SCS/HB 677 (2023).

APRN GEOGRAPHIC PROXIMITY (Section 334.104)

This act modifies collaborative practice arrangements regarding geographic proximity between nurses and physicians. Currently, an advanced practice registered nurse (APRN) and physician in a collaborative practice arrangement shall maintain a geographic proximity of 75 miles of each other, unless otherwise specified in law. Under this act and until August 28, 2025, an APRN and physician may practice within 200 miles by road of each other if the APRN is providing services in a correctional center. An incarcerated patient who requests or requires a physician consultation shall be treated by a physician as soon as appropriate.

This provision is identical to a provision in the perfected HCS/HBs 119, 372, 382, 420, 550, & 693 (2023) and substantially similar to a provision in the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), the truly agreed to and finally passed SS/HB 402 (2023), and the truly agreed to and finally passed SS/HCS/HBs 115 & 99 (2023).

ADMINISTRATION OF MEDICATIONS BY PHARMACISTS (Sections 338.010 and 338.012)

This act modifies several provisions relating to the administration of medications by pharmacists. First, this act modifies the definition of a medication therapeutic plan by repealing language defining it by the prescription order so long as the prescription order is specific to each patient for care by a pharmacist. This act also repeals language from current law defining the practice of pharmacy as including the administration of specific vaccines by written physician protocol for specific patients and adds language defining the practice of pharmacy as including the ordering and administering of certain FDA-approved or authorized vaccines to persons at least 7 years of age or the CDC-approved age, whichever is older, pursuant to rules promulgated by the Board of Pharmacy and the Board of Registration for the Healing Arts or rules promulgated under a state of emergency.

Under current law, any pharmacist who accepts a prescription order for a medication therapeutic plan shall have a written protocol from the referring physician. This act repeals this provision and permits a pharmacist with a certificate of medication therapeutic plan authority to provide medication therapy services pursuant to a written physician protocol to patients with an established physician-patient relationship with the protocol physician.

Under this act, a licensed pharmacist may order and administer vaccines approved or authorized by the FDA to address a public health need, as authorized by the state or federal government, during a state or federally-declared public health emergency.

Finally, a pharmacist with a certificate of medication therapeutic plan authority may provide influenza, group A streptococcus, and COVID-19 medication therapy services pursuant to a statewide standing order issued by the Director of the Department of Health and Senior Services or a physician licensed by the Department.

These provisions are identical to provisions in the truly agreed to and finally passed SS/HCS/HBs 115 & 99 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), the perfected SS/SCS/SB 41 (2023), and SCS/HCS/HBs 117, 343, & 1091 (2023) and substantially similar to provisions in HCS/HB 2452 (2022), SB 1126 (2022), and HCS/SS/SB 690 (2022).

ACCESS TO DENTAL PROVIDER NETWORKS (Section 376.1060)

This act modifies a statute regarding access to dental provider networks to apply to dentists providing any health care service under network plans, as defined in the act.

The act repeals certain limitations on sale, assignment, or other grants of access to dentists' health care services, and specifies that a contracting entity shall only grant a third party, as such terms are defined in the act, access to the dentists' services if certain conditions are met.

The act repeals a requirement that upon a dentist's request, a contracting entity shall properly identify any third-party that has been granted access to the dentist's services. The act also specifies that no dentist shall be required to perform health care services under a provider network to which access has been granted to a third party in violation of the act.

The act also repeals a requirement that third parties who have contracted for access to participating dentists' discounted rates shall comply with the dentists' contracts unless otherwise agreed by the dentists, including with regard to payment rates and methods.

Additionally, the act repeals a provision of law specifying that a contracting entity shall be deemed in compliance with the statute if the insured's identification card identifies the insurance carrier to be used to reimburse the participating dentist for the covered services.

This act shall not apply if access to a provider network contract is granted to any entity operating in accordance with the same brand licensee program as the contracting entity, or to affiliates of the contracting entity. A list of the contracting entity's affiliates shall be made available to a provider on the contracting entity's website. This act shall not apply to provider network contracts for health care services provided to beneficiaries of state-sponsored health insurance programs, including but not limited to MO HealthNet and the Children's Health Insurance Program (CHIP).

These provisions are similar to SB 527 (2023) and HB 100 (2023).

FENTANYL TESTING (Section 579.088)

Under this act, it shall not be unlawful to manufacture, possess, sell, deliver, or use any device, equipment, or other material for the purpose of analyzing controlled substances for the presence of fentanyl.

This provision is identical to a provision in the truly agreed to and finally passed SS/SCS/SBs 189, 36, & 37 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), the truly agreed to and finally passed HCS/SS/SB 24 (2023), the truly agreed to and finally passed SS/HB 402 (2023), SB 480 (2023), HB 927 (2023), HB 250 (2023), and SCS/HCS/SBs 117, 343, & 1091 (2023).

SARAH HASKINS