HCS/SS/SCS/SB 106 - This act modifies several provisions relating to public health, including: (1) Rare Kidney Disease Awareness Month; (2) Office of Child Advocate; (3) "Missouri as a Model Employer" initiative; (4) special education records; (5) outside the hospital do not resuscitate act; (6) patient examinations; (7) health professional loans and grants; (8) breast examinations; (9) pharmacy settlements; (10) rural emergency hospitals; (11) supplemental assistance; (12) transitional public assistance benefits; (13) public assistance benefits applications; (14) Ticket to Work Health Assurance Program; (15) MO HealthNet for pregnant and postpartum women; (16) out-of-state Mo HealthNet payments; (17) Mo HealthNet eligibility redeterminations; (18) Missouri Employment First Act; (19) confidential information of certain children; (20) physical therapists; (21) mental health coordinators; (22) behavioral health services for certain accused persons; (23) civil commitments; and (24) lead poisoning.RARE KIDNEY DISEASE AWARENESS MONTH (Section 9.388)
This act establishes March of each year as "Rare Kidney Disease" in Missouri.
This provision is similar to a provision in 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 SCS/HB 677 (2023) and substantially similar to 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 HCS/HB 971 (2023) and substantially similar to SB 978 (2020) and HB 2358 (2020).
SPECIAL EDUCATION RECORDS (Section 167.027)
Under this act, a student's special education record shall be deemed a permanent record and shall be maintained as a part of a child's cumulative scholastic record. No school district or pubic school shall destroy a child's most recent student special education record.
This provision is substantially similar to HB 1289 (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 substantially similar to provisions in SS/HB 402 (2023) and SS/SCS/SB 228 (2023) and similar to HB 2741 (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 SS/HB 402 (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 HCS/HB 1162 (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 SS/HB 402 (2023) and HB 775 (2023).
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 any such examination 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 substantially similar to SCS/HB 283 (2023), HCS/HB 1742 (2022), and SB 746 (2022).
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 similar to provisions of the perfected SS/SB 82 (2023).
PUBLIC ASSISTANCE APPLICATIONS (Sections 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 substantially similar to a provisions in SS/SB 82 (2023), HB 1960 (2020) and similar to HB 2048 (2022).
BREAST EXAMINATIONS (Sections 192.775, 376.782, and 376.1183)
This act prohibits certain mammography facilities from requiring a referral from a primary care provider for a screening mammogram that is consistent with the recommendations in the most recent guidelines established by the American College of Radiology.
This act prohibits cost-sharing requirements under coverage for certain low-dose mammography screenings if a separate provision of law prohibits cost-sharing requirements with respect to such coverage. The act also prohibits health carriers from requiring a referral from a primary care provider to obtain a low-dose mammography screening required by law to be covered.
This act prohibits cost-sharing requirements under coverage provided for diagnostic breast examinations, supplemental breast examinations, or low-dose mammography screenings. If these provisions would result in health savings account (HSA) ineligibility, these provisions shall apply to HSA-qualified high-deductible health plans only after the deductible has been met.
These provisions are substantially similar to HCS/HBs 575 & 910 (2023) and similar to provisions in SB 461 (2023), SB 1166 (2022), and HB 2427 (2021).
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 SS/HB 402 (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 SS/HB 402 (2023) and substantially similar to SB 420 (2023).
SUPPLEMENTAL WELFARE ASSISTANCE (Section 208.030)
Under current law, certain persons may be eligible for up to $156 a month in supplemental welfare assistance for home care in licensed residential care facilities. This act removes that monthly cap and makes such assistance subject to appropriations.
This provision is identical to SB 336 (2023) and SB 1192 (2022), and to a provision in SS/HB 402 (2023), and is similar to provisions in CCS/HCS/SS/SB 690 (2022) and HCS/HB 2727 (2022).
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 similar to provisions of the perfected SS/SB 82 (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 substantially similar to a provisions in SS/SB 82 (2023), HB 1960 (2020) and similar to HB 2048 (2022).
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 HCS/HBs 971 & 970 (2023) and HB 194 (2023), and to a provision in CCS/HCS/SS/SCS/SBs 45 & 90 (2023), and 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 FOR PREGNANT AND POSTPARTUM WOMEN (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. This coverage shall begin on the effective date of the act and shall continue during any period of time the federal authorization for such coverage is in effect.
These provisions have an emergency clause.
These provisions are substantially similar to CCS/HCS/SS/SCS/SBs 45 & 90 (2023), 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 is identical to SB 282 (2023), SB 933 (2022), and SB 895 (2020), and to a provision in CCS/HCS/SS/SCS/SBs 45 & 90 (2023).
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 is identical to a provision in CCS/HCS/SS/SCS/SBs 45 & 90 (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 CCS/HCS/SS/SCS/SBs 45 & 90 (2023), HCS/HBs 971 & 970 (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 substantially similar to HB 1010 (2023) and similar to SB 628 (2023).
PRACTICE OF PHYSICAL THERAPY (Sections 334.100, 334.506, and 334.613)
This act modifies provisions relating to the practice of physical therapy. Under this act, physical therapists with a doctorate of physical therapy or 5 years of clinical experience may evaluate and initiate treatment on a patient without a prescription or referral from an approved health care provider. Physical therapists may provide certain educational information, fitness or wellness programs, screenings, and consultations without a prescription or referral regardless of whether a patient is symptomatic.
This act repeals provisions limiting the ability of a physical therapist to examine and treat certain conditions or injuries without a prescription or referral. Under this act, physical therapists shall refer to an approved health care provider patients with certain conditions, including those with conditions beyond the scope of practice of physical therapy, as well as any patient who does not demonstrate measurable or functional improvement within ten visits or 30 days, whichever occurs first.
A physical therapist shall consult with an approved health care provider after ten visits or 30 days, whichever occurs first, before continuing physical therapy if a patient's condition has improved and the physical therapist believes that continued physical therapy is reasonable and necessary. The physical therapist shall provide the provider certain information specified in the act during such consultation and continued physical therapy shall proceed in accordance with input from the provider. The physical therapist shall notify the provider of continuing physical therapy every 10 visits or 30 days unless the provider directs otherwise.
This act allows the Board of Registration for the Healing Arts to file a complaint against a physical therapist for evaluating or treating a patient in a manner inconsistent with provisions of the act and existing law governing the scope of practice for physical therapists, rather than allowing the Board to file a complaint for practicing or offering to practice independent of a prescription and the direction of certain health care providers listed in current law.
These provisions are identical to SS/SB 51 (2023), and are substantially similar to HB 1555 (2022) and provisions in HCS/SB 330 (2021).
MENTAL HEALTH COORDINATORS (Sections 441.740, 552.050, 630.045, 630.140, 630.175, 630.120, 631.135, 631.140, 631.150, 631.165, 632.005, 632.150, 632.155, 632.300, 632.305, 632.310, 632.315, 632.320, 632.325, 632.330, 632.335, 632.340, 632.345, 632.350, 632.355, 632.370, 632.375, 632.385, 632.390, 632.392, 632.395, 632.400, 632.410, 632.415, 632.420, 632.430, 632.440, 632.455, and 633.125)
This act repeals references to mental health coordinators throughout statutes regulating civil commitments. Additionally, this act changes the time frame for a designated staff member at a mental health facility to meet with an individual civilly detained at such facility from within 4 days of arrival at the facility to within 48 hours of arrival at the facility.
These provisions are identical to HB 1094 (2023) and SCS/SB 538 (2023).
BEHAVIORAL HEALTH SERVICES FOR CERTAIN ACCUSED PERSONS (Sections 552.020, 552.030, 552.040, and 552.080)
Currently, a judge may order a pretrial examination of an accused person whom the judge has reasonable cause to believe lacks mental fitness to proceed. The psychiatrist, psychologist, or physician performing the examination shall submit a report with findings, opinions, and recommendations on treatment in suitable hospitals. This act requires the examination report to contain opinions as to the accused's mental fitness to proceed in the reasonably foreseeable future and recommendations as to whether the accused, if found to lack mental fitness to proceed, should be committed to a suitable hospital for treatment or if the treatment can be provided in a county jail or other detention facility approved by the Director of the Department of Mental Health. Additionally, the report shall contain a recommendation as to whether the accused, if found to lack mental fitness to proceed and if not charged with a dangerous felony, murder in the first degree, or rape in the second degree, should be committed to a suitable hospital facility or may be appropriately treated in the community, and whether the accused can comply with bond conditions and treatment conditions.
This provision is substantially similar to SCS/SB 387 (2023).
LEAD POISONING (Sections 701.336, 701.340, 701.342, 701.344, and 701.348)
Currently, the Department of Health and Senior Services, in collaboration with the Department of Social Services and other health care organizations, shall develop an educational strategy to increase the number of children who are tested for lead poisoning under the Medicaid program. This act repeals a provision describing the goals and timelines of the educational strategy.
Under this act, every medical provider serving children shall annually provide education to all parents and guardians of children under 4 years of age regarding lead hazards and provide the option to test every child under 4 years of age with the consent of the parent or guardian. This act repeals the requirement that parents or guardians provide a written statement refusing lead testing.
This act repeals provisions requiring all children less than 6 years of age who reside or spend more than 10 hours a week in a high risk area to be annually tested for lead poisoning. Instead, every child under 6 years of age shall be annually assessed for lead poisoning risk and may be tested with the consent of the child's parent or guardian.
Finally, every child care facility located in a geographic area of high risk for lead poisoning shall, within 30 days of enrollment of a child age 12 months of age or older and under 5 years of age, require the child's parents or guardians to provide evidence of lead poisoning testing or a statement of refusal of such testing.
These provisions are identical to the perfected HCS/HB 906 (2023) and SCS/SB 507 (2023).
SARAH HASKINS