FIRSTREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
HOUSEBILLNO.489
102NDGENERALASSEMBLY
1261H.02C DANARADEMANMILLER,ChiefClerk
ANACT
Toamendchapters191and292,RSMo,byaddingtheretothirteennewsectionsrelatingto
healthcare,withpenaltyprovisions.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Chapters191and292,RSMo,areamendedbyaddingtheretothirteennew
2sections,tobeknownassections191.230,191.1770,191.1775,191.1780,191.1785,
3191.1790,191.1795,191.1800,191.1802,191.1805,191.1807,191.1810,and292.648,to
4readasfollows:
191.230.1.Nopublicschooldistrictorpubliccharterschoolreceivingpublic
2fundsshallrequireanystudent,asaconditionofenrollment,asaconditionof
3attendanceatanyschooleventoractivity,orforanyotherreason,to:
4 (1)ReceiveaCOVID-19vaccination;
5 (2)Receiveadoseofmessengerribonucleicacid;
6 (3)Receiveanytreatmentorprocedureintendedordesignedtoeditoralter
7humandeoxyribonucleicacidorthehumangenome;or
8 (4)Haveplacedunderthestudent'sskinanymechanicalorelectronicdevice.
9 2.Nopublicbody,asdefinedinsection290.210,statedepartmentoragency,
10politicalsubdivision,judgeorjudicialofficial,peaceofficer,publicofficial,orany
11personappointedbythegovernoractinginanofficialcapacityundersuchappointment
12shall:
13 (1)Requireanypersonto:
14 (a)ReceiveaCOVID-19vaccination;
15 (b)Receiveadoseofmessengerribonucleicacid;
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 16 (c)Receiveanytreatmentorprocedureintendedordesignedtoeditoralter
17humandeoxyribonucleicacidorthehumangenome;or
18 (d)Haveplacedundertheperson'sskinanymechanicalorelectronicdevice;or
19 (2)Imposeanyfine,tax,orcriminalorcivilpenalty,orconditionanypersonal
20right,basedonwhetherapersonhasreceivedorundergoneanyinterventiondescribed
21inparagraphs(a)to(d)ofsubdivision(1)ofthissubsection.
22 3.(1)TheprovisionsofthissectionrelatingtoCOVID-19vaccinationshallnot
23applytopubliccollegesanduniversitieswhereaCOVID-19vaccinationisrequiredfor
24employeesorselectstudentparticipantsinorderforthecollegesoruniversitiesto
25receivefederalfundsbutshallbeconstruedtoprohibitageneralrequirementthat
26studentsreceiveaCOVID-19vaccinationasaconditionofenrollment.
27 (2)TheprovisionsofthissectionrelatingtoCOVID-19vaccinationshallnot
28applytoanystudenttraininginahealthcarefieldorafieldrelatedtohealthcarewhois
29receivingclinicalhoursorothertrainingatafacilityorentitydescribedinsubdivisions
30(1)to(5)ofsubsection4ofthissection.
31 4.Theprovisionsofthissectionshallnotapplyto:
32 (1)Anyfacilitythatmeetsthedefinitionofahospitalinsection197.020;
33 (2)Anylong-termcarefacilitylicensedunderchapter198;
34 (3)Anyentitythatmeetsthedefinitionoffacilityinsection199.170;
35 (4)AnyfacilitycertifiedbytheCentersforMedicareandMedicaidServices;
36 (5)Anyentityorindividuallicensedundersections190.001to190.245;or
37 (6)Anyemployeesofanystatedepartmentoragencywhoarepartofanonsite
38surveyteamperformingfederaloversightofcertifiedprovidersandsuppliersforthe
39CentersforMedicareandMedicaidServices.
40 5.Acourtmaygrantanypersonwhoserightsareviolatedbythissectionrelief,
41includinginjunctiverelief.Acourtmayawardtheprevailingpartyinacauseofaction
42broughtunderthissectionreasonableattorney'sfees.
191.1770.Sections191.1770to191.1810shallbeknownandmaybecitedasthe
2"DoNoHarmAct".
191.1775.Forpurposesofsections191.1770to191.1810,thefollowingterms
2mean:
3 (1)"Academicstandards",thegradepointaverage,standardizedtestscore,or
4otherobjectivemetricusedtomeasureastudent'sachievementsforthepurposeof
5admissioninto,advancementin,orgraduationfromamedicalinstitutionofhigher
6education;
7 (2)"Diversity-equity-inclusion"or"DEI":
HCSHB489 2 8 (a)Anyefforttopromoteracialdiversityinanyaspectofahealthcare-related
9academicprogram;
10 (b)Anyreferencetogroupdifferenceswithinagivensettingwithrespectto
11culture,ethnicity,gender,genderidentity,nationalorigin,race,religion,orsexual
12orientation;and
13 (c)Thepromulgationofpolicies,practices,andproceduresdesignedor
14implementedwithreferencetothegroupdifferencesdescribedinparagraph(b)ofthis
15subdivision.
16
17Theterm"diversity-equity-inclusion"or"DEI"shallnotincludeequalopportunityor
18equalemploymentopportunitymaterialsdesignedtoinformindividualsaboutthe
19prohibitionondiscriminationbasedonprotectedstatusunderstateandfederallaw;
20 (3)"Healthcareprovider",anypublichospitalorpublichealthcareprovider
21including,butnotlimitedto,physicians'offices,outpatientclinics,medicaltestingsites,
22medicallaboratories,physicaloroccupationaltherapyorrehabilitationproviders,
23chiropractors,dentists,optometrists,mentalhealthandclinicalsocialworkers,and
24relatedproviders;
25 (4)"Healthcare-relatedacademicprogram",anyhealthcare-relatedareaof
26studydesignedtopreparestudentsforemploymentasorwithahealthcareproviderby
27conferringadegreeorcertificationincluding,butnotlimitedto,programsinnursing,
28pre-medicalstudies,medicaleducation,psychiatry,clinicalsocialwork,dentistry,dental
29hygiene,physicaloroccupationaltherapy,chiropracticcare,medicalequipment
30technicianstudies,andallrelatedfields;
31 (5)"Healthcare-relatedprofessionallicensingboard",theboardofpodiatric
32medicine,thestateboardofchiropracticexaminers,thedentalboard,thestateboardof
33registrationforthehealingarts,thestateboardofnursing,thestateboardof
34optometry,thestatecommitteeofpsychologists,thecommitteeforprofessional
35counselors,thestatecommitteeforsocialworkers,thestatecommitteeformarital
36andfamilytherapists,thestateboardofpharmacy,theboardofoccupationaltherapy,
37thestatecommitteeofdietitians,andtheboardoftherapeuticmassage;
38 (6)"Institutionofhighereducation",any:
39 (a)Statecommunitycollege;
40 (b)Statecollegeoruniversityofferingbachelor'sdegrees,master'sdegrees,or
41doctoratedegrees;or
42 (c)Tradeschool;
HCSHB489 3 43 (7)"Medicalinstitutionofhighereducation",anyinstitutionofhighereducation
44thatreceivesstatefundsandthatoffershealthcare-relateddegrees,healthcare-related
45certifications,orhealthcare-relatedtraining.
191.1780.1.Eachmedicalinstitutionofhighereducationshallsubmitanannual
2certificationbeforeDecemberthirty-firsttothestateboardofregistrationforthe
3healingartsandthecoordinatingboardforhighereducationstatingthattheinstitution:
4 (1)Doesnotrequireapplicantstosubscribetodiversity-equity-inclusion(DEI)
5ideologiesanddoesnotdiscriminateagainstapplicantswhodonotsubscribetoDEI
6ideologiesduringtheapplicationprocess;and
7 (2)DoesnotrequireadmittedstudentstostudyorsubscribetoDEIideologies
8withinthemedicalinstitutionofhighereducation.
9 2.Eachmedicalinstitutionofhighereducationshallpublishthetitlesandsyllabi
10forallmandatorycourses,seminars,classes,workshops,andtrainingsessionsonits
11websiteinanonlinedatabasethatisreadilysearchablebythepublic.
12 3.MedicalinstitutionsofhighereducationshallnotconductinternalDEIaudits
13orotherwiseengageDEIconsultants.
191.1785.1.Allmedicalinstitutionsofhighereducationinthisstateotherthan
2open-enrollmentinstitutionsshallrequireapplicantstocompleteastandardized
3admissionstestfocusedonknowledgeandcriticalthinkingwithrespecttoscience
4andmedicaltraininginordertoqualifyforadmission.
5 2.Amedicalinstitutionofhighereducationshallnotaltertheacademic
6standardsfortheadmissionofnewstudentstoahealthcare-relatedcourseofstudyor
7fortheconferralofahealthcare-relateddegreeorcertificateunlesstheinstitution
8submitstothegeneralassemblyandthecoordinatingboardforhighereducation:
9 (1)Acopyoftheproposedacademicstandards;
10 (2)Aconcisegeneralstatementrelatingtotheproposedstandards;and
11 (3)Theproposedeffectivedateoftheproposedstandards.
12 3.Theproposedstandardsdescribedinsubsection2ofthissectionshallbecome
13effectivenoearlierthansixtydaysfromthedateofthesubmissionoftheproposed
14standards,excludingdayseitherchamberofthegeneralassemblyisadjournedformore
15thanthreedays.
16 4.(1)Theproposedstandardsdescribedinsubsection2ofthissectionshallnot
17becomeeffectiveif,beforetheearliestdateonwhichthestandardsmaybecomeeffective
18asdescribedinsubsection3ofthissection,bothchambersofthegeneralassemblypass
19andthegovernorapprovesajointresolutionofdisapproval.
20 (2)Forpurposesofthissubsection,theterm"jointresolutionofdisapproval"
21meansaresolutionintroducedafterthesubmissionoftheproposedstandardsdescribed
HCSHB489 4 22insubsection2ofthissectionthatcontainsastatementinsubstantiallythefollowing
23form:"Thegeneralassemblydisapprovesthestandardssubmittedby______________
24____(themedicalinstitutionofhighereducation)relatingto__________________(the
25descriptionofthestandards),andsuchstandardsshallhavenoforceoreffect.".
191.1790.1.Healthcare-relatedprofessionallicensingboardsshallnotadoptor
2impose,asaconditionofobtainingorrenewinganylicense,anyincentivesor
3requirementsforapplicantsforlicensureorrenewaloflicensuretoundergo,
4demonstratefamiliaritywith,orsupportanydiversity-equity-inclusion(DEI)
5training,education,material,orprogram.
6 2.Organizationsthatissuestate-requiredhealthcare-relatedprofessional
7certificationsshallnotuseDEImaterialorrequireDEItrainingaspartofthe
8certificationprocess.
9 3.Healthcare-relatedprofessionallicensingboardsandorganizationsthatissue
10healthcare-relatedprofessionalcertificationsshallnotconductinternalDEIauditsor
11otherwiseengageDEIconsultants.
191.1795.1.Ahealthcareproviderormedicalinstitutionofhighereducation
2shallnotreceiveanystatecontractorgrantunlesstheproviderorinstitutionhas
3certifiedbeforetheawardofthecontractorgrantthatitdoesnotandwillnotrequire
4itsemployees,contractors,volunteers,vendors,oragentstosubscribeto,study,or
5receiveinstructionondiversity-equity-inclusionmaterialinconnectionwiththeuseof
6statefunds.
7 2.Eachhealthcareproviderandmedicalinstitutionofhighereducationshall
8submitanannualcertificationbeforeDecemberthirty-firsttothestateboardof
9registrationforthehealingartsstatingthattheproviderorinstitutiondoesnotandwill
10notrequireitsemployees,contractors,volunteers,vendors,oragentstosubscribeto,
11study,orreceiveinstructionondiversity-equity-inclusionmaterialinconnectionwith
12theuseofstatefunds.
191.1800.Anystateentityapplyingforafederalhealthcare-relatedgrant
2relatedtodiversity-equity-inclusionshallpublishonitswebsiteallmaterials,
3requirements,andinstructionsrelatedtothefederalgrantapplicationthatareinthe
4entity'spossession,submitacopyofthegrantproposaltothestateboardofregistration
5forthehealingartsforpublicposting,andsubmitacopyofthegrantproposaltoall
6membersofthehouseandsenatecommitteesonhealthpolicy.
191.1802.1.Anaggrievedpersonmaycommenceanactionagainstahealthcare
2providerormedicalinstitutionofhighereducationforviolationsofsections191.1770to
3191.1810.
HCSHB489 5 4 2.Ifanaggrievedpersonprovesthatahealthcareproviderormedical
5institutionofhighereducationviolatedsections191.1770to191.1810,thepersonis
6entitledtorecover:
7 (1)Declaratoryrelief;
8 (2)Injunctiverelief;
9 (3)Statutorydamagesofnotlessthanonehundredthousanddollarsassessed
10againstthehealthcareproviderormedicalinstitutionofhighereducationfoundbya
11courttohaveviolatedsections191.1770to191.1810;
12 (4)Compensatorydamages;and
13 (5)Costsandattorney'sfees.
14 3.Sovereignimmunitytosuitiswaivedandabolishedtotheextentofliability
15createdbysections191.1770to191.1810.Apersonhavingaclaimundersections
16191.1770to191.1810maysueahealthcareproviderormedicalinstitutionofhigher
17educationthatwouldotherwisebeentitledtosuchimmunityfordamagesallowedby
18sections191.1770to191.1810.
19 4.Anaggrievedpersonshallbringsuitundersections191.1770to191.1810not
20laterthanoneyearaftertheallegedviolationoccurred.
191.1805.1.Anyhealthcareproviderwithmorethanfiftyemployeesormedical
2institutionofhighereducationshallsubmitanannualcertificationtothestateboardof
3registrationforthehealingartsandtheattorneygeneralsignedbyanofficerofthe
4providerorinstitutionunderpenaltyofperjurystatingthattheproviderorinstitution
5isincompliancewiththeprovisionsofsections191.1770to191.1810.
6 2.Theattorneygeneralshallhavetheauthoritytoinvestigateallegationsof
7violationsofsections191.1770to191.1810.
8 3.Inadditiontoanyreliefgrantedtoaggrievedpersonsunderaprivaterightof
9action,theattorneygeneralmayseekcivilpenaltiesofuptoonemilliondollarsagainsta
10healthcareproviderormedicalinstitutionofhighereducationforeachviolationof
11sections191.1770to191.1810.
12 4.Theattorneygeneralmayfilesuitforawritofmandamuscompellingpublic
13healthcareprovidersorpublicmedicalinstitutionsofhighereducationtocomplywith
14sections191.1770to191.1810.
15 5.Theattorneygeneralshallhavetheauthoritytoestablish,byregulation,
16proceduresforinvestigatingviolationsofsections191.1770to191.1810.Anyruleor
17portionofarule,asthattermisdefinedinsection536.010,thatiscreatedunderthe
18authoritydelegatedinthissectionshallbecomeeffectiveonlyifitcomplieswithandis
19subjecttoalloftheprovisionsofchapter536and,ifapplicable,section536.028.This
20sectionandchapter536arenonseverableandifanyofthepowersvestedwiththe
HCSHB489 6 21generalassemblypursuanttochapter536toreview,todelaytheeffectivedate,orto
22disapproveandannularulearesubsequentlyheldunconstitutional,thenthegrantof
23rulemakingauthorityandanyruleproposedoradoptedafterAugust28,2023,shallbe
24invalidandvoid.
191.1807.Thestateboardofregistrationforthehealingartsshallpublishonits
2website,onanannualbasisbeforeDecemberthirty-first,alistofallthehealthcare
3providersandmedicalinstitutionsofhighereducationthathaveprovidedDEI
4certificationasrequiredundersections191.1770to191.1810.
191.1810.Ifanyprovisionofsections191.1770to191.1810ortheapplication
2thereoftoanypersonorcircumstanceisheldinvalid,suchdeterminationshallnotaffect
3theprovisionsorapplicationsofsections191.1770to191.1810whichmaybegiveneffect
4withouttheinvalidprovisionorapplication,andtothatendtheprovisionsofsections
5191.1770to191.1810areseverable.
292.648.1.Forpurposesofthissection,thefollowingtermsmean:
2 (1)"Employer",thesamemeaninggiventotheterminsection213.010,except
3thattheterm"employer"shallincludeanypubliccollegeoruniversity,anyfacilitythat
4meetsthedefinitionofahospitalinsection197.020,anylong-termcarefacilitylicensed
5underchapter198,anyentitythatmeetsthedefinitionoffacilityinsection199.170,and
6anyfacilitycertifiedbytheCentersforMedicareandMedicaidServices;
7 (2)"Medicaltreatment",any:
8 (a)Drug,medicine,syntheticsubstance,ortherapy,whethertherapeuticor
9preventive,thatisfullyapprovedorgrantedanemergencyuseauthorizationbythe
10UnitedStatesFoodandDrugAdministration(FDA),orpendingapprovalbytheFDA,
11orthatwouldrequireapprovalfromtheFDAtobesoldorprescribedtothegeneral
12public;
13 (b)Treatmentorprocedureintendedordesignedtoeditoralterhuman
14deoxyribonucleicacidorthehumangenome;or
15 (c)Mechanicalorelectronicdeviceplacedunderaperson'sskin.
16 2.Astudentshallbeexemptfromapubliccollege'soruniversity'srequirement
17toreceivemedicaltreatmentasaconditionofparticipationinanyprojectoractivity
18sponsoredbythecollegeoruniversityandshallnotbesubjecttoadverseactionbythe
19collegeoruniversityfordecliningtoreceivethemedicaltreatmentif:
20 (1)Thestudent:
21 (a)Holdsasincerelyheldreligiousbelief,whichmayincludeadeeplyheld
22nontheisticmoralbelief,thatforbidsthestudentfromreceivingthemedicaltreatment
23andthereasonableaccommodationofsuchbeliefwouldnotposeanunduehardshipon
24thecollegeoruniversity;or
HCSHB489 7 25 (b)Thestudenthasreceivedawrittenrecommendation,basedonthestudent's
26uniqueandindividualmedicalsituation,fromaphysicianlicensedtopracticemedicine
27inthestateofMissouri,advisingthestudentnottoreceivetherequiredmedical
28treatmentonthebasisthatthemedicaltreatmentislikelytobeharmfultothestudent
29orisnotinthebestmedicalinterestofthestudentforotherspecifiedreasons;and
30 (2)Thestudentsubmitsawrittenrequestfortheexemptiondescribedin
31subdivision(1)ofthissubsectiontothecollegeoruniversity.
32 3.Acourtmaygrantanypersonwhoserightsareviolatedbythissectionrelief,
33includinginjunctiverelief.Acourtmayawardtheprevailingpartyinacauseofaction
34broughtunderthissectionreasonableattorney'sfees.
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HCSHB489 8