Missouri 2023 Regular Session

Missouri Senate Bill SB45 Compare Versions

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1	1
2	2	EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
3	3	and is intended to be omitted in the law.
4	4	FIRST REGULAR SESSION
5	5	[TRULY AGREED TO AND FINALLY PASSED ]
6	6	CONFERENCE COMMITTEE SUBSTITUTE FOR
7	7	HOUSE COMMITTEE SUBSTITUTE FOR
8	8	SENATE SUBSTITUTE FOR
9	9	SENATE COMMITTEE SUBSTITUTE FOR
10	10	SENATE BILLS NOS. 45 & 90
11	11	102ND GENERAL ASSEMBLY
12	12	2023
13	13	0453S.10T
14	14	AN ACT
15	15	To repeal sections 37.725, 190.255, 190.600, 190.603, 190.606, 190.612, 191.500, 191.505,
16	16	191.510, 191.515, 191.520, 191.525, 191.530, 191.535, 191.540, 191.545, 191.550,
17	17	191.600, 191.828, 191.831, 195.206, 196.1050, 197.020, 208.053, 208.072, 208.146,
18	18	208.151, 208.662, 334.104, 335.203, 335.212, 335.215, 335.218, 335.221, 335.224,
19	19	335.227, 335.230, 335.233, 335.236, 335.239, 335.242, 335.245, 335.248, 335.251,
20	20	335.254, 335.257, 338.010, and 376.1060, RSMo, and to enact in lieu thereof forty-
21	21	two new sections relating to health care, with an emergency clause for certain sections
22	22	and penalty provisions.
23	23
24	24	Be it enacted by the General Assembly of the State of Missouri, as follows:
25	25	Section A. Sections 37.725, 190.255, 190 .600, 190.603, 1
26	26	190.606, 190.612, 191.500, 191.505, 191.510, 191.515, 191.520, 2
27	27	191.525, 191.530, 191.535, 191.540, 191.545, 191.550, 191.600, 3
28	28	191.828, 191.831, 195.206, 196.1050, 197.020, 208.053, 208.072, 4
29	29	208.146, 208.151, 208.662, 334.104, 335.203, 335.21 2, 335.215, 5
30	30	335.218, 335.221, 335.224, 335.227, 335.230, 335.233, 335.236, 6
31	31	335.239, 335.242, 335.245, 335.248, 335.251, 335.254, 335.257, 7
32	32	338.010, and 376.1060, RSMo, are repealed and forty -two new 8
33	33	sections enacted in lieu thereof, to be known as sections 9.371, 9
34	34	9.381, 9.388, 37.725, 37.980, 190.255, 190.600, 190.603, 10 2
35	35	CCS HCS SS SCS SBs 45 & 90
36	36	190.606, 190.612, 190.613, 191.240, 191.430, 191.435, 191.440, 11
37	37	191.445, 191.450, 191.592, 191.600, 191.828, 191.831, 195.206, 12
38	38	196.1050, 197.020, 208.035, 208.053, 208.066, 208.072, 208.146, 13
39	39	208.151, 208.186, 208.239, 208.662, 209.700, 210.1360, 334.104, 14
40	40	335.203, 335.205, 338.010, 338.012, 376.1060, and 579.088, to 15
41	41	read as follows:16
42	42	9.371. The first Saturday of October of each year is 1
43	43	hereby designated as "Breast Cancer Awareness Day" in 2
44	44	Missouri. The citizens of this state are encouraged to 3
45	45	participate in appropriate events and activities to raise 4
46	46	awareness and celebrate survivors of breast cancer, the most 5
47	47	commonly occurring cancer among women in the United States. 6
48	48	9.381. October second of each year is hereby 1
49	49	designated as "Premenstrual Dysphoric Disorder (PMDD) 2
50	50	Awareness Day" in Missouri. The citizens of this state are 3
51	51	encouraged to participate in appropriate events and 4
52	52	activities to raise PMDD awareness. 5
53	53	9.388. The month of March of each year is hereby 1
54	54	designated as "Rare Kidney Disease Awareness Month". The 2
55	55	citizens of this state are encouraged to participate in 3
56	56	appropriate awareness and educational activities for rare 4
57	57	kidney disease, available screening and genetic testing 5
58	58	options, and efforts to improve treatment for patients. 6
59	59	37.725. 1. Any files maintained by the advocate 1
60	60	program shall be disclosed only at the discretion of the 2
61	61	child advocate; except th at the identity of any complainant 3
62	62	or recipient shall not be disclosed by the office unless: 4
63	63	(1) The complainant or recipient, or the complainant's 5
64	64	or recipient's legal representative, consents in writing to 6
65	65	such disclosure; [or] 7
66	66	(2) Such disclosure is required by court order ; or 8 3
67	67	CCS HCS SS SCS SBs 45 & 90
68	68	(3) The child advocate determines that disclosure to 9
69	69	law enforcement is necessary to ensure immediate child 10
70	70	safety. 11
71	71	2. Any statement or communication made by the office 12
72	72	relevant to a complaint received by, proceedings before, or 13
73	73	activities of the office and any complaint or information 14
74	74	made or provided in good faith by any person shall be 15
75	75	absolutely privileged and such person shall be immune from 16
76	76	suit. 17
77	77	3. Any representative of the office condu cting or 18
78	78	participating in any examination of a complaint who 19
79	79	knowingly and willfully discloses to any person other than 20
80	80	the office, or those persons authorized by the office to 21
81	81	receive it, the name of any witness examined or any 22
82	82	information obtained o r given during such examination is 23
83	83	guilty of a class A misdemeanor. However, the office 24
84	84	conducting or participating in any examination of a 25
85	85	complaint shall disclose the final result of the examination 26
86	86	with the consent of the recipient. 27
87	87	4. The office shall not be required to testify in any 28
88	88	court with respect to matters held to be confidential in 29
89	89	this section except as the court may deem necessary to 30
90	90	enforce the provisions of sections 37.700 to 37.730, or 31
91	91	where otherwise required by court order . 32
92	92	37.980. 1. The office of administration shall submit 1
93	93	a report to the general assembly before December thirty - 2
94	94	first of each year, beginning in 2023, describing the 3
95	95	progress made by the state with respect to the directives 4
96	96	issued as part of the "Missouri as a Model Employer" 5
97	97	initiative described in executive order 19 -16. 6
98	98	2. The report shall include, but not be limited to, 7
99	99	the data described in the following subdivisions, which 8 4
100	100	CCS HCS SS SCS SBs 45 & 90
101	101	shall be collected through voluntary self -disclosure. To 9
102	102	the extent possible, for each subdivision, the report shall 10
103	103	include general data for all relevant employees, in addition 11
104	104	to data comparing the employees of each agency within the 12
105	105	state workforce: 13
106	106	(1) The baseline number of employees in the state 14
107	107	workforce who disclosed disabilities when the initiative 15
108	108	began; 16
109	109	(2) The number of employees in the state workforce who 17
110	110	disclose disabilities at the time of the compiling of the 18
111	111	annual report and statistics providing the size and the 19
112	112	percentage of any increase or decrease in such numbers since 20
113	113	the initiative began and since the compilation of any 21
114	114	previous annual report; 22
115	115	(3) The baseline percentage of employees in the state 23
116	116	workforce who disclosed disabilities when the initiativ e 24
117	117	began; 25
118	118	(4) The percentage of employees in the state workforce 26
119	119	who disclose disabilities at the time of the compiling of 27
120	120	the annual report and statistics providing the size of any 28
121	121	increase or decrease in such percentage since the initiative 29
122	122	began and since the compilation of any previous annual 30
123	123	report; 31
124	124	(5) A description and analysis of any disparity that 32
125	125	may exist from the time the initiative began and the time of 33
126	126	the compiling of the annual reports, and of any disparity 34
127	127	that may exist from the time of the most recent previous 35
128	128	annual report, if any, and the time of the current annual 36
129	129	report, between the percentage of individuals in the state 37
130	130	of working age who disclose disabilities and the percentage 38
131	131	of individuals in the state work force who disclose or have 39
132	132	disabilities; and 40 5
133	133	CCS HCS SS SCS SBs 45 & 90
134	134	(6) A description and analysis of any pay differential 41
135	135	that may exist in the state workforce between individuals 42
136	136	who disclose disabilities and individuals who do not 43
137	137	disclose disabilities. 44
138	138	3. The report shall also include descriptions of 45
139	139	specific efforts made by state agencies to recruit, hire, 46
140	140	advance, and retain individuals with disabilities including, 47
141	141	but not limited to, individuals with the most significant 48
142	142	disabilities, as defined in 5 CS R 20-500.160. Such 49
143	143	descriptions shall include, but not be limited to, best, 50
144	144	promising, and emerging practices related to: 51
145	145	(1) Setting annual goals; 52
146	146	(2) Analyzing barriers to recruiting, hiring, 53
147	147	advancing, and retaining individuals with disa bilities; 54
148	148	(3) Establishing and maintaining contacts with 55
149	149	entities and organizations that specialize in providing 56
150	150	education, training, or assistance to individuals with 57
151	151	disabilities in securing employment; 58
152	152	(4) Using internships, apprenticeshi ps, and job 59
153	153	shadowing; 60
154	154	(5) Using supported employment, individual placement 61
155	155	with support services, customized employment, telework, 62
156	156	mentoring and management training, stay -at-work and return- 63
157	157	to-work programs, and exit interviews; 64
158	158	(6) Adopting, posting, and making available to all job 65
159	159	applicants and employees reasonable accommodation procedures 66
160	160	in written and accessible formats; 67
161	161	(7) Providing periodic disability awareness training 68
162	162	to employees to build and sustain a culture of inclus ion in 69
163	163	the workplace, including rights to reasonable accommodation 70
164	164	in the workplace; 71 6
165	165	CCS HCS SS SCS SBs 45 & 90
166	166	(8) Providing periodic training to human resources and 72
167	167	hiring managers in disability rights, hiring, and workplace 73
168	168	policies designed to promote a diverse and inc lusive 74
169	169	workforce; and 75
170	170	(9) Making web-based hiring portals accessible to and 76
171	171	usable by applicants with disabilities. 77
172	172	190.255. 1. Any qualified first responder may obtain 1
173	173	and administer naloxone , or any other drug or device 2
174	174	approved by the United States Food and Drug Administration, 3
175	175	that blocks the effects of an opioid overdose and is 4
176	176	administered in a manner approved by the United States Food 5
177	177	and Drug Administration to a person suffering from an 6
178	178	apparent narcotic or opiate -related overdose in order to 7
179	179	revive the person. 8
180	180	2. Any licensed drug distributor or pharmacy in 9
181	181	Missouri may sell naloxone , or any other drug or device 10
182	182	approved by the United States Food and Drug Administration, 11
183	183	that blocks the effects of an opio id overdose and is 12
184	184	administered in a manner approved by the United States Food 13
185	185	and Drug Administration to qualified first responder 14
186	186	agencies to allow the agency to stock naloxone or other such 15
187	187	drugs or devices for the administration of such drug or 16
188	188	device to persons suffering from an apparent narcotic or 17
189	189	opiate overdose in order to revive the person. 18
190	190	3. For the purposes of this section, "qualified first 19
191	191	responder" shall mean any [state and local law enforcement 20
192	192	agency staff,] fire department personnel, fire district 21
193	193	personnel, or licensed emergency medical technician who is 22
194	194	acting under the directives and established protocols of a 23
195	195	medical director of a local licensed ground ambulance 24
196	196	service licensed under section 190.109 , or any state or 25
197	197	local law enforcement agency staff member, who comes in 26 7
198	198	CCS HCS SS SCS SBs 45 & 90
199	199	contact with a person suffering from an apparent narcotic or 27
200	200	opiate-related overdose and who has received training in 28
201	201	recognizing and responding to a narcotic or opiate overdose 29
202	202	and the administration of naloxone, or any other drug or 30
203	203	device approved by the United States Food and Drug 31
204	204	Administration, that blocks the effects of an opioid 32
205	205	overdose and is administered in a manner approved by the 33
206	206	United States Food and Drug Administration to a person 34
207	207	suffering from an apparent narcotic or opiate -related 35
208	208	overdose. "Qualified first responder agencies" shall mean 36
209	209	any state or local law enforcement agency, fire department, 37
210	210	or ambulance service that provides documented training to 38
211	211	its staff related to the administration of naloxone or other 39
212	212	such drugs or devices in an apparent narcotic or opiate 40
213	213	overdose situation. 41
214	214	4. A qualified first responder shall only administer 42
215	215	naloxone, or any other drug or device approved by the United 43
216	216	States Food and Drug Administration, that blocks the effects 44
217	217	of an opioid overdose and is administered in a manner 45
218	218	approved by the United States Food and Drug Administration 46
219	219	by such means as the qualified first responder has received 47
220	220	training for the administrati on of naloxone or other such 48
221	221	drugs or devices. 49
222	222	190.600. 1. Sections 190.600 to 190.621 shall be 1
223	223	known and may be cited as the "Outside the Hospital Do -Not- 2
224	224	Resuscitate Act". 3
225	225	2. As used in sections 190.600 to 190.621, unless the 4
226	226	context clearly requires otherwise, the following terms 5
227	227	shall mean: 6
228	228	(1) "Attending physician": 7 8
229	229	CCS HCS SS SCS SBs 45 & 90
230	230	(a) A physician licensed under chapter 334 selected by 8
231	231	or assigned to a patient who has primary responsibility for 9
232	232	treatment and care of the pat ient; or 10
233	233	(b) If more than one physician shares responsibility 11
234	234	for the treatment and care of a patient, one such physician 12
235	235	who has been designated the attending physician by the 13
236	236	patient or the patient's representative shall serve as the 14
237	237	attending physician; 15
238	238	(2) "Cardiopulmonary resuscitation" or "CPR", 16
239	239	emergency medical treatment administered to a patient in the 17
240	240	event of the patient's cardiac or respiratory arrest, and 18
241	241	shall include cardiac compression, endotracheal intubation 19
242	242	and other advanced airway management, artificial 20
243	243	ventilation, defibrillation, administration of cardiac 21
244	244	resuscitation medications, and related procedures; 22
245	245	(3) "Department", the department of health and senior 23
246	246	services; 24
247	247	(4) "Emergency medical services p ersonnel", paid or 25
248	248	volunteer firefighters, law enforcement officers, first 26
249	249	responders, emergency medical technicians, or other 27
250	250	emergency service personnel acting within the ordinary 28
251	251	course and scope of their professions, but excluding 29
252	252	physicians; 30
253	253	(5) "Health care facility", any institution, building, 31
254	254	or agency or portion thereof, private or public, excluding 32
255	255	federal facilities and hospitals, whether organized for 33
256	256	profit or not, used, operated, or designed to provide health 34
257	257	services, medical treatment, or nursing, rehabilitative, or 35
258	258	preventive care to any person or persons. Health care 36
259	259	facility includes but is not limited to ambulatory surgical 37
260	260	facilities, health maintenance organizations, home health 38
261	261	agencies, hospices, infirmaries, renal dialysis centers, 39 9
262	262	CCS HCS SS SCS SBs 45 & 90
263	263	long-term care facilities licensed under sections 198.003 to 40
264	264	198.186, medical assistance facilities, mental health 41
265	265	centers, outpatient facilities, public health centers, 42
266	266	rehabilitation facilities, and residential treatment 43
267	267	facilities; 44
268	268	(6) "Hospital", a place devoted primarily to the 45
269	269	maintenance and operation of facilities for the diagnosis, 46
270	270	treatment, or care for not less than twenty -four consecutive 47
271	271	hours in any week of three or more nonrelated individuals 48
272	272	suffering from illness, disease, injury, deformity, or other 49
273	273	abnormal physical conditions; or a place devoted primarily 50
274	274	to provide for not less than twenty -four consecutive hours 51
275	275	in any week medical or nursing care for three or more 52
276	276	nonrelated individuals. Hospital does not include any long - 53
277	277	term care facility licensed under sections 198.003 to 54
278	278	198.186; 55
279	279	(7) "Outside the hospital do -not-resuscitate 56
280	280	identification" or "outside the hospital DNR 57
281	281	identification", a standardized identification card, 58
282	282	bracelet, or necklace of a single color, form, and design as 59
283	283	described by rule of the department that signifies that the 60
284	284	patient's attending physician has issued an outside the 61
285	285	hospital do-not-resuscitate order for the patient and has 62
286	286	documented the grounds for the order in the patient's 63
287	287	medical file; 64
288	288	(8) "Outside the hospital do -not-resuscitate order" or 65
289	289	"outside the hospital DNR order", a written physician's 66
290	290	order signed by the patient and the attending physician, or 67
291	291	the patient's representative and the a ttending physician, in 68
292	292	a form promulgated by rule of the department which 69
293	293	authorizes emergency medical services personnel to withhold 70 10
294	294	CCS HCS SS SCS SBs 45 & 90
295	295	or withdraw cardiopulmonary resuscitation from the patient 71
296	296	in the event of cardiac or respiratory arrest; 72
297	297	(9) "Outside the hospital do -not-resuscitate protocol" 73
298	298	or "outside the hospital DNR protocol", a standardized 74
299	299	method or procedure promulgated by rule of the department 75
300	300	for the withholding or withdrawal of cardiopulmonary 76
301	301	resuscitation by emergency medical se rvices personnel from a 77
302	302	patient in the event of cardiac or respiratory arrest; 78
303	303	(10) "Patient", a person eighteen years of age or 79
304	304	older who is not incapacitated, as defined in section 80
305	305	475.010, and who is otherwise competent to give informed 81
306	306	consent to an outside the hospital do -not-resuscitate order 82
307	307	at the time such order is issued, and who, with his or her 83
308	308	attending physician, has executed an outside the hospital do - 84
309	309	not-resuscitate order under sections 190.600 to 190.621. A 85
310	310	person who has a patient's representative shall also be a 86
311	311	patient for the purposes of sections 190.600 to 190.621, if 87
312	312	the person or the person's patient's representative has 88
313	313	executed an outside the hospital do -not-resuscitate order 89
314	314	under sections 190.600 to 190.621 . A person under eighteen 90
315	315	years of age shall also be a patient for purposes of 91
316	316	sections 190.600 to 190.621 if the person has had a do -not- 92
317	317	resuscitate order issued on his or her behalf under the 93
318	318	provisions of section 191.250 ; 94
319	319	(11) "Patient's represent ative": 95
320	320	(a) An attorney in fact designated in a durable power 96
321	321	of attorney for health care for a patient determined to be 97
322	322	incapacitated under sections 404.800 to 404.872; or 98
323	323	(b) A guardian or limited guardian appointed under 99
324	324	chapter 475 to have responsibility for an incapacitated 100
325	325	patient. 101 11
326	326	CCS HCS SS SCS SBs 45 & 90
327	327	190.603. 1. A patient or patient's representative and 1
328	328	the patient's attending physician may execute an outside the 2
329	329	hospital do-not-resuscitate order. An outside the hospital 3
330	330	do-not-resuscitate order shall not be effective unless it is 4
331	331	executed by the patient or patient's representative and the 5
332	332	patient's attending physician, and it is in the form 6
333	333	promulgated by rule of the department. 7
334	334	2. A patient under eighteen years of age i s not 8
335	335	authorized to execute an outside the hospital do -not- 9
336	336	resuscitate order for himself or herself but may have a do - 10
337	337	not-resuscitate order issued on his or her behalf by one 11
338	338	parent or legal guardian or by a juvenile or family court 12
339	339	under the provisions of section 191.250. Such do-not- 13
340	340	resuscitate order shall also function as an outside the 14
341	341	hospital do-not-resuscitate order for the purposes of 15
342	342	sections 190.600 to 190.621 unless such do -not-resuscitate 16
343	343	order authorized under the provisions of sectio n 191.250 17
344	344	states otherwise. 18
345	345	3. If an outside the hospital do -not-resuscitate order 19
346	346	has been executed, it shall be maintained as the first page 20
347	347	of a patient's medical record in a health care facility 21
348	348	unless otherwise specified in the health care f acility's 22
349	349	policies and procedures. 23
350	350	[3.] 4. An outside the hospital do -not-resuscitate 24
351	351	order shall be transferred with the patient when the patient 25
352	352	is transferred from one health care facility to another 26
353	353	health care facility. If the patient is tr ansferred outside 27
354	354	of a hospital, the outside the hospital DNR form shall be 28
355	355	provided to any other facility, person, or agency 29
356	356	responsible for the medical care of the patient or to the 30
357	357	patient or patient's representative. 31 12
358	358	CCS HCS SS SCS SBs 45 & 90
359	359	190.606. The following persons and entities shall not 1
360	360	be subject to civil, criminal, or administrative liability 2
361	361	and are not guilty of unprofessional conduct for the 3
362	362	following acts or omissions that follow discovery of an 4
363	363	outside the hospital do -not-resuscitate identification upon 5
364	364	a patient or a do-not-resuscitate order functioning as an 6
365	365	outside the hospital do -not-resuscitate order for a patient 7
366	366	under eighteen years of age , or upon being presented with an 8
367	367	outside the hospital do -not-resuscitate order [from 9
368	368	Missouri, another state, the District of Columbia, or a 10
369	369	territory of the United States ]; provided that the acts or 11
370	370	omissions are done in good faith and in accordance with the 12
371	371	provisions of sections 190.600 to 190.621 and the provisions 13
372	372	of an outside the hospital do-not-resuscitate order executed 14
373	373	under sections 190.600 to 190.621: 15
374	374	(1) Physicians, persons under the direction or 16
375	375	authorization of a physician, emergency medical services 17
376	376	personnel, or health care facilities that cause or 18
377	377	participate in the withholding or withdrawal of 19
378	378	cardiopulmonary resuscitation from such patient; and 20
379	379	(2) Physicians, persons under the direction or 21
380	380	authorization of a physician, emergency medical services 22
381	381	personnel, or health care facilities that provide 23
382	382	cardiopulmonary resuscitation to such patient under an oral 24
383	383	or written request communicated to them by the patient or 25
384	384	the patient's representative. 26
385	385	190.612. 1. Emergency medical services personnel are 1
386	386	authorized to comply with the outs ide the hospital do-not- 2
387	387	resuscitate protocol when presented with an outside the 3
388	388	hospital do-not-resuscitate identification or an outside the 4
389	389	hospital do-not-resuscitate order. However, emergency 5
390	390	medical services personnel shall not comply with an outs ide 6 13
391	391	CCS HCS SS SCS SBs 45 & 90
392	392	the hospital do-not-resuscitate order or the outside the 7
393	393	hospital do-not-resuscitate protocol when the patient or 8
394	394	patient's representative expresses to such personnel in any 9
395	395	manner, before or after the onset of a cardiac or 10
396	396	respiratory arrest, the desire to be resuscitated. 11
397	397	2. [Emergency medical services personnel are 12
398	398	authorized to comply with the outside the hospital do -not- 13
399	399	resuscitate protocol when presented with an outside the 14
400	400	hospital do-not-resuscitate order from another state, the 15
401	401	District of Columbia, or a territory of the United States if 16
402	402	such order is on a standardized written form: 17
403	403	(1) Signed by the patient or the patient's 18
404	404	representative and a physician who is licensed to practice 19
405	405	in the other state, the District of Col umbia, or the 20
406	406	territory of the United States; and 21
407	407	(2) Such form has been previously reviewed and 22
408	408	approved by the department of health and senior services to 23
409	409	authorize emergency medical services personnel to withhold 24
410	410	or withdraw cardiopulmonary re suscitation from the patient 25
411	411	in the event of a cardiac or respiratory arrest. 26
412	412	Emergency medical services personnel shall not comply with 27
413	413	an outside the hospital do -not-resuscitate order from 28
414	414	another state, the District of Columbia, or a territory of 29
415	415	the United States or the outside the hospital do -not- 30
416	416	resuscitate protocol when the patient or patient's 31
417	417	representative expresses to such personnel in any manner, 32
418	418	before or after the onset of a cardiac or respiratory 33
419	419	arrest, the desire to be resuscitated. ] 34
420	420	(1) Except as provided in subdivision (2) of this 35
421	421	subsection, emergency medical services personnel are 36
422	422	authorized to comply with the outside the hospital do -not- 37 14
423	423	CCS HCS SS SCS SBs 45 & 90
424	424	resuscitate protocol when presented with a do -not- 38
425	425	resuscitate order functioning as an outside the hospital do - 39
426	426	not-resuscitate order for a patient under eighteen years of 40
427	427	age if such do-not-resuscitate order has been authorized by 41
428	428	one parent or legal guardian or by a juvenile or family 42
429	429	court under the provisions of section 191.250. 43
430	430	(2) Emergency medical services personnel shall not 44
431	431	comply with a do-not-resuscitate order or the outside the 45
432	432	hospital do-not-resuscitate protocol when the patient under 46
433	433	eighteen years of age, either parent of such patient, the 47
434	434	patient's legal guard ian, or the juvenile or family court 48
435	435	expresses to such personnel in any manner, before or after 49
436	436	the onset of a cardiac or respiratory arrest, the desire for 50
437	437	the patient to be resuscitated. 51
438	438	3. If a physician or a health care facility other than 52
439	439	a hospital admits or receives a patient with an outside the 53
440	440	hospital do-not-resuscitate identification or an outside the 54
441	441	hospital do-not-resuscitate order, and the patient or 55
442	442	patient's representative has not expressed or does not 56
443	443	express to the physician or health care facility the desire 57
444	444	to be resuscitated, and the physician or health care 58
445	445	facility is unwilling or unable to comply with the outside 59
446	446	the hospital do-not-resuscitate order, the physician or 60
447	447	health care facility shall take all reasonable s teps to 61
448	448	transfer the patient to another physician or health care 62
449	449	facility where the outside the hospital do -not-resuscitate 63
450	450	order will be complied with. 64
451	451	190.613. 1. A patient or patient's representative and 1
452	452	the patient's attending physician may execute an outside the 2
453	453	hospital do-not-resuscitate order through the presentation 3
454	454	of a properly executed outside the hospital do -not- 4
455	455	resuscitate order from another state, the District of 5 15
456	456	CCS HCS SS SCS SBs 45 & 90
457	457	Columbia, or a territory of the United States, or a 6
458	458	Transportable Physician Orders for Patient Preferences 7
459	459	(TPOPP)/Physician Orders for Life -Sustaining Treatment 8
460	460	(POLST) form containing a specific do -not-resuscitate 9
461	461	section. 10
462	462	2. Any outside the hospital do -not-resuscitate form 11
463	463	identified from another state, the District of Columbia, or 12
464	464	a territory of the United States, or a TPOPP/POLST form, 13
465	465	shall: 14
466	466	(1) Have been previously reviewed and approved by the 15
467	467	department as in compliance with the provisions of sections 16
468	468	190.600 to 190.621; 17
469	469	(2) Not be accepted for a patient under eighteen years 18
470	470	of age, except as allowed under section 191.250; and 19
471	471	(3) Not be effective during such time as the patient 20
472	472	is pregnant as set forth in section 190.609. 21
473	473	A patient or patient's representative may e xpress to 22
474	474	emergency medical services personnel, at any time and by any 23
475	475	means, the intent to revoke the outside the hospital do -not- 24
476	476	resuscitate order. 25
477	477	3. The provisions of section 190.606 shall apply to 26
478	478	the good faith acts or omissions of emergenc y medical 27
479	479	services personnel under this section. 28
480	480	191.240. 1. For purposes of this section, the 1
481	481	following terms mean: 2
482	482	(1) "Health care provider", the same meaning given to 3
483	483	the term in section 191.900; 4
484	484	(2) "Patient examination", a prostate, anal, or pelvic 5
485	485	examination. 6
486	486	2. A health care provider, or any student or trainee 7
487	487	under the supervision of a health care provider, shall not 8 16
488	488	CCS HCS SS SCS SBs 45 & 90
489	489	knowingly perform a patient examination upon an anesthetized 9
490	490	or unconscious patient in a health care facility unless: 10
491	491	(1) The patient or a person authorized to make health 11
492	492	care decisions for the patient has given specific informed 12
493	493	consent to the patient examination for nonmedical purposes; 13
494	494	(2) The patient examination is necess ary for 14
495	495	diagnostic or treatment purposes; 15
496	496	(3) The collection of evidence through a forensic 16
497	497	examination, as defined under subsection 8 of section 17
498	498	595.220, for a suspected sexual assault on the anesthetized 18
499	499	or unconscious patient is necessary beca use the evidence 19
500	500	will be lost or the patient is unable to give informed 20
501	501	consent due to a medical condition; or 21
502	502	(4) Circumstances are present which imply consent, as 22
503	503	described in section 431.063. 23
504	504	3. A health care provider shall notify a patie nt of 24
505	505	any patient examination performed under subdivisions (2) to 25
506	506	(4) of subsection 2 of this section if the patient is unable 26
507	507	to give verbal or written consent. 27
508	508	4. A health care provider who violates the provisions 28
509	509	of this section, or who superv ises a student or trainee who 29
510	510	violates the provisions of this section, shall be subject to 30
511	511	discipline by any licensing board that licenses the health 31
512	512	care provider. 32
513	513	191.430. 1. There is hereby established within the 1
514	514	department of health and senior services the "Health 2
515	515	Professional Loan Repayment Program" to provide forgivable 3
516	516	loans for the purpose of repaying existing loans related to 4
517	517	applicable educational expenses for health care, mental 5
518	518	health, and public health professionals . The department of 6
519	519	health and senior services shall be the administrative 7 17
520	520	CCS HCS SS SCS SBs 45 & 90
521	521	agency for the implementation of the program established by 8
522	522	this section. 9
523	523	2. The department of health and senior services shall 10
524	524	prescribe the form and the time and method of filing 11
525	525	applications and supervise the processing, including 12
526	526	oversight and monitoring of the program, and shall 13
527	527	promulgate rules to implement the provisions of sections 14
528	528	191.430 to 191.450. Any rule or portion of a rule, as that 15
529	529	term is defined in section 536.010, that is created under 16
530	530	the authority delegated in this section shall become 17
531	531	effective only if it complies with and is subject to all of 18
532	532	the provisions of chapter 536 and, if applicable, section 19
533	533	536.028. This section and chapter 536 are nonseverable and 20
534	534	if any of the powers vested with the general assembly 21
535	535	pursuant to chapter 536 to review, to delay the effective 22
536	536	date, or to disapprove and annul a rule are subsequently 23
537	537	held unconstitutional, then the grant of rulemaking 24
538	538	authority and any rule proposed or adopted after August 28, 25
539	539	2023, shall be invalid and void. 26
540	540	3. The director of the department of health and senior 27
541	541	services shall have the discretion to determine the health 28
542	542	professionals and practitioners who will receive for givable 29
543	543	health professional loans from the department to pay their 30
544	544	existing loans. The director shall make such determinations 31
545	545	each fiscal year based on evidence associated with the 32
546	546	greatest needs in the best interests of the public. The 33
547	547	health care, mental health, and public health professionals 34
548	548	or disciplines funded in any given year shall be contingent 35
549	549	upon consultation with the office of workforce development 36
550	550	in the department of higher education and workforce 37
551	551	development and the department o f mental health, or their 38
552	552	successor agencies. 39 18
553	553	CCS HCS SS SCS SBs 45 & 90
554	554	4. The department of health and senior services shall 40
555	555	enter into a contract with each selected applicant who 41
556	556	receives a health professional loan under this section. 42
557	557	Each selected applicant shall appl y the loan award to his or 43
558	558	her educational debt. The contract shall detail the methods 44
559	559	of forgiveness associated with a service obligation and the 45
560	560	terms associated with the principal and interest accruing on 46
561	561	the loan at the time of the award. The contract shall 47
562	562	contain details concerning how forgiveness is earned, 48
563	563	including when partial forgiveness is earned through a 49
564	564	service obligation, and the terms and conditions associated 50
565	565	with repayment of the loans for any obligation not served. 51
566	566	5. All health professional loans shall be made from 52
567	567	funds appropriated by the general assembly to the health 53
568	568	professional loan incentive fund established in section 54
569	569	191.445. 55
570	570	191.435. The department of health and senior services 1
571	571	shall designate counties, communities, or sections of areas 2
572	572	in the state as areas of defined need for health care, 3
573	573	mental health, and public health services. If a county, 4
574	574	community, or section of an area has been designated or 5
575	575	determined as a professional short age area, a shortage area, 6
576	576	or a health care, mental health, or public health 7
577	577	professional shortage area by the federal Department of 8
578	578	Health and Human Services or its successor agency, the 9
579	579	department of health and senior services shall designate it 10
580	580	as an area of defined need under this section. If the 11
581	581	director of the department of health and senior services 12
582	582	determines that a county, community, or section of an area 13
583	583	has an extraordinary need for health care professional 14
584	584	services without a correspond ing supply of such 15
585	585	professionals, the department of health and senior services 16 19
586	586	CCS HCS SS SCS SBs 45 & 90
587	587	may designate it as an area of defined need under this 17
588	588	section. 18
589	589	191.440. 1. The department of health and senior 1
590	590	services shall enter into a contract wit h each individual 2
591	591	qualifying for a forgivable loan under sections 191.430 to 3
592	592	191.450. The written contract between the department and 4
593	593	the individual shall contain, but not be limited to, the 5
594	594	following: 6
595	595	(1) An agreement that the state agrees to a ward a loan 7
596	596	and the individual agrees to serve for a period equal to two 8
597	597	years, or a longer period as the individual may agree to, in 9
598	598	an area of defined need as designated by the department, 10
599	599	with such service period to begin on the date identified on 11
600	600	the signed contract; 12
601	601	(2) A provision that any financial obligations arising 13
602	602	out of a contract entered into and any obligation of the 14
603	603	individual that is conditioned thereon is contingent upon 15
604	604	funds being appropriated for loans; 16
605	605	(3) The area of defined need where the person will 17
606	606	practice; 18
607	607	(4) A statement of the damages to which the state is 19
608	608	entitled for the individual's breach of the contract; and 20
609	609	(5) Such other statements of the rights and 21
610	610	liabilities of the department and of th e individual not 22
611	611	inconsistent with sections 191.430 to 191.450. 23
612	612	2. The department of health and senior services may 24
613	613	stipulate specific practice sites, contingent upon 25
614	614	department-generated health care, mental health, and public 26
615	615	health professional need priorities, where applicants shall 27
616	616	agree to practice for the duration of their participation in 28
617	617	the program. 29 20
618	618	CCS HCS SS SCS SBs 45 & 90
619	619	191.445. There is hereby created in the state treasury 1
620	620	the "Health Professional Loan Incentive Fund", which shall 2
621	621	consist of any appropriations made by the general assembly, 3
622	622	all funds recovered from an individual under section 4
623	623	191.450, and all funds generated by loan repayments received 5
624	624	under sections 191.430 to 191.450. The state treasurer 6
625	625	shall be custodian of the fund. In accordance with sections 7
626	626	30.170 and 30.180, the state treasurer may approve 8
627	627	disbursements. The fund shall be a dedicated fund and, upon 9
628	628	appropriation, moneys in this fund shall be used solely by 10
629	629	the department of health and senior services to provide 11
630	630	loans under sections 191.430 to 191.450. Notwithstanding 12
631	631	the provisions of section 33.080 to the contrary, any moneys 13
632	632	remaining in the fund at the end of the biennium shall not 14
633	633	revert to the credit of the general revenue fund. The state 15
634	634	treasurer shall invest moneys in the fund in the same manner 16
635	635	as other funds are invested. Any interest and moneys earned 17
636	636	on such investments shall be credited to the fund. 18
637	637	191.450. 1. An individual who enters into a written 1
638	638	contract with the department of health and senior services, 2
639	639	as described in section 191.440, and who fails to maintain 3
640	640	an acceptable employment status shall be liable to the state 4
641	641	for any amount awarded as a loan by the department directly 5
642	642	to the individual wh o entered into the contract that has not 6
643	643	yet been forgiven. 7
644	644	2. An individual fails to maintain an acceptable 8
645	645	employment status under this section when the contracted 9
646	646	individual involuntarily or voluntarily terminates 10
647	647	qualifying employment, is dis missed from such employment 11
648	648	before completion of the contractual service obligation 12
649	649	within the specific time frame outlined in the contract, or 13
650	650	fails to respond to requests made by the department. 14 21
651	651	CCS HCS SS SCS SBs 45 & 90
652	652	3. If an individual breaches the written contract of 15
653	653	the individual by failing to begin or complete such 16
654	654	individual's service obligation, the state shall be entitled 17
655	655	to recover from the individual an amount equal to the sum of: 18
656	656	(1) The total amount of the loan awarded by the 19
657	657	department or, if th e department had already awarded partial 20
658	658	forgiveness at the time of the breach, the amount of the 21
659	659	loan not yet forgiven; 22
660	660	(2) The interest on the amount that would be payable 23
661	661	if at the time the loan was awarded it was a loan bearing 24
662	662	interest at the maximum prevailing rate as determined by the 25
663	663	Treasurer of the United States; 26
664	664	(3) An amount equal to any damages incurred by the 27
665	665	department as a result of the breach; and 28
666	666	(4) Any legal fees or associated costs incurred by the 29
667	667	department or the state of Missouri in the collection of 30
668	668	damages. 31
669	669	191.592. 1. For purposes of this section, the 1
670	670	following terms mean: 2
671	671	(1) "Department", the department of health and senior 3
672	672	services; 4
673	673	(2) "Eligible entity", an entity tha t operates a 5
674	674	physician medical residency program in this state and that 6
675	675	is accredited by the Accreditation Council for Graduate 7
676	676	Medical Education; 8
677	677	(3) "General primary care and psychiatry", family 9
678	678	medicine, general internal medicine, general pedi atrics, 10
679	679	internal medicine-pediatrics, general obstetrics and 11
680	680	gynecology, or general psychiatry; 12
681	681	(4) "Grant-funded residency position", a position that 13
682	682	is accredited by the Accreditation Council for Graduate 14
683	683	Medical Education, that is established as a result of 15 22
684	684	CCS HCS SS SCS SBs 45 & 90
685	685	funding awarded to an eligible entity for the purpose of 16
686	686	establishing an additional medical resident position beyond 17
687	687	the currently existing medical resident positions, and that 18
688	688	is within the fields of general primary care and 19
689	689	psychiatry. Such position shall end when the medical 20
690	690	residency funding under this section is completed or when 21
691	691	the resident in the medical grant -funded residency position 22
692	692	is no longer employed by the eligible entity, whichever is 23
693	693	earlier; 24
694	694	(5) "Participating medical resident", an individual 25
695	695	who is a medical school graduate with a doctor of medicine 26
696	696	degree or doctor of osteopathic medicine degree, who is 27
697	697	participating in a postgraduate training program at an 28
698	698	eligible entity, and who is filling a grant -funded residency 29
699	699	position. 30
700	700	2. (1) Subject to appropriation, the department shall 31
701	701	establish a medical residency grant program to award grants 32
702	702	to eligible entities for the purpose of establishing and 33
703	703	funding new general primary care and psychiatry m edical 34
704	704	residency positions in this state and continuing the funding 35
705	705	of such new residency positions for the duration of the 36
706	706	funded residency. 37
707	707	(2) (a) Funding shall be available for three years 38
708	708	for residency positions in family medicine, general internal 39
709	709	medicine, and general pediatrics. 40
710	710	(b) Funding shall be available for four years for 41
711	711	residency positions in general obstetrics and gynecology, 42
712	712	internal medicine-pediatrics, and general psychiatry. 43
713	713	3. (1) There is hereby created in t he state treasury 44
714	714	the "Medical Residency Grant Program Fund". Moneys in the 45
715	715	fund shall be used to implement and fund grants to eligible 46
716	716	entities. 47 23
717	717	CCS HCS SS SCS SBs 45 & 90
718	718	(2) The medical residency grant program fund shall 48
719	719	include funds appropriated by the general assemb ly, 49
720	720	reimbursements from awarded eligible entities that were not 50
721	721	able to fill the residency position or positions with an 51
722	722	individual medical resident or residents, and any gifts, 52
723	723	contributions, grants, or bequests received from federal, 53
724	724	private, or other sources. 54
725	725	(3) The state treasurer shall be custodian of the 55
726	726	fund. In accordance with sections 30.170 and 30.180, the 56
727	727	state treasurer may approve disbursements. The fund shall 57
728	728	be a dedicated fund and, upon appropriation, moneys in the 58
729	729	fund shall be used solely as provided in this section. 59
730	730	(4) Notwithstanding the provisions of section 33.080 60
731	731	to the contrary, any moneys remaining in the fund at the end 61
732	732	of the biennium shall not revert to the credit of the 62
733	733	general revenue fund. 63
734	734	(5) The state treasurer shall invest moneys in the 64
735	735	fund in the same manner as other funds are invested. Any 65
736	736	interest and moneys earned on such investments shall be 66
737	737	credited to the fund. 67
738	738	4. Subject to appropriation, the department shall 68
739	739	expend moneys in the medical residency grant program fund in 69
740	740	the following order: 70
741	741	(1) Necessary costs of the department to implement 71
742	742	this section; 72
743	743	(2) Funding of grant-funded residency positions of 73
744	744	individuals in the fourth year of their residency, as 74
745	745	applicable to residents in general obstetrics and 75
746	746	gynecology, internal medicine -pediatrics, and general 76
747	747	psychiatry; 77
748	748	(3) Funding of grant-funded residency positions of 78
749	749	individuals in the third year of their residency; 79 24
750	750	CCS HCS SS SCS SBs 45 & 90
751	751	(4) Funding of grant-funded residency positions of 80
752	752	individuals in the second year of their residency; 81
753	753	(5) Funding of grant-funded residency positions of 82
754	754	individuals in the first year of their residency; and 83
755	755	(6) The establishment of new grant -funded residency 84
756	756	positions at awarded eligible entities. 85
757	757	5. The department shall establish criteria to evaluate 86
758	758	which eligible entities shall be awarded grants for new 87
759	759	grant-funded residency positions, criteria for determining 88
760	760	the amount and duration of grants, the cont ents of the grant 89
761	761	application, procedures and timelines by which eligible 90
762	762	entities may apply for grants, and all other rules needed to 91
763	763	implement the purposes of this section. Such criteria shall 92
764	764	include a preference for eligible entities located in ar eas 93
765	765	of highest need for general primary care and psychiatric 94
766	766	care physicians, as determined by the health professional 95
767	767	shortage area score. 96
768	768	6. Eligible entities that receive grants under this 97
769	769	section shall: 98
770	770	(1) Agree to supplement awarded funds under this 99
771	771	section, if necessary, to establish or maintain a grant - 100
772	772	funded residency position for the duration of the funded 101
773	773	resident's medical residency; and 102
774	774	(2) Agree to abide by other requirements imposed by 103
775	775	rule. 104
776	776	7. Annual funding per participating medical resident 105
777	777	shall be limited to: 106
778	778	(1) Direct graduate medical education costs including, 107
779	779	but not limited to: 108
780	780	(a) Salaries and benefits for residents, faculty, and 109
781	781	program staff; 110 25
782	782	CCS HCS SS SCS SBs 45 & 90
783	783	(b) Malpractice insurance, licenses , and other 111
784	784	required fees; and 112
785	785	(c) Program administration and educational materials; 113
786	786	and 114
787	787	(2) Indirect costs of graduate medical education 115
788	788	necessary to meet the standards of the Accreditation Council 116
789	789	for Graduate Medical Education. 117
790	790	8. No new grant-funded residency positions under this 118
791	791	section shall be established after the tenth fiscal year in 119
792	792	which grants are awarded. However, any residency positions 120
793	793	funded under this section may continue to be funded until 121
794	794	the completion of the r esident's medical residency. 122
795	795	9. The department shall submit an annual report to the 123
796	796	general assembly regarding the implementation of the program 124
797	797	developed under this section. 125
798	798	10. The department may promulgate all necessary rules 126
799	799	and regulations for the administration of this section. Any 127
800	800	rule or portion of a rule, as that term is defined in 128
801	801	section 536.010, that is created under the authority 129
802	802	delegated in this section shall become effective only if it 130
803	803	complies with and is subject to all of the provisions of 131
804	804	chapter 536 and, if applicable, section 536.028. This 132
805	805	section and chapter 536 are nonseverable and if any of the 133
806	806	powers vested with the general assembly pursuant to chapter 134
807	807	536 to review, to delay the effective date, or to disapp rove 135
808	808	and annul a rule are subsequently held unconstitutional, 136
809	809	then the grant of rulemaking authority and any rule proposed 137
810	810	or adopted after the effective date of this section shall be 138
811	811	invalid and void. 139
812	812	11. The provisions of this section shall exp ire on 140
813	813	January 1, 2038. 141 26
814	814	CCS HCS SS SCS SBs 45 & 90
815	815	191.600. 1. Sections 191.600 to 191.615 establish a 1
816	816	loan repayment program for graduates of approved medical 2
817	817	schools, schools of osteopathic medicine, schools of 3
818	818	dentistry and accredited chiropractic college s who practice 4
819	819	in areas of defined need and shall be known as the "Health 5
820	820	Professional Student Loan Repayment Program". Sections 6
821	821	191.600 to 191.615 shall apply to graduates of accredited 7
822	822	chiropractic colleges when federal guidelines for 8
823	823	chiropractic shortage areas are developed. 9
824	824	2. The "Health Professional Student Loan and Loan 10
825	825	Repayment Program Fund" is hereby created in the state 11
826	826	treasury. All funds recovered from an individual pursuant 12
827	827	to section 191.614 and all funds generated by loan 13
828	828	repayments and penalties received pursuant to section 14
829	829	191.540 shall be credited to the fund. The moneys in the 15
830	830	fund shall be used by the department of health and senior 16
831	831	services to provide loan repayments pursuant to section 17
832	832	191.611 in accordance with sections 191.600 to 191.614 [and 18
833	833	to provide loans pursuant to sections 191.500 to 191.550 ]. 19
834	834	191.828. 1. The following departments shall conduct 1
835	835	on-going evaluations of the effect of the initiatives 2
836	836	enacted by the following sections: 3
837	837	(1) The department of commerce and insurance shall 4
838	838	evaluate the effect of revising section 376.782 and sections 5
839	839	143.999, 208.178, 374.126, and 376.891 to 376.894; 6
840	840	(2) The department of health and senior services shall 7
841	841	evaluate the effect of revising sections 105.711 and 8
842	842	[sections 191.520 and ] 191.600 and enacting section 191.411, 9
843	843	and sections 167.600 to 167.621, 191.231, 208.177, 431.064, 10
844	844	and 660.016. In collaboration with the state board of 11
845	845	registration for the healing arts, the state board of 12
846	846	nursing, and the state board of pharmacy, the department of 13 27
847	847	CCS HCS SS SCS SBs 45 & 90
848	848	health and senior services shall also evaluate the effect of 14
849	849	revising section 195.070, section 334.100, and section 15
850	850	335.016, and of sections 334.104 and 334.112, and section 16
851	851	338.095 and 338.198; 17
852	852	(3) The department of social services shall evaluate 18
853	853	the effect of revising section 198.090, and sections 19
854	854	208.151, 208.152 and 208.215, and section 383.125, and of 20
855	855	sections 167.600 to 167.621, 208.177, 208.178, 208.179, 21
856	856	208.181, and 211.490; 22
857	857	(4) The office of administration shall evaluate the 23
858	858	effect of revising sections 105.711 and 105.721; 24
859	859	(5) The Missouri consolidated health care plan shall 25
860	860	evaluate the effect of section 103.178; and 26
861	861	(6) The department of mental health shall evaluate the 27
862	862	effect of section 191.831 as it relates to substance abuse 28
863	863	treatment and of section 191.835. 29
864	864	2. The department of revenue and office of 30
865	865	administration shall make biannual reports to the general 31
866	866	assembly and the governor concerning the income received 32
867	867	into the health initiatives fund and the level of funding 33
868	868	required to operate the programs and initiatives funded by 34
869	869	the health initiatives fund at an optimal level. 35
870	870	191.831. 1. There is hereby establi shed in the state 1
871	871	treasury a "Health Initiatives Fund", to which shall be 2
872	872	deposited all revenues designated for the fund under 3
873	873	subsection 8 of section 149.015, and subsection 3 of section 4
874	874	149.160, and section 167.609, and all other funds donated to 5
875	875	the fund or otherwise deposited pursuant to law. The state 6
876	876	treasurer shall administer the fund. Money in the fund 7
877	877	shall be appropriated to provide funding for implementing 8
878	878	the new programs and initiatives established by sections 9
879	879	105.711 and 105.721. The moneys in the fund may further be 10 28
880	880	CCS HCS SS SCS SBs 45 & 90
881	881	used to fund those programs established by sections 11
882	882	191.411[, 191.520] and 191.600, sections 208.151 and 12
883	883	208.152, and sections 103.178, 143.999, 167.600 to 167.621, 13
884	884	188.230, 191.211, 191.231, 191.825 to 191.839, 192 .013, 14
885	885	208.177, 208.178, 208.179 and 208.181, 211.490, 285.240, 15
886	886	337.093, 374.126, 376.891 to 376.894, 431.064, 660.016, 16
887	887	660.017 and 660.018; in addition, not less than fifteen 17
888	888	percent of the proceeds deposited to the health initiative 18
889	889	fund pursuant to sections 149.015 and 149.160 shall be 19
890	890	appropriated annually to provide funding for the C -STAR 20
891	891	substance abuse rehabilitation program of the department of 21
892	892	mental health, or its successor program, and a C -STAR pilot 22
893	893	project developed by the director of t he division of alcohol 23
894	894	and drug abuse and the director of the department of 24
895	895	corrections as an alternative to incarceration, as provided 25
896	896	in subsections 2, 3, and 4 of this section. Such pilot 26
897	897	project shall be known as the "Alt -care" program. In 27
898	898	addition, some of the proceeds deposited to the health 28
899	899	initiatives fund pursuant to sections 149.015 and 149.160 29
900	900	shall be appropriated annually to the division of alcohol 30
901	901	and drug abuse of the department of mental health to be used 31
902	902	for the administration an d oversight of the substance abuse 32
903	903	traffic [offenders] offender program defined in section 33
904	904	302.010 [and section 577.001]. The provisions of section 34
905	905	33.080 to the contrary notwithstanding, money in the health 35
906	906	initiatives fund shall not be transferred a t the close of 36
907	907	the biennium to the general revenue fund. 37
908	908	2. The director of the division of alcohol and drug 38
909	909	abuse and the director of the department of corrections 39
910	910	shall develop and administer a pilot project to provide a 40
911	911	comprehensive substance abuse treatment and rehabilitation 41
912	912	program as an alternative to incarceration, hereinafter 42 29
913	913	CCS HCS SS SCS SBs 45 & 90
914	914	referred to as "Alt-care". Alt-care shall be funded using 43
915	915	money provided under subsection 1 of this section through 44
916	916	the Missouri Medicaid program, the C -STAR program of the 45
917	917	department of mental health, and the division of alcohol and 46
918	918	drug abuse's purchase -of-service system. Alt-care shall 47
919	919	offer a flexible combination of clinical services and living 48
920	920	arrangements individually adapted to each client and her 49
921	921	children. Alt-care shall consist of the following 50
922	922	components: 51
923	923	(1) Assessment and treatment planning; 52
924	924	(2) Community support to provide continuity, 53
925	925	monitoring of progress and access to services and resources; 54
926	926	(3) Counseling from individua l to family therapy; 55
927	927	(4) Day treatment services which include accessibility 56
928	928	seven days per week, transportation to and from the Alt -care 57
929	929	program, weekly drug testing, leisure activities, weekly 58
930	930	events for families and companions, job and education 59
931	931	preparedness training, peer support and self -help and daily 60
932	932	living skills; and 61
933	933	(5) Living arrangement options which are permanent, 62
934	934	substance-free and conducive to treatment and recovery. 63
935	935	3. Any female who is pregnant or is the custodial 64
936	936	parent of a child or children under the age of twelve years, 65
937	937	and who has pleaded guilty to or found guilty of violating 66
938	938	the provisions of chapter 195, and whose controlled 67
939	939	substance abuse was a precipitating or contributing factor 68
940	940	in the commission of th e offense, and who is placed on 69
941	941	probation may be required, as a condition of probation, to 70
942	942	participate in Alt-care, if space is available in the pilot 71
943	943	project area. Determinations of eligibility for the 72
944	944	program, placement, and continued participation shall be 73 30
945	945	CCS HCS SS SCS SBs 45 & 90
946	946	made by the division of alcohol and drug abuse, in 74
947	947	consultation with the department of corrections. 75
948	948	4. The availability of space in Alt -care shall be 76
949	949	determined by the director of the division of alcohol and 77
950	950	drug abuse in conjunction wit h the director of the 78
951	951	department of corrections. If the sentencing court is 79
952	952	advised that there is no space available, the court shall 80
953	953	consider other authorized dispositions. 81
954	954	195.206. 1. As used in this section, the following 1
955	955	terms shall mean: 2
956	956	(1) "Addiction mitigation medication", naltrexone 3
957	957	hydrochloride that is administered in a manner approved by 4
958	958	the United States Food and Drug Administration or any 5
959	959	accepted medical practice method of administering; 6
960	960	(2) "Opioid antagonist", naloxone hydrochloride , or 7
961	961	any other drug or device approved by the United States Food 8
962	962	and Drug Administration, that blocks the effects of an 9
963	963	opioid overdose [that] and is administered in a manner 10
964	964	approved by the United States Food and Drug Administration 11
965	965	or any accepted medical practice method of administering; 12
966	966	(3) "Opioid-related drug overdose", a condition 13
967	967	including, but not limited to, extreme physical illness, 14
968	968	decreased level of consciousness, respiratory depression, 15
969	969	coma, or death resulting from the consumption or use of an 16
970	970	opioid or other substance with which an opioid was combined 17
971	971	or a condition that a layperson would reasonably believe to 18
972	972	be an opioid-related drug overdose that requires medical 19
973	973	assistance. 20
974	974	2. Notwithstanding any other law or regulation to the 21
975	975	contrary: 22
976	976	(1) The director of the department of health and 23
977	977	senior services, if a licensed physician, may issue a 24 31
978	978	CCS HCS SS SCS SBs 45 & 90
979	979	statewide standing order for an opioid antagonist or an 25
980	980	addiction mitigation medication ; 26
981	981	(2) In the alternative, the department may employ or 27
982	982	contract with a licensed physician who may issue a statewide 28
983	983	standing order for an opioid antagonist or an addiction 29
984	984	mitigation medication with the express written consent of 30
985	985	the department director. 31
986	986	3. Notwithstanding any other law or regulation to the 32
987	987	contrary, any licensed pharmacist in Missouri may sell and 33
988	988	dispense an opioid antagonist or an addiction mitigation 34
989	989	medication under physician protocol or under a statewide 35
990	990	standing order issued under subsection 2 of this section. 36
991	991	4. A licensed pharmacist who, acting in good faith and 37
992	992	with reasonable care, sells or dispenses an opioid 38
993	993	antagonist or an addiction mitigation medication and an 39
994	994	appropriate device to administer the drug, and the protocol 40
995	995	physician, shall not be subject to any criminal or civil 41
996	996	liability or any professional disciplinary action for 42
997	997	prescribing or dispensing the opioid antagonist or an 43
998	998	addiction mitigation medication or any outcome resulting 44
999	999	from the administration of the opioid antagonist or an 45
1000	1000	addiction mitigation medication. A physician issuing a 46
1001	1001	statewide standing order under subsection 2 of this section 47
1002	1002	shall not be subject to any criminal or civil liability or 48
1003	1003	any professional disciplinar y action for issuing the 49
1004	1004	standing order or for any outcome related to the order or 50
1005	1005	the administration of the opioid antagonist or an addiction 51
1006	1006	mitigation medication. 52
1007	1007	5. Notwithstanding any other law or regulation to the 53
1008	1008	contrary, it shall be perm issible for any person to possess 54
1009	1009	an opioid antagonist or an addiction mitigation medication. 55 32
1010	1010	CCS HCS SS SCS SBs 45 & 90
1011	1011	6. Any person who administers an opioid antagonist to 56
1012	1012	another person shall, immediately after administering the 57
1013	1013	drug, contact emergency personnel. Any person who, acting 58
1014	1014	in good faith and with reasonable care, administers an 59
1015	1015	opioid antagonist to another person whom the person believes 60
1016	1016	to be suffering an opioid -related drug overdose shall be 61
1017	1017	immune from criminal prosecution, disciplinary actions from 62
1018	1018	his or her professional licensing board, and civil liability 63
1019	1019	due to the administration of the opioid antagonist. 64
1020	1020	196.1050. 1. The proceeds of any monetary settlement 1
1021	1021	or portion of a global settlement between the attorney 2
1022	1022	general of the state and any drug manufacturers, 3
1023	1023	distributors, pharmacies, or combination thereof to resolve 4
1024	1024	an opioid-related cause of action against such drug 5
1025	1025	manufacturers, distributors, pharmacies, or combination 6
1026	1026	thereof in a state or federal court shall only be utilized 7
1027	1027	to pay for opioid addiction treatment and prevention 8
1028	1028	services and health care and law enforcement costs related 9
1029	1029	to opioid addiction treatment and prevention. Under no 10
1030	1030	circumstances shall such settlement moneys be utilized to 11
1031	1031	fund other services, programs, or expenses not reasonably 12
1032	1032	related to opioid addiction treatment and prevention. 13
1033	1033	2. (1) There is hereby established in the state 14
1034	1034	treasury the "Opioid Addiction Treatment and Recovery Fund", 15
1035	1035	which shall consist of the proceeds o f any settlement 16
1036	1036	described in subsection 1 of this section, as well as any 17
1037	1037	funds appropriated by the general assembly, or gifts, 18
1038	1038	grants, donations, or bequests. The state treasurer shall 19
1039	1039	be custodian of the fund. In accordance with sections 20
1040	1040	30.170 and 30.180, the state treasurer may approve 21
1041	1041	disbursements. The fund shall be a dedicated fund and money 22
1042	1042	in the fund shall be used by the department of mental 23 33
1043	1043	CCS HCS SS SCS SBs 45 & 90
1044	1044	health, the department of health and senior services, the 24
1045	1045	department of social services, the d epartment of public 25
1046	1046	safety, the department of corrections, and the judiciary for 26
1047	1047	the purposes set forth in subsection 1 of this section. 27
1048	1048	(2) Notwithstanding the provisions of section 33.080 28
1049	1049	to the contrary, any moneys remaining in the fund at the end 29
1050	1050	of the biennium shall not revert to the credit of the 30
1051	1051	general revenue fund. 31
1052	1052	(3) The state treasurer shall invest moneys in the 32
1053	1053	fund in the same manner as other funds are invested. Any 33
1054	1054	interest and moneys earned on such investments shall be 34
1055	1055	credited to the fund. 35
1056	1056	197.020. 1. "Governmental unit" means any county, 1
1057	1057	municipality or other political subdivision or any 2
1058	1058	department, division, board or other agency of any of the 3
1059	1059	foregoing. 4
1060	1060	2. "Hospital" means a place devote d primarily to the 5
1061	1061	maintenance and operation of facilities for the diagnosis, 6
1062	1062	treatment or care for not less than twenty -four consecutive 7
1063	1063	hours in any week of three or more nonrelated individuals 8
1064	1064	suffering from illness, disease, injury, deformity or ot her 9
1065	1065	abnormal physical conditions; or a place devoted primarily 10
1066	1066	to provide for not less than twenty -four consecutive hours 11
1067	1067	in any week medical or nursing care for three or more 12
1068	1068	nonrelated individuals. The term "hospital" shall include a 13
1069	1069	facility designated as a rural emergency hospital by the 14
1070	1070	Centers for Medicare and Medicaid Services. The term 15
1071	1071	"hospital" does not include convalescent, nursing, shelter 16
1072	1072	or boarding homes as defined in chapter 198. 17
1073	1073	3. "Person" means any individual, firm, partne rship, 18
1074	1074	corporation, company or association and the legal successors 19
1075	1075	thereof. 20 34
1076	1076	CCS HCS SS SCS SBs 45 & 90
1077	1077	208.035. 1. Subject to appropriations and any 1
1078	1078	necessary waivers or approvals, the department of social 2
1079	1079	services shall develop and implement a transitional benefits 3
1080	1080	program for temporary assistance for needy families (TANF) 4
1081	1081	and the supplemental nutrition assistance program (SNAP) 5
1082	1082	that is designed in such a way that a TANF or SNAP 6
1083	1083	beneficiary will not experience an immediate loss of 7
1084	1084	benefits should the b eneficiary's income exceed the maximum 8
1085	1085	allowable income for such program. The transitional 9
1086	1086	benefits offered shall provide for a transition to self - 10
1087	1087	sufficiency while incentivizing work and financial stability. 11
1088	1088	2. The transitional benefits offered shall gradually 12
1089	1089	step down the beneficiary's monthly benefit proportionate to 13
1090	1090	the increase in the beneficiary's income. The determination 14
1091	1091	for a beneficiary's transitional benefit shall be as follows: 15
1092	1092	(1) One hundred percent of the monthly benefit for 16
1093	1093	beneficiaries with monthly household incomes less than or 17
1094	1094	equal to one hundred thirty -eight percent of the federal 18
1095	1095	poverty level; 19
1096	1096	(2) Eighty percent of the monthly benefit for 20
1097	1097	beneficiaries with monthly household incomes greater than 21
1098	1098	one hundred thirty-eight percent but less than or equal to 22
1099	1099	one hundred fifty percent of the federal poverty level; 23
1100	1100	(3) Sixty percent of the monthly benefit for 24
1101	1101	beneficiaries with monthly household incomes greater than 25
1102	1102	one hundred fifty percent but less t han or equal to one 26
1103	1103	hundred seventy percent of the federal poverty level; 27
1104	1104	(4) Forty percent of the monthly benefit for 28
1105	1105	beneficiaries with monthly household incomes greater than 29
1106	1106	one hundred seventy percent but less than or equal to one 30
1107	1107	hundred ninety percent of the federal poverty level; and 31 35
1108	1108	CCS HCS SS SCS SBs 45 & 90
1109	1109	(5) Twenty percent of the monthly benefit for 32
1110	1110	beneficiaries with monthly household incomes greater than 33
1111	1111	one hundred ninety percent but less than or equal to two 34
1112	1112	hundred percent of the federal poverty l evel. 35
1113	1113	Notwithstanding any provision of this section to the 36
1114	1114	contrary, any beneficiary where monthly household income 37
1115	1115	exceeds five thousand eight hundred twenty -two dollars, as 38
1116	1116	adjusted for inflation, shall not be eligible for any 39
1117	1117	transitional benefit un der this section. 40
1118	1118	3. Beneficiaries receiving transitional benefits under 41
1119	1119	this section shall comply with all requirements of each 42
1120	1120	program for which they are eligible, including work 43
1121	1121	requirements. Transitional benefits received under this 44
1122	1122	section shall not be included in the lifetime limit for 45
1123	1123	receipt of TANF benefits under section 208.040. 46
1124	1124	4. The department may promulgate any rules or 47
1125	1125	regulations necessary for the implementation of this 48
1126	1126	section. Any rule or portion of a rule, as that ter m is 49
1127	1127	defined in section 536.010, that is created under the 50
1128	1128	authority delegated in this section shall become effective 51
1129	1129	only if it complies with and is subject to all of the 52
1130	1130	provisions of chapter 536 and, if applicable, section 53
1131	1131	536.028. This section and chapter 536 are nonseverable and 54
1132	1132	if any of the powers vested with the general assembly 55
1133	1133	pursuant to chapter 536 to review, to delay the effective 56
1134	1134	date, or to disapprove and annul a rule are subsequently 57
1135	1135	held unconstitutional, then the grant of rulemak ing 58
1136	1136	authority and any rule proposed or adopted after August 28, 59
1137	1137	2023, shall be invalid and void. 60
1138	1138	208.053. 1. [The provisions of this section shall be 1
1139	1139	known as the "Low-Wage Trap Elimination Act". ] In order to 2 36
1140	1140	CCS HCS SS SCS SBs 45 & 90
1141	1141	more effectively tran sition persons receiving state -funded 3
1142	1142	child care subsidy benefits under this chapter, the 4
1143	1143	department of elementary and secondary education [, in 5
1144	1144	conjunction with the department of revenue, ] shall, subject 6
1145	1145	to appropriations, by July 1, [2022] 2024, implement a 7
1146	1146	[pilot] program [in a county with a charter form of 8
1147	1147	government and with more than six hundred thousand but fewer 9
1148	1148	than seven hundred thousand inhabitants, a county of the 10
1149	1149	first classification with more than two hundred sixty 11
1150	1150	thousand but fewer t han three hundred thousand inhabitants, 12
1151	1151	and a county of the first classification with more than two 13
1152	1152	hundred thousand but fewer than two hundred sixty thousand 14
1153	1153	inhabitants, to be called the "Hand -Up Program",] to allow 15
1154	1154	[applicants in the program ] recipients to receive 16
1155	1155	transitional child care benefits without the requirement 17
1156	1156	that such [applicants] recipients first be eligible for full 18
1157	1157	child care benefits. 19
1158	1158	(1) For purposes of this section, "full child care 20
1159	1159	benefits" shall be the full benefits awa rded to a recipient 21
1160	1160	based on the income eligibility amount established by the 22
1161	1161	department through the annual appropriations process as of 23
1162	1162	August 28, [2021] 2023, to qualify for the benefits and 24
1163	1163	shall not include the transitional child care benefits that 25
1164	1164	are awarded to recipients whose income surpasses the 26
1165	1165	eligibility level for full benefits to continue. The [hand- 27
1166	1166	up] program shall be voluntary and shall be designed such 28
1167	1167	that [an applicant] a recipient may begin receiving the 29
1168	1168	transitional child care benefit without having first 30
1169	1169	qualified for the full child care benefit or any other tier 31
1170	1170	of the transitional child care benefit. [Under no 32
1171	1171	circumstances shall any applicant be eligible for the hand - 33
1172	1172	up program if the applicant's income does not fall w ithin 34 37
1173	1173	CCS HCS SS SCS SBs 45 & 90
1174	1174	the transitional child care benefit income limits 35
1175	1175	established through the annual appropriations process. ] 36
1176	1176	(2) Transitional child care benefits shall be 37
1177	1177	determined on a sliding scale as follows for recipients with 38
1178	1178	household incomes in excess of the eligibility level for 39
1179	1179	full benefits: 40
1180	1180	(a) Eighty percent of the state base rate for 41
1181	1181	recipients with household incomes greater than the 42
1182	1182	eligibility level for full benefits but less than or equal 43
1183	1183	to one hundred fifty percent of the federal p overty level; 44
1184	1184	(b) Sixty percent of the state base rate for 45
1185	1185	recipients with household incomes greater than one hundred 46
1186	1186	fifty percent but less than or equal to one hundred seventy 47
1187	1187	percent of the federal poverty level; 48
1188	1188	(c) Forty percent of the state base rate for 49
1189	1189	recipients with household incomes greater than one hundred 50
1190	1190	seventy percent but less than or equal to one hundred ninety 51
1191	1191	percent of the federal poverty level; and 52
1192	1192	(d) Twenty percent of the state base rate for 53
1193	1193	recipients with household incomes greater than one hundred 54
1194	1194	ninety percent but less than or equal to two hundred percent 55
1195	1195	of the federal poverty level, but not greater than eighty - 56
1196	1196	five percent of the state median income. 57
1197	1197	(3) As used in this section, "state base rate" shall 58
1198	1198	refer to the rate established by the department for provider 59
1199	1199	payments that accounts for geographic area, type of 60
1200	1200	facility, duration of care, and age of the child, as well as 61
1201	1201	any enhancements reflecting after -hours or weekend care, 62
1202	1202	accreditation, or licensure status, as determined by the 63
1203	1203	department. Recipients shall be responsible for paying the 64
1204	1204	remaining sliding fee to the child care provider. 65 38
1205	1205	CCS HCS SS SCS SBs 45 & 90
1206	1206	(4) A participating recipient shall be allowed to opt 66
1207	1207	out of the program at any time, but suc h person shall not be 67
1208	1208	allowed to participate in the program a second time. 68
1209	1209	2. The department shall track the number of 69
1210	1210	participants in the [hand-up] program and shall issue an 70
1211	1211	annual report to the general assembly by September 1, [2023] 71
1212	1212	2025, and annually on September first thereafter, detailing 72
1213	1213	the effectiveness of the [pilot] program in encouraging 73
1214	1214	recipients to secure employment earning an income greater 74
1215	1215	than the maximum wage eligible for the full child care 75
1216	1216	benefit. The report shall also detail the costs of 76
1217	1217	administration and the increased amount of state income tax 77
1218	1218	paid as a result of the program [, as well as an analysis of 78
1219	1219	whether the pilot program could be expanded to include other 79
1220	1220	types of benefits, including, but not limited to, f ood 80
1221	1221	stamps, temporary assistance for needy families, low -income 81
1222	1222	heating assistance, women, infants and children supplemental 82
1223	1223	nutrition program, the state children's health insurance 83
1224	1224	program, and MO HealthNet benefits ]. 84
1225	1225	3. The department shall pur sue all necessary waivers 85
1226	1226	from the federal government to implement the [hand-up] 86
1227	1227	program. If the department is unable to obtain such 87
1228	1228	waivers, the department shall implement the program to the 88
1229	1229	degree possible without such waivers. 89
1230	1230	4. Any rule or portion of a rule, as that term is 90
1231	1231	defined in section 536.010, that is created under the 91
1232	1232	authority delegated under this section shall become 92
1233	1233	effective only if it complies with and is subject to all of 93
1234	1234	the provisions of chapter 536 and, if applicable, s ection 94
1235	1235	536.028. This section and chapter 536 are nonseverable and 95
1236	1236	if any of the powers vested with the general assembly 96
1237	1237	pursuant to chapter 536 to review, to delay the effective 97 39
1238	1238	CCS HCS SS SCS SBs 45 & 90
1239	1239	date, or to disapprove and annul a rule are subsequently 98
1240	1240	held unconstitutional, then the grant of rulemaking 99
1241	1241	authority and any rule proposed or adopted after August 28, 100
1242	1242	2012, shall be invalid and void. 101
1243	1243	[5. Pursuant to section 23.253 of the Missouri sunset 102
1244	1244	act: 103
1245	1245	(1) The provisions of the new program authorized und er 104
1246	1246	this section shall sunset automatically three years after 105
1247	1247	August 28, 2021, unless reauthorized by an act of the 106
1248	1248	general assembly; and 107
1249	1249	(2) If such program is reauthorized, the program 108
1250	1250	authorized under this section shall sunset automatically 109
1251	1251	three years after the effective date of the reauthorization 110
1252	1252	of this section; and 111
1253	1253	(3) This section shall terminate on September first of 112
1254	1254	the calendar year immediately following the calendar year in 113
1255	1255	which the program authorized under this section is s unset.] 114
1256	1256	208.066. 1. Upon approval by the Centers for Medicare 1
1257	1257	and Medicaid Services, the Food and Nutrition Services 2
1258	1258	within the United States Department of Agriculture, or any 3
1259	1259	other relevant federal agency, the department of socia l 4
1260	1260	services shall limit any initial application for the 5
1261	1261	Supplemental Nutrition Assistance Program (SNAP), the 6
1262	1262	Temporary Assistance for Needy Families program (TANF), the 7
1263	1263	child care assistance program, or MO HealthNet to a one -page 8
1264	1264	form that is easily a ccessible on the department of social 9
1265	1265	services' website. 10
1266	1266	2. Persons who are participants in a program listed in 11
1267	1267	subsection 1 of this section who are required to complete a 12
1268	1268	periodic eligibility review form may submit such form as an 13
1269	1269	attachment to their Missouri state individual income tax 14
1270	1270	return if the person's eligibility review form is due before 15 40
1271	1271	CCS HCS SS SCS SBs 45 & 90
1272	1272	or at the same time that he or she files such state tax 16
1273	1273	return. The department of social services shall limit 17
1274	1274	periodic eligibility review forms ass ociated with the 18
1275	1275	programs listed in subsection 1 of this section to a one - 19
1276	1276	page form that is easily accessible on both the department 20
1277	1277	of social services' website and the department of revenue's 21
1278	1278	website. 22
1279	1279	3. Notwithstanding the provisions of section 32.057 to 23
1280	1280	the contrary, the department of revenue shall share any 24
1281	1281	eligibility form submitted under this section with the 25
1282	1282	department of social services. 26
1283	1283	4. The department of revenue may promulgate all 27
1284	1284	necessary rules and regulations for the admin istration of 28
1285	1285	this section. Any rule or portion of a rule, as that term 29
1286	1286	is defined in section 536.010, that is created under the 30
1287	1287	authority delegated in this section shall become effective 31
1288	1288	only if it complies with and is subject to all of the 32
1289	1289	provisions of chapter 536 and, if applicable, section 33
1290	1290	536.028. This section and chapter 536 are nonseverable, and 34
1291	1291	if any of the powers vested with the general assembly 35
1292	1292	pursuant to chapter 536 to review, to delay the effective 36
1293	1293	date, or to disapprove and annul a rule are subsequently 37
1294	1294	held unconstitutional, then the grant of rulemaking 38
1295	1295	authority and any rule proposed or adopted after August 28, 39
1296	1296	2023, shall be invalid and void. 40
1297	1297	208.072. 1. A completed application for medical 1
1298	1298	assistance for services described in section 208.152 shall 2
1299	1299	be approved or denied within thirty days from submission to 3
1300	1300	the family support division or its successor. 4
1301	1301	2. The MO HealthNet division shall remit to a licensed 5
1302	1302	nursing home operator the Medicaid payment for a newly 6
1303	1303	admitted Medicaid resident in a licensed long -term care 7 41
1304	1304	CCS HCS SS SCS SBs 45 & 90
1305	1305	facility within forty -five days of the resident's date of 8
1306	1306	admission. 9
1307	1307	3. In accordance with 42 CFR 435.907(a), as amended, 10
1308	1308	if the applicant is a minor or incapacitated, the famil y 11
1309	1309	support division or its successor shall accept an 12
1310	1310	application from someone acting responsibly for the 13
1311	1311	applicant. 14
1312	1312	208.146. 1. The program established under this 1
1313	1313	section shall be known as the "Ticket to Work Health 2
1314	1314	Assurance Program". Subject to appropriations and in 3
1315	1315	accordance with the federal Ticket to Work and Work 4
1316	1316	Incentives Improvement Act of 1999 (TWWIIA), Public Law 106 - 5
1317	1317	170, the medical assistance provided for in section 208.151 6
1318	1318	may be paid for a person who is employed and who: 7
1319	1319	(1) Except for earnings, meets the definition of 8
1320	1320	disabled under the Supplemental Security Income Program or 9
1321	1321	meets the definition of an employed individual with a 10
1322	1322	medically improved disability under TWWIIA; 11
1323	1323	(2) Has earned income, as defined in subsection 2 of 12
1324	1324	this section; 13
1325	1325	(3) Meets the asset limits in subsection 3 of this 14
1326	1326	section; and 15
1327	1327	(4) Has [net] income, as [defined] determined in 16
1328	1328	subsection 3 of this section, that does not exceed [the 17
1329	1329	limit for permanent and totall y disabled individuals to 18
1330	1330	receive nonspenddown MO HealthNet under subdivision (24) of 19
1331	1331	subsection 1 of section 208.151; and 20
1332	1332	(5) Has a gross income of ] two hundred fifty percent 21
1333	1333	[or less] of the federal poverty level, excluding any earned 22
1334	1334	income of the worker with a disability between two hundred 23
1335	1335	fifty and three hundred percent of the federal poverty 24
1336	1336	level. [For purposes of this subdivision, "gross income" 25 42
1337	1337	CCS HCS SS SCS SBs 45 & 90
1338	1338	includes all income of the person and the person's spouse 26
1339	1339	that would be considered in det ermining MO HealthNet 27
1340	1340	eligibility for permanent and totally disabled individuals 28
1341	1341	under subdivision (24) of subsection 1 of section 208.151. 29
1342	1342	Individuals with gross incomes in excess of one hundred 30
1343	1343	percent of the federal poverty level shall pay a premiu m for 31
1344	1344	participation in accordance with subsection 4 of this 32
1345	1345	section.] 33
1346	1346	2. For income to be considered earned income for 34
1347	1347	purposes of this section, the department of social services 35
1348	1348	shall document that Medicare and Social Security taxes are 36
1349	1349	withheld from such income. Self-employed persons shall 37
1350	1350	provide proof of payment of Medicare and Social Security 38
1351	1351	taxes for income to be considered earned. 39
1352	1352	3. (1) For purposes of determining eligibility under 40
1353	1353	this section, the available asset limit and t he definition 41
1354	1354	of available assets shall be the same as those used to 42
1355	1355	determine MO HealthNet eligibility for permanent and totally 43
1356	1356	disabled individuals under subdivision (24) of subsection 1 44
1357	1357	of section 208.151 except for: 45
1358	1358	(a) Medical savings accou nts limited to deposits of 46
1359	1359	earned income and earnings on such income while a 47
1360	1360	participant in the program created under this section with a 48
1361	1361	value not to exceed five thousand dollars per year; [and] 49
1362	1362	(b) Independent living accounts limited to deposits of 50
1363	1363	earned income and earnings on such income while a 51
1364	1364	participant in the program created under this section with a 52
1365	1365	value not to exceed five thousand dollars per year. For 53
1366	1366	purposes of this section, an "independent living account" 54
1367	1367	means an account esta blished and maintained to provide 55
1368	1368	savings for transportation, housing, home modification, and 56 43
1369	1369	CCS HCS SS SCS SBs 45 & 90
1370	1370	personal care services and assistive devices associated with 57
1371	1371	such person's disability ; and 58
1372	1372	(c) Retirement accounts including, but not limited to, 59
1373	1373	individual accounts, 401(k) plans, 403(b) plans, Keogh 60
1374	1374	plans, and pension plans, provided that income from such 61
1375	1375	accounts be calculated as income under subdivision (4) of 62
1376	1376	subsection 1 of this section . 63
1377	1377	(2) To determine [net] income, the following shall be 64
1378	1378	disregarded: 65
1379	1379	(a) [All earned income of the disabled worker; 66
1380	1380	(b)] The first [sixty-five dollars and one -half] fifty 67
1381	1381	thousand dollars of [the remaining] earned income of [a 68
1382	1382	nondisabled spouse's earned income ] the person's spouse; 69
1383	1383	[(c)] (b) A twenty dollar standard deduction; 70
1384	1384	[(d)] (c) Health insurance premiums; 71
1385	1385	[(e)] (d) A seventy-five dollar a month standard 72
1386	1386	deduction for the disabled worker's dental and optical 73
1387	1387	insurance when the total dental and optical insurance 74
1388	1388	premiums are less than seventy -five dollars; 75
1389	1389	[(f)] (e) All Supplemental Security Income payments, 76
1390	1390	and the first fifty dollars of SSDI payments; and 77
1391	1391	[(g)] (f) A standard deduction for impairment -related 78
1392	1392	employment expenses equal to one -half of the disabled 79
1393	1393	worker's earned income. 80
1394	1394	4. Any person whose [gross] income exceeds one hundred 81
1395	1395	percent of the federal poverty level shall pay a premium for 82
1396	1396	participation in the medical assistance provided in this 83
1397	1397	section. Such premium shall be: 84
1398	1398	(1) For a person whose [gross] income is more than one 85
1399	1399	hundred percent but less than one hundred fifty percent of 86
1400	1400	the federal poverty level, four percent of income at one 87
1401	1401	hundred percent of the federal poverty level; 88 44
1402	1402	CCS HCS SS SCS SBs 45 & 90
1403	1403	(2) For a person whose [gross] income equals or 89
1404	1404	exceeds one hundred fifty percent but is less than two 90
1405	1405	hundred percent of the federal poverty level, four percent 91
1406	1406	of income at one hundred fifty percent of the federal 92
1407	1407	poverty level; 93
1408	1408	(3) For a person whose [gross] income equals or 94
1409	1409	exceeds two hundred percent but less than two hundred fifty 95
1410	1410	percent of the federal poverty level, five percent of income 96
1411	1411	at two hundred percent of the federal poverty level; 97
1412	1412	(4) For a person whose [gross] income equals or 98
1413	1413	exceeds two hundred fif ty percent up to and including three 99
1414	1414	hundred percent of the federal poverty level, six percent of 100
1415	1415	income at two hundred fifty percent of the federal poverty 101
1416	1416	level. 102
1417	1417	5. Recipients of services through this program shall 103
1418	1418	report any change in income o r household size within ten 104
1419	1419	days of the occurrence of such change. An increase in 105
1420	1420	premiums resulting from a reported change in income or 106
1421	1421	household size shall be effective with the next premium 107
1422	1422	invoice that is mailed to a person after due process 108
1423	1423	requirements have been met. A decrease in premiums shall be 109
1424	1424	effective the first day of the month immediately following 110
1425	1425	the month in which the change is reported. 111
1426	1426	6. If an eligible person's employer offers employer - 112
1427	1427	sponsored health insurance and the d epartment of social 113
1428	1428	services determines that it is more cost effective, such 114
1429	1429	person shall participate in the employer -sponsored 115
1430	1430	insurance. The department shall pay such person's portion 116
1431	1431	of the premiums, co-payments, and any other costs associated 117
1432	1432	with participation in the employer -sponsored health 118
1433	1433	insurance. If the department elects to pay such person's 119
1434	1434	employer-sponsored insurance costs under this subsection, 120 45
1435	1435	CCS HCS SS SCS SBs 45 & 90
1436	1436	the medical assistance provided under this section shall be 121
1437	1437	provided to an eligible per son as a secondary or 122
1438	1438	supplemental policy for only personal care assistance 123
1439	1439	services, as defined in section 208.900, and related costs 124
1440	1440	and nonemergency medical transportation to any employer - 125
1441	1441	sponsored benefits that may be available to such person. 126
1442	1442	7. The department of social services shall provide to 127
1443	1443	the general assembly an annual report that identifies the 128
1444	1444	number of participants in the program and describes the 129
1445	1445	outreach and education efforts to increase awareness and 130
1446	1446	enrollment in the program. 131
1447	1447	8. The department of social services shall submit such 132
1448	1448	state plan amendments and waivers to the Centers for 133
1449	1449	Medicare and Medicaid Services of the federal Department of 134
1450	1450	Health and Human Services as the department determines are 135
1451	1451	necessary to implement the provisions of this section. 136
1452	1452	9. The provisions of this section shall expire August 137
1453	1453	28, 2025. 138
1454	1454	208.151. 1. Medical assistance on behalf of needy 1
1455	1455	persons shall be known as "MO HealthNet". For the purpose 2
1456	1456	of paying MO HealthNet benefits and to comply with Title 3
1457	1457	XIX, Public Law 89-97, 1965 amendments to the federal Social 4
1458	1458	Security Act (42 U.S.C. Section 301, et seq.) as amended, 5
1459	1459	the following needy persons shall be eligible to receive MO 6
1460	1460	HealthNet benefits to the exten t and in the manner 7
1461	1461	hereinafter provided: 8
1462	1462	(1) All participants receiving state supplemental 9
1463	1463	payments for the aged, blind and disabled; 10
1464	1464	(2) All participants receiving aid to families with 11
1465	1465	dependent children benefits, including all persons und er 12
1466	1466	nineteen years of age who would be classified as dependent 13
1467	1467	children except for the requirements of subdivision (1) of 14 46
1468	1468	CCS HCS SS SCS SBs 45 & 90
1469	1469	subsection 1 of section 208.040. Participants eligible 15
1470	1470	under this subdivision who are participating in treatment 16
1471	1471	court, as defined in section 478.001, shall have their 17
1472	1472	eligibility automatically extended sixty days from the time 18
1473	1473	their dependent child is removed from the custody of the 19
1474	1474	participant, subject to approval of the Centers for Medicare 20
1475	1475	and Medicaid Services; 21
1476	1476	(3) All participants receiving blind pension benefits; 22
1477	1477	(4) All persons who would be determined to be eligible 23
1478	1478	for old age assistance benefits, permanent and total 24
1479	1479	disability benefits, or aid to the blind benefits under the 25
1480	1480	eligibility standards in effec t December 31, 1973, or less 26
1481	1481	restrictive standards as established by rule of the family 27
1482	1482	support division, who are sixty -five years of age or over 28
1483	1483	and are patients in state institutions for mental diseases 29
1484	1484	or tuberculosis; 30
1485	1485	(5) All persons under th e age of twenty-one years who 31
1486	1486	would be eligible for aid to families with dependent 32
1487	1487	children except for the requirements of subdivision (2) of 33
1488	1488	subsection 1 of section 208.040, and who are residing in an 34
1489	1489	intermediate care facility, or receiving active tr eatment as 35
1490	1490	inpatients in psychiatric facilities or programs, as defined 36
1491	1491	in 42 U.S.C. Section 1396d, as amended; 37
1492	1492	(6) All persons under the age of twenty -one years who 38
1493	1493	would be eligible for aid to families with dependent 39
1494	1494	children benefits except fo r the requirement of deprivation 40
1495	1495	of parental support as provided for in subdivision (2) of 41
1496	1496	subsection 1 of section 208.040; 42
1497	1497	(7) All persons eligible to receive nursing care 43
1498	1498	benefits; 44
1499	1499	(8) All participants receiving family foster home or 45
1500	1500	nonprofit private child-care institution care, subsidized 46 47
1501	1501	CCS HCS SS SCS SBs 45 & 90
1502	1502	adoption benefits and parental school care wherein state 47
1503	1503	funds are used as partial or full payment for such care; 48
1504	1504	(9) All persons who were participants receiving old 49
1505	1505	age assistance benefits, ai d to the permanently and totally 50
1506	1506	disabled, or aid to the blind benefits on December 31, 1973, 51
1507	1507	and who continue to meet the eligibility requirements, 52
1508	1508	except income, for these assistance categories, but who are 53
1509	1509	no longer receiving such benefits because o f the 54
1510	1510	implementation of Title XVI of the federal Social Security 55
1511	1511	Act, as amended; 56
1512	1512	(10) Pregnant women who meet the requirements for aid 57
1513	1513	to families with dependent children, except for the 58
1514	1514	existence of a dependent child in the home; 59
1515	1515	(11) Pregnant women who meet the requirements for aid 60
1516	1516	to families with dependent children, except for the 61
1517	1517	existence of a dependent child who is deprived of parental 62
1518	1518	support as provided for in subdivision (2) of subsection 1 63
1519	1519	of section 208.040; 64
1520	1520	(12) Pregnant women or infants under one year of age, 65
1521	1521	or both, whose family income does not exceed an income 66
1522	1522	eligibility standard equal to one hundred eighty -five 67
1523	1523	percent of the federal poverty level as established and 68
1524	1524	amended by the federal Department of Health and Human 69
1525	1525	Services, or its successor agency; 70
1526	1526	(13) Children who have attained one year of age but 71
1527	1527	have not attained six years of age who are eligible for 72
1528	1528	medical assistance under 6401 of P.L. 101 -239 (Omnibus 73
1529	1529	Budget Reconciliation Act of 1989) (4 2 U.S.C. Sections 1396a 74
1530	1530	to 1396b). The family support division shall use an income 75
1531	1531	eligibility standard equal to one hundred thirty -three 76
1532	1532	percent of the federal poverty level established by the 77 48
1533	1533	CCS HCS SS SCS SBs 45 & 90
1534	1534	Department of Health and Human Services, or its successor 78
1535	1535	agency; 79
1536	1536	(14) Children who have attained six years of age but 80
1537	1537	have not attained nineteen years of age. For children who 81
1538	1538	have attained six years of age but have not attained 82
1539	1539	nineteen years of age, the family support division shall use 83
1540	1540	an income assessment methodology which provides for 84
1541	1541	eligibility when family income is equal to or less than 85
1542	1542	equal to one hundred percent of the federal poverty level 86
1543	1543	established by the Department of Health and Human Services, 87
1544	1544	or its successor agency. As necessary to provide MO 88
1545	1545	HealthNet coverage under this subdivision, the department of 89
1546	1546	social services may revise the state MO HealthNet plan to 90
1547	1547	extend coverage under 42 U.S.C. Section 91
1548	1548	1396a(a)(10)(A)(i)(III) to children who have attained six 92
1549	1549	years of age but have not attained nineteen years of age as 93
1550	1550	permitted by paragraph (2) of subsection (n) of 42 U.S.C. 94
1551	1551	Section 1396d using a more liberal income assessment 95
1552	1552	methodology as authorized by paragraph (2) of subsection (r) 96
1553	1553	of 42 U.S.C. Section 1396a; 97
1554	1554	(15) The family support division shall not establish a 98
1555	1555	resource eligibility standard in assessing eligibility for 99
1556	1556	persons under subdivision (12), (13) or (14) of this 100
1557	1557	subsection. The MO HealthNet division shall define the 101
1558	1558	amount and scope of benefits whi ch are available to 102
1559	1559	individuals eligible under each of the subdivisions (12), 103
1560	1560	(13), and (14) of this subsection, in accordance with the 104
1561	1561	requirements of federal law and regulations promulgated 105
1562	1562	thereunder; 106
1563	1563	(16) Notwithstanding any other provisions of law to 107
1564	1564	the contrary, ambulatory prenatal care shall be made 108
1565	1565	available to pregnant women during a period of presumptive 109 49
1566	1566	CCS HCS SS SCS SBs 45 & 90
1567	1567	eligibility pursuant to 42 U.S.C. Section 1396r -1, as 110
1568	1568	amended; 111
1569	1569	(17) A child born to a woman eligible for and 112
1570	1570	receiving MO HealthNet benefits under this section on the 113
1571	1571	date of the child's birth shall be deemed to have applied 114
1572	1572	for MO HealthNet benefits and to have been found eligible 115
1573	1573	for such assistance under such plan on the date of such 116
1574	1574	birth and to remain eligible for suc h assistance for a 117
1575	1575	period of time determined in accordance with applicable 118
1576	1576	federal and state law and regulations so long as the child 119
1577	1577	is a member of the woman's household and either the woman 120
1578	1578	remains eligible for such assistance or for children born on 121
1579	1579	or after January 1, 1991, the woman would remain eligible 122
1580	1580	for such assistance if she were still pregnant. Upon 123
1581	1581	notification of such child's birth, the family support 124
1582	1582	division shall assign a MO HealthNet eligibility 125
1583	1583	identification number to the child so that claims may be 126
1584	1584	submitted and paid under such child's identification number; 127
1585	1585	(18) Pregnant women and children eligible for MO 128
1586	1586	HealthNet benefits pursuant to subdivision (12), (13) or 129
1587	1587	(14) of this subsection shall not as a condition of 130
1588	1588	eligibility for MO HealthNet benefits be required to apply 131
1589	1589	for aid to families with dependent children. The family 132
1590	1590	support division shall utilize an application for 133
1591	1591	eligibility for such persons which eliminates information 134
1592	1592	requirements other than those ne cessary to apply for MO 135
1593	1593	HealthNet benefits. The division shall provide such 136
1594	1594	application forms to applicants whose preliminary income 137
1595	1595	information indicates that they are ineligible for aid to 138
1596	1596	families with dependent children. Applicants for MO 139
1597	1597	HealthNet benefits under subdivision (12), (13) or (14) of 140
1598	1598	this subsection shall be informed of the aid to families 141 50
1599	1599	CCS HCS SS SCS SBs 45 & 90
1600	1600	with dependent children program and that they are entitled 142
1601	1601	to apply for such benefits. Any forms utilized by the 143
1602	1602	family support division for assessing eligibility under this 144
1603	1603	chapter shall be as simple as practicable; 145
1604	1604	(19) Subject to appropriations necessary to recruit 146
1605	1605	and train such staff, the family support division shall 147
1606	1606	provide one or more full -time, permanent eligibility 148
1607	1607	specialists to process applications for MO HealthNet 149
1608	1608	benefits at the site of a health care provider, if the 150
1609	1609	health care provider requests the placement of such 151
1610	1610	eligibility specialists and reimburses the division for the 152
1611	1611	expenses including but not limited to sal aries, benefits, 153
1612	1612	travel, training, telephone, supplies, and equipment of such 154
1613	1613	eligibility specialists. The division may provide a health 155
1614	1614	care provider with a part -time or temporary eligibility 156
1615	1615	specialist at the site of a health care provider if the 157
1616	1616	health care provider requests the placement of such an 158
1617	1617	eligibility specialist and reimburses the division for the 159
1618	1618	expenses, including but not limited to the salary, benefits, 160
1619	1619	travel, training, telephone, supplies, and equipment, of 161
1620	1620	such an eligibility s pecialist. The division may seek to 162
1621	1621	employ such eligibility specialists who are otherwise 163
1622	1622	qualified for such positions and who are current or former 164
1623	1623	welfare participants. The division may consider training 165
1624	1624	such current or former welfare participants as eligibility 166
1625	1625	specialists for this program; 167
1626	1626	(20) Pregnant women who are eligible for, have applied 168
1627	1627	for and have received MO HealthNet benefits under 169
1628	1628	subdivision (2), (10), (11) or (12) of this subsection shall 170
1629	1629	continue to be considered eligible for all pregnancy-related 171
1630	1630	and postpartum MO HealthNet benefits provided under section 172
1631	1631	208.152 until the end of the sixty -day period beginning on 173 51
1632	1632	CCS HCS SS SCS SBs 45 & 90
1633	1633	the last day of their pregnancy. Pregnant women receiving 174
1634	1634	mental health treatment for postpartum depressio n or related 175
1635	1635	mental health conditions within sixty days of giving birth 176
1636	1636	shall, subject to appropriations and any necessary federal 177
1637	1637	approval, be eligible for MO HealthNet benefits for mental 178
1638	1638	health services for the treatment of postpartum depression 179
1639	1639	and related mental health conditions for up to twelve 180
1640	1640	additional months. Pregnant women receiving substance abuse 181
1641	1641	treatment within sixty days of giving birth shall, subject 182
1642	1642	to appropriations and any necessary federal approval, be 183
1643	1643	eligible for MO HealthN et benefits for substance abuse 184
1644	1644	treatment and mental health services for the treatment of 185
1645	1645	substance abuse for no more than twelve additional months, 186
1646	1646	as long as the woman remains adherent with treatment. The 187
1647	1647	department of mental health and the departme nt of social 188
1648	1648	services shall seek any necessary waivers or state plan 189
1649	1649	amendments from the Centers for Medicare and Medicaid 190
1650	1650	Services and shall develop rules relating to treatment plan 191
1651	1651	adherence. No later than fifteen months after receiving any 192
1652	1652	necessary waiver, the department of mental health and the 193
1653	1653	department of social services shall report to the house of 194
1654	1654	representatives budget committee and the senate 195
1655	1655	appropriations committee on the compliance with federal cost 196
1656	1656	neutrality requirements; 197
1657	1657	(21) Case management services for pregnant women and 198
1658	1658	young children at risk shall be a covered service. To the 199
1659	1659	greatest extent possible, and in compliance with federal law 200
1660	1660	and regulations, the department of health and senior 201
1661	1661	services shall provide case management services to pregnant 202
1662	1662	women by contract or agreement with the department of social 203
1663	1663	services through local health departments organized under 204
1664	1664	the provisions of chapter 192 or chapter 205 or a city 205 52
1665	1665	CCS HCS SS SCS SBs 45 & 90
1666	1666	health department operated under a city charte r or a 206
1667	1667	combined city-county health department or other department 207
1668	1668	of health and senior services designees. To the greatest 208
1669	1669	extent possible the department of social services and the 209
1670	1670	department of health and senior services shall mutually 210
1671	1671	coordinate all services for pregnant women and children with 211
1672	1672	the crippled children's program, the prevention of 212
1673	1673	intellectual disability and developmental disability program 213
1674	1674	and the prenatal care program administered by the department 214
1675	1675	of health and senior services. The department of social 215
1676	1676	services shall by regulation establish the methodology for 216
1677	1677	reimbursement for case management services provided by the 217
1678	1678	department of health and senior services. For purposes of 218
1679	1679	this section, the term "case management" shall me an those 219
1680	1680	activities of local public health personnel to identify 220
1681	1681	prospective MO HealthNet -eligible high-risk mothers and 221
1682	1682	enroll them in the state's MO HealthNet program, refer them 222
1683	1683	to local physicians or local health departments who provide 223
1684	1684	prenatal care under physician protocol and who participate 224
1685	1685	in the MO HealthNet program for prenatal care and to ensure 225
1686	1686	that said high-risk mothers receive support from all private 226
1687	1687	and public programs for which they are eligible and shall 227
1688	1688	not include involvement in any MO HealthNet prepaid, case - 228
1689	1689	managed programs; 229
1690	1690	(22) By January 1, 1988, the department of social 230
1691	1691	services and the department of health and senior services 231
1692	1692	shall study all significant aspects of presumptive 232
1693	1693	eligibility for pregnant women and submit a joint report on 233
1694	1694	the subject, including projected costs and the time needed 234
1695	1695	for implementation, to the general assembly. The department 235
1696	1696	of social services, at the direction of the general 236 53
1697	1697	CCS HCS SS SCS SBs 45 & 90
1698	1698	assembly, may implement presumptive eligibility by 237
1699	1699	regulation promulgated pursuant to chapter 207; 238
1700	1700	(23) All participants who would be eligible for aid to 239
1701	1701	families with dependent children benefits except for the 240
1702	1702	requirements of paragraph (d) of subdivision (1) of section 241
1703	1703	208.150; 242
1704	1704	(24) (a) All persons who would be determined to be 243
1705	1705	eligible for old age assistance benefits under the 244
1706	1706	eligibility standards in effect December 31, 1973, as 245
1707	1707	authorized by 42 U.S.C. Section 1396a(f), or less 246
1708	1708	restrictive methodologies as contained in the MO HealthNet 247
1709	1709	state plan as of January 1, 2005; except that, on or after 248
1710	1710	July 1, 2005, less restrictive income methodologies, as 249
1711	1711	authorized in 42 U.S.C. Section 1396a(r)(2), may be used to 250
1712	1712	change the income limit if authorized by annual 251
1713	1713	appropriation; 252
1714	1714	(b) All persons who would be determined to be eligible 253
1715	1715	for aid to the blind benefits under the eligibility 254
1716	1716	standards in effect December 31, 1973, as authorized by 42 255
1717	1717	U.S.C. Section 1396a(f), or less restrictive methodologies 256
1718	1718	as contained in the MO HealthNet st ate plan as of January 1, 257
1719	1719	2005, except that less restrictive income methodologies, as 258
1720	1720	authorized in 42 U.S.C. Section 1396a(r)(2), shall be used 259
1721	1721	to raise the income limit to one hundred percent of the 260
1722	1722	federal poverty level; 261
1723	1723	(c) All persons who would be determined to be eligible 262
1724	1724	for permanent and total disability benefits under the 263
1725	1725	eligibility standards in effect December 31, 1973, as 264
1726	1726	authorized by 42 U.S.C. Section 1396a(f); or less 265
1727	1727	restrictive methodologies as contained in the MO HealthNet 266
1728	1728	state plan as of January 1, 2005; except that, on or after 267
1729	1729	July 1, 2005, less restrictive income methodologies, as 268 54
1730	1730	CCS HCS SS SCS SBs 45 & 90
1731	1731	authorized in 42 U.S.C. Section 1396a(r)(2), may be used to 269
1732	1732	change the income limit if authorized by annual 270
1733	1733	appropriations. Eligibility standards for permanent and 271
1734	1734	total disability benefits shall not be limited by age; 272
1735	1735	(25) Persons who have been diagnosed with breast or 273
1736	1736	cervical cancer and who are eligible for coverage pursuant 274
1737	1737	to 42 U.S.C. Section 1396a(a)(10)(A)(ii)(XVIII). Such 275
1738	1738	persons shall be eligible during a period of presumptive 276
1739	1739	eligibility in accordance with 42 U.S.C. Section 1396r -1; 277
1740	1740	(26) Persons who are in foster care under the 278
1741	1741	responsibility of the state of Missouri on the date such 279
1742	1742	persons attained the age of eighteen years, or at any time 280
1743	1743	during the thirty-day period preceding their eighteenth 281
1744	1744	birthday, or persons who received foster care for at least 282
1745	1745	six months in another state, are residing in Missouri, and 283
1746	1746	are at least eighteen years of age, without re gard to income 284
1747	1747	or assets, if such persons: 285
1748	1748	(a) Are under twenty-six years of age; 286
1749	1749	(b) Are not eligible for coverage under another 287
1750	1750	mandatory coverage group; and 288
1751	1751	(c) Were covered by Medicaid while they were in foster 289
1752	1752	care; 290
1753	1753	(27) Any homeless child or homeless youth, as those 291
1754	1754	terms are defined in section 167.020, subject to approval of 292
1755	1755	a state plan amendment by the Centers for Medicare and 293
1756	1756	Medicaid Services; 294
1757	1757	(28) (a) Subject to approval of any necessary state 295
1758	1758	plan amendments or waivers, beginning on the effective date 296
1759	1759	of this act, pregnant women who are eligible for, have 297
1760	1760	applied for, and have received MO HealthNet benefits under 298
1761	1761	subdivision (2), (10), (11), or (12) of this subsection 299
1762	1762	shall be eligible for medical assis tance during the 300 55
1763	1763	CCS HCS SS SCS SBs 45 & 90
1764	1764	pregnancy and during the twelve -month period that begins on 301
1765	1765	the last day of the woman's pregnancy and ends on the last 302
1766	1766	day of the month in which such twelve -month period ends, 303
1767	1767	consistent with the provisions of 42 U.S.C. Section 304
1768	1768	1396a(e)(16). The department shall submit a state plan 305
1769	1769	amendment to the Centers for Medicare and Medicaid Services 306
1770	1770	when the number of ineligible MO HealthNet participants 307
1771	1771	removed from the program in 2023 pursuant to section 208.239 308
1772	1772	exceeds the projected num ber of beneficiaries likely to 309
1773	1773	enroll in benefits in 2023 under this subdivision and 310
1774	1774	subdivision (2) of subsection 6 of section 208.662, as 311
1775	1775	determined by the department, by at least one hundred 312
1776	1776	individuals; 313
1777	1777	(b) The provisions of this subdivision shall remain in 314
1778	1778	effect for any period of time during which the federal 315
1779	1779	authority under 42 U.S.C. Section 1396a(e)(16), as amended, 316
1780	1780	or any successor statutes or implementing regulations, is in 317
1781	1781	effect. 318
1782	1782	2. Rules and regulations to implement this sec tion 319
1783	1783	shall be promulgated in accordance with chapter 536. Any 320
1784	1784	rule or portion of a rule, as that term is defined in 321
1785	1785	section 536.010, that is created under the authority 322
1786	1786	delegated in this section shall become effective only if it 323
1787	1787	complies with and is subject to all of the provisions of 324
1788	1788	chapter 536 and, if applicable, section 536.028. This 325
1789	1789	section and chapter 536 are nonseverable and if any of the 326
1790	1790	powers vested with the general assembly pursuant to chapter 327
1791	1791	536 to review, to delay the effective date or to disapprove 328
1792	1792	and annul a rule are subsequently held unconstitutional, 329
1793	1793	then the grant of rulemaking authority and any rule proposed 330
1794	1794	or adopted after August 28, 2002, shall be invalid and void. 331 56
1795	1795	CCS HCS SS SCS SBs 45 & 90
1796	1796	3. After December 31, 1973, and before April 1, 19 90, 332
1797	1797	any family eligible for assistance pursuant to 42 U.S.C. 333
1798	1798	Section 601, et seq., as amended, in at least three of the 334
1799	1799	last six months immediately preceding the month in which 335
1800	1800	such family became ineligible for such assistance because of 336
1801	1801	increased income from employment shall, while a member of 337
1802	1802	such family is employed, remain eligible for MO HealthNet 338
1803	1803	benefits for four calendar months following the month in 339
1804	1804	which such family would otherwise be determined to be 340
1805	1805	ineligible for such assistance because of income and 341
1806	1806	resource limitation. After April 1, 1990, any family 342
1807	1807	receiving aid pursuant to 42 U.S.C. Section 601, et seq., as 343
1808	1808	amended, in at least three of the six months immediately 344
1809	1809	preceding the month in which such family becomes ineligible 345
1810	1810	for such aid, because of hours of employment or income from 346
1811	1811	employment of the caretaker relative, shall remain eligible 347
1812	1812	for MO HealthNet benefits for six calendar months following 348
1813	1813	the month of such ineligibility as long as such family 349
1814	1814	includes a child as p rovided in 42 U.S.C. Section 1396r -6. 350
1815	1815	Each family which has received such medical assistance 351
1816	1816	during the entire six -month period described in this section 352
1817	1817	and which meets reporting requirements and income tests 353
1818	1818	established by the division and continues to include a child 354
1819	1819	as provided in 42 U.S.C. Section 1396r -6 shall receive MO 355
1820	1820	HealthNet benefits without fee for an additional six 356
1821	1821	months. The MO HealthNet division may provide by rule and 357
1822	1822	as authorized by annual appropriation the scope of MO 358
1823	1823	HealthNet coverage to be granted to such families. 359
1824	1824	4. When any individual has been determined to be 360
1825	1825	eligible for MO HealthNet benefits, such medical assistance 361
1826	1826	will be made available to him or her for care and services 362
1827	1827	furnished in or after the third mon th before the month in 363 57
1828	1828	CCS HCS SS SCS SBs 45 & 90
1829	1829	which he made application for such assistance if such 364
1830	1830	individual was, or upon application would have been, 365
1831	1831	eligible for such assistance at the time such care and 366
1832	1832	services were furnished; provided, further, that such 367
1833	1833	medical expenses remain unpaid. 368
1834	1834	5. The department of social services may apply to the 369
1835	1835	federal Department of Health and Human Services for a MO 370
1836	1836	HealthNet waiver amendment to the Section 1115 demonstration 371
1837	1837	waiver or for any additional MO HealthNet waivers neces sary 372
1838	1838	not to exceed one million dollars in additional costs to the 373
1839	1839	state, unless subject to appropriation or directed by 374
1840	1840	statute, but in no event shall such waiver applications or 375
1841	1841	amendments seek to waive the services of a rural health 376
1842	1842	clinic or a federally qualified health center as defined in 377
1843	1843	42 U.S.C. Section 1396d(l)(1) and (2) or the payment 378
1844	1844	requirements for such clinics and centers as provided in 42 379
1845	1845	U.S.C. Section 1396a(a)(15) and 1396a(bb) unless such waiver 380
1846	1846	application is approved by the ove rsight committee created 381
1847	1847	in section 208.955. A request for such a waiver so 382
1848	1848	submitted shall only become effective by executive order not 383
1849	1849	sooner than ninety days after the final adjournment of the 384
1850	1850	session of the general assembly to which it is submitte d, 385
1851	1851	unless it is disapproved within sixty days of its submission 386
1852	1852	to a regular session by a senate or house resolution adopted 387
1853	1853	by a majority vote of the respective elected members 388
1854	1854	thereof, unless the request for such a waiver is made 389
1855	1855	subject to appropriation or directed by statute. 390
1856	1856	6. Notwithstanding any other provision of law to the 391
1857	1857	contrary, in any given fiscal year, any persons made 392
1858	1858	eligible for MO HealthNet benefits under subdivisions (1) to 393
1859	1859	(22) of subsection 1 of this section shall only be eligible 394
1860	1860	if annual appropriations are made for such eligibility. 395 58
1861	1861	CCS HCS SS SCS SBs 45 & 90
1862	1862	This subsection shall not apply to classes of individuals 396
1863	1863	listed in 42 U.S.C. Section 1396a(a)(10)(A)(i). 397
1864	1864	7. (1) Notwithstanding any provision of law to the 398
1865	1865	contrary, a military service member, or an immediate family 399
1866	1866	member residing with such military service member, who is a 400
1867	1867	legal resident of this state and is eligible for MO 401
1868	1868	HealthNet developmental disability services, shall have his 402
1869	1869	or her eligibility for MO HealthNet devel opmental disability 403
1870	1870	services temporarily suspended for any period of time during 404
1871	1871	which such person temporarily resides outside of this state 405
1872	1872	for reasons relating to military service, but shall have his 406
1873	1873	or her eligibility immediately restored upon retur ning to 407
1874	1874	this state to reside. 408
1875	1875	(2) Notwithstanding any provision of law to the 409
1876	1876	contrary, if a military service member, or an immediate 410
1877	1877	family member residing with such military service member, is 411
1878	1878	not a legal resident of this state, but would other wise be 412
1879	1879	eligible for MO HealthNet developmental disability services, 413
1880	1880	such individual shall be deemed eligible for MO HealthNet 414
1881	1881	developmental disability services for the duration of any 415
1882	1882	time in which such individual is temporarily present in this 416
1883	1883	state for reasons relating to military service. 417
1884	1884	208.186. The state shall not provide payments, add - 1
1885	1885	ons, or reimbursements to health care providers through MO 2
1886	1886	HealthNet for medical assistance services provided to 3
1887	1887	persons who do not reside in this state, as determined under 4
1888	1888	42 CFR 435.403, or any amendments or successor regulations 5
1889	1889	thereto. 6
1890	1890	208.239. The department of social services shall 1
1891	1891	resume annual MO HealthNet eligibility redeterminations, 2
1892	1892	renewals, and postenrol lment verifications no later than 3
1893	1893	thirty days after the effective date of this act. 4 59
1894	1894	CCS HCS SS SCS SBs 45 & 90
1895	1895	208.662. 1. There is hereby established within the 1
1896	1896	department of social services the "Show -Me Healthy Babies 2
1897	1897	Program" as a separate children's healt h insurance program 3
1898	1898	(CHIP) for any low-income unborn child. The program shall 4
1899	1899	be established under the authority of Title XXI of the 5
1900	1900	federal Social Security Act, the State Children's Health 6
1901	1901	Insurance Program, as amended, and 42 CFR 457.1. 7
1902	1902	2. For an unborn child to be enrolled in the show -me 8
1903	1903	healthy babies program, his or her mother shall not be 9
1904	1904	eligible for coverage under Title XIX of the federal Social 10
1905	1905	Security Act, the Medicaid program, as it is administered by 11
1906	1906	the state, and shall not have access to affordable employer - 12
1907	1907	subsidized health care insurance or other affordable health 13
1908	1908	care coverage that includes coverage for the unborn child. 14
1909	1909	In addition, the unborn child shall be in a family with 15
1910	1910	income eligibility of no more than three hund red percent of 16
1911	1911	the federal poverty level, or the equivalent modified 17
1912	1912	adjusted gross income, unless the income eligibility is set 18
1913	1913	lower by the general assembly through appropriations. In 19
1914	1914	calculating family size as it relates to income eligibility, 20
1915	1915	the family shall include, in addition to other family 21
1916	1916	members, the unborn child, or in the case of a mother with a 22
1917	1917	multiple pregnancy, all unborn children. 23
1918	1918	3. Coverage for an unborn child enrolled in the show - 24
1919	1919	me healthy babies program shall include a ll prenatal care 25
1920	1920	and pregnancy-related services that benefit the health of 26
1921	1921	the unborn child and that promote healthy labor, delivery, 27
1922	1922	and birth. Coverage need not include services that are 28
1923	1923	solely for the benefit of the pregnant mother, that are 29
1924	1924	unrelated to maintaining or promoting a healthy pregnancy, 30
1925	1925	and that provide no benefit to the unborn child. However, 31 60
1926	1926	CCS HCS SS SCS SBs 45 & 90
1927	1927	the department may include pregnancy -related assistance as 32
1928	1928	defined in 42 U.S.C. Section 1397ll. 33
1929	1929	4. There shall be no waiting period be fore an unborn 34
1930	1930	child may be enrolled in the show -me healthy babies 35
1931	1931	program. In accordance with the definition of child in 42 36
1932	1932	CFR 457.10, coverage shall include the period from 37
1933	1933	conception to birth. The department shall develop a 38
1934	1934	presumptive eligibili ty procedure for enrolling an unborn 39
1935	1935	child. There shall be verification of the pregnancy. 40
1936	1936	5. Coverage for the child shall continue for up to one 41
1937	1937	year after birth, unless otherwise prohibited by law or 42
1938	1938	unless otherwise limited by the general assem bly through 43
1939	1939	appropriations. 44
1940	1940	6. (1) Pregnancy-related and postpartum coverage for 45
1941	1941	the mother shall begin on the day the pregnancy ends and 46
1942	1942	extend through the last day of the month that includes the 47
1943	1943	sixtieth day after the pregnancy ends, unless ot herwise 48
1944	1944	prohibited by law or unless otherwise limited by the general 49
1945	1945	assembly through appropriations. The department may include 50
1946	1946	pregnancy-related assistance as defined in 42 U.S.C. Section 51
1947	1947	1397ll. 52
1948	1948	(2) (a) Subject to approval of any necessary s tate 53
1949	1949	plan amendments or waivers, beginning on the effective date 54
1950	1950	of this act, mothers eligible to receive coverage under this 55
1951	1951	section shall receive medical assistance benefits during the 56
1952	1952	pregnancy and during the twelve -month period that begins on 57
1953	1953	the last day of the woman's pregnancy and ends on the last 58
1954	1954	day of the month in which such twelve -month period ends, 59
1955	1955	consistent with the provisions of 42 U.S.C. Section 60
1956	1956	1397gg(e)(1)(J). The department shall seek any necessary 61
1957	1957	state plan amendments or waive rs to implement the provisions 62
1958	1958	of this subdivision when the number of ineligible MO 63 61
1959	1959	CCS HCS SS SCS SBs 45 & 90
1960	1960	HealthNet participants removed from the program in 2023 64
1961	1961	pursuant to section 208.239 exceeds the projected number of 65
1962	1962	beneficiaries likely to enroll in benefits in 2023 u nder 66
1963	1963	this subdivision and subdivision (28) of subsection 1 of 67
1964	1964	section 208.151, as determined by the department, by at 68
1965	1965	least one hundred individuals. 69
1966	1966	(b) The provisions of this subdivision shall remain in 70
1967	1967	effect for any period of time during which the federal 71
1968	1968	authority under 42 U.S.C. Section 1397gg(e)(1)(J), as 72
1969	1969	amended, or any successor statutes or implementing 73
1970	1970	regulations, is in effect. 74
1971	1971	7. The department shall provide coverage for an unborn 75
1972	1972	child enrolled in the show -me healthy babies program in the 76
1973	1973	same manner in which the department provides coverage for 77
1974	1974	the children's health insurance program (CHIP) in the county 78
1975	1975	of the primary residence of the mother. 79
1976	1976	8. The department shall provide information about the 80
1977	1977	show-me healthy babies program to maternity homes as defined 81
1978	1978	in section 135.600, pregnancy resource centers as defined in 82
1979	1979	section 135.630, and other similar agencies and programs in 83
1980	1980	the state that assist unborn children and their mothers. 84
1981	1981	The department shall consider a llowing such agencies and 85
1982	1982	programs to assist in the enrollment of unborn children in 86
1983	1983	the program, and in making determinations about presumptive 87
1984	1984	eligibility and verification of the pregnancy. 88
1985	1985	9. Within sixty days after August 28, 2014, the 89
1986	1986	department shall submit a state plan amendment or seek any 90
1987	1987	necessary waivers from the federal Department of Health and 91
1988	1988	Human Services requesting approval for the show -me healthy 92
1989	1989	babies program. 93
1990	1990	10. At least annually, the department shall prepare 94
1991	1991	and submit a report to the governor, the speaker of the 95 62
1992	1992	CCS HCS SS SCS SBs 45 & 90
1993	1993	house of representatives, and the president pro tempore of 96
1994	1994	the senate analyzing and projecting the cost savings and 97
1995	1995	benefits, if any, to the state, counties, local communities, 98
1996	1996	school districts, law enf orcement agencies, correctional 99
1997	1997	centers, health care providers, employers, other public and 100
1998	1998	private entities, and persons by enrolling unborn children 101
1999	1999	in the show-me healthy babies program. The analysis and 102
2000	2000	projection of cost savings and benefits, if any, may include 103
2001	2001	but need not be limited to: 104
2002	2002	(1) The higher federal matching rate for having an 105
2003	2003	unborn child enrolled in the show -me healthy babies program 106
2004	2004	versus the lower federal matching rate for a pregnant woman 107
2005	2005	being enrolled in MO HealthNet or other federal programs; 108
2006	2006	(2) The efficacy in providing services to unborn 109
2007	2007	children through managed care organizations, group or 110
2008	2008	individual health insurance providers or premium assistance, 111
2009	2009	or through other nontraditional arrangements of providi ng 112
2010	2010	health care; 113
2011	2011	(3) The change in the proportion of unborn children 114
2012	2012	who receive care in the first trimester of pregnancy due to 115
2013	2013	a lack of waiting periods, by allowing presumptive 116
2014	2014	eligibility, or by removal of other barriers, and any 117
2015	2015	resulting or projected decrease in health problems and other 118
2016	2016	problems for unborn children and women throughout pregnancy; 119
2017	2017	at labor, delivery, and birth; and during infancy and 120
2018	2018	childhood; 121
2019	2019	(4) The change in healthy behaviors by pregnant women, 122
2020	2020	such as the cessation of the use of tobacco, alcohol, 123
2021	2021	illicit drugs, or other harmful practices, and any resulting 124
2022	2022	or projected short-term and long-term decrease in birth 125
2023	2023	defects; poor motor skills; vision, speech, and hearing 126
2024	2024	problems; breathing and respiratory probl ems; feeding and 127 63
2025	2025	CCS HCS SS SCS SBs 45 & 90
2026	2026	digestive problems; and other physical, mental, educational, 128
2027	2027	and behavioral problems; and 129
2028	2028	(5) The change in infant and maternal mortality, 130
2029	2029	preterm births and low birth weight babies and any resulting 131
2030	2030	or projected decrease in shor t-term and long-term medical 132
2031	2031	and other interventions. 133
2032	2032	11. The show-me healthy babies program shall not be 134
2033	2033	deemed an entitlement program, but instead shall be subject 135
2034	2034	to a federal allotment or other federal appropriations and 136
2035	2035	matching state approp riations. 137
2036	2036	12. Nothing in this section shall be construed as 138
2037	2037	obligating the state to continue the show -me healthy babies 139
2038	2038	program if the allotment or payments from the federal 140
2039	2039	government end or are not sufficient for the program to 141
2040	2040	operate, or if the general assembly does not appropriate 142
2041	2041	funds for the program. 143
2042	2042	13. Nothing in this section shall be construed as 144
2043	2043	expanding MO HealthNet or fulfilling a mandate imposed by 145
2044	2044	the federal government on the state. 146
2045	2045	209.700. 1. This section shall be known and may be 1
2046	2046	cited as the "Missouri Employment First Act". 2
2047	2047	2. As used in this section, unless the context clearly 3
2048	2048	requires otherwise, the following terms mean: 4
2049	2049	(1) "Competitive integrated employment", work that: 5
2050	2050	(a) Is performed on a full -time or part-time basis, 6
2051	2051	including self-employment, and for which a person is 7
2052	2052	compensated at a rate that: 8
2053	2053	a. Is no less than the higher of the rate specified in 9
2054	2054	29 U.S.C. Section 206(a)(1) or the rate required under any 10
2055	2055	applicable state or local minimum wage law for the place of 11
2056	2056	employment; 12 64
2057	2057	CCS HCS SS SCS SBs 45 & 90
2058	2058	b. Is no less than the customary rate paid by the 13
2059	2059	employer for the same or similar work performed by other 14
2060	2060	employees who are not persons with disabilities and who are 15
2061	2061	similarly situated in similar occupations by the same 16
2062	2062	employer and who have similar training, experience, and 17
2063	2063	skills; 18
2064	2064	c. In the case of a person who is self -employed, 19
2065	2065	yields an income that is comparable to the income received 20
2066	2066	by other persons who are not persons with disabilities and 21
2067	2067	who are self-employed in similar occupations or on similar 22
2068	2068	tasks and who have similar training, experience, and skills; 23
2069	2069	and 24
2070	2070	d. Is eligible for the level of benefits provided to 25
2071	2071	other employees; 26
2072	2072	(b) Is at a location: 27
2073	2073	a. Typically found in the community; and 28
2074	2074	b. Where the employee with a disability interacts for 29
2075	2075	the purpose of performing the duties of the position with 30
2076	2076	other employees within the particular work unit and the 31
2077	2077	entire work site and, as a ppropriate to the work performed, 32
2078	2078	other persons, such as customers and vendors, who are not 33
2079	2079	persons with disabilities, other than supervisory personnel 34
2080	2080	or persons who are providing services to such employee, to 35
2081	2081	the same extent that employees who are no t persons with 36
2082	2082	disabilities and who are in comparable positions interact 37
2083	2083	with these persons; and 38
2084	2084	(c) Presents, as appropriate, opportunities for 39
2085	2085	advancement that are similar to those for other employees 40
2086	2086	who are not persons with disabilities and w ho have similar 41
2087	2087	positions; 42 65
2088	2088	CCS HCS SS SCS SBs 45 & 90
2089	2089	(2) "Customized employment", competitive integrated 43
2090	2090	employment for a person with a significant disability that 44
2091	2091	is: 45
2092	2092	(a) Based on an individualized determination of the 46
2093	2093	unique strengths, needs, and interests of the person with a 47
2094	2094	significant disability; 48
2095	2095	(b) Designed to meet the specific abilities of the 49
2096	2096	person with a significant disability and the business needs 50
2097	2097	of the employer; and 51
2098	2098	(c) Carried out through flexible strategies, such as: 52
2099	2099	a. Job exploration by the person; and 53
2100	2100	b. Working with an employer to facilitate placement, 54
2101	2101	including: 55
2102	2102	(i) Customizing a job description based on current 56
2103	2103	employer needs or on previously unidentified and unmet 57
2104	2104	employer needs; 58
2105	2105	(ii) Developing a set of job duties, a work schedule 59
2106	2106	and job arrangement, and specifics of supervision, including 60
2107	2107	performance evaluation and review, and determining a job 61
2108	2108	location; 62
2109	2109	(iii) Using a professional representative chosen by 63
2110	2110	the person or self-representation, if elected, to work with 64
2111	2111	an employer to facilitate placement; and 65
2112	2112	(iv) Providing services and supports at the job 66
2113	2113	location; 67
2114	2114	(3) "Disability", a physical or mental impairment that 68
2115	2115	substantially limits one or more major life activities of a 69
2116	2116	person, as defined in the Americans with Disabilities Act of 70
2117	2117	1990, as amended. The term "disability" does not include 71
2118	2118	brief periods of intoxication caused by alcohol or drugs or 72
2119	2119	dependence upon or addiction to any alcohol or drug; 73 66
2120	2120	CCS HCS SS SCS SBs 45 & 90
2121	2121	(4) "Employment first", a concept to facilitate the 74
2122	2122	full inclusion of persons with disabilities in the workplace 75
2123	2123	and community in which community -based, competitive 76
2124	2124	integrated employment is the first and preferred outcome for 77
2125	2125	employment services for persons with disab ilities; 78
2126	2126	(5) "Employment-related services", services provided 79
2127	2127	to persons, including persons with disabilities, to assist 80
2128	2128	them in finding employment. The term "employment -related 81
2129	2129	services" includes, but is not limited to, resume 82
2130	2130	development, job fairs, and interview training; 83
2131	2131	(6) "Integrated setting", a setting: 84
2132	2132	(a) Typically found in the community; and 85
2133	2133	(b) Where the employee with a disability interacts for 86
2134	2134	the purpose of performing the duties of the position with 87
2135	2135	other employees within the particular work unit and the 88
2136	2136	entire work site and, as appropriate to the work performed, 89
2137	2137	other persons, such as customers and vendors, who are not 90
2138	2138	persons with disabilities, other than supervisory personnel 91
2139	2139	or persons who are providing se rvices to such employee, to 92
2140	2140	the same extent that employees who are not persons with 93
2141	2141	disabilities and who are in comparable positions interact 94
2142	2142	with these persons; 95
2143	2143	(7) "Outcome", with respect to a person entering, 96
2144	2144	advancing in, or retaining full -time or, if appropriate, 97
2145	2145	part-time competitive integrated employment, including 98
2146	2146	customized employment, self -employment, telecommuting, or 99
2147	2147	business ownership, or supported employment that is 100
2148	2148	consistent with a person's unique strengths, resources, 101
2149	2149	priorities, concerns, abilities, capabilities, interests, 102
2150	2150	and informed choice; 103
2151	2151	(8) "Sheltered workshop", the same meaning given to 104
2152	2152	the term in section 178.900; 105 67
2153	2153	CCS HCS SS SCS SBs 45 & 90
2154	2154	(9) "State agency", an authority, board, branch, 106
2155	2155	commission, committee, department, divi sion, or other 107
2156	2156	instrumentality of the executive branch of state government; 108
2157	2157	(10) "Supported employment", competitive integrated 109
2158	2158	employment, including customized employment, or employment 110
2159	2159	in an integrated setting in which persons are working toward 111
2160	2160	a competitive integrated employment, that is individualized 112
2161	2161	and customized consistent with the strengths, abilities, 113
2162	2162	interests, and informed choice of the persons involved who, 114
2163	2163	because of the nature and severity of their disabilities, 115
2164	2164	need intensive supported employment services and extended 116
2165	2165	services in order to perform the work involved; 117
2166	2166	(11) "Supported employment services", ongoing support 118
2167	2167	services, including customized employment, needed to support 119
2168	2168	and maintain a person with a most signifi cant disability in 120
2169	2169	supported employment, that: 121
2170	2170	(a) Are provided singly or in combination and are 122
2171	2171	organized and made available in such a way as to assist an 123
2172	2172	eligible person to achieve competitive integrated 124
2173	2173	employment; and 125
2174	2174	(b) Are based on a determination of the needs of an 126
2175	2175	eligible person, as specified in an individualized plan for 127
2176	2176	employment; 128
2177	2177	(12) "Working age", sixteen years of age or older; 129
2178	2178	(13) "Youth with a disability", any person fourteen 130
2179	2179	years of age or older and under eighteen years of age who 131
2180	2180	has a disability. 132
2181	2181	3. All state agencies that provide employment -related 133
2182	2182	services or that provide services or support to persons with 134
2183	2183	disabilities shall: 135 68
2184	2184	CCS HCS SS SCS SBs 45 & 90
2185	2185	(1) Develop collaborative relationships with each 136
2186	2186	other, confirmed by a written memorandum of understanding 137
2187	2187	signed by each such state agency; and 138
2188	2188	(2) Implement coordinated strategies to promote 139
2189	2189	competitive integrated employment including, but not limited 140
2190	2190	to, coordinated service planning, job exploration, in creased 141
2191	2191	job training, and internship opportunities. 142
2192	2192	4. All state agencies that provide employment -related 143
2193	2193	services or that provide services or support to persons with 144
2194	2194	disabilities shall: 145
2195	2195	(1) Implement an employment first policy by 146
2196	2196	considering competitive integrated employment as the first 147
2197	2197	and preferred outcome when planning or providing services or 148
2198	2198	supports to persons with disabilities who are of working age; 149
2199	2199	(2) Offer information on competitive integrated 150
2200	2200	employment to all working -age persons with disabilities. 151
2201	2201	The information offered shall include an explanation of the 152
2202	2202	relationship between a person's earned income and his or her 153
2203	2203	public benefits, information on Achieving a Better Life 154
2204	2204	Experience (ABLE) accounts, and information on accessing 155
2205	2205	assistive technology; 156
2206	2206	(3) Ensure that persons with disabilities receive the 157
2207	2207	opportunity to understand and explore education and training 158
2208	2208	as pathways to employment, including postsecondary, 159
2209	2209	graduate, and postgraduate education; vocat ional and 160
2210	2210	technical training; and other training. State agencies 161
2211	2211	shall not be required to fund any education or training 162
2212	2212	unless otherwise required by law; 163
2213	2213	(4) Promote the availability and accessibility of 164
2214	2214	individualized training designed to prep are a person with a 165
2215	2215	disability for the person's preferred employment; 166 69
2216	2216	CCS HCS SS SCS SBs 45 & 90
2217	2217	(5) Promote partnerships with private agencies that 167
2218	2218	offer supported employment services, if appropriate; 168
2219	2219	(6) Promote partnerships with employers to overcome 169
2220	2220	barriers to meeting workforce needs with the creative use of 170
2221	2221	technology and innovation; 171
2222	2222	(7) Ensure that staff members of public schools, 172
2223	2223	vocational service programs, and community providers receive 173
2224	2224	the support, guidance, and training that they need to 174
2225	2225	contribute to attainment of the goal of competitive 175
2226	2226	integrated employment for all persons with disabilities; 176
2227	2227	(8) Ensure that competitive integrated employment, 177
2228	2228	while the first and preferred outcome when planning or 178
2229	2229	providing services or supports to person s with disabilities 179
2230	2230	who are of working age, is not required of a person with a 180
2231	2231	disability to secure or maintain public benefits for which 181
2232	2232	the person is otherwise eligible; and 182
2233	2233	(9) At least once each year, discuss basic information 183
2234	2234	about competitive integrated employment with the parents or 184
2235	2235	guardians of a youth with a disability. If the youth with a 185
2236	2236	disability has been emancipated, state agencies shall 186
2237	2237	discuss this information with the youth with a disability. 187
2238	2238	The information offered shall in clude an explanation of the 188
2239	2239	relationship between a person's earned income and his or her 189
2240	2240	public benefits, information about ABLE accounts, and 190
2241	2241	information about accessing assistive technology. 191
2242	2242	5. Nothing in this section shall require a state 192
2243	2243	agency to perform any action that would interfere with the 193
2244	2244	state agency's ability to fulfill duties and requirements 194
2245	2245	mandated by federal law. 195
2246	2246	6. Nothing in this section shall be construed to limit 196
2247	2247	or disallow any disability benefits to which a person with a 197 70
2248	2248	CCS HCS SS SCS SBs 45 & 90
2249	2249	disability who is unable to engage in competitive integrated 198
2250	2250	employment would otherwise be entitled. 199
2251	2251	7. Nothing in this section shall be construed to 200
2252	2252	eliminate any supported employment services or sheltered 201
2253	2253	workshop settings as options. 202
2254	2254	8. (1) Nothing in this section shall be construed to 203
2255	2255	require any state agency or other employer to give a 204
2256	2256	preference in hiring to persons with disabilities or to 205
2257	2257	prohibit any employment relationship or program that is 206
2258	2258	otherwise permitted under app licable law. 207
2259	2259	(2) Any person who is employed by a state agency shall 208
2260	2260	meet the minimum qualifications and requirements for the 209
2261	2261	position in which the person is employed. 210
2262	2262	9. All state agencies that provide employment -related 211
2263	2263	services or that pro vide services or support to persons with 212
2264	2264	disabilities shall coordinate efforts and collaborate within 213
2265	2265	and among each other to ensure that state programs, 214
2266	2266	policies, and procedures support competitive integrated 215
2267	2267	employment for persons with disabilities w ho are of working 216
2268	2268	age. All such state agencies, when feasible, shall share 217
2269	2269	data and information across systems in order to track 218
2270	2270	progress toward full implementation of this section. All 219
2271	2271	such state agencies are encouraged to adopt measurable goals 220
2272	2272	and objectives to promote assessment of progress in 221
2273	2273	implementing this section. 222
2274	2274	10. State agencies may promulgate all necessary rules 223
2275	2275	and regulations for the administration of this section. Any 224
2276	2276	rule or portion of a rule, as that term is defined in 225
2277	2277	section 536.010, that is created under the authority 226
2278	2278	delegated in this section shall become effective only if it 227
2279	2279	complies with and is subject to all of the provisions of 228
2280	2280	chapter 536 and, if applicable, section 536.028. This 229 71
2281	2281	CCS HCS SS SCS SBs 45 & 90
2282	2282	section and chapter 536 are nonseverable and if any of the 230
2283	2283	powers vested with the general assembly pursuant to chapter 231
2284	2284	536 to review, to delay the effective date, or to disapprove 232
2285	2285	and annul a rule are subsequently held unconstitutional, 233
2286	2286	then the grant of rulemaking authority and any rule proposed 234
2287	2287	or adopted after August 28, 2023, shall be invalid and void. 235
2288	2288	210.1360. 1. Any personally identifiable information 1
2289	2289	regarding any child under eighteen years of age receiving 2
2290	2290	child care from any provider or applying for or receiving 3
2291	2291	any services through a state program shall not be subject to 4
2292	2292	disclosure except as otherwise provided by law. 5
2293	2293	2. This section shall not prohibit any state agency 6
2294	2294	from disclosing personally identifiable information to 7
2295	2295	governmental entities or its agents, vendors, grantees, and 8
2296	2296	contractors in connection to matters relating to its 9
2297	2297	official duties. The provisions of this section shall not 10
2298	2298	apply to any state, county, or municipal law enforcement 11
2299	2299	agency acting in its official capaci ty. 12
2300	2300	3. This section shall not prevent a parent or legal 13
2301	2301	guardian from accessing the parent's or legal guardian's 14
2302	2302	child's records. 15
2303	2303	334.104. 1. A physician may enter into collaborative 1
2304	2304	practice arrangements with registered profe ssional nurses. 2
2305	2305	Collaborative practice arrangements shall be in the form of 3
2306	2306	written agreements, jointly agreed -upon protocols, or 4
2307	2307	standing orders for the delivery of health care services. 5
2308	2308	Collaborative practice arrangements, which shall be in 6
2309	2309	writing, may delegate to a registered professional nurse the 7
2310	2310	authority to administer or dispense drugs and provide 8
2311	2311	treatment as long as the delivery of such health care 9
2312	2312	services is within the scope of practice of the registered 10 72
2313	2313	CCS HCS SS SCS SBs 45 & 90
2314	2314	professional nurse and is cons istent with that nurse's 11
2315	2315	skill, training and competence. 12
2316	2316	2. Collaborative practice arrangements, which shall be 13
2317	2317	in writing, may delegate to a registered professional nurse 14
2318	2318	the authority to administer, dispense or prescribe drugs and 15
2319	2319	provide treatment if the registered professional nurse is an 16
2320	2320	advanced practice registered nurse as defined in subdivision 17
2321	2321	(2) of section 335.016. Collaborative practice arrangements 18
2322	2322	may delegate to an advanced practice registered nurse, as 19
2323	2323	defined in section 335.0 16, the authority to administer, 20
2324	2324	dispense, or prescribe controlled substances listed in 21
2325	2325	Schedules III, IV, and V of section 195.017, and Schedule 22
2326	2326	II - hydrocodone; except that, the collaborative practice 23
2327	2327	arrangement shall not delegate the authority to administer 24
2328	2328	any controlled substances listed in Schedules III, IV, and V 25
2329	2329	of section 195.017, or Schedule II - hydrocodone for the 26
2330	2330	purpose of inducing sedation or general anesthesia for 27
2331	2331	therapeutic, diagnostic, or surgical procedures. Schedule 28
2332	2332	III narcotic controlled substance and Schedule II - 29
2333	2333	hydrocodone prescriptions shall be limited to a one hundred 30
2334	2334	twenty-hour supply without refill. Such collaborative 31
2335	2335	practice arrangements shall be in the form of written 32
2336	2336	agreements, jointly agreed -upon protocols or standing orders 33
2337	2337	for the delivery of health care services. An advanced 34
2338	2338	practice registered nurse may prescribe buprenorphine for up 35
2339	2339	to a thirty-day supply without refill for patients receiving 36
2340	2340	medication-assisted treatment for substance use disor ders 37
2341	2341	under the direction of the collaborating physician. 38
2342	2342	3. The written collaborative practice arrangement 39
2343	2343	shall contain at least the following provisions: 40 73
2344	2344	CCS HCS SS SCS SBs 45 & 90
2345	2345	(1) Complete names, home and business addresses, zip 41
2346	2346	codes, and telephone numbers of the collaborating physician 42
2347	2347	and the advanced practice registered nurse; 43
2348	2348	(2) A list of all other offices or locations besides 44
2349	2349	those listed in subdivision (1) of this subsection where the 45
2350	2350	collaborating physician authorized the advanced practice 46
2351	2351	registered nurse to prescribe; 47
2352	2352	(3) A requirement that there shall be posted at every 48
2353	2353	office where the advanced practice registered nurse is 49
2354	2354	authorized to prescribe, in collaboration with a physician, 50
2355	2355	a prominently displayed disclosure statement infor ming 51
2356	2356	patients that they may be seen by an advanced practice 52
2357	2357	registered nurse and have the right to see the collaborating 53
2358	2358	physician; 54
2359	2359	(4) All specialty or board certifications of the 55
2360	2360	collaborating physician and all certifications of the 56
2361	2361	advanced practice registered nurse; 57
2362	2362	(5) The manner of collaboration between the 58
2363	2363	collaborating physician and the advanced practice registered 59
2364	2364	nurse, including how the collaborating physician and the 60
2365	2365	advanced practice registered nurse will: 61
2366	2366	(a) Engage in collaborative practice consistent with 62
2367	2367	each professional's skill, training, education, and 63
2368	2368	competence; 64
2369	2369	(b) Maintain geographic proximity, except as specified 65
2370	2370	in this paragraph. The following provisions shall apply 66
2371	2371	with respect to this requirem ent: 67
2372	2372	a. Until August 28, 2025, an advanced practice 68
2373	2373	registered nurse providing services in a correctional 69
2374	2374	center, as defined in section 217.010, and his or her 70
2375	2375	collaborating physician shall satisfy the geographic 71 74
2376	2376	CCS HCS SS SCS SBs 45 & 90
2377	2377	proximity requirement if they pra ctice within two hundred 72
2378	2378	miles by road of one another; 73
2379	2379	b. The collaborative practice arrangement may allow 74
2380	2380	for geographic proximity to be waived for a maximum of 75
2381	2381	twenty-eight days per calendar year for rural health clinics 76
2382	2382	as defined by [P.L.] Pub. L. 95-210 (42 U.S.C. Section 77
2383	2383	1395x, as amended), as long as the collaborative practice 78
2384	2384	arrangement includes alternative plans as required in 79
2385	2385	paragraph (c) of this subdivision. This exception to 80
2386	2386	geographic proximity shall apply only to independent r ural 81
2387	2387	health clinics, provider -based rural health clinics where 82
2388	2388	the provider is a critical access hospital as provided in 42 83
2389	2389	U.S.C. Section 1395i -4, and provider-based rural health 84
2390	2390	clinics where the main location of the hospital sponsor is 85
2391	2391	greater than fifty miles from the clinic [.]; and 86
2392	2392	c. The collaborating physician is required to maintain 87
2393	2393	documentation related to this requirement and to present it 88
2394	2394	to the state board of registration for the healing arts when 89
2395	2395	requested; and 90
2396	2396	(c) Provide coverage during absence, incapacity, 91
2397	2397	infirmity, or emergency by the collaborating physician; 92
2398	2398	(6) A description of the advanced practice registered 93
2399	2399	nurse's controlled substance prescriptive authority in 94
2400	2400	collaboration with the physician, including a list of the 95
2401	2401	controlled substances the physician authorizes the nurse to 96
2402	2402	prescribe and documentation that it is consistent with each 97
2403	2403	professional's education, knowledge, skill, and competence; 98
2404	2404	(7) A list of all other written practice agreements o f 99
2405	2405	the collaborating physician and the advanced practice 100
2406	2406	registered nurse; 101 75
2407	2407	CCS HCS SS SCS SBs 45 & 90
2408	2408	(8) The duration of the written practice agreement 102
2409	2409	between the collaborating physician and the advanced 103
2410	2410	practice registered nurse; 104
2411	2411	(9) A description of the time and m anner of the 105
2412	2412	collaborating physician's review of the advanced practice 106
2413	2413	registered nurse's delivery of health care services. The 107
2414	2414	description shall include provisions that the advanced 108
2415	2415	practice registered nurse shall submit a minimum of ten 109
2416	2416	percent of the charts documenting the advanced practice 110
2417	2417	registered nurse's delivery of health care services to the 111
2418	2418	collaborating physician for review by the collaborating 112
2419	2419	physician, or any other physician designated in the 113
2420	2420	collaborative practice arrangement, ever y fourteen days; and 114
2421	2421	(10) The collaborating physician, or any other 115
2422	2422	physician designated in the collaborative practice 116
2423	2423	arrangement, shall review every fourteen days a minimum of 117
2424	2424	twenty percent of the charts in which the advanced practice 118
2425	2425	registered nurse prescribes controlled substances. The 119
2426	2426	charts reviewed under this subdivision may be counted in the 120
2427	2427	number of charts required to be reviewed under subdivision 121
2428	2428	(9) of this subsection. 122
2429	2429	4. The state board of registration for the healing 123
2430	2430	arts pursuant to section 334.125 and the board of nursing 124
2431	2431	pursuant to section 335.036 may jointly promulgate rules 125
2432	2432	regulating the use of collaborative practice arrangements. 126
2433	2433	Such rules shall be limited to specifying geographic areas 127
2434	2434	to be covered, the me thods of treatment that may be covered 128
2435	2435	by collaborative practice arrangements and the requirements 129
2436	2436	for review of services provided pursuant to collaborative 130
2437	2437	practice arrangements including delegating authority to 131
2438	2438	prescribe controlled substances. Any rules relating to 132
2439	2439	geographic proximity shall allow a collaborating physician 133 76
2440	2440	CCS HCS SS SCS SBs 45 & 90
2441	2441	and a collaborating advanced practice registered nurse to 134
2442	2442	practice within two hundred miles by road of one another 135
2443	2443	until August 28, 2025, if the nurse is providing services in 136
2444	2444	a correctional center, as defined in section 217.010. Any 137
2445	2445	rules relating to dispensing or distribution of medications 138
2446	2446	or devices by prescription or prescription drug orders under 139
2447	2447	this section shall be subject to the approval of the state 140
2448	2448	board of pharmacy. Any rules relating to dispensing or 141
2449	2449	distribution of controlled substances by prescription or 142
2450	2450	prescription drug orders under this section shall be subject 143
2451	2451	to the approval of the department of health and senior 144
2452	2452	services and the state board of pha rmacy. In order to take 145
2453	2453	effect, such rules shall be approved by a majority vote of a 146
2454	2454	quorum of each board. Neither the state board of 147
2455	2455	registration for the healing arts nor the board of nursing 148
2456	2456	may separately promulgate rules relating to collaborative 149
2457	2457	practice arrangements. Such jointly promulgated rules shall 150
2458	2458	be consistent with guidelines for federally funded clinics. 151
2459	2459	The rulemaking authority granted in this subsection shall 152
2460	2460	not extend to collaborative practice arrangements of 153
2461	2461	hospital employees providing inpatient care within hospitals 154
2462	2462	as defined pursuant to chapter 197 or population -based 155
2463	2463	public health services as defined by 20 CSR 2150 -5.100 as of 156
2464	2464	April 30, 2008. 157
2465	2465	5. The state board of registration for the healing 158
2466	2466	arts shall not deny, revoke, suspend or otherwise take 159
2467	2467	disciplinary action against a physician for health care 160
2468	2468	services delegated to a registered professional nurse 161
2469	2469	provided the provisions of this section and the rules 162
2470	2470	promulgated thereunder are satisfied. Upon the written 163
2471	2471	request of a physician subject to a disciplinary action 164
2472	2472	imposed as a result of an agreement between a physician and 165 77
2473	2473	CCS HCS SS SCS SBs 45 & 90
2474	2474	a registered professional nurse or registered physician 166
2475	2475	assistant, whether written or not, prior to August 28, 1993, 167
2476	2476	all records of such disciplinary licensure action and all 168
2477	2477	records pertaining to the filing, investigation or review of 169
2478	2478	an alleged violation of this chapter incurred as a result of 170
2479	2479	such an agreement shall be removed from the records of the 171
2480	2480	state board of registration for the healing arts and the 172
2481	2481	division of professional registration and shall not be 173
2482	2482	disclosed to any public or private entity seeking such 174
2483	2483	information from the board or the division. The state board 175
2484	2484	of registration for the healing arts shall take act ion to 176
2485	2485	correct reports of alleged violations and disciplinary 177
2486	2486	actions as described in this section which have been 178
2487	2487	submitted to the National Practitioner Data Bank. In 179
2488	2488	subsequent applications or representations relating to his 180
2489	2489	or her medical practice, a physician completing forms or 181
2490	2490	documents shall not be required to report any actions of the 182
2491	2491	state board of registration for the healing arts for which 183
2492	2492	the records are subject to removal under this section. 184
2493	2493	6. Within thirty days of any change an d on each 185
2494	2494	renewal, the state board of registration for the healing 186
2495	2495	arts shall require every physician to identify whether the 187
2496	2496	physician is engaged in any collaborative practice 188
2497	2497	agreement, including collaborative practice agreements 189
2498	2498	delegating the authority to prescribe controlled substances, 190
2499	2499	or physician assistant agreement and also report to the 191
2500	2500	board the name of each licensed professional with whom the 192
2501	2501	physician has entered into such agreement. The board may 193
2502	2502	make this information available to th e public. The board 194
2503	2503	shall track the reported information and may routinely 195
2504	2504	conduct random reviews of such agreements to ensure that 196
2505	2505	agreements are carried out for compliance under this chapter. 197 78
2506	2506	CCS HCS SS SCS SBs 45 & 90
2507	2507	7. Notwithstanding any law to the contrary, a 198
2508	2508	certified registered nurse anesthetist as defined in 199
2509	2509	subdivision (8) of section 335.016 shall be permitted to 200
2510	2510	provide anesthesia services without a collaborative practice 201
2511	2511	arrangement provided that he or she is under the supervision 202
2512	2512	of an anesthesiologist or other physician, dentist, or 203
2513	2513	podiatrist who is immediately available if needed. Nothing 204
2514	2514	in this subsection shall be construed to prohibit or prevent 205
2515	2515	a certified registered nurse anesthetist as defined in 206
2516	2516	subdivision (8) of section 335.016 from enteri ng into a 207
2517	2517	collaborative practice arrangement under this section, 208
2518	2518	except that the collaborative practice arrangement may not 209
2519	2519	delegate the authority to prescribe any controlled 210
2520	2520	substances listed in Schedules III, IV, and V of section 211
2521	2521	195.017, or Schedule II - hydrocodone. 212
2522	2522	8. A collaborating physician shall not enter into a 213
2523	2523	collaborative practice arrangement with more than six full - 214
2524	2524	time equivalent advanced practice registered nurses, full - 215
2525	2525	time equivalent licensed physician assistants, or full -time 216
2526	2526	equivalent assistant physicians, or any combination 217
2527	2527	thereof. This limitation shall not apply to collaborative 218
2528	2528	arrangements of hospital employees providing inpatient care 219
2529	2529	service in hospitals as defined in chapter 197 or population - 220
2530	2530	based public health services as defined by 20 CSR 2150 -5.100 221
2531	2531	as of April 30, 2008, or to a certified registered nurse 222
2532	2532	anesthetist providing anesthesia services under the 223
2533	2533	supervision of an anesthesiologist or other physician, 224
2534	2534	dentist, or podiatrist who is immediately av ailable if 225
2535	2535	needed as set out in subsection 7 of this section. 226
2536	2536	9. It is the responsibility of the collaborating 227
2537	2537	physician to determine and document the completion of at 228
2538	2538	least a one-month period of time during which the advanced 229 79
2539	2539	CCS HCS SS SCS SBs 45 & 90
2540	2540	practice registered nurse shall practice with the 230
2541	2541	collaborating physician continuously present before 231
2542	2542	practicing in a setting where the collaborating physician is 232
2543	2543	not continuously present. This limitation shall not apply 233
2544	2544	to collaborative arrangements of providers of pop ulation- 234
2545	2545	based public health services as defined by 20 CSR 2150 -5.100 235
2546	2546	as of April 30, 2008. 236
2547	2547	10. No agreement made under this section shall 237
2548	2548	supersede current hospital licensing regulations governing 238
2549	2549	hospital medication orders under protocols or sta nding 239
2550	2550	orders for the purpose of delivering inpatient or emergency 240
2551	2551	care within a hospital as defined in section 197.020 if such 241
2552	2552	protocols or standing orders have been approved by the 242
2553	2553	hospital's medical staff and pharmaceutical therapeutics 243
2554	2554	committee. 244
2555	2555	11. No contract or other agreement shall require a 245
2556	2556	physician to act as a collaborating physician for an 246
2557	2557	advanced practice registered nurse against the physician's 247
2558	2558	will. A physician shall have the right to refuse to act as 248
2559	2559	a collaborating physicia n, without penalty, for a particular 249
2560	2560	advanced practice registered nurse. No contract or other 250
2561	2561	agreement shall limit the collaborating physician's ultimate 251
2562	2562	authority over any protocols or standing orders or in the 252
2563	2563	delegation of the physician's authorit y to any advanced 253
2564	2564	practice registered nurse, but this requirement shall not 254
2565	2565	authorize a physician in implementing such protocols, 255
2566	2566	standing orders, or delegation to violate applicable 256
2567	2567	standards for safe medical practice established by 257
2568	2568	hospital's medical staff. 258
2569	2569	12. No contract or other agreement shall require any 259
2570	2570	advanced practice registered nurse to serve as a 260
2571	2571	collaborating advanced practice registered nurse for any 261 80
2572	2572	CCS HCS SS SCS SBs 45 & 90
2573	2573	collaborating physician against the advanced practice 262
2574	2574	registered nurse's will. An advanced practice registered 263
2575	2575	nurse shall have the right to refuse to collaborate, without 264
2576	2576	penalty, with a particular physician. 265
2577	2577	335.203. 1. There is hereby established the "Nursing 1
2578	2578	Education Incentive Program" within the state board of 2
2579	2579	nursing. 3
2580	2580	2. Subject to appropriation and board disbursement, 4
2581	2581	grants shall be awarded through the nursing education 5
2582	2582	incentive program to eligible institutions of higher 6
2583	2583	education based on criteria jointly determined by the board 7
2584	2584	and the department of higher education and workforce 8
2585	2585	development. [Grant award amounts shall not exceed one 9
2586	2586	hundred fifty thousand dollars. ] No campus shall receive 10
2587	2587	more than one grant per year. 11
2588	2588	3. To be considered for a grant, an eligible 12
2589	2589	institution of higher education shall offer a program of 13
2590	2590	nursing that meets the predetermined category and area of 14
2591	2591	need as established by the board and the department under 15
2592	2592	subsection 4 of this section. 16
2593	2593	4. The board and the department shall determine 17
2594	2594	categories and areas of need for designating grants to 18
2595	2595	eligible institutions of higher education. In establishing 19
2596	2596	categories and areas of need, the board and department may 20
2597	2597	consider criteria including, but not limited to: 21
2598	2598	(1) Data generated from licensu re renewal data and the 22
2599	2599	department of health and senior services; and 23
2600	2600	(2) National nursing statistical data and trends that 24
2601	2601	have identified nursing shortages. 25
2602	2602	5. The board shall be the administrative agency 26
2603	2603	responsible for implementation of the program established 27
2604	2604	under sections 335.200 to 335.203, and shall promulgate 28 81
2605	2605	CCS HCS SS SCS SBs 45 & 90
2606	2606	reasonable rules for the exercise of its functions and the 29
2607	2607	effectuation of the purposes of sections 335.200 to 30
2608	2608	335.203. The board shall, by rule, prescribe the form, 31
2609	2609	time, and method of filing applications and shall supervise 32
2610	2610	the processing of such applications. 33
2611	2611	6. Any rule or portion of a rule, as that term is 34
2612	2612	defined in section 536.010, that is created under the 35
2613	2613	authority delegated in this section shall become e ffective 36
2614	2614	only if it complies with and is subject to all of the 37
2615	2615	provisions of chapter 536 and, if applicable, section 38
2616	2616	536.028. This section and chapter 536 are nonseverable and 39
2617	2617	if any of the powers vested with the general assembly 40
2618	2618	pursuant to chapter 536 to review, to delay the effective 41
2619	2619	date, or to disapprove and annul a rule are subsequently 42
2620	2620	held unconstitutional, then the grant of rulemaking 43
2621	2621	authority and any rule proposed or adopted after August 28, 44
2622	2622	2011, shall be invalid and void. 45
2623	2623	335.205. The board, in addition to any other duties it 1
2624	2624	may have regarding licensure of nurses, shall collect, at 2
2625	2625	the time of any initial license application or license 3
2626	2626	renewal application, a nursing education incentive program 4
2627	2627	surcharge from each person licensed or relicensed under this 5
2628	2628	chapter, in the amount of one dollar per year for practical 6
2629	2629	nurses and five dollars per year for registered professional 7
2630	2630	nurses. These funds shall be deposited in the state board 8
2631	2631	of nursing fund described in section 335.036. 9
2632	2632	338.010. 1. The "practice of pharmacy" [means] 1
2633	2633	includes: 2
2634	2634	(1) The interpretation, implementation, and evaluation 3
2635	2635	of medical prescription orders, including any legend drugs 4
2636	2636	under 21 U.S.C. Section 353 [;], and the receipt, 5 82
2637	2637	CCS HCS SS SCS SBs 45 & 90
2638	2638	transmission, or handling of such orders or facilitating the 6
2639	2639	dispensing of such orders; 7
2640	2640	(2) The designing, initiating, implementing, and 8
2641	2641	monitoring of a medication therapeutic plan [as defined by 9
2642	2642	the prescription order so long as the prescription order is 10
2643	2643	specific to each patient for care by a pharmacist ] in 11
2644	2644	accordance with the provisions of this section ; 12
2645	2645	(3) The compounding, dispensing, labeling, and 13
2646	2646	administration of drugs and devices pursuant to medical 14
2647	2647	prescription orders [and administration of viral influenza, 15
2648	2648	pneumonia, shingles, hepatitis A, hepatitis B, diphtheria, 16
2649	2649	tetanus, pertussis, and meningitis vaccines by written 17
2650	2650	protocol authorized by a physician for persons at least 18
2651	2651	seven years of age or the age recommended by the Centers for 19
2652	2652	Disease Control and Prevention, whichever is higher, or the 20
2653	2653	administration of pneumonia, shingles, hepatitis A, 21
2654	2654	hepatitis B, diphtheria, tetanus, pertussis, meningitis, and 22
2655	2655	viral influenza vaccines by written protocol authorized by a 23
2656	2656	physician for a specific patient as authorized by rule ]; 24
2657	2657	(4) The ordering and administration of vaccines 25
2658	2658	approved or authorized by the U.S. Food and Drug 26
2659	2659	Administration, excluding vaccines for cholera, monkeypox, 27
2660	2660	Japanese encephalitis, typhoid, rabies, yellow fever, tick - 28
2661	2661	borne encephalitis, anthrax, tuberculosis, dengue, Hib, 29
2662	2662	polio, rotavirus, smallpox, and any vaccine approved after 30
2663	2663	January 1, 2023, to persons at least seven years of age or 31
2664	2664	the age recommended by the Centers for Disease Con trol and 32
2665	2665	Prevention, whichever is older, pursuant to joint 33
2666	2666	promulgation of rules established by the board of pharmacy 34
2667	2667	and the state board of registration for the healing arts 35
2668	2668	unless rules are established under a state of emergency as 36
2669	2669	described in section 44.100; 37 83
2670	2670	CCS HCS SS SCS SBs 45 & 90
2671	2671	(5) The participation in drug selection according to 38
2672	2672	state law and participation in drug utilization reviews; 39
2673	2673	(6) The proper and safe storage of drugs and devices 40
2674	2674	and the maintenance of proper records thereof; 41
2675	2675	(7) Consultation with patients and other health care 42
2676	2676	practitioners, and veterinarians and their clients about 43
2677	2677	legend drugs, about the safe and effective use of drugs and 44
2678	2678	devices; 45
2679	2679	(8) The prescribing and dispensing of any nicotine 46
2680	2680	replacement therapy product un der section 338.665; 47
2681	2681	(9) The dispensing of HIV postexposure prophylaxis 48
2682	2682	pursuant to section 338.730; and 49
2683	2683	(10) The offering or performing of those acts, 50
2684	2684	services, operations, or transactions necessary in the 51
2685	2685	conduct, operation, management and control of a pharmacy. 52
2686	2686	2. No person shall engage in the practice of pharmacy 53
2687	2687	unless he or she is licensed under the provisions of this 54
2688	2688	chapter. 55
2689	2689	3. This chapter shall not be construed to prohibit the 56
2690	2690	use of auxiliary personnel under the dire ct supervision of a 57
2691	2691	pharmacist from assisting the pharmacist in any of his or 58
2692	2692	her duties. This assistance in no way is intended to 59
2693	2693	relieve the pharmacist from his or her responsibilities for 60
2694	2694	compliance with this chapter and he or she will be 61
2695	2695	responsible for the actions of the auxiliary personnel 62
2696	2696	acting in his or her assistance. 63
2697	2697	4. This chapter shall [also] not be construed to 64
2698	2698	prohibit or interfere with any legally registered 65
2699	2699	practitioner of medicine, dentistry, or podiatry, or 66
2700	2700	veterinary medicine only for use in animals, or the practice 67
2701	2701	of optometry in accordance with and as provided in sections 68 84
2702	2702	CCS HCS SS SCS SBs 45 & 90
2703	2703	195.070 and 336.220 in the compounding, administering, 69
2704	2704	prescribing, or dispensing of his or her own prescriptions. 70
2705	2705	[2. Any pharmacist who ac cepts a prescription order 71
2706	2706	for a medication therapeutic plan shall have a written 72
2707	2707	protocol from the physician who refers the patient for 73
2708	2708	medication therapy services. ] 74
2709	2709	5. A pharmacist with a certificate of medication 75
2710	2710	therapeutic plan authority ma y provide medication therapy 76
2711	2711	services pursuant to a written protocol from a physician 77
2712	2712	licensed under chapter 334 to patients who have established 78
2713	2713	a physician-patient relationship, as described in 79
2714	2714	subdivision (1) of subsection 1 of section 191.1146, wit h 80
2715	2715	the protocol physician. The written protocol [and the 81
2716	2716	prescription order for a medication therapeutic plan ] 82
2717	2717	authorized by this section shall come only from the 83
2718	2718	physician [only,] and shall not come from a nurse engaged in 84
2719	2719	a collaborative practice ar rangement under section 334.104, 85
2720	2720	or from a physician assistant engaged in a collaborative 86
2721	2721	practice arrangement under section 334.735. 87
2722	2722	[3.] 6. Nothing in this section shall be construed as 88
2723	2723	to prevent any person, firm or corporation from owning a 89
2724	2724	pharmacy regulated by sections 338.210 to 338.315, provided 90
2725	2725	that a licensed pharmacist is in charge of such pharmacy. 91
2726	2726	[4.] 7. Nothing in this section shall be construed to 92
2727	2727	apply to or interfere with the sale of nonprescription drugs 93
2728	2728	and the ordinary household remedies and such drugs or 94
2729	2729	medicines as are normally sold by those engaged in the sale 95
2730	2730	of general merchandise. 96
2731	2731	[5.] 8. No health carrier as defined in chapter 376 97
2732	2732	shall require any physician with which they contract to 98
2733	2733	enter into a written protocol with a pharmacist for 99
2734	2734	medication therapeutic services. 100 85
2735	2735	CCS HCS SS SCS SBs 45 & 90
2736	2736	[6.] 9. This section shall not be construed to allow a 101
2737	2737	pharmacist to diagnose or independently prescribe 102
2738	2738	pharmaceuticals. 103
2739	2739	[7.] 10. The state board of registration for the 104
2740	2740	healing arts, under section 334.125, and the state board of 105
2741	2741	pharmacy, under section 338.140, shall jointly promulgate 106
2742	2742	rules regulating the use of protocols [for prescription 107
2743	2743	orders] for medication therapy services [and administration 108
2744	2744	of viral influenza vaccines]. Such rules shall require 109
2745	2745	protocols to include provisions allowing for timely 110
2746	2746	communication between the pharmacist and the [referring] 111
2747	2747	protocol physician or similar body authorized by this 112
2748	2748	section, and any other patient protection provisio ns deemed 113
2749	2749	appropriate by both boards. In order to take effect, such 114
2750	2750	rules shall be approved by a majority vote of a quorum of 115
2751	2751	each board. Neither board shall separately promulgate rules 116
2752	2752	regulating the use of protocols for [prescription orders 117
2753	2753	for] medication therapy services [and administration of 118
2754	2754	viral influenza vaccines ]. Any rule or portion of a rule, 119
2755	2755	as that term is defined in section 536.010, that is created 120
2756	2756	under the authority delegated in this section shall become 121
2757	2757	effective only if it com plies with and is subject to all of 122
2758	2758	the provisions of chapter 536 and, if applicable, section 123
2759	2759	536.028. This section and chapter 536 are nonseverable and 124
2760	2760	if any of the powers vested with the general assembly 125
2761	2761	pursuant to chapter 536 to review, to delay the effective 126
2762	2762	date, or to disapprove and annul a rule are subsequently 127
2763	2763	held unconstitutional, then the grant of rulemaking 128
2764	2764	authority and any rule proposed or adopted after August 28, 129
2765	2765	2007, shall be invalid and void. 130
2766	2766	[8.] 11. The state board of ph armacy may grant a 131
2767	2767	certificate of medication therapeutic plan authority to a 132 86
2768	2768	CCS HCS SS SCS SBs 45 & 90
2769	2769	licensed pharmacist who submits proof of successful 133
2770	2770	completion of a board -approved course of academic clinical 134
2771	2771	study beyond a bachelor of science in pharmacy, including 135
2772	2772	but not limited to clinical assessment skills, from a 136
2773	2773	nationally accredited college or university, or a 137
2774	2774	certification of equivalence issued by a nationally 138
2775	2775	recognized professional organization and approved by the 139
2776	2776	board of pharmacy. 140
2777	2777	[9.] 12. Any pharmacist who has received a certificate 141
2778	2778	of medication therapeutic plan authority may engage in the 142
2779	2779	designing, initiating, implementing, and monitoring of a 143
2780	2780	medication therapeutic plan as defined by a [prescription 144
2781	2781	order] written protocol from a physician that [is] may be 145
2782	2782	specific to each patient for care by a pharmacist. 146
2783	2783	[10.] 13. Nothing in this section shall be construed 147
2784	2784	to allow a pharmacist to make a therapeutic substitution of 148
2785	2785	a pharmaceutical prescribed by a physician unless authorized 149
2786	2786	by the written protocol or the physician's prescription 150
2787	2787	order. 151
2788	2788	[11.] 14. "Veterinarian", "doctor of veterinary 152
2789	2789	medicine", "practitioner of veterinary medicine", "DVM", 153
2790	2790	"VMD", "BVSe", "BVMS", "BSe (Vet Science)", "VMB", "MRCVS", 154
2791	2791	or an equivalent title means a person who has received a 155
2792	2792	doctor's degree in veterinary medicine from an accredited 156
2793	2793	school of veterinary medicine or holds an Educational 157
2794	2794	Commission for Foreign Veterinary Graduates (EDFVG) 158
2795	2795	certificate issued by the American Veterinary Medical 159
2796	2796	Association (AVMA). 160
2797	2797	[12.] 15. In addition to other requirements 161
2798	2798	established by the joint promulgation of rules by the board 162
2799	2799	of pharmacy and the state board of registration for the 163
2800	2800	healing arts: 164 87
2801	2801	CCS HCS SS SCS SBs 45 & 90
2802	2802	(1) A pharmacist shall administer vaccines by protocol 165
2803	2803	in accordance with treatment guidelines established by the 166
2804	2804	Centers for Disease Control and Prevention (CDC); 167
2805	2805	(2) A pharmacist who is administering a vaccine shall 168
2806	2806	request a patient to remain in the pharmacy a safe amount of 169
2807	2807	time after administering the vaccine to observe any adverse 170
2808	2808	reactions. Such pharmacist shall have adopted emergency 171
2809	2809	treatment protocols; 172
2810	2810	[(3)] 16. In addition to other requirements by the 173
2811	2811	board, a pharmacist shall receive additional training as 174
2812	2812	required by the board and evidenced by receiving a 175
2813	2813	certificate from the board upon completion, and shall 176
2814	2814	display the certification in his or her pharmacy where 177
2815	2815	vaccines are delivered. 178
2816	2816	[13.] 17. A pharmacist shall inform the patient that 179
2817	2817	the administration of [the] a vaccine will be entered into 180
2818	2818	the ShowMeVax system, as administered by the department of 181
2819	2819	health and senior services. The patient shall attest to the 182
2820	2820	inclusion of such information in the system by signing a 183
2821	2821	form provided by the pharmacist. If the patient indicates 184
2822	2822	that he or she does not want such information entered into 185
2823	2823	the ShowMeVax system, the pharmacist shall provide a written 186
2824	2824	report within fourteen days of administration of a vaccine 187
2825	2825	to the patient's health care provider, if provided by the 188
2826	2826	patient, containing: 189
2827	2827	(1) The identity of the patient; 190
2828	2828	(2) The identity of the vaccine or vaccines 191
2829	2829	administered; 192
2830	2830	(3) The route of administration; 193
2831	2831	(4) The anatomic site of the administration; 194
2832	2832	(5) The dose administered; and 195
2833	2833	(6) The date of administration. 196 88
2834	2834	CCS HCS SS SCS SBs 45 & 90
2835	2835	18. A pharmacist licensed under this chapter may order 197
2836	2836	and administer vaccines approved or authorized by the U.S. 198
2837	2837	Food and Drug Administration to address a public health 199
2838	2838	need, as lawfully authorized by the state or federal 200
2839	2839	government, or a department or agency thereof, during a 201
2840	2840	state or federally declared public health emergency. 202
2841	2841	338.012. 1. A pharmacist with a certificate of 1
2842	2842	medication therapeutic plan authority may provide influenz a, 2
2843	2843	group A streptococcus, and COVID -19 medication therapy 3
2844	2844	services pursuant to a statewide standing order issued by 4
2845	2845	the director or chief medical officer of the department of 5
2846	2846	health and senior services if that person is a licensed 6
2847	2847	physician, or a lice nsed physician designated by the 7
2848	2848	department of health and senior services. 8
2849	2849	2. The state board of registration for the healing 9
2850	2850	arts, pursuant to section 334.125, and the state board of 10
2851	2851	pharmacy, pursuant to section 338.140, shall jointly 11
2852	2852	promulgate rules to implement the provisions of this 12
2853	2853	section. Any rule or portion of a rule, as that term is 13
2854	2854	defined in section 536.010, that is created under the 14
2855	2855	authority delegated in this section shall become effective 15
2856	2856	only if it complies with and is subjec t to all of the 16
2857	2857	provisions of chapter 536 and, if applicable, section 17
2858	2858	536.028. This section and chapter 536 are nonseverable and 18
2859	2859	if any of the powers vested with the general assembly 19
2860	2860	pursuant to chapter 536 to review, to delay the effective 20
2861	2861	date, or to disapprove and annul a rule are subsequently 21
2862	2862	held unconstitutional, then the grant of rulemaking 22
2863	2863	authority and any rule proposed or adopted after August 28, 23
2864	2864	2023, shall be invalid and void. 24
2865	2865	376.1060. 1. As used in this section, t he following 1
2866	2866	terms shall mean: 2 89
2867	2867	CCS HCS SS SCS SBs 45 & 90
2868	2868	(1) "Contracting entity", any person or entity , 3
2869	2869	including a health carrier, that is engaged in the act of 4
2870	2870	contracting with providers for the delivery of [dental] 5
2871	2871	health care services [or the selling or assigning of dental 6
2872	2872	network plans to other health care entities ]; 7
2873	2873	(2) ["Identify", providing in writing, by email or 8
2874	2874	otherwise, to the participating provider the name, address, 9
2875	2875	and telephone number, to the extent possible, for any third 10
2876	2876	party to which the con tracting entity has granted access to 11
2877	2877	the health care services of the participating provider; 12
2878	2878	(3) "Network plan", health insurance coverage offered 13
2879	2879	by a health insurance issuer under which the financing and 14
2880	2880	delivery of dental services are provided in whole or in part 15
2881	2881	through a defined set of participating providers under 16
2882	2882	contract with the health insurance issuer ] "Health care 17
2883	2883	service", the same meaning given to the term in section 18
2884	2884	376.1350; 19
2885	2885	[(4)] (3) "Health carrier", the same meaning give n to 20
2886	2886	the term in section 376.1350. The term "health carrier" 21
2887	2887	shall also include any entity described in subdivision (4) 22
2888	2888	of section 354.700; 23
2889	2889	(4) "Participating provider", a provider who, under a 24
2890	2890	contract with a contracting entity, has agreed to p rovide 25
2891	2891	[dental] health care services with an expectation of 26
2892	2892	receiving payment, other than coinsurance, co -payments or 27
2893	2893	deductibles, directly or indirectly from the contracting 28
2894	2894	entity; 29
2895	2895	(5) "Provider", any person licensed under section 30
2896	2896	332.071; 31
2897	2897	(6) "Provider network contract", a contract between a 32
2898	2898	contracting entity and a provider that specifies the rights 33 90
2899	2899	CCS HCS SS SCS SBs 45 & 90
2900	2900	and responsibilities of the contracting entity and provides 34
2901	2901	for the delivery and payment of health care services; 35
2902	2902	(7) "Third party", a person or entity that enters into 36
2903	2903	a contract with a contracting entity or with another third 37
2904	2904	party to gain access to the health care services or 38
2905	2905	contractual discounts of a provider network contract. 39
2906	2906	"Third party" does not include an employer or o ther group 40
2907	2907	for whom the health carrier or contracting entity provides 41
2908	2908	administrative services . 42
2909	2909	2. A contracting entity [shall not sell, assign, or 43
2910	2910	otherwise] shall only grant a third party access to [the 44
2911	2911	dental services of] a participating [provider under a health 45
2912	2912	care contract unless expressly authorized by the health care 46
2913	2913	contract. The health care contract shall specifically 47
2914	2914	provide that one purpose of the contract is the selling, 48
2915	2915	assigning, or giving the contracting entity rights to the 49
2916	2916	services of the participating provider, including network 50
2917	2917	plans] provider's health care services or contractual 51
2918	2918	discounts provided in accordance with a contract between a 52
2919	2919	participating provider and a contracting entity and only if: 53
2920	2920	(1) The contract specifically states that the 54
2921	2921	contracting entity may enter into an agreement with a third 55
2922	2922	party allowing the third party to obtain the contracting 56
2923	2923	entity's rights and responsibilities as if the third party 57
2924	2924	were the contracting entity, and the contract allows the 58
2925	2925	provider to choose not to participate in third -party access 59
2926	2926	at the time the contract is entered into or renewed or when 60
2927	2927	there are material modifications to the contract. The third- 61
2928	2928	party access provision of any provider network contract 62
2929	2929	shall also specifically state that the contract grants third - 63
2930	2930	party access to the provider's health care services and that 64
2931	2931	the provider has the right to choose not to participate in 65 91
2932	2932	CCS HCS SS SCS SBs 45 & 90
2933	2933	third-party access to the contract or to enter into a 66
2934	2934	contract directly wi th the third party. A provider's 67
2935	2935	decision not to participate in third -party access shall not 68
2936	2936	permit the contracting entity to cancel or otherwise end a 69
2937	2937	contractual relationship with the provider. When initially 70
2938	2938	contracting with a provider, a contrac ting entity shall 71
2939	2939	accept a qualified provider even if the provider chooses not 72
2940	2940	to participate in the third -party access provision; 73
2941	2941	(2) The third party accessing the contract agrees to 74
2942	2942	comply with all of the contract's terms; 75
2943	2943	(3) The contracting entity identifies, in writing or 76
2944	2944	electronic form to the provider, all third parties in 77
2945	2945	existence as of the date the contract is entered into or 78
2946	2946	renewed; 79
2947	2947	(4) The contracting entity identifies all third 80
2948	2948	parties in existence in a list on its int ernet website that 81
2949	2949	is updated at least once every ninety days; 82
2950	2950	(5) The contracting entity notifies providers that a 83
2951	2951	new third party is accessing a provider network contract at 84
2952	2952	least thirty days in advance of the relationship taking 85
2953	2953	effect; 86
2954	2954	(6) The contracting entity notifies the third party of 87
2955	2955	the termination of a provider network contract no later than 88
2956	2956	thirty days from the termination date with the contracting 89
2957	2957	entity; 90
2958	2958	(7) A third party's right to a provider's discounted 91
2959	2959	rate ceases as of the termination date of the provider 92
2960	2960	network contract; 93
2961	2961	(8) The provider is not already a participating 94
2962	2962	provider of the third party; and 95
2963	2963	(9) The contracting entity makes available a copy of 96
2964	2964	the provider network contract relied on in t he adjudication 97 92
2965	2965	CCS HCS SS SCS SBs 45 & 90
2966	2966	of a claim to a participating provider within thirty days of 98
2967	2967	a request from the provider . 99
2968	2968	3. [Upon entering a contract with a participating 100
2969	2969	provider and upon request by a participating provider, a 101
2970	2970	contracting entity shall properly identify any third party 102
2971	2971	that has been granted access to the dental services of the 103
2972	2972	participating provider ] No provider shall be bound by or 104
2973	2973	required to perform health care services under a provider 105
2974	2974	network contract that has been granted to a third pa rty in 106
2975	2975	violation of the provisions of this section . 107
2976	2976	4. A contracting entity that sells, assigns, or 108
2977	2977	otherwise grants a third party access to [the dental 109
2978	2978	services of] a participating [provider] provider's health 110
2979	2979	care services shall maintain an int ernet website or a toll - 111
2980	2980	free telephone number through which the participating 112
2981	2981	provider may obtain information which identifies the 113
2982	2982	[insurance carrier] third party to be used to reimburse the 114
2983	2983	participating provider for the covered [dental] health care 115
2984	2984	services. 116
2985	2985	5. A contracting entity that sells, assigns, or 117
2986	2986	otherwise grants a third party access to a participating 118
2987	2987	provider's [dental] health care services shall ensure that 119
2988	2988	an explanation of benefits or remittance advice furnished to 120
2989	2989	the participating provider that delivers [dental] health 121
2990	2990	care services [under the health care contract ] for the third 122
2991	2991	party identifies the contractual source of any applicable 123
2992	2992	discount. 124
2993	2993	6. [All third parties that have contracted with a 125
2994	2994	contracting entity to purchase, be assigned, or otherwise be 126
2995	2995	granted access to the participating provider's discounted 127
2996	2996	rate shall comply with the participating provider's 128
2997	2997	contract, including all requirements to encourage access to 129 93
2998	2998	CCS HCS SS SCS SBs 45 & 90
2999	2999	the participating provider, and pay the pa rticipating 130
3000	3000	provider pursuant to the rates of payment and methodology 131
3001	3001	set forth in that contract, unless otherwise agreed to by a 132
3002	3002	participating provider. 133
3003	3003	7. A contracting entity is deemed in compliance with 134
3004	3004	this section when the insured's identif ication card provides 135
3005	3005	information which identifies the insurance carrier to be 136
3006	3006	used to reimburse the participating provider for the covered 137
3007	3007	dental services] (1) The provisions of this section shall 138
3008	3008	not apply if access to a provider network contract is 139
3009	3009	granted to any entity operating in accordance with the same 140
3010	3010	brand licensee program as the contracting entity or to any 141
3011	3011	entity that is an affiliate of the contracting entity. A 142
3012	3012	list of the contracting entity's affiliates shall be made 143
3013	3013	available to a provider on the contracting entity's website. 144
3014	3014	(2) The provisions of this section shall not apply to 145
3015	3015	a provider network contract for health care services 146
3016	3016	provided to beneficiaries of any state -sponsored health 147
3017	3017	insurance programs including, but not limited to, MO 148
3018	3018	HealthNet and the state children's health insurance program 149
3019	3019	authorized in sections 208.631 to 208.658 . 150
3020	3020	579.088. Notwithstanding any other provision of this 1
3021	3021	chapter or chapter 195 to the contrary, it shall not be 2
3022	3022	unlawful to manufacture, possess, sell, deliver, or use any 3
3023	3023	device, equipment, or other material for the purpose of 4
3024	3024	analyzing controlled substances to detect the presence of 5
3025	3025	fentanyl or any synthetic controlled substance fentanyl 6
3026	3026	analogue. 7
3027	3027	[191.500. As used in sections 191.500 to 1
3028	3028	191.550, unless the context clearly indicates 2
3029	3029	otherwise, the following terms mean: 3
3030	3030	(1) "Area of defined need", a community or 4
3031	3031	section of an urban area of this state which is 5
3032	3032	certified by the department of health and senior 6 94
3033	3033	CCS HCS SS SCS SBs 45 & 90
3034	3034	services as being in need of the services of a 7
3035	3035	physician to improve the patient -doctor ratio in 8
3036	3036	the area, to contribute professional physician 9
3037	3037	services to an area of economic impact, or to 10
3038	3038	contribute professional physician service s to an 11
3039	3039	area suffering from the effects of a natural 12
3040	3040	disaster; 13
3041	3041	(2) "Department", the department of health 14
3042	3042	and senior services; 15
3043	3043	(3) "Eligible student", a full -time 16
3044	3044	student accepted and enrolled in a formal course 17
3045	3045	of instruction leading to a degree of doctor of 18
3046	3046	medicine or doctor of osteopathy, including 19
3047	3047	psychiatry, at a participating school, or a 20
3048	3048	doctor of dental surgery, doctor of dental 21
3049	3049	medicine, or a bachelor of science degree in 22
3050	3050	dental hygiene; 23
3051	3051	(4) "Financial assistance", an a mount of 24
3052	3052	money paid by the state of Missouri to a 25
3053	3053	qualified applicant pursuant to sections 191.500 26
3054	3054	to 191.550; 27
3055	3055	(5) "Participating school", an institution 28
3056	3056	of higher learning within this state which 29
3057	3057	grants the degrees of doctor of medicine or 30
3058	3058	doctor of osteopathy, and which is accredited in 31
3059	3059	the appropriate degree program by the American 32
3060	3060	Medical Association or the American Osteopathic 33
3061	3061	Association, or a degree program by the American 34
3062	3062	Dental Association or the American Psychiatric 35
3063	3063	Association, and applicable residency programs 36
3064	3064	for each degree type and discipline; 37
3065	3065	(6) "Primary care", general or family 38
3066	3066	practice, internal medicine, pediatric , 39
3067	3067	psychiatric, obstetric and gynecological care as 40
3068	3068	provided to the general public by physicians 41
3069	3069	licensed and registered pursuant to chapter 334, 42
3070	3070	dental practice, or a dental hygienist licensed 43
3071	3071	and registered pursuant to chapter 332; 44
3072	3072	(7) "Resident", any natural person who has 45
3073	3073	lived in this state for one or more years for 46
3074	3074	any purpose other than the attending of an 47
3075	3075	educational institution located within this 48
3076	3076	state; 49
3077	3077	(8) "Rural area", a town or community 50
3078	3078	within this state which is not within a standard 51
3079	3079	metropolitan statistical area, and has a 52
3080	3080	population of six thousand or fewer inhabitan ts 53
3081	3081	as determined by the last preceding federal 54
3082	3082	decennial census or any unincorporated area not 55
3083	3083	within a standard metropolitan statistical area. ] 56
3084	3084	[191.505. The department of health and 1
3085	3085	senior services shall be the administrative 2
3086	3086	agency for the implementation of the program 3
3087	3087	established by sections 191.500 to 191.550. The 4
3088	3088	department shall promulgate reasonable rules and 5
3089	3089	regulations for the exercise of its functions in 6 95
3090	3090	CCS HCS SS SCS SBs 45 & 90
3091	3091	the effectuation of the purposes of sections 7
3092	3092	191.500 to 191.550. It shall prescribe the form 8
3093	3093	and the time and method of filing applications 9
3094	3094	and supervise the processing thereof. ] 10
3095	3095	[191.510. The department shall enter into 1
3096	3096	a contract with each applicant receiving a state 2
3097	3097	loan under sections 191 .500 to 191.550 for 3
3098	3098	repayment of the principal and interest and for 4
3099	3099	forgiveness of a portion thereof for 5
3100	3100	participation in the service areas as provided 6
3101	3101	in sections 191.500 to 191.550. ] 7
3102	3102	[191.515. An eligible student may apply to 1
3103	3103	the department for a loan under sections 191.500 2
3104	3104	to 191.550 only if, at the time of his 3
3105	3105	application and throughout the period during 4
3106	3106	which he receives the loan, he has been formally 5
3107	3107	accepted as a student in a participating school 6
3108	3108	in a course of study lea ding to the degree of 7
3109	3109	doctor of medicine or doctor of osteopathy, 8
3110	3110	including psychiatry, or a doctor of dental 9
3111	3111	surgery, a doctor of dental medicine, or a 10
3112	3112	bachelor of science degree in dental hygiene, 11
3113	3113	and is a resident of this state. ] 12
3114	3114	[191.520. No loan to any eligible student 1
3115	3115	shall exceed twenty-five thousand dollars for 2
3116	3116	each academic year, which shall run from August 3
3117	3117	first of any year through July thirty -first of 4
3118	3118	the following year. All loans shall be made 5
3119	3119	from funds appropriat ed to the medical school 6
3120	3120	loan and loan repayment program fund created by 7
3121	3121	section 191.600, by the general assembly. ] 8
3122	3122	[191.525. No more than twenty-five loans 1
3123	3123	shall be made to eligible students during the 2
3124	3124	first academic year this prog ram is in effect. 3
3125	3125	Twenty-five new loans may be made for the next 4
3126	3126	three academic years until a total of one 5
3127	3127	hundred loans are available. At least one-half 6
3128	3128	of the loans shall be made to students from 7
3129	3129	rural areas as defined in section 191.500. An 8
3130	3130	eligible student may receive loans for each 9
3131	3131	academic year he is pursuing a course of study 10
3132	3132	directly leading to a degree of doctor of 11
3133	3133	medicine or doctor of osteopathy, doctor of 12
3134	3134	dental surgery, or doctor of dental medicine, or 13
3135	3135	a bachelor of science degree in dental hygiene.] 14
3136	3136	[191.530. Interest at the rate of nine and 1
3137	3137	one-half percent per year shall be charged on 2
3138	3138	all loans made under sections 191.500 to 191.550 3
3139	3139	but one-fourth of the interest and principal of 4
3140	3140	the total loan at the tim e of the awarding of 5
3141	3141	the degree shall be forgiven for each year of 6
3142	3142	participation by an applicant in the practice of 7
3143	3143	his profession in a rural area or an area of 8
3144	3144	defined need. The department shall grant a 9 96
3145	3145	CCS HCS SS SCS SBs 45 & 90
3146	3146	deferral of interest and principal payments to a 10
3147	3147	loan recipient who is pursuing an internship or 11
3148	3148	a residency in primary care. The deferral shall 12
3149	3149	not exceed three years. The status of each loan 13
3150	3150	recipient receiving a deferral shall be reviewed 14
3151	3151	annually by the department to ensure compliance 15
3152	3152	with the intent of this provision. The loan 16
3153	3153	recipient will repay the loan beginning with the 17
3154	3154	calendar year following completion of his 18
3155	3155	internship or his primary care residency in 19
3156	3156	accordance with the loan contract. ] 20
3157	3157	[191.535. If a student ceases his study 1
3158	3158	prior to receiving a degree, interest at the 2
3159	3159	rate specified in section 191.530 shall be 3
3160	3160	charged on the amount received from the state 4
3161	3161	under the provisions of sections 191.500 to 5
3162	3162	191.550.] 6
3163	3163	[191.540. 1. The department shall 1
3164	3164	establish schedules and procedures for repayment 2
3165	3165	of the principal and interest of any loan made 3
3166	3166	under the provisions of sections 191.500 to 4
3167	3167	191.550 and not forgiven as provided in section 5
3168	3168	191.530. 6
3169	3169	2. A penalty shall be levied against a 7
3170	3170	person in breach of contract. Such penalty shall 8
3171	3171	be twice the sum of the principal and the 9
3172	3172	accrued interest.] 10
3173	3173	[191.545. When necessary to protect the 1
3174	3174	interest of the state in any loan transaction 2
3175	3175	under sections 191.500 to 191.55 0, the board may 3
3176	3176	institute any action to recover any amount due. ] 4
3177	3177	[191.550. The contracts made with the 1
3178	3178	participating students shall be approved by the 2
3179	3179	attorney general.] 3
3180	3180	[335.212. As used in sections 335.212 to 1
3181	3181	335.242, the following terms mean: 2
3182	3182	(1) "Board", the Missouri state board of 3
3183	3183	nursing; 4
3184	3184	(2) "Department", the Missouri department 5
3185	3185	of health and senior services; 6
3186	3186	(3) "Director", director of the Missouri 7
3187	3187	department of health and senior serv ices; 8
3188	3188	(4) "Eligible student", a resident who has 9
3189	3189	been accepted as a full -time student in a formal 10
3190	3190	course of instruction leading to an associate 11
3191	3191	degree, a diploma, a bachelor of science, a 12
3192	3192	master of science in nursing (M.S.N.), a 13
3193	3193	doctorate in nursing (Ph.D. or D.N.P.), or a 14
3194	3194	student with a master of science in nursing 15
3195	3195	seeking a doctorate in education (Ed.D.), or 16
3196	3196	leading to the completion of educational 17
3197	3197	requirements for a licensed practical nurse. 18
3198	3198	The doctoral applicant may be a part -time 19
3199	3199	student; 20 97
3200	3200	CCS HCS SS SCS SBs 45 & 90
3201	3201	(5) "Participating school", an institution 21
3202	3202	within this state which is approved by the board 22
3203	3203	for participation in the professional and 23
3204	3204	practical nursing student loan program 24
3205	3205	established by sections 335.212 to 335.242, 25
3206	3206	having a nursing depar tment and offering a 26
3207	3207	course of instruction based on nursing theory 27
3208	3208	and clinical nursing experience; 28
3209	3209	(6) "Qualified applicant", an eligible 29
3210	3210	student approved by the board for participation 30
3211	3211	in the professional and practical nursing 31
3212	3212	student loan program established by sections 32
3213	3213	335.212 to 335.242; 33
3214	3214	(7) "Qualified employment", employment on 34
3215	3215	a full-time basis in Missouri in a position 35
3216	3216	requiring licensure as a licensed practical 36
3217	3217	nurse or registered professional nurse in any 37
3218	3218	hospital as defined in section 197.020 or in any 38
3219	3219	agency, institution, or organization located in 39
3220	3220	an area of need as determined by the department 40
3221	3221	of health and senior services. Any forgiveness 41
3222	3222	of such principal and interest for any qualified 42
3223	3223	applicant engaged in qualifie d employment on a 43
3224	3224	less than full-time basis may be prorated to 44
3225	3225	reflect the amounts provided in this section; 45
3226	3226	(8) "Resident", any person who has lived 46
3227	3227	in this state for one or more years for any 47
3228	3228	purpose other than the attending of an 48
3229	3229	educational institution located within this 49
3230	3230	state.] 50
3231	3231	[335.215. 1. The department of health and 1
3232	3232	senior services shall be the administrative 2
3233	3233	agency for the implementation of the 3
3234	3234	professional and practical nursing student loan 4
3235	3235	program established under sections 335.212 to 5
3236	3236	335.242, and the nursing student loan repayment 6
3237	3237	program established under sections 335.245 to 7
3238	3238	335.259. 8
3239	3239	2. An advisory panel of nurses shall be 9
3240	3240	appointed by the director. It shall be composed 10
3241	3241	of not more than eleven me mbers representing 11
3242	3242	practical, associate degree, diploma, 12
3243	3243	baccalaureate and graduate nursing education, 13
3244	3244	community health, primary care, hospital, long - 14
3245	3245	term care, a consumer, and the Missouri state 15
3246	3246	board of nursing. The panel shall make 16
3247	3247	recommendations to the director on the content 17
3248	3248	of any rules, regulations or guidelines prior to 18
3249	3249	their promulgation. The panel may make 19
3250	3250	recommendations to the director regarding fund 20
3251	3251	allocations for loans and loan repayment based 21
3252	3252	on current nursing shortage needs. 22
3253	3253	3. The department of health and senior 23
3254	3254	services shall promulgate reasonable rules and 24
3255	3255	regulations for the exercise of its function 25
3256	3256	pursuant to sections 335.212 to 335.259. It 26 98
3257	3257	CCS HCS SS SCS SBs 45 & 90
3258	3258	shall prescribe the form, the time and method of 27
3259	3259	filing applications a nd supervise the 28
3260	3260	proceedings thereof. No rule or portion of a 29
3261	3261	rule promulgated under the authority of sections 30
3262	3262	335.212 to 335.257 shall become effective unless 31
3263	3263	it has been promulgated pursuant to the 32
3264	3264	provisions of section 536.024. 33
3265	3265	4. Ninety-five percent of funds loaned 34
3266	3266	pursuant to sections 335.212 to 335.242 shall be 35
3267	3267	loaned to qualified applicants who are enrolled 36
3268	3268	in professional nursing programs in 37
3269	3269	participating schools and five percent of the 38
3270	3270	funds loaned pursuant to sections 335.212 to 39
3271	3271	335.242 shall be loaned to qualified applicants 40
3272	3272	who are enrolled in practical nursing programs. 41
3273	3273	Priority shall be given to eligible students who 42
3274	3274	have established financial need. All loan 43
3275	3275	repayment funds pursuant to sections 335.245 to 44
3276	3276	335.259 shall be used to reimburse successful 45
3277	3277	associate, diploma, baccalaureate or graduate 46
3278	3278	professional nurse applicants' educational loans 47
3279	3279	who agree to serve in areas of defined need as 48
3280	3280	determined by the department. ] 49
3281	3281	[335.218. There is hereby established the 1
3282	3282	"Professional and Practical Nursing Student Loan 2
3283	3283	and Nurse Loan Repayment Fund". All fees 3
3284	3284	pursuant to section 335.221, general revenue 4
3285	3285	appropriations to the student loan or loan 5
3286	3286	repayment program, voluntary contributions to 6
3287	3287	support or match the student loan and loan 7
3288	3288	repayment program activities, funds collected 8
3289	3289	from repayment and penalties, and funds received 9
3290	3290	from the federal government shall be deposited 10
3291	3291	in the state treasury and be placed to the 11
3292	3292	credit of the professional and pr actical nursing 12
3293	3293	student loan and nurse loan repayment fund. The 13
3294	3294	fund shall be managed by the department of 14
3295	3295	health and senior services and all 15
3296	3296	administrative costs and expenses incurred as a 16
3297	3297	result of the effectuation of sections 335.212 17
3298	3298	to 335.259 shall be paid from this fund. ] 18
3299	3299	[335.221. The board, in addition to any 1
3300	3300	other duties it may have regarding licensure of 2
3301	3301	nurses, shall collect, at the time of licensure 3
3302	3302	or licensure renewal, an education surcharge 4
3303	3303	from each person lice nsed or relicensed pursuant 5
3304	3304	to sections 335.011 to 335.096, in the amount of 6
3305	3305	one dollar per year for practical nurses and 7
3306	3306	five dollars per year for professional nurses. 8
3307	3307	These funds shall be deposited in the 9
3308	3308	professional and practical nursing student loan 10
3309	3309	and nurse loan repayment fund. All expenditures 11
3310	3310	authorized by sections 335.212 to 335.259 shall 12
3311	3311	be paid from funds appropriated by the general 13
3312	3312	assembly from the professional and practical 14
3313	3313	nursing student loan and nurse loan repayment 15 99
3314	3314	CCS HCS SS SCS SBs 45 & 90
3315	3315	fund. The provisions of section 33.080 to the 16
3316	3316	contrary notwithstanding, money in this fund 17
3317	3317	shall not be transferred and placed to the 18
3318	3318	credit of general revenue. ] 19
3319	3319	[335.224. The department of health and 1
3320	3320	senior services shall enter into a contr act with 2
3321	3321	each qualified applicant receiving financial 3
3322	3322	assistance under the provisions of sections 4
3323	3323	335.212 to 335.242 for repayment of the 5
3324	3324	principal and interest. ] 6
3325	3325	[335.227. An eligible student may apply to 1
3326	3326	the department for financ ial assistance under 2
3327	3327	the provisions of sections 335.212 to 335.242 3
3328	3328	if, at the time of his application for a loan, 4
3329	3329	the eligible student has formally applied for 5
3330	3330	acceptance at a participating school. Receipt 6
3331	3331	of financial assistance is contingent upon 7
3332	3332	acceptance and continued enrollment at a 8
3333	3333	participating school. ] 9
3334	3334	[335.230. Financial assistance to any 1
3335	3335	qualified applicant shall not exceed ten 2
3336	3336	thousand dollars for each academic year for a 3
3337	3337	professional nursing program and shall not 4
3338	3338	exceed five thousand dollars for each academic 5
3339	3339	year for a practical nursing program. All 6
3340	3340	financial assistance shall be made from funds 7
3341	3341	credited to the professional and practical 8
3342	3342	nursing student loan and nurse loan repayment 9
3343	3343	fund. A qualified applicant may receive 10
3344	3344	financial assistance for each academic year he 11
3345	3345	remains a student in good standing at a 12
3346	3346	participating school. ] 13
3347	3347	[335.233. The department shall establish 1
3348	3348	schedules for repayment of the principal and 2
3349	3349	interest on any financial assistance made under 3
3350	3350	the provisions of sections 335.212 to 335.242. 4
3351	3351	Interest at the rate of nine and one -half 5
3352	3352	percent per annum shall be charged on all 6
3353	3353	financial assistance made under the provisions 7
3354	3354	of sections 335.212 to 335.242, but the int erest 8
3355	3355	and principal of the total financial assistance 9
3356	3356	granted to a qualified applicant at the time of 10
3357	3357	the successful completion of a nursing degree, 11
3358	3358	diploma program or a practical nursing program 12
3359	3359	shall be forgiven through qualified employment. ] 13
3360	3360	[335.236. The financial assistance 1
3361	3361	recipient shall repay the financial assistance 2
3362	3362	principal and interest beginning not more than 3
3363	3363	six months after completion of the degree for 4
3364	3364	which the financial assistance was made in 5
3365	3365	accordance with the repayment contract. If an 6
3366	3366	eligible student ceases his study prior to 7
3367	3367	successful completion of a degree or graduation 8
3368	3368	at a participating school, interest at the rate 9 100
3369	3369	CCS HCS SS SCS SBs 45 & 90
3370	3370	specified in section 335.233 shall be charged on 10
3371	3371	the amount of financial assi stance received from 11
3372	3372	the state under the provisions of sections 12
3373	3373	335.212 to 335.242, and repayment, in accordance 13
3374	3374	with the repayment contract, shall begin within 14
3375	3375	ninety days of the date the financial aid 15
3376	3376	recipient ceased to be an eligible student. All 16
3377	3377	funds repaid by recipients of financial 17
3378	3378	assistance to the department shall be deposited 18
3379	3379	in the professional and practical nursing 19
3380	3380	student loan and nurse loan repayment fund for 20
3381	3381	use pursuant to sections 335.212 to 335.259. ] 21
3382	3382	[335.239. The department shall grant a 1
3383	3383	deferral of interest and principal payments to a 2
3384	3384	financial assistance recipient who is pursuing 3
3385	3385	an advanced degree, special nursing program, or 4
3386	3386	upon special conditions established by the 5
3387	3387	department. The deferral shall not exceed four 6
3388	3388	years. The status of each deferral shall be 7
3389	3389	reviewed annually by the department of health 8
3390	3390	and senior services to ensure compliance with 9
3391	3391	the intent of this section. ] 10
3392	3392	[335.242. When necessary to protect the 1
3393	3393	interest of the state in any financial 2
3394	3394	assistance transaction under sections 335.212 to 3
3395	3395	335.259, the department of health and senior 4
3396	3396	services may institute any action to recover any 5
3397	3397	amount due.] 6
3398	3398	[335.245. As used in sections 335.245 to 1
3399	3399	335.259, the following terms mean: 2
3400	3400	(1) "Department", the Missouri department 3
3401	3401	of health and senior services; 4
3402	3402	(2) "Eligible applicant", a Missouri 5
3403	3403	licensed nurse who has attained either an 6
3404	3404	associate degree, a diploma, a bachelor of 7
3405	3405	science, or graduate degree in nursing from an 8
3406	3406	accredited institution approved by the board of 9
3407	3407	nursing or a student nurse in the final year of 10
3408	3408	a full-time baccalaureate school of nursing 11
3409	3409	leading to a baccalaureate degree or graduate 12
3410	3410	nursing program leading to a mas ter's degree in 13
3411	3411	nursing and has agreed to serve in an area of 14
3412	3412	defined need as established by the department; 15
3413	3413	(3) "Participating school", an institution 16
3414	3414	within this state which grants an associate 17
3415	3415	degree in nursing, grants a bachelor or master 18
3416	3416	of science degree in nursing or provides a 19
3417	3417	diploma nursing program which is accredited by 20
3418	3418	the state board of nursing, or a regionally 21
3419	3419	accredited institution in this state which 22
3420	3420	provides a bachelor of science completion 23
3421	3421	program for registered professiona l nurses; 24
3422	3422	(4) "Qualified employment", employment on 25
3423	3423	a full-time basis in Missouri in a position 26
3424	3424	requiring licensure as a licensed practical 27 101
3425	3425	CCS HCS SS SCS SBs 45 & 90
3426	3426	nurse or registered professional nurse in any 28
3427	3427	hospital as defined in section 197.020 or public 29
3428	3428	or nonprofit agency, institution, or 30
3429	3429	organization located in an area of need as 31
3430	3430	determined by the department of health and 32
3431	3431	senior services. Any forgiveness of such 33
3432	3432	principal and interest for any qualified 34
3433	3433	applicant engaged in qualified employment on a 35
3434	3434	less than full-time basis may be prorated to 36
3435	3435	reflect the amounts provided in this section. ] 37
3436	3436	[335.248. Sections 335.245 to 335.259 1
3437	3437	shall be known as the "Nursing Student Loan 2
3438	3438	Repayment Program". The department of health 3
3439	3439	and senior services shall be the administrative 4
3440	3440	agency for the implementation of the authority 5
3441	3441	established by sections 335.245 to 335.259. The 6
3442	3442	department shall promulgate reasonable rules and 7
3443	3443	regulations necessary to implement sections 8
3444	3444	335.245 to 335.259. Promulgated rules shall 9
3445	3445	include, but not be limited to, applicant 10
3446	3446	eligibility, selection criteria, prioritization 11
3447	3447	of service obligation sites and the content of 12
3448	3448	loan repayment contracts, including repayment 13
3449	3449	schedules for those in default and penalties. 14
3450	3450	The department shall promulgate rules regarding 15
3451	3451	recruitment opportunities for minority students 16
3452	3452	into nursing schools. Priority for student loan 17
3453	3453	repayment shall be given to eligible applicants 18
3454	3454	who have demonstrated financial need. All funds 19
3455	3455	collected by the department from participants 20
3456	3456	not meeting their contractual obligations to the 21
3457	3457	state shall be deposited in the professional and 22
3458	3458	practical nursing student loan and nurse loan 23
3459	3459	repayment fund for use pursuant to sections 24
3460	3460	335.212 to 335.259.] 25
3461	3461	[335.251. Upon proper verification to the 1
3462	3462	department by the eligible applicant of securing 2
3463	3463	qualified employment in this state, the 3
3464	3464	department shall enter into a loan repayment 4
3465	3465	contract with the eligible applicant to repay 5
3466	3466	the interest and princ ipal on the educational 6
3467	3467	loans of the applicant to the limit of the 7
3468	3468	contract, which contract shall provide for 8
3469	3469	instances of less than full -time qualified 9
3470	3470	employment consistent with the provisions of 10
3471	3471	section 335.233, out of any appropriation made 11
3472	3472	to the professional and practical nursing 12
3473	3473	student loan and nurse loan repayment fund. If 13
3474	3474	the applicant breaches the contract by failing 14
3475	3475	to begin or complete the qualified employment, 15
3476	3476	the department is entitled to recover the total 16
3477	3477	of the loan repayment pa id by the department 17
3478	3478	plus interest on the repaid amount at the rate 18
3479	3479	of nine and one-half percent per annum. ] 19 102
3480	3480	CCS HCS SS SCS SBs 45 & 90
3481	3481	[335.254. Sections 335.212 to 335.259 1
3482	3482	shall not be construed to require the department 2
3483	3483	to enter into contracts with individ uals who 3
3484	3484	qualify for nursing education loans or nursing 4
3485	3485	loan repayment programs when federal, state and 5
3486	3486	local funds are not available for such purposes. ] 6
3487	3487	[335.257. Successful applicants for whom 1
3488	3488	loan payments are made under the prov isions of 2
3489	3489	sections 335.245 to 335.259 shall verify to the 3
3490	3490	department twice each year in the manner 4
3491	3491	prescribed by the department that qualified 5
3492	3492	employment in this state is being maintained. ] 6
3493	3493	Section B. Because of the importance of en suring 1
3494	3494	healthy pregnancies and healthy women and children in 2
3495	3495	Missouri in the face of growing maternal mortality and to 3
3496	3496	ensure the integrity of the MO HealthNet program and because 4
3497	3497	immediate action is necessary to address the shortage of 5
3498	3498	health care providers in this state, the enactment of 6
3499	3499	sections 191.592, 208.186, and 208.239 and the repeal and 7
3500	3500	reenactment of sections 208.151 and 208.662 of section A of 8
3501	3501	this act are deemed necessary for the immediate preservation 9
3502	3502	of the public health, welfare, pe ace, and safety, and are 10
3503	3503	hereby declared to be emergency acts within the meaning of 11
3504	3504	the constitution, and the enactment of sections 191.592, 12
3505	3505	208.186, and 208.239 and the repeal and reenactment of 13
3506	3506	sections 208.151 and 208.662 of section A of this act sh all 14
3507	3507	be in full force and effect upon its passage and approval. 15
3508	3508	