EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
[TRULY AGREED TO AND FINALLY PASSED ]
CONFERENCE COMMITTEE SUBSTITUTE FOR
HOUSE COMMITTEE SUBSTITUTE FOR
SENATE SUBSTITUTE FOR
SENATE COMMITTEE SUBSTITUTE FOR
SENATE BILLS NOS. 45 & 90
102ND GENERAL ASSEMBLY
2023
0453S.10T
AN ACT
To repeal sections 37.725, 190.255, 190.600, 190.603, 190.606, 190.612, 191.500, 191.505,
191.510, 191.515, 191.520, 191.525, 191.530, 191.535, 191.540, 191.545, 191.550,
191.600, 191.828, 191.831, 195.206, 196.1050, 197.020, 208.053, 208.072, 208.146,
208.151, 208.662, 334.104, 335.203, 335.212, 335.215, 335.218, 335.221, 335.224,
335.227, 335.230, 335.233, 335.236, 335.239, 335.242, 335.245, 335.248, 335.251,
335.254, 335.257, 338.010, and 376.1060, RSMo, and to enact in lieu thereof forty-
two new sections relating to health care, with an emergency clause for certain sections
and penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 37.725, 190.255, 190 .600, 190.603, 1
190.606, 190.612, 191.500, 191.505, 191.510, 191.515, 191.520, 2
191.525, 191.530, 191.535, 191.540, 191.545, 191.550, 191.600, 3
191.828, 191.831, 195.206, 196.1050, 197.020, 208.053, 208.072, 4
208.146, 208.151, 208.662, 334.104, 335.203, 335.21 2, 335.215, 5
335.218, 335.221, 335.224, 335.227, 335.230, 335.233, 335.236, 6
335.239, 335.242, 335.245, 335.248, 335.251, 335.254, 335.257, 7
338.010, and 376.1060, RSMo, are repealed and forty -two new 8
sections enacted in lieu thereof, to be known as sections 9.371, 9
9.381, 9.388, 37.725, 37.980, 190.255, 190.600, 190.603, 10 2
CCS HCS SS SCS SBs 45 & 90
190.606, 190.612, 190.613, 191.240, 191.430, 191.435, 191.440, 11
191.445, 191.450, 191.592, 191.600, 191.828, 191.831, 195.206, 12
196.1050, 197.020, 208.035, 208.053, 208.066, 208.072, 208.146, 13
208.151, 208.186, 208.239, 208.662, 209.700, 210.1360, 334.104, 14
335.203, 335.205, 338.010, 338.012, 376.1060, and 579.088, to 15
read as follows:16
9.371. The first Saturday of October of each year is 1
hereby designated as "Breast Cancer Awareness Day" in 2
Missouri. The citizens of this state are encouraged to 3
participate in appropriate events and activities to raise 4
awareness and celebrate survivors of breast cancer, the most 5
commonly occurring cancer among women in the United States. 6
9.381. October second of each year is hereby 1
designated as "Premenstrual Dysphoric Disorder (PMDD) 2
Awareness Day" in Missouri. The citizens of this state are 3
encouraged to participate in appropriate events and 4
activities to raise PMDD awareness. 5
9.388. The month of March of each year is hereby 1
designated as "Rare Kidney Disease Awareness Month". The 2
citizens of this state are encouraged to participate in 3
appropriate awareness and educational activities for rare 4
kidney disease, available screening and genetic testing 5
options, and efforts to improve treatment for patients. 6
37.725. 1. Any files maintained by the advocate 1
program shall be disclosed only at the discretion of the 2
child advocate; except th at the identity of any complainant 3
or recipient shall not be disclosed by the office unless: 4
(1) The complainant or recipient, or the complainant's 5
or recipient's legal representative, consents in writing to 6
such disclosure; [or] 7
(2) Such disclosure is required by court order ; or 8 3
CCS HCS SS SCS SBs 45 & 90
(3) The child advocate determines that disclosure to 9
law enforcement is necessary to ensure immediate child 10
safety. 11
2. Any statement or communication made by the office 12
relevant to a complaint received by, proceedings before, or 13
activities of the office and any complaint or information 14
made or provided in good faith by any person shall be 15
absolutely privileged and such person shall be immune from 16
suit. 17
3. Any representative of the office condu cting or 18
participating in any examination of a complaint who 19
knowingly and willfully discloses to any person other than 20
the office, or those persons authorized by the office to 21
receive it, the name of any witness examined or any 22
information obtained o r given during such examination is 23
guilty of a class A misdemeanor. However, the office 24
conducting or participating in any examination of a 25
complaint shall disclose the final result of the examination 26
with the consent of the recipient. 27
4. The office shall not be required to testify in any 28
court with respect to matters held to be confidential in 29
this section except as the court may deem necessary to 30
enforce the provisions of sections 37.700 to 37.730, or 31
where otherwise required by court order . 32
37.980. 1. The office of administration shall submit 1
a report to the general assembly before December thirty - 2
first of each year, beginning in 2023, describing the 3
progress made by the state with respect to the directives 4
issued as part of the "Missouri as a Model Employer" 5
initiative described in executive order 19 -16. 6
2. The report shall include, but not be limited to, 7
the data described in the following subdivisions, which 8 4
CCS HCS SS SCS SBs 45 & 90
shall be collected through voluntary self -disclosure. To 9
the extent possible, for each subdivision, the report shall 10
include general data for all relevant employees, in addition 11
to data comparing the employees of each agency within the 12
state workforce: 13
(1) The baseline number of employees in the state 14
workforce who disclosed disabilities when the initiative 15
began; 16
(2) The number of employees in the state workforce who 17
disclose disabilities at the time of the compiling of the 18
annual report and statistics providing the size and the 19
percentage of any increase or decrease in such numbers since 20
the initiative began and since the compilation of any 21
previous annual report; 22
(3) The baseline percentage of employees in the state 23
workforce who disclosed disabilities when the initiativ e 24
began; 25
(4) The percentage of employees in the state workforce 26
who disclose disabilities at the time of the compiling of 27
the annual report and statistics providing the size of any 28
increase or decrease in such percentage since the initiative 29
began and since the compilation of any previous annual 30
report; 31
(5) A description and analysis of any disparity that 32
may exist from the time the initiative began and the time of 33
the compiling of the annual reports, and of any disparity 34
that may exist from the time of the most recent previous 35
annual report, if any, and the time of the current annual 36
report, between the percentage of individuals in the state 37
of working age who disclose disabilities and the percentage 38
of individuals in the state work force who disclose or have 39
disabilities; and 40 5
CCS HCS SS SCS SBs 45 & 90
(6) A description and analysis of any pay differential 41
that may exist in the state workforce between individuals 42
who disclose disabilities and individuals who do not 43
disclose disabilities. 44
3. The report shall also include descriptions of 45
specific efforts made by state agencies to recruit, hire, 46
advance, and retain individuals with disabilities including, 47
but not limited to, individuals with the most significant 48
disabilities, as defined in 5 CS R 20-500.160. Such 49
descriptions shall include, but not be limited to, best, 50
promising, and emerging practices related to: 51
(1) Setting annual goals; 52
(2) Analyzing barriers to recruiting, hiring, 53
advancing, and retaining individuals with disa bilities; 54
(3) Establishing and maintaining contacts with 55
entities and organizations that specialize in providing 56
education, training, or assistance to individuals with 57
disabilities in securing employment; 58
(4) Using internships, apprenticeshi ps, and job 59
shadowing; 60
(5) Using supported employment, individual placement 61
with support services, customized employment, telework, 62
mentoring and management training, stay -at-work and return- 63
to-work programs, and exit interviews; 64
(6) Adopting, posting, and making available to all job 65
applicants and employees reasonable accommodation procedures 66
in written and accessible formats; 67
(7) Providing periodic disability awareness training 68
to employees to build and sustain a culture of inclus ion in 69
the workplace, including rights to reasonable accommodation 70
in the workplace; 71 6
CCS HCS SS SCS SBs 45 & 90
(8) Providing periodic training to human resources and 72
hiring managers in disability rights, hiring, and workplace 73
policies designed to promote a diverse and inc lusive 74
workforce; and 75
(9) Making web-based hiring portals accessible to and 76
usable by applicants with disabilities. 77
190.255. 1. Any qualified first responder may obtain 1
and administer naloxone , or any other drug or device 2
approved by the United States Food and Drug Administration, 3
that blocks the effects of an opioid overdose and is 4
administered in a manner approved by the United States Food 5
and Drug Administration to a person suffering from an 6
apparent narcotic or opiate -related overdose in order to 7
revive the person. 8
2. Any licensed drug distributor or pharmacy in 9
Missouri may sell naloxone , or any other drug or device 10
approved by the United States Food and Drug Administration, 11
that blocks the effects of an opio id overdose and is 12
administered in a manner approved by the United States Food 13
and Drug Administration to qualified first responder 14
agencies to allow the agency to stock naloxone or other such 15
drugs or devices for the administration of such drug or 16
device to persons suffering from an apparent narcotic or 17
opiate overdose in order to revive the person. 18
3. For the purposes of this section, "qualified first 19
responder" shall mean any [state and local law enforcement 20
agency staff,] fire department personnel, fire district 21
personnel, or licensed emergency medical technician who is 22
acting under the directives and established protocols of a 23
medical director of a local licensed ground ambulance 24
service licensed under section 190.109 , or any state or 25
local law enforcement agency staff member, who comes in 26 7
CCS HCS SS SCS SBs 45 & 90
contact with a person suffering from an apparent narcotic or 27
opiate-related overdose and who has received training in 28
recognizing and responding to a narcotic or opiate overdose 29
and the administration of naloxone, or any other drug or 30
device approved by the United States Food and Drug 31
Administration, that blocks the effects of an opioid 32
overdose and is administered in a manner approved by the 33
United States Food and Drug Administration to a person 34
suffering from an apparent narcotic or opiate -related 35
overdose. "Qualified first responder agencies" shall mean 36
any state or local law enforcement agency, fire department, 37
or ambulance service that provides documented training to 38
its staff related to the administration of naloxone or other 39
such drugs or devices in an apparent narcotic or opiate 40
overdose situation. 41
4. A qualified first responder shall only administer 42
naloxone, or any other drug or device approved by the United 43
States Food and Drug Administration, that blocks the effects 44
of an opioid overdose and is administered in a manner 45
approved by the United States Food and Drug Administration 46
by such means as the qualified first responder has received 47
training for the administrati on of naloxone or other such 48
drugs or devices. 49
190.600. 1. Sections 190.600 to 190.621 shall be 1
known and may be cited as the "Outside the Hospital Do -Not- 2
Resuscitate Act". 3
2. As used in sections 190.600 to 190.621, unless the 4
context clearly requires otherwise, the following terms 5
shall mean: 6
(1) "Attending physician": 7 8
CCS HCS SS SCS SBs 45 & 90
(a) A physician licensed under chapter 334 selected by 8
or assigned to a patient who has primary responsibility for 9
treatment and care of the pat ient; or 10
(b) If more than one physician shares responsibility 11
for the treatment and care of a patient, one such physician 12
who has been designated the attending physician by the 13
patient or the patient's representative shall serve as the 14
attending physician; 15
(2) "Cardiopulmonary resuscitation" or "CPR", 16
emergency medical treatment administered to a patient in the 17
event of the patient's cardiac or respiratory arrest, and 18
shall include cardiac compression, endotracheal intubation 19
and other advanced airway management, artificial 20
ventilation, defibrillation, administration of cardiac 21
resuscitation medications, and related procedures; 22
(3) "Department", the department of health and senior 23
services; 24
(4) "Emergency medical services p ersonnel", paid or 25
volunteer firefighters, law enforcement officers, first 26
responders, emergency medical technicians, or other 27
emergency service personnel acting within the ordinary 28
course and scope of their professions, but excluding 29
physicians; 30
(5) "Health care facility", any institution, building, 31
or agency or portion thereof, private or public, excluding 32
federal facilities and hospitals, whether organized for 33
profit or not, used, operated, or designed to provide health 34
services, medical treatment, or nursing, rehabilitative, or 35
preventive care to any person or persons. Health care 36
facility includes but is not limited to ambulatory surgical 37
facilities, health maintenance organizations, home health 38
agencies, hospices, infirmaries, renal dialysis centers, 39 9
CCS HCS SS SCS SBs 45 & 90
long-term care facilities licensed under sections 198.003 to 40
198.186, medical assistance facilities, mental health 41
centers, outpatient facilities, public health centers, 42
rehabilitation facilities, and residential treatment 43
facilities; 44
(6) "Hospital", a place devoted primarily to the 45
maintenance and operation of facilities for the diagnosis, 46
treatment, or care for not less than twenty -four consecutive 47
hours in any week of three or more nonrelated individuals 48
suffering from illness, disease, injury, deformity, or other 49
abnormal physical conditions; or a place devoted primarily 50
to provide for not less than twenty -four consecutive hours 51
in any week medical or nursing care for three or more 52
nonrelated individuals. Hospital does not include any long - 53
term care facility licensed under sections 198.003 to 54
198.186; 55
(7) "Outside the hospital do -not-resuscitate 56
identification" or "outside the hospital DNR 57
identification", a standardized identification card, 58
bracelet, or necklace of a single color, form, and design as 59
described by rule of the department that signifies that the 60
patient's attending physician has issued an outside the 61
hospital do-not-resuscitate order for the patient and has 62
documented the grounds for the order in the patient's 63
medical file; 64
(8) "Outside the hospital do -not-resuscitate order" or 65
"outside the hospital DNR order", a written physician's 66
order signed by the patient and the attending physician, or 67
the patient's representative and the a ttending physician, in 68
a form promulgated by rule of the department which 69
authorizes emergency medical services personnel to withhold 70 10
CCS HCS SS SCS SBs 45 & 90
or withdraw cardiopulmonary resuscitation from the patient 71
in the event of cardiac or respiratory arrest; 72
(9) "Outside the hospital do -not-resuscitate protocol" 73
or "outside the hospital DNR protocol", a standardized 74
method or procedure promulgated by rule of the department 75
for the withholding or withdrawal of cardiopulmonary 76
resuscitation by emergency medical se rvices personnel from a 77
patient in the event of cardiac or respiratory arrest; 78
(10) "Patient", a person eighteen years of age or 79
older who is not incapacitated, as defined in section 80
475.010, and who is otherwise competent to give informed 81
consent to an outside the hospital do -not-resuscitate order 82
at the time such order is issued, and who, with his or her 83
attending physician, has executed an outside the hospital do - 84
not-resuscitate order under sections 190.600 to 190.621. A 85
person who has a patient's representative shall also be a 86
patient for the purposes of sections 190.600 to 190.621, if 87
the person or the person's patient's representative has 88
executed an outside the hospital do -not-resuscitate order 89
under sections 190.600 to 190.621 . A person under eighteen 90
years of age shall also be a patient for purposes of 91
sections 190.600 to 190.621 if the person has had a do -not- 92
resuscitate order issued on his or her behalf under the 93
provisions of section 191.250 ; 94
(11) "Patient's represent ative": 95
(a) An attorney in fact designated in a durable power 96
of attorney for health care for a patient determined to be 97
incapacitated under sections 404.800 to 404.872; or 98
(b) A guardian or limited guardian appointed under 99
chapter 475 to have responsibility for an incapacitated 100
patient. 101 11
CCS HCS SS SCS SBs 45 & 90
190.603. 1. A patient or patient's representative and 1
the patient's attending physician may execute an outside the 2
hospital do-not-resuscitate order. An outside the hospital 3
do-not-resuscitate order shall not be effective unless it is 4
executed by the patient or patient's representative and the 5
patient's attending physician, and it is in the form 6
promulgated by rule of the department. 7
2. A patient under eighteen years of age i s not 8
authorized to execute an outside the hospital do -not- 9
resuscitate order for himself or herself but may have a do - 10
not-resuscitate order issued on his or her behalf by one 11
parent or legal guardian or by a juvenile or family court 12
under the provisions of section 191.250. Such do-not- 13
resuscitate order shall also function as an outside the 14
hospital do-not-resuscitate order for the purposes of 15
sections 190.600 to 190.621 unless such do -not-resuscitate 16
order authorized under the provisions of sectio n 191.250 17
states otherwise. 18
3. If an outside the hospital do -not-resuscitate order 19
has been executed, it shall be maintained as the first page 20
of a patient's medical record in a health care facility 21
unless otherwise specified in the health care f acility's 22
policies and procedures. 23
[3.] 4. An outside the hospital do -not-resuscitate 24
order shall be transferred with the patient when the patient 25
is transferred from one health care facility to another 26
health care facility. If the patient is tr ansferred outside 27
of a hospital, the outside the hospital DNR form shall be 28
provided to any other facility, person, or agency 29
responsible for the medical care of the patient or to the 30
patient or patient's representative. 31 12
CCS HCS SS SCS SBs 45 & 90
190.606. The following persons and entities shall not 1
be subject to civil, criminal, or administrative liability 2
and are not guilty of unprofessional conduct for the 3
following acts or omissions that follow discovery of an 4
outside the hospital do -not-resuscitate identification upon 5
a patient or a do-not-resuscitate order functioning as an 6
outside the hospital do -not-resuscitate order for a patient 7
under eighteen years of age , or upon being presented with an 8
outside the hospital do -not-resuscitate order [from 9
Missouri, another state, the District of Columbia, or a 10
territory of the United States ]; provided that the acts or 11
omissions are done in good faith and in accordance with the 12
provisions of sections 190.600 to 190.621 and the provisions 13
of an outside the hospital do-not-resuscitate order executed 14
under sections 190.600 to 190.621: 15
(1) Physicians, persons under the direction or 16
authorization of a physician, emergency medical services 17
personnel, or health care facilities that cause or 18
participate in the withholding or withdrawal of 19
cardiopulmonary resuscitation from such patient; and 20
(2) Physicians, persons under the direction or 21
authorization of a physician, emergency medical services 22
personnel, or health care facilities that provide 23
cardiopulmonary resuscitation to such patient under an oral 24
or written request communicated to them by the patient or 25
the patient's representative. 26
190.612. 1. Emergency medical services personnel are 1
authorized to comply with the outs ide the hospital do-not- 2
resuscitate protocol when presented with an outside the 3
hospital do-not-resuscitate identification or an outside the 4
hospital do-not-resuscitate order. However, emergency 5
medical services personnel shall not comply with an outs ide 6 13
CCS HCS SS SCS SBs 45 & 90
the hospital do-not-resuscitate order or the outside the 7
hospital do-not-resuscitate protocol when the patient or 8
patient's representative expresses to such personnel in any 9
manner, before or after the onset of a cardiac or 10
respiratory arrest, the desire to be resuscitated. 11
2. [Emergency medical services personnel are 12
authorized to comply with the outside the hospital do -not- 13
resuscitate protocol when presented with an outside the 14
hospital do-not-resuscitate order from another state, the 15
District of Columbia, or a territory of the United States if 16
such order is on a standardized written form: 17
(1) Signed by the patient or the patient's 18
representative and a physician who is licensed to practice 19
in the other state, the District of Col umbia, or the 20
territory of the United States; and 21
(2) Such form has been previously reviewed and 22
approved by the department of health and senior services to 23
authorize emergency medical services personnel to withhold 24
or withdraw cardiopulmonary re suscitation from the patient 25
in the event of a cardiac or respiratory arrest. 26
Emergency medical services personnel shall not comply with 27
an outside the hospital do -not-resuscitate order from 28
another state, the District of Columbia, or a territory of 29
the United States or the outside the hospital do -not- 30
resuscitate protocol when the patient or patient's 31
representative expresses to such personnel in any manner, 32
before or after the onset of a cardiac or respiratory 33
arrest, the desire to be resuscitated. ] 34
(1) Except as provided in subdivision (2) of this 35
subsection, emergency medical services personnel are 36
authorized to comply with the outside the hospital do -not- 37 14
CCS HCS SS SCS SBs 45 & 90
resuscitate protocol when presented with a do -not- 38
resuscitate order functioning as an outside the hospital do - 39
not-resuscitate order for a patient under eighteen years of 40
age if such do-not-resuscitate order has been authorized by 41
one parent or legal guardian or by a juvenile or family 42
court under the provisions of section 191.250. 43
(2) Emergency medical services personnel shall not 44
comply with a do-not-resuscitate order or the outside the 45
hospital do-not-resuscitate protocol when the patient under 46
eighteen years of age, either parent of such patient, the 47
patient's legal guard ian, or the juvenile or family court 48
expresses to such personnel in any manner, before or after 49
the onset of a cardiac or respiratory arrest, the desire for 50
the patient to be resuscitated. 51
3. If a physician or a health care facility other than 52
a hospital admits or receives a patient with an outside the 53
hospital do-not-resuscitate identification or an outside the 54
hospital do-not-resuscitate order, and the patient or 55
patient's representative has not expressed or does not 56
express to the physician or health care facility the desire 57
to be resuscitated, and the physician or health care 58
facility is unwilling or unable to comply with the outside 59
the hospital do-not-resuscitate order, the physician or 60
health care facility shall take all reasonable s teps to 61
transfer the patient to another physician or health care 62
facility where the outside the hospital do -not-resuscitate 63
order will be complied with. 64
190.613. 1. A patient or patient's representative and 1
the patient's attending physician may execute an outside the 2
hospital do-not-resuscitate order through the presentation 3
of a properly executed outside the hospital do -not- 4
resuscitate order from another state, the District of 5 15
CCS HCS SS SCS SBs 45 & 90
Columbia, or a territory of the United States, or a 6
Transportable Physician Orders for Patient Preferences 7
(TPOPP)/Physician Orders for Life -Sustaining Treatment 8
(POLST) form containing a specific do -not-resuscitate 9
section. 10
2. Any outside the hospital do -not-resuscitate form 11
identified from another state, the District of Columbia, or 12
a territory of the United States, or a TPOPP/POLST form, 13
shall: 14
(1) Have been previously reviewed and approved by the 15
department as in compliance with the provisions of sections 16
190.600 to 190.621; 17
(2) Not be accepted for a patient under eighteen years 18
of age, except as allowed under section 191.250; and 19
(3) Not be effective during such time as the patient 20
is pregnant as set forth in section 190.609. 21
A patient or patient's representative may e xpress to 22
emergency medical services personnel, at any time and by any 23
means, the intent to revoke the outside the hospital do -not- 24
resuscitate order. 25
3. The provisions of section 190.606 shall apply to 26
the good faith acts or omissions of emergenc y medical 27
services personnel under this section. 28
191.240. 1. For purposes of this section, the 1
following terms mean: 2
(1) "Health care provider", the same meaning given to 3
the term in section 191.900; 4
(2) "Patient examination", a prostate, anal, or pelvic 5
examination. 6
2. A health care provider, or any student or trainee 7
under the supervision of a health care provider, shall not 8 16
CCS HCS SS SCS SBs 45 & 90
knowingly perform a patient examination upon an anesthetized 9
or unconscious patient in a health care facility unless: 10
(1) The patient or a person authorized to make health 11
care decisions for the patient has given specific informed 12
consent to the patient examination for nonmedical purposes; 13
(2) The patient examination is necess ary for 14
diagnostic or treatment purposes; 15
(3) The collection of evidence through a forensic 16
examination, as defined under subsection 8 of section 17
595.220, for a suspected sexual assault on the anesthetized 18
or unconscious patient is necessary beca use the evidence 19
will be lost or the patient is unable to give informed 20
consent due to a medical condition; or 21
(4) Circumstances are present which imply consent, as 22
described in section 431.063. 23
3. A health care provider shall notify a patie nt of 24
any patient examination performed under subdivisions (2) to 25
(4) of subsection 2 of this section if the patient is unable 26
to give verbal or written consent. 27
4. A health care provider who violates the provisions 28
of this section, or who superv ises a student or trainee who 29
violates the provisions of this section, shall be subject to 30
discipline by any licensing board that licenses the health 31
care provider. 32
191.430. 1. There is hereby established within the 1
department of health and senior services the "Health 2
Professional Loan Repayment Program" to provide forgivable 3
loans for the purpose of repaying existing loans related to 4
applicable educational expenses for health care, mental 5
health, and public health professionals . The department of 6
health and senior services shall be the administrative 7 17
CCS HCS SS SCS SBs 45 & 90
agency for the implementation of the program established by 8
this section. 9
2. The department of health and senior services shall 10
prescribe the form and the time and method of filing 11
applications and supervise the processing, including 12
oversight and monitoring of the program, and shall 13
promulgate rules to implement the provisions of sections 14
191.430 to 191.450. Any rule or portion of a rule, as that 15
term is defined in section 536.010, that is created under 16
the authority delegated in this section shall become 17
effective only if it complies with and is subject to all of 18
the provisions of chapter 536 and, if applicable, section 19
536.028. This section and chapter 536 are nonseverable and 20
if any of the powers vested with the general assembly 21
pursuant to chapter 536 to review, to delay the effective 22
date, or to disapprove and annul a rule are subsequently 23
held unconstitutional, then the grant of rulemaking 24
authority and any rule proposed or adopted after August 28, 25
2023, shall be invalid and void. 26
3. The director of the department of health and senior 27
services shall have the discretion to determine the health 28
professionals and practitioners who will receive for givable 29
health professional loans from the department to pay their 30
existing loans. The director shall make such determinations 31
each fiscal year based on evidence associated with the 32
greatest needs in the best interests of the public. The 33
health care, mental health, and public health professionals 34
or disciplines funded in any given year shall be contingent 35
upon consultation with the office of workforce development 36
in the department of higher education and workforce 37
development and the department o f mental health, or their 38
successor agencies. 39 18
CCS HCS SS SCS SBs 45 & 90
4. The department of health and senior services shall 40
enter into a contract with each selected applicant who 41
receives a health professional loan under this section. 42
Each selected applicant shall appl y the loan award to his or 43
her educational debt. The contract shall detail the methods 44
of forgiveness associated with a service obligation and the 45
terms associated with the principal and interest accruing on 46
the loan at the time of the award. The contract shall 47
contain details concerning how forgiveness is earned, 48
including when partial forgiveness is earned through a 49
service obligation, and the terms and conditions associated 50
with repayment of the loans for any obligation not served. 51
5. All health professional loans shall be made from 52
funds appropriated by the general assembly to the health 53
professional loan incentive fund established in section 54
191.445. 55
191.435. The department of health and senior services 1
shall designate counties, communities, or sections of areas 2
in the state as areas of defined need for health care, 3
mental health, and public health services. If a county, 4
community, or section of an area has been designated or 5
determined as a professional short age area, a shortage area, 6
or a health care, mental health, or public health 7
professional shortage area by the federal Department of 8
Health and Human Services or its successor agency, the 9
department of health and senior services shall designate it 10
as an area of defined need under this section. If the 11
director of the department of health and senior services 12
determines that a county, community, or section of an area 13
has an extraordinary need for health care professional 14
services without a correspond ing supply of such 15
professionals, the department of health and senior services 16 19
CCS HCS SS SCS SBs 45 & 90
may designate it as an area of defined need under this 17
section. 18
191.440. 1. The department of health and senior 1
services shall enter into a contract wit h each individual 2
qualifying for a forgivable loan under sections 191.430 to 3
191.450. The written contract between the department and 4
the individual shall contain, but not be limited to, the 5
following: 6
(1) An agreement that the state agrees to a ward a loan 7
and the individual agrees to serve for a period equal to two 8
years, or a longer period as the individual may agree to, in 9
an area of defined need as designated by the department, 10
with such service period to begin on the date identified on 11
the signed contract; 12
(2) A provision that any financial obligations arising 13
out of a contract entered into and any obligation of the 14
individual that is conditioned thereon is contingent upon 15
funds being appropriated for loans; 16
(3) The area of defined need where the person will 17
practice; 18
(4) A statement of the damages to which the state is 19
entitled for the individual's breach of the contract; and 20
(5) Such other statements of the rights and 21
liabilities of the department and of th e individual not 22
inconsistent with sections 191.430 to 191.450. 23
2. The department of health and senior services may 24
stipulate specific practice sites, contingent upon 25
department-generated health care, mental health, and public 26
health professional need priorities, where applicants shall 27
agree to practice for the duration of their participation in 28
the program. 29 20
CCS HCS SS SCS SBs 45 & 90
191.445. There is hereby created in the state treasury 1
the "Health Professional Loan Incentive Fund", which shall 2
consist of any appropriations made by the general assembly, 3
all funds recovered from an individual under section 4
191.450, and all funds generated by loan repayments received 5
under sections 191.430 to 191.450. The state treasurer 6
shall be custodian of the fund. In accordance with sections 7
30.170 and 30.180, the state treasurer may approve 8
disbursements. The fund shall be a dedicated fund and, upon 9
appropriation, moneys in this fund shall be used solely by 10
the department of health and senior services to provide 11
loans under sections 191.430 to 191.450. Notwithstanding 12
the provisions of section 33.080 to the contrary, any moneys 13
remaining in the fund at the end of the biennium shall not 14
revert to the credit of the general revenue fund. The state 15
treasurer shall invest moneys in the fund in the same manner 16
as other funds are invested. Any interest and moneys earned 17
on such investments shall be credited to the fund. 18
191.450. 1. An individual who enters into a written 1
contract with the department of health and senior services, 2
as described in section 191.440, and who fails to maintain 3
an acceptable employment status shall be liable to the state 4
for any amount awarded as a loan by the department directly 5
to the individual wh o entered into the contract that has not 6
yet been forgiven. 7
2. An individual fails to maintain an acceptable 8
employment status under this section when the contracted 9
individual involuntarily or voluntarily terminates 10
qualifying employment, is dis missed from such employment 11
before completion of the contractual service obligation 12
within the specific time frame outlined in the contract, or 13
fails to respond to requests made by the department. 14 21
CCS HCS SS SCS SBs 45 & 90
3. If an individual breaches the written contract of 15
the individual by failing to begin or complete such 16
individual's service obligation, the state shall be entitled 17
to recover from the individual an amount equal to the sum of: 18
(1) The total amount of the loan awarded by the 19
department or, if th e department had already awarded partial 20
forgiveness at the time of the breach, the amount of the 21
loan not yet forgiven; 22
(2) The interest on the amount that would be payable 23
if at the time the loan was awarded it was a loan bearing 24
interest at the maximum prevailing rate as determined by the 25
Treasurer of the United States; 26
(3) An amount equal to any damages incurred by the 27
department as a result of the breach; and 28
(4) Any legal fees or associated costs incurred by the 29
department or the state of Missouri in the collection of 30
damages. 31
191.592. 1. For purposes of this section, the 1
following terms mean: 2
(1) "Department", the department of health and senior 3
services; 4
(2) "Eligible entity", an entity tha t operates a 5
physician medical residency program in this state and that 6
is accredited by the Accreditation Council for Graduate 7
Medical Education; 8
(3) "General primary care and psychiatry", family 9
medicine, general internal medicine, general pedi atrics, 10
internal medicine-pediatrics, general obstetrics and 11
gynecology, or general psychiatry; 12
(4) "Grant-funded residency position", a position that 13
is accredited by the Accreditation Council for Graduate 14
Medical Education, that is established as a result of 15 22
CCS HCS SS SCS SBs 45 & 90
funding awarded to an eligible entity for the purpose of 16
establishing an additional medical resident position beyond 17
the currently existing medical resident positions, and that 18
is within the fields of general primary care and 19
psychiatry. Such position shall end when the medical 20
residency funding under this section is completed or when 21
the resident in the medical grant -funded residency position 22
is no longer employed by the eligible entity, whichever is 23
earlier; 24
(5) "Participating medical resident", an individual 25
who is a medical school graduate with a doctor of medicine 26
degree or doctor of osteopathic medicine degree, who is 27
participating in a postgraduate training program at an 28
eligible entity, and who is filling a grant -funded residency 29
position. 30
2. (1) Subject to appropriation, the department shall 31
establish a medical residency grant program to award grants 32
to eligible entities for the purpose of establishing and 33
funding new general primary care and psychiatry m edical 34
residency positions in this state and continuing the funding 35
of such new residency positions for the duration of the 36
funded residency. 37
(2) (a) Funding shall be available for three years 38
for residency positions in family medicine, general internal 39
medicine, and general pediatrics. 40
(b) Funding shall be available for four years for 41
residency positions in general obstetrics and gynecology, 42
internal medicine-pediatrics, and general psychiatry. 43
3. (1) There is hereby created in t he state treasury 44
the "Medical Residency Grant Program Fund". Moneys in the 45
fund shall be used to implement and fund grants to eligible 46
entities. 47 23
CCS HCS SS SCS SBs 45 & 90
(2) The medical residency grant program fund shall 48
include funds appropriated by the general assemb ly, 49
reimbursements from awarded eligible entities that were not 50
able to fill the residency position or positions with an 51
individual medical resident or residents, and any gifts, 52
contributions, grants, or bequests received from federal, 53
private, or other sources. 54
(3) The state treasurer shall be custodian of the 55
fund. In accordance with sections 30.170 and 30.180, the 56
state treasurer may approve disbursements. The fund shall 57
be a dedicated fund and, upon appropriation, moneys in the 58
fund shall be used solely as provided in this section. 59
(4) Notwithstanding the provisions of section 33.080 60
to the contrary, any moneys remaining in the fund at the end 61
of the biennium shall not revert to the credit of the 62
general revenue fund. 63
(5) The state treasurer shall invest moneys in the 64
fund in the same manner as other funds are invested. Any 65
interest and moneys earned on such investments shall be 66
credited to the fund. 67
4. Subject to appropriation, the department shall 68
expend moneys in the medical residency grant program fund in 69
the following order: 70
(1) Necessary costs of the department to implement 71
this section; 72
(2) Funding of grant-funded residency positions of 73
individuals in the fourth year of their residency, as 74
applicable to residents in general obstetrics and 75
gynecology, internal medicine -pediatrics, and general 76
psychiatry; 77
(3) Funding of grant-funded residency positions of 78
individuals in the third year of their residency; 79 24
CCS HCS SS SCS SBs 45 & 90
(4) Funding of grant-funded residency positions of 80
individuals in the second year of their residency; 81
(5) Funding of grant-funded residency positions of 82
individuals in the first year of their residency; and 83
(6) The establishment of new grant -funded residency 84
positions at awarded eligible entities. 85
5. The department shall establish criteria to evaluate 86
which eligible entities shall be awarded grants for new 87
grant-funded residency positions, criteria for determining 88
the amount and duration of grants, the cont ents of the grant 89
application, procedures and timelines by which eligible 90
entities may apply for grants, and all other rules needed to 91
implement the purposes of this section. Such criteria shall 92
include a preference for eligible entities located in ar eas 93
of highest need for general primary care and psychiatric 94
care physicians, as determined by the health professional 95
shortage area score. 96
6. Eligible entities that receive grants under this 97
section shall: 98
(1) Agree to supplement awarded funds under this 99
section, if necessary, to establish or maintain a grant - 100
funded residency position for the duration of the funded 101
resident's medical residency; and 102
(2) Agree to abide by other requirements imposed by 103
rule. 104
7. Annual funding per participating medical resident 105
shall be limited to: 106
(1) Direct graduate medical education costs including, 107
but not limited to: 108
(a) Salaries and benefits for residents, faculty, and 109
program staff; 110 25
CCS HCS SS SCS SBs 45 & 90
(b) Malpractice insurance, licenses , and other 111
required fees; and 112
(c) Program administration and educational materials; 113
and 114
(2) Indirect costs of graduate medical education 115
necessary to meet the standards of the Accreditation Council 116
for Graduate Medical Education. 117
8. No new grant-funded residency positions under this 118
section shall be established after the tenth fiscal year in 119
which grants are awarded. However, any residency positions 120
funded under this section may continue to be funded until 121
the completion of the r esident's medical residency. 122
9. The department shall submit an annual report to the 123
general assembly regarding the implementation of the program 124
developed under this section. 125
10. The department may promulgate all necessary rules 126
and regulations for the administration of this section. Any 127
rule or portion of a rule, as that term is defined in 128
section 536.010, that is created under the authority 129
delegated in this section shall become effective only if it 130
complies with and is subject to all of the provisions of 131
chapter 536 and, if applicable, section 536.028. This 132
section and chapter 536 are nonseverable and if any of the 133
powers vested with the general assembly pursuant to chapter 134
536 to review, to delay the effective date, or to disapp rove 135
and annul a rule are subsequently held unconstitutional, 136
then the grant of rulemaking authority and any rule proposed 137
or adopted after the effective date of this section shall be 138
invalid and void. 139
11. The provisions of this section shall exp ire on 140
January 1, 2038. 141 26
CCS HCS SS SCS SBs 45 & 90
191.600. 1. Sections 191.600 to 191.615 establish a 1
loan repayment program for graduates of approved medical 2
schools, schools of osteopathic medicine, schools of 3
dentistry and accredited chiropractic college s who practice 4
in areas of defined need and shall be known as the "Health 5
Professional Student Loan Repayment Program". Sections 6
191.600 to 191.615 shall apply to graduates of accredited 7
chiropractic colleges when federal guidelines for 8
chiropractic shortage areas are developed. 9
2. The "Health Professional Student Loan and Loan 10
Repayment Program Fund" is hereby created in the state 11
treasury. All funds recovered from an individual pursuant 12
to section 191.614 and all funds generated by loan 13
repayments and penalties received pursuant to section 14
191.540 shall be credited to the fund. The moneys in the 15
fund shall be used by the department of health and senior 16
services to provide loan repayments pursuant to section 17
191.611 in accordance with sections 191.600 to 191.614 [and 18
to provide loans pursuant to sections 191.500 to 191.550 ]. 19
191.828. 1. The following departments shall conduct 1
on-going evaluations of the effect of the initiatives 2
enacted by the following sections: 3
(1) The department of commerce and insurance shall 4
evaluate the effect of revising section 376.782 and sections 5
143.999, 208.178, 374.126, and 376.891 to 376.894; 6
(2) The department of health and senior services shall 7
evaluate the effect of revising sections 105.711 and 8
[sections 191.520 and ] 191.600 and enacting section 191.411, 9
and sections 167.600 to 167.621, 191.231, 208.177, 431.064, 10
and 660.016. In collaboration with the state board of 11
registration for the healing arts, the state board of 12
nursing, and the state board of pharmacy, the department of 13 27
CCS HCS SS SCS SBs 45 & 90
health and senior services shall also evaluate the effect of 14
revising section 195.070, section 334.100, and section 15
335.016, and of sections 334.104 and 334.112, and section 16
338.095 and 338.198; 17
(3) The department of social services shall evaluate 18
the effect of revising section 198.090, and sections 19
208.151, 208.152 and 208.215, and section 383.125, and of 20
sections 167.600 to 167.621, 208.177, 208.178, 208.179, 21
208.181, and 211.490; 22
(4) The office of administration shall evaluate the 23
effect of revising sections 105.711 and 105.721; 24
(5) The Missouri consolidated health care plan shall 25
evaluate the effect of section 103.178; and 26
(6) The department of mental health shall evaluate the 27
effect of section 191.831 as it relates to substance abuse 28
treatment and of section 191.835. 29
2. The department of revenue and office of 30
administration shall make biannual reports to the general 31
assembly and the governor concerning the income received 32
into the health initiatives fund and the level of funding 33
required to operate the programs and initiatives funded by 34
the health initiatives fund at an optimal level. 35
191.831. 1. There is hereby establi shed in the state 1
treasury a "Health Initiatives Fund", to which shall be 2
deposited all revenues designated for the fund under 3
subsection 8 of section 149.015, and subsection 3 of section 4
149.160, and section 167.609, and all other funds donated to 5
the fund or otherwise deposited pursuant to law. The state 6
treasurer shall administer the fund. Money in the fund 7
shall be appropriated to provide funding for implementing 8
the new programs and initiatives established by sections 9
105.711 and 105.721. The moneys in the fund may further be 10 28
CCS HCS SS SCS SBs 45 & 90
used to fund those programs established by sections 11
191.411[, 191.520] and 191.600, sections 208.151 and 12
208.152, and sections 103.178, 143.999, 167.600 to 167.621, 13
188.230, 191.211, 191.231, 191.825 to 191.839, 192 .013, 14
208.177, 208.178, 208.179 and 208.181, 211.490, 285.240, 15
337.093, 374.126, 376.891 to 376.894, 431.064, 660.016, 16
660.017 and 660.018; in addition, not less than fifteen 17
percent of the proceeds deposited to the health initiative 18
fund pursuant to sections 149.015 and 149.160 shall be 19
appropriated annually to provide funding for the C -STAR 20
substance abuse rehabilitation program of the department of 21
mental health, or its successor program, and a C -STAR pilot 22
project developed by the director of t he division of alcohol 23
and drug abuse and the director of the department of 24
corrections as an alternative to incarceration, as provided 25
in subsections 2, 3, and 4 of this section. Such pilot 26
project shall be known as the "Alt -care" program. In 27
addition, some of the proceeds deposited to the health 28
initiatives fund pursuant to sections 149.015 and 149.160 29
shall be appropriated annually to the division of alcohol 30
and drug abuse of the department of mental health to be used 31
for the administration an d oversight of the substance abuse 32
traffic [offenders] offender program defined in section 33
302.010 [and section 577.001]. The provisions of section 34
33.080 to the contrary notwithstanding, money in the health 35
initiatives fund shall not be transferred a t the close of 36
the biennium to the general revenue fund. 37
2. The director of the division of alcohol and drug 38
abuse and the director of the department of corrections 39
shall develop and administer a pilot project to provide a 40
comprehensive substance abuse treatment and rehabilitation 41
program as an alternative to incarceration, hereinafter 42 29
CCS HCS SS SCS SBs 45 & 90
referred to as "Alt-care". Alt-care shall be funded using 43
money provided under subsection 1 of this section through 44
the Missouri Medicaid program, the C -STAR program of the 45
department of mental health, and the division of alcohol and 46
drug abuse's purchase -of-service system. Alt-care shall 47
offer a flexible combination of clinical services and living 48
arrangements individually adapted to each client and her 49
children. Alt-care shall consist of the following 50
components: 51
(1) Assessment and treatment planning; 52
(2) Community support to provide continuity, 53
monitoring of progress and access to services and resources; 54
(3) Counseling from individua l to family therapy; 55
(4) Day treatment services which include accessibility 56
seven days per week, transportation to and from the Alt -care 57
program, weekly drug testing, leisure activities, weekly 58
events for families and companions, job and education 59
preparedness training, peer support and self -help and daily 60
living skills; and 61
(5) Living arrangement options which are permanent, 62
substance-free and conducive to treatment and recovery. 63
3. Any female who is pregnant or is the custodial 64
parent of a child or children under the age of twelve years, 65
and who has pleaded guilty to or found guilty of violating 66
the provisions of chapter 195, and whose controlled 67
substance abuse was a precipitating or contributing factor 68
in the commission of th e offense, and who is placed on 69
probation may be required, as a condition of probation, to 70
participate in Alt-care, if space is available in the pilot 71
project area. Determinations of eligibility for the 72
program, placement, and continued participation shall be 73 30
CCS HCS SS SCS SBs 45 & 90
made by the division of alcohol and drug abuse, in 74
consultation with the department of corrections. 75
4. The availability of space in Alt -care shall be 76
determined by the director of the division of alcohol and 77
drug abuse in conjunction wit h the director of the 78
department of corrections. If the sentencing court is 79
advised that there is no space available, the court shall 80
consider other authorized dispositions. 81
195.206. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Addiction mitigation medication", naltrexone 3
hydrochloride that is administered in a manner approved by 4
the United States Food and Drug Administration or any 5
accepted medical practice method of administering; 6
(2) "Opioid antagonist", naloxone hydrochloride , or 7
any other drug or device approved by the United States Food 8
and Drug Administration, that blocks the effects of an 9
opioid overdose [that] and is administered in a manner 10
approved by the United States Food and Drug Administration 11
or any accepted medical practice method of administering; 12
(3) "Opioid-related drug overdose", a condition 13
including, but not limited to, extreme physical illness, 14
decreased level of consciousness, respiratory depression, 15
coma, or death resulting from the consumption or use of an 16
opioid or other substance with which an opioid was combined 17
or a condition that a layperson would reasonably believe to 18
be an opioid-related drug overdose that requires medical 19
assistance. 20
2. Notwithstanding any other law or regulation to the 21
contrary: 22
(1) The director of the department of health and 23
senior services, if a licensed physician, may issue a 24 31
CCS HCS SS SCS SBs 45 & 90
statewide standing order for an opioid antagonist or an 25
addiction mitigation medication ; 26
(2) In the alternative, the department may employ or 27
contract with a licensed physician who may issue a statewide 28
standing order for an opioid antagonist or an addiction 29
mitigation medication with the express written consent of 30
the department director. 31
3. Notwithstanding any other law or regulation to the 32
contrary, any licensed pharmacist in Missouri may sell and 33
dispense an opioid antagonist or an addiction mitigation 34
medication under physician protocol or under a statewide 35
standing order issued under subsection 2 of this section. 36
4. A licensed pharmacist who, acting in good faith and 37
with reasonable care, sells or dispenses an opioid 38
antagonist or an addiction mitigation medication and an 39
appropriate device to administer the drug, and the protocol 40
physician, shall not be subject to any criminal or civil 41
liability or any professional disciplinary action for 42
prescribing or dispensing the opioid antagonist or an 43
addiction mitigation medication or any outcome resulting 44
from the administration of the opioid antagonist or an 45
addiction mitigation medication. A physician issuing a 46
statewide standing order under subsection 2 of this section 47
shall not be subject to any criminal or civil liability or 48
any professional disciplinar y action for issuing the 49
standing order or for any outcome related to the order or 50
the administration of the opioid antagonist or an addiction 51
mitigation medication. 52
5. Notwithstanding any other law or regulation to the 53
contrary, it shall be perm issible for any person to possess 54
an opioid antagonist or an addiction mitigation medication. 55 32
CCS HCS SS SCS SBs 45 & 90
6. Any person who administers an opioid antagonist to 56
another person shall, immediately after administering the 57
drug, contact emergency personnel. Any person who, acting 58
in good faith and with reasonable care, administers an 59
opioid antagonist to another person whom the person believes 60
to be suffering an opioid -related drug overdose shall be 61
immune from criminal prosecution, disciplinary actions from 62
his or her professional licensing board, and civil liability 63
due to the administration of the opioid antagonist. 64
196.1050. 1. The proceeds of any monetary settlement 1
or portion of a global settlement between the attorney 2
general of the state and any drug manufacturers, 3
distributors, pharmacies, or combination thereof to resolve 4
an opioid-related cause of action against such drug 5
manufacturers, distributors, pharmacies, or combination 6
thereof in a state or federal court shall only be utilized 7
to pay for opioid addiction treatment and prevention 8
services and health care and law enforcement costs related 9
to opioid addiction treatment and prevention. Under no 10
circumstances shall such settlement moneys be utilized to 11
fund other services, programs, or expenses not reasonably 12
related to opioid addiction treatment and prevention. 13
2. (1) There is hereby established in the state 14
treasury the "Opioid Addiction Treatment and Recovery Fund", 15
which shall consist of the proceeds o f any settlement 16
described in subsection 1 of this section, as well as any 17
funds appropriated by the general assembly, or gifts, 18
grants, donations, or bequests. The state treasurer shall 19
be custodian of the fund. In accordance with sections 20
30.170 and 30.180, the state treasurer may approve 21
disbursements. The fund shall be a dedicated fund and money 22
in the fund shall be used by the department of mental 23 33
CCS HCS SS SCS SBs 45 & 90
health, the department of health and senior services, the 24
department of social services, the d epartment of public 25
safety, the department of corrections, and the judiciary for 26
the purposes set forth in subsection 1 of this section. 27
(2) Notwithstanding the provisions of section 33.080 28
to the contrary, any moneys remaining in the fund at the end 29
of the biennium shall not revert to the credit of the 30
general revenue fund. 31
(3) The state treasurer shall invest moneys in the 32
fund in the same manner as other funds are invested. Any 33
interest and moneys earned on such investments shall be 34
credited to the fund. 35
197.020. 1. "Governmental unit" means any county, 1
municipality or other political subdivision or any 2
department, division, board or other agency of any of the 3
foregoing. 4
2. "Hospital" means a place devote d primarily to the 5
maintenance and operation of facilities for the diagnosis, 6
treatment or care for not less than twenty -four consecutive 7
hours in any week of three or more nonrelated individuals 8
suffering from illness, disease, injury, deformity or ot her 9
abnormal physical conditions; or a place devoted primarily 10
to provide for not less than twenty -four consecutive hours 11
in any week medical or nursing care for three or more 12
nonrelated individuals. The term "hospital" shall include a 13
facility designated as a rural emergency hospital by the 14
Centers for Medicare and Medicaid Services. The term 15
"hospital" does not include convalescent, nursing, shelter 16
or boarding homes as defined in chapter 198. 17
3. "Person" means any individual, firm, partne rship, 18
corporation, company or association and the legal successors 19
thereof. 20 34
CCS HCS SS SCS SBs 45 & 90
208.035. 1. Subject to appropriations and any 1
necessary waivers or approvals, the department of social 2
services shall develop and implement a transitional benefits 3
program for temporary assistance for needy families (TANF) 4
and the supplemental nutrition assistance program (SNAP) 5
that is designed in such a way that a TANF or SNAP 6
beneficiary will not experience an immediate loss of 7
benefits should the b eneficiary's income exceed the maximum 8
allowable income for such program. The transitional 9
benefits offered shall provide for a transition to self - 10
sufficiency while incentivizing work and financial stability. 11
2. The transitional benefits offered shall gradually 12
step down the beneficiary's monthly benefit proportionate to 13
the increase in the beneficiary's income. The determination 14
for a beneficiary's transitional benefit shall be as follows: 15
(1) One hundred percent of the monthly benefit for 16
beneficiaries with monthly household incomes less than or 17
equal to one hundred thirty -eight percent of the federal 18
poverty level; 19
(2) Eighty percent of the monthly benefit for 20
beneficiaries with monthly household incomes greater than 21
one hundred thirty-eight percent but less than or equal to 22
one hundred fifty percent of the federal poverty level; 23
(3) Sixty percent of the monthly benefit for 24
beneficiaries with monthly household incomes greater than 25
one hundred fifty percent but less t han or equal to one 26
hundred seventy percent of the federal poverty level; 27
(4) Forty percent of the monthly benefit for 28
beneficiaries with monthly household incomes greater than 29
one hundred seventy percent but less than or equal to one 30
hundred ninety percent of the federal poverty level; and 31 35
CCS HCS SS SCS SBs 45 & 90
(5) Twenty percent of the monthly benefit for 32
beneficiaries with monthly household incomes greater than 33
one hundred ninety percent but less than or equal to two 34
hundred percent of the federal poverty l evel. 35
Notwithstanding any provision of this section to the 36
contrary, any beneficiary where monthly household income 37
exceeds five thousand eight hundred twenty -two dollars, as 38
adjusted for inflation, shall not be eligible for any 39
transitional benefit un der this section. 40
3. Beneficiaries receiving transitional benefits under 41
this section shall comply with all requirements of each 42
program for which they are eligible, including work 43
requirements. Transitional benefits received under this 44
section shall not be included in the lifetime limit for 45
receipt of TANF benefits under section 208.040. 46
4. The department may promulgate any rules or 47
regulations necessary for the implementation of this 48
section. Any rule or portion of a rule, as that ter m is 49
defined in section 536.010, that is created under the 50
authority delegated in this section shall become effective 51
only if it complies with and is subject to all of the 52
provisions of chapter 536 and, if applicable, section 53
536.028. This section and chapter 536 are nonseverable and 54
if any of the powers vested with the general assembly 55
pursuant to chapter 536 to review, to delay the effective 56
date, or to disapprove and annul a rule are subsequently 57
held unconstitutional, then the grant of rulemak ing 58
authority and any rule proposed or adopted after August 28, 59
2023, shall be invalid and void. 60
208.053. 1. [The provisions of this section shall be 1
known as the "Low-Wage Trap Elimination Act". ] In order to 2 36
CCS HCS SS SCS SBs 45 & 90
more effectively tran sition persons receiving state -funded 3
child care subsidy benefits under this chapter, the 4
department of elementary and secondary education [, in 5
conjunction with the department of revenue, ] shall, subject 6
to appropriations, by July 1, [2022] 2024, implement a 7
[pilot] program [in a county with a charter form of 8
government and with more than six hundred thousand but fewer 9
than seven hundred thousand inhabitants, a county of the 10
first classification with more than two hundred sixty 11
thousand but fewer t han three hundred thousand inhabitants, 12
and a county of the first classification with more than two 13
hundred thousand but fewer than two hundred sixty thousand 14
inhabitants, to be called the "Hand -Up Program",] to allow 15
[applicants in the program ] recipients to receive 16
transitional child care benefits without the requirement 17
that such [applicants] recipients first be eligible for full 18
child care benefits. 19
(1) For purposes of this section, "full child care 20
benefits" shall be the full benefits awa rded to a recipient 21
based on the income eligibility amount established by the 22
department through the annual appropriations process as of 23
August 28, [2021] 2023, to qualify for the benefits and 24
shall not include the transitional child care benefits that 25
are awarded to recipients whose income surpasses the 26
eligibility level for full benefits to continue. The [hand- 27
up] program shall be voluntary and shall be designed such 28
that [an applicant] a recipient may begin receiving the 29
transitional child care benefit without having first 30
qualified for the full child care benefit or any other tier 31
of the transitional child care benefit. [Under no 32
circumstances shall any applicant be eligible for the hand - 33
up program if the applicant's income does not fall w ithin 34 37
CCS HCS SS SCS SBs 45 & 90
the transitional child care benefit income limits 35
established through the annual appropriations process. ] 36
(2) Transitional child care benefits shall be 37
determined on a sliding scale as follows for recipients with 38
household incomes in excess of the eligibility level for 39
full benefits: 40
(a) Eighty percent of the state base rate for 41
recipients with household incomes greater than the 42
eligibility level for full benefits but less than or equal 43
to one hundred fifty percent of the federal p overty level; 44
(b) Sixty percent of the state base rate for 45
recipients with household incomes greater than one hundred 46
fifty percent but less than or equal to one hundred seventy 47
percent of the federal poverty level; 48
(c) Forty percent of the state base rate for 49
recipients with household incomes greater than one hundred 50
seventy percent but less than or equal to one hundred ninety 51
percent of the federal poverty level; and 52
(d) Twenty percent of the state base rate for 53
recipients with household incomes greater than one hundred 54
ninety percent but less than or equal to two hundred percent 55
of the federal poverty level, but not greater than eighty - 56
five percent of the state median income. 57
(3) As used in this section, "state base rate" shall 58
refer to the rate established by the department for provider 59
payments that accounts for geographic area, type of 60
facility, duration of care, and age of the child, as well as 61
any enhancements reflecting after -hours or weekend care, 62
accreditation, or licensure status, as determined by the 63
department. Recipients shall be responsible for paying the 64
remaining sliding fee to the child care provider. 65 38
CCS HCS SS SCS SBs 45 & 90
(4) A participating recipient shall be allowed to opt 66
out of the program at any time, but suc h person shall not be 67
allowed to participate in the program a second time. 68
2. The department shall track the number of 69
participants in the [hand-up] program and shall issue an 70
annual report to the general assembly by September 1, [2023] 71
2025, and annually on September first thereafter, detailing 72
the effectiveness of the [pilot] program in encouraging 73
recipients to secure employment earning an income greater 74
than the maximum wage eligible for the full child care 75
benefit. The report shall also detail the costs of 76
administration and the increased amount of state income tax 77
paid as a result of the program [, as well as an analysis of 78
whether the pilot program could be expanded to include other 79
types of benefits, including, but not limited to, f ood 80
stamps, temporary assistance for needy families, low -income 81
heating assistance, women, infants and children supplemental 82
nutrition program, the state children's health insurance 83
program, and MO HealthNet benefits ]. 84
3. The department shall pur sue all necessary waivers 85
from the federal government to implement the [hand-up] 86
program. If the department is unable to obtain such 87
waivers, the department shall implement the program to the 88
degree possible without such waivers. 89
4. Any rule or portion of a rule, as that term is 90
defined in section 536.010, that is created under the 91
authority delegated under this section shall become 92
effective only if it complies with and is subject to all of 93
the provisions of chapter 536 and, if applicable, s ection 94
536.028. This section and chapter 536 are nonseverable and 95
if any of the powers vested with the general assembly 96
pursuant to chapter 536 to review, to delay the effective 97 39
CCS HCS SS SCS SBs 45 & 90
date, or to disapprove and annul a rule are subsequently 98
held unconstitutional, then the grant of rulemaking 99
authority and any rule proposed or adopted after August 28, 100
2012, shall be invalid and void. 101
[5. Pursuant to section 23.253 of the Missouri sunset 102
act: 103
(1) The provisions of the new program authorized und er 104
this section shall sunset automatically three years after 105
August 28, 2021, unless reauthorized by an act of the 106
general assembly; and 107
(2) If such program is reauthorized, the program 108
authorized under this section shall sunset automatically 109
three years after the effective date of the reauthorization 110
of this section; and 111
(3) This section shall terminate on September first of 112
the calendar year immediately following the calendar year in 113
which the program authorized under this section is s unset.] 114
208.066. 1. Upon approval by the Centers for Medicare 1
and Medicaid Services, the Food and Nutrition Services 2
within the United States Department of Agriculture, or any 3
other relevant federal agency, the department of socia l 4
services shall limit any initial application for the 5
Supplemental Nutrition Assistance Program (SNAP), the 6
Temporary Assistance for Needy Families program (TANF), the 7
child care assistance program, or MO HealthNet to a one -page 8
form that is easily a ccessible on the department of social 9
services' website. 10
2. Persons who are participants in a program listed in 11
subsection 1 of this section who are required to complete a 12
periodic eligibility review form may submit such form as an 13
attachment to their Missouri state individual income tax 14
return if the person's eligibility review form is due before 15 40
CCS HCS SS SCS SBs 45 & 90
or at the same time that he or she files such state tax 16
return. The department of social services shall limit 17
periodic eligibility review forms ass ociated with the 18
programs listed in subsection 1 of this section to a one - 19
page form that is easily accessible on both the department 20
of social services' website and the department of revenue's 21
website. 22
3. Notwithstanding the provisions of section 32.057 to 23
the contrary, the department of revenue shall share any 24
eligibility form submitted under this section with the 25
department of social services. 26
4. The department of revenue may promulgate all 27
necessary rules and regulations for the admin istration of 28
this section. Any rule or portion of a rule, as that term 29
is defined in section 536.010, that is created under the 30
authority delegated in this section shall become effective 31
only if it complies with and is subject to all of the 32
provisions of chapter 536 and, if applicable, section 33
536.028. This section and chapter 536 are nonseverable, and 34
if any of the powers vested with the general assembly 35
pursuant to chapter 536 to review, to delay the effective 36
date, or to disapprove and annul a rule are subsequently 37
held unconstitutional, then the grant of rulemaking 38
authority and any rule proposed or adopted after August 28, 39
2023, shall be invalid and void. 40
208.072. 1. A completed application for medical 1
assistance for services described in section 208.152 shall 2
be approved or denied within thirty days from submission to 3
the family support division or its successor. 4
2. The MO HealthNet division shall remit to a licensed 5
nursing home operator the Medicaid payment for a newly 6
admitted Medicaid resident in a licensed long -term care 7 41
CCS HCS SS SCS SBs 45 & 90
facility within forty -five days of the resident's date of 8
admission. 9
3. In accordance with 42 CFR 435.907(a), as amended, 10
if the applicant is a minor or incapacitated, the famil y 11
support division or its successor shall accept an 12
application from someone acting responsibly for the 13
applicant. 14
208.146. 1. The program established under this 1
section shall be known as the "Ticket to Work Health 2
Assurance Program". Subject to appropriations and in 3
accordance with the federal Ticket to Work and Work 4
Incentives Improvement Act of 1999 (TWWIIA), Public Law 106 - 5
170, the medical assistance provided for in section 208.151 6
may be paid for a person who is employed and who: 7
(1) Except for earnings, meets the definition of 8
disabled under the Supplemental Security Income Program or 9
meets the definition of an employed individual with a 10
medically improved disability under TWWIIA; 11
(2) Has earned income, as defined in subsection 2 of 12
this section; 13
(3) Meets the asset limits in subsection 3 of this 14
section; and 15
(4) Has [net] income, as [defined] determined in 16
subsection 3 of this section, that does not exceed [the 17
limit for permanent and totall y disabled individuals to 18
receive nonspenddown MO HealthNet under subdivision (24) of 19
subsection 1 of section 208.151; and 20
(5) Has a gross income of ] two hundred fifty percent 21
[or less] of the federal poverty level, excluding any earned 22
income of the worker with a disability between two hundred 23
fifty and three hundred percent of the federal poverty 24
level. [For purposes of this subdivision, "gross income" 25 42
CCS HCS SS SCS SBs 45 & 90
includes all income of the person and the person's spouse 26
that would be considered in det ermining MO HealthNet 27
eligibility for permanent and totally disabled individuals 28
under subdivision (24) of subsection 1 of section 208.151. 29
Individuals with gross incomes in excess of one hundred 30
percent of the federal poverty level shall pay a premiu m for 31
participation in accordance with subsection 4 of this 32
section.] 33
2. For income to be considered earned income for 34
purposes of this section, the department of social services 35
shall document that Medicare and Social Security taxes are 36
withheld from such income. Self-employed persons shall 37
provide proof of payment of Medicare and Social Security 38
taxes for income to be considered earned. 39
3. (1) For purposes of determining eligibility under 40
this section, the available asset limit and t he definition 41
of available assets shall be the same as those used to 42
determine MO HealthNet eligibility for permanent and totally 43
disabled individuals under subdivision (24) of subsection 1 44
of section 208.151 except for: 45
(a) Medical savings accou nts limited to deposits of 46
earned income and earnings on such income while a 47
participant in the program created under this section with a 48
value not to exceed five thousand dollars per year; [and] 49
(b) Independent living accounts limited to deposits of 50
earned income and earnings on such income while a 51
participant in the program created under this section with a 52
value not to exceed five thousand dollars per year. For 53
purposes of this section, an "independent living account" 54
means an account esta blished and maintained to provide 55
savings for transportation, housing, home modification, and 56 43
CCS HCS SS SCS SBs 45 & 90
personal care services and assistive devices associated with 57
such person's disability ; and 58
(c) Retirement accounts including, but not limited to, 59
individual accounts, 401(k) plans, 403(b) plans, Keogh 60
plans, and pension plans, provided that income from such 61
accounts be calculated as income under subdivision (4) of 62
subsection 1 of this section . 63
(2) To determine [net] income, the following shall be 64
disregarded: 65
(a) [All earned income of the disabled worker; 66
(b)] The first [sixty-five dollars and one -half] fifty 67
thousand dollars of [the remaining] earned income of [a 68
nondisabled spouse's earned income ] the person's spouse; 69
[(c)] (b) A twenty dollar standard deduction; 70
[(d)] (c) Health insurance premiums; 71
[(e)] (d) A seventy-five dollar a month standard 72
deduction for the disabled worker's dental and optical 73
insurance when the total dental and optical insurance 74
premiums are less than seventy -five dollars; 75
[(f)] (e) All Supplemental Security Income payments, 76
and the first fifty dollars of SSDI payments; and 77
[(g)] (f) A standard deduction for impairment -related 78
employment expenses equal to one -half of the disabled 79
worker's earned income. 80
4. Any person whose [gross] income exceeds one hundred 81
percent of the federal poverty level shall pay a premium for 82
participation in the medical assistance provided in this 83
section. Such premium shall be: 84
(1) For a person whose [gross] income is more than one 85
hundred percent but less than one hundred fifty percent of 86
the federal poverty level, four percent of income at one 87
hundred percent of the federal poverty level; 88 44
CCS HCS SS SCS SBs 45 & 90
(2) For a person whose [gross] income equals or 89
exceeds one hundred fifty percent but is less than two 90
hundred percent of the federal poverty level, four percent 91
of income at one hundred fifty percent of the federal 92
poverty level; 93
(3) For a person whose [gross] income equals or 94
exceeds two hundred percent but less than two hundred fifty 95
percent of the federal poverty level, five percent of income 96
at two hundred percent of the federal poverty level; 97
(4) For a person whose [gross] income equals or 98
exceeds two hundred fif ty percent up to and including three 99
hundred percent of the federal poverty level, six percent of 100
income at two hundred fifty percent of the federal poverty 101
level. 102
5. Recipients of services through this program shall 103
report any change in income o r household size within ten 104
days of the occurrence of such change. An increase in 105
premiums resulting from a reported change in income or 106
household size shall be effective with the next premium 107
invoice that is mailed to a person after due process 108
requirements have been met. A decrease in premiums shall be 109
effective the first day of the month immediately following 110
the month in which the change is reported. 111
6. If an eligible person's employer offers employer - 112
sponsored health insurance and the d epartment of social 113
services determines that it is more cost effective, such 114
person shall participate in the employer -sponsored 115
insurance. The department shall pay such person's portion 116
of the premiums, co-payments, and any other costs associated 117
with participation in the employer -sponsored health 118
insurance. If the department elects to pay such person's 119
employer-sponsored insurance costs under this subsection, 120 45
CCS HCS SS SCS SBs 45 & 90
the medical assistance provided under this section shall be 121
provided to an eligible per son as a secondary or 122
supplemental policy for only personal care assistance 123
services, as defined in section 208.900, and related costs 124
and nonemergency medical transportation to any employer - 125
sponsored benefits that may be available to such person. 126
7. The department of social services shall provide to 127
the general assembly an annual report that identifies the 128
number of participants in the program and describes the 129
outreach and education efforts to increase awareness and 130
enrollment in the program. 131
8. The department of social services shall submit such 132
state plan amendments and waivers to the Centers for 133
Medicare and Medicaid Services of the federal Department of 134
Health and Human Services as the department determines are 135
necessary to implement the provisions of this section. 136
9. The provisions of this section shall expire August 137
28, 2025. 138
208.151. 1. Medical assistance on behalf of needy 1
persons shall be known as "MO HealthNet". For the purpose 2
of paying MO HealthNet benefits and to comply with Title 3
XIX, Public Law 89-97, 1965 amendments to the federal Social 4
Security Act (42 U.S.C. Section 301, et seq.) as amended, 5
the following needy persons shall be eligible to receive MO 6
HealthNet benefits to the exten t and in the manner 7
hereinafter provided: 8
(1) All participants receiving state supplemental 9
payments for the aged, blind and disabled; 10
(2) All participants receiving aid to families with 11
dependent children benefits, including all persons und er 12
nineteen years of age who would be classified as dependent 13
children except for the requirements of subdivision (1) of 14 46
CCS HCS SS SCS SBs 45 & 90
subsection 1 of section 208.040. Participants eligible 15
under this subdivision who are participating in treatment 16
court, as defined in section 478.001, shall have their 17
eligibility automatically extended sixty days from the time 18
their dependent child is removed from the custody of the 19
participant, subject to approval of the Centers for Medicare 20
and Medicaid Services; 21
(3) All participants receiving blind pension benefits; 22
(4) All persons who would be determined to be eligible 23
for old age assistance benefits, permanent and total 24
disability benefits, or aid to the blind benefits under the 25
eligibility standards in effec t December 31, 1973, or less 26
restrictive standards as established by rule of the family 27
support division, who are sixty -five years of age or over 28
and are patients in state institutions for mental diseases 29
or tuberculosis; 30
(5) All persons under th e age of twenty-one years who 31
would be eligible for aid to families with dependent 32
children except for the requirements of subdivision (2) of 33
subsection 1 of section 208.040, and who are residing in an 34
intermediate care facility, or receiving active tr eatment as 35
inpatients in psychiatric facilities or programs, as defined 36
in 42 U.S.C. Section 1396d, as amended; 37
(6) All persons under the age of twenty -one years who 38
would be eligible for aid to families with dependent 39
children benefits except fo r the requirement of deprivation 40
of parental support as provided for in subdivision (2) of 41
subsection 1 of section 208.040; 42
(7) All persons eligible to receive nursing care 43
benefits; 44
(8) All participants receiving family foster home or 45
nonprofit private child-care institution care, subsidized 46 47
CCS HCS SS SCS SBs 45 & 90
adoption benefits and parental school care wherein state 47
funds are used as partial or full payment for such care; 48
(9) All persons who were participants receiving old 49
age assistance benefits, ai d to the permanently and totally 50
disabled, or aid to the blind benefits on December 31, 1973, 51
and who continue to meet the eligibility requirements, 52
except income, for these assistance categories, but who are 53
no longer receiving such benefits because o f the 54
implementation of Title XVI of the federal Social Security 55
Act, as amended; 56
(10) Pregnant women who meet the requirements for aid 57
to families with dependent children, except for the 58
existence of a dependent child in the home; 59
(11) Pregnant women who meet the requirements for aid 60
to families with dependent children, except for the 61
existence of a dependent child who is deprived of parental 62
support as provided for in subdivision (2) of subsection 1 63
of section 208.040; 64
(12) Pregnant women or infants under one year of age, 65
or both, whose family income does not exceed an income 66
eligibility standard equal to one hundred eighty -five 67
percent of the federal poverty level as established and 68
amended by the federal Department of Health and Human 69
Services, or its successor agency; 70
(13) Children who have attained one year of age but 71
have not attained six years of age who are eligible for 72
medical assistance under 6401 of P.L. 101 -239 (Omnibus 73
Budget Reconciliation Act of 1989) (4 2 U.S.C. Sections 1396a 74
to 1396b). The family support division shall use an income 75
eligibility standard equal to one hundred thirty -three 76
percent of the federal poverty level established by the 77 48
CCS HCS SS SCS SBs 45 & 90
Department of Health and Human Services, or its successor 78
agency; 79
(14) Children who have attained six years of age but 80
have not attained nineteen years of age. For children who 81
have attained six years of age but have not attained 82
nineteen years of age, the family support division shall use 83
an income assessment methodology which provides for 84
eligibility when family income is equal to or less than 85
equal to one hundred percent of the federal poverty level 86
established by the Department of Health and Human Services, 87
or its successor agency. As necessary to provide MO 88
HealthNet coverage under this subdivision, the department of 89
social services may revise the state MO HealthNet plan to 90
extend coverage under 42 U.S.C. Section 91
1396a(a)(10)(A)(i)(III) to children who have attained six 92
years of age but have not attained nineteen years of age as 93
permitted by paragraph (2) of subsection (n) of 42 U.S.C. 94
Section 1396d using a more liberal income assessment 95
methodology as authorized by paragraph (2) of subsection (r) 96
of 42 U.S.C. Section 1396a; 97
(15) The family support division shall not establish a 98
resource eligibility standard in assessing eligibility for 99
persons under subdivision (12), (13) or (14) of this 100
subsection. The MO HealthNet division shall define the 101
amount and scope of benefits whi ch are available to 102
individuals eligible under each of the subdivisions (12), 103
(13), and (14) of this subsection, in accordance with the 104
requirements of federal law and regulations promulgated 105
thereunder; 106
(16) Notwithstanding any other provisions of law to 107
the contrary, ambulatory prenatal care shall be made 108
available to pregnant women during a period of presumptive 109 49
CCS HCS SS SCS SBs 45 & 90
eligibility pursuant to 42 U.S.C. Section 1396r -1, as 110
amended; 111
(17) A child born to a woman eligible for and 112
receiving MO HealthNet benefits under this section on the 113
date of the child's birth shall be deemed to have applied 114
for MO HealthNet benefits and to have been found eligible 115
for such assistance under such plan on the date of such 116
birth and to remain eligible for suc h assistance for a 117
period of time determined in accordance with applicable 118
federal and state law and regulations so long as the child 119
is a member of the woman's household and either the woman 120
remains eligible for such assistance or for children born on 121
or after January 1, 1991, the woman would remain eligible 122
for such assistance if she were still pregnant. Upon 123
notification of such child's birth, the family support 124
division shall assign a MO HealthNet eligibility 125
identification number to the child so that claims may be 126
submitted and paid under such child's identification number; 127
(18) Pregnant women and children eligible for MO 128
HealthNet benefits pursuant to subdivision (12), (13) or 129
(14) of this subsection shall not as a condition of 130
eligibility for MO HealthNet benefits be required to apply 131
for aid to families with dependent children. The family 132
support division shall utilize an application for 133
eligibility for such persons which eliminates information 134
requirements other than those ne cessary to apply for MO 135
HealthNet benefits. The division shall provide such 136
application forms to applicants whose preliminary income 137
information indicates that they are ineligible for aid to 138
families with dependent children. Applicants for MO 139
HealthNet benefits under subdivision (12), (13) or (14) of 140
this subsection shall be informed of the aid to families 141 50
CCS HCS SS SCS SBs 45 & 90
with dependent children program and that they are entitled 142
to apply for such benefits. Any forms utilized by the 143
family support division for assessing eligibility under this 144
chapter shall be as simple as practicable; 145
(19) Subject to appropriations necessary to recruit 146
and train such staff, the family support division shall 147
provide one or more full -time, permanent eligibility 148
specialists to process applications for MO HealthNet 149
benefits at the site of a health care provider, if the 150
health care provider requests the placement of such 151
eligibility specialists and reimburses the division for the 152
expenses including but not limited to sal aries, benefits, 153
travel, training, telephone, supplies, and equipment of such 154
eligibility specialists. The division may provide a health 155
care provider with a part -time or temporary eligibility 156
specialist at the site of a health care provider if the 157
health care provider requests the placement of such an 158
eligibility specialist and reimburses the division for the 159
expenses, including but not limited to the salary, benefits, 160
travel, training, telephone, supplies, and equipment, of 161
such an eligibility s pecialist. The division may seek to 162
employ such eligibility specialists who are otherwise 163
qualified for such positions and who are current or former 164
welfare participants. The division may consider training 165
such current or former welfare participants as eligibility 166
specialists for this program; 167
(20) Pregnant women who are eligible for, have applied 168
for and have received MO HealthNet benefits under 169
subdivision (2), (10), (11) or (12) of this subsection shall 170
continue to be considered eligible for all pregnancy-related 171
and postpartum MO HealthNet benefits provided under section 172
208.152 until the end of the sixty -day period beginning on 173 51
CCS HCS SS SCS SBs 45 & 90
the last day of their pregnancy. Pregnant women receiving 174
mental health treatment for postpartum depressio n or related 175
mental health conditions within sixty days of giving birth 176
shall, subject to appropriations and any necessary federal 177
approval, be eligible for MO HealthNet benefits for mental 178
health services for the treatment of postpartum depression 179
and related mental health conditions for up to twelve 180
additional months. Pregnant women receiving substance abuse 181
treatment within sixty days of giving birth shall, subject 182
to appropriations and any necessary federal approval, be 183
eligible for MO HealthN et benefits for substance abuse 184
treatment and mental health services for the treatment of 185
substance abuse for no more than twelve additional months, 186
as long as the woman remains adherent with treatment. The 187
department of mental health and the departme nt of social 188
services shall seek any necessary waivers or state plan 189
amendments from the Centers for Medicare and Medicaid 190
Services and shall develop rules relating to treatment plan 191
adherence. No later than fifteen months after receiving any 192
necessary waiver, the department of mental health and the 193
department of social services shall report to the house of 194
representatives budget committee and the senate 195
appropriations committee on the compliance with federal cost 196
neutrality requirements; 197
(21) Case management services for pregnant women and 198
young children at risk shall be a covered service. To the 199
greatest extent possible, and in compliance with federal law 200
and regulations, the department of health and senior 201
services shall provide case management services to pregnant 202
women by contract or agreement with the department of social 203
services through local health departments organized under 204
the provisions of chapter 192 or chapter 205 or a city 205 52
CCS HCS SS SCS SBs 45 & 90
health department operated under a city charte r or a 206
combined city-county health department or other department 207
of health and senior services designees. To the greatest 208
extent possible the department of social services and the 209
department of health and senior services shall mutually 210
coordinate all services for pregnant women and children with 211
the crippled children's program, the prevention of 212
intellectual disability and developmental disability program 213
and the prenatal care program administered by the department 214
of health and senior services. The department of social 215
services shall by regulation establish the methodology for 216
reimbursement for case management services provided by the 217
department of health and senior services. For purposes of 218
this section, the term "case management" shall me an those 219
activities of local public health personnel to identify 220
prospective MO HealthNet -eligible high-risk mothers and 221
enroll them in the state's MO HealthNet program, refer them 222
to local physicians or local health departments who provide 223
prenatal care under physician protocol and who participate 224
in the MO HealthNet program for prenatal care and to ensure 225
that said high-risk mothers receive support from all private 226
and public programs for which they are eligible and shall 227
not include involvement in any MO HealthNet prepaid, case - 228
managed programs; 229
(22) By January 1, 1988, the department of social 230
services and the department of health and senior services 231
shall study all significant aspects of presumptive 232
eligibility for pregnant women and submit a joint report on 233
the subject, including projected costs and the time needed 234
for implementation, to the general assembly. The department 235
of social services, at the direction of the general 236 53
CCS HCS SS SCS SBs 45 & 90
assembly, may implement presumptive eligibility by 237
regulation promulgated pursuant to chapter 207; 238
(23) All participants who would be eligible for aid to 239
families with dependent children benefits except for the 240
requirements of paragraph (d) of subdivision (1) of section 241
208.150; 242
(24) (a) All persons who would be determined to be 243
eligible for old age assistance benefits under the 244
eligibility standards in effect December 31, 1973, as 245
authorized by 42 U.S.C. Section 1396a(f), or less 246
restrictive methodologies as contained in the MO HealthNet 247
state plan as of January 1, 2005; except that, on or after 248
July 1, 2005, less restrictive income methodologies, as 249
authorized in 42 U.S.C. Section 1396a(r)(2), may be used to 250
change the income limit if authorized by annual 251
appropriation; 252
(b) All persons who would be determined to be eligible 253
for aid to the blind benefits under the eligibility 254
standards in effect December 31, 1973, as authorized by 42 255
U.S.C. Section 1396a(f), or less restrictive methodologies 256
as contained in the MO HealthNet st ate plan as of January 1, 257
2005, except that less restrictive income methodologies, as 258
authorized in 42 U.S.C. Section 1396a(r)(2), shall be used 259
to raise the income limit to one hundred percent of the 260
federal poverty level; 261
(c) All persons who would be determined to be eligible 262
for permanent and total disability benefits under the 263
eligibility standards in effect December 31, 1973, as 264
authorized by 42 U.S.C. Section 1396a(f); or less 265
restrictive methodologies as contained in the MO HealthNet 266
state plan as of January 1, 2005; except that, on or after 267
July 1, 2005, less restrictive income methodologies, as 268 54
CCS HCS SS SCS SBs 45 & 90
authorized in 42 U.S.C. Section 1396a(r)(2), may be used to 269
change the income limit if authorized by annual 270
appropriations. Eligibility standards for permanent and 271
total disability benefits shall not be limited by age; 272
(25) Persons who have been diagnosed with breast or 273
cervical cancer and who are eligible for coverage pursuant 274
to 42 U.S.C. Section 1396a(a)(10)(A)(ii)(XVIII). Such 275
persons shall be eligible during a period of presumptive 276
eligibility in accordance with 42 U.S.C. Section 1396r -1; 277
(26) Persons who are in foster care under the 278
responsibility of the state of Missouri on the date such 279
persons attained the age of eighteen years, or at any time 280
during the thirty-day period preceding their eighteenth 281
birthday, or persons who received foster care for at least 282
six months in another state, are residing in Missouri, and 283
are at least eighteen years of age, without re gard to income 284
or assets, if such persons: 285
(a) Are under twenty-six years of age; 286
(b) Are not eligible for coverage under another 287
mandatory coverage group; and 288
(c) Were covered by Medicaid while they were in foster 289
care; 290
(27) Any homeless child or homeless youth, as those 291
terms are defined in section 167.020, subject to approval of 292
a state plan amendment by the Centers for Medicare and 293
Medicaid Services; 294
(28) (a) Subject to approval of any necessary state 295
plan amendments or waivers, beginning on the effective date 296
of this act, pregnant women who are eligible for, have 297
applied for, and have received MO HealthNet benefits under 298
subdivision (2), (10), (11), or (12) of this subsection 299
shall be eligible for medical assis tance during the 300 55
CCS HCS SS SCS SBs 45 & 90
pregnancy and during the twelve -month period that begins on 301
the last day of the woman's pregnancy and ends on the last 302
day of the month in which such twelve -month period ends, 303
consistent with the provisions of 42 U.S.C. Section 304
1396a(e)(16). The department shall submit a state plan 305
amendment to the Centers for Medicare and Medicaid Services 306
when the number of ineligible MO HealthNet participants 307
removed from the program in 2023 pursuant to section 208.239 308
exceeds the projected num ber of beneficiaries likely to 309
enroll in benefits in 2023 under this subdivision and 310
subdivision (2) of subsection 6 of section 208.662, as 311
determined by the department, by at least one hundred 312
individuals; 313
(b) The provisions of this subdivision shall remain in 314
effect for any period of time during which the federal 315
authority under 42 U.S.C. Section 1396a(e)(16), as amended, 316
or any successor statutes or implementing regulations, is in 317
effect. 318
2. Rules and regulations to implement this sec tion 319
shall be promulgated in accordance with chapter 536. Any 320
rule or portion of a rule, as that term is defined in 321
section 536.010, that is created under the authority 322
delegated in this section shall become effective only if it 323
complies with and is subject to all of the provisions of 324
chapter 536 and, if applicable, section 536.028. This 325
section and chapter 536 are nonseverable and if any of the 326
powers vested with the general assembly pursuant to chapter 327
536 to review, to delay the effective date or to disapprove 328
and annul a rule are subsequently held unconstitutional, 329
then the grant of rulemaking authority and any rule proposed 330
or adopted after August 28, 2002, shall be invalid and void. 331 56
CCS HCS SS SCS SBs 45 & 90
3. After December 31, 1973, and before April 1, 19 90, 332
any family eligible for assistance pursuant to 42 U.S.C. 333
Section 601, et seq., as amended, in at least three of the 334
last six months immediately preceding the month in which 335
such family became ineligible for such assistance because of 336
increased income from employment shall, while a member of 337
such family is employed, remain eligible for MO HealthNet 338
benefits for four calendar months following the month in 339
which such family would otherwise be determined to be 340
ineligible for such assistance because of income and 341
resource limitation. After April 1, 1990, any family 342
receiving aid pursuant to 42 U.S.C. Section 601, et seq., as 343
amended, in at least three of the six months immediately 344
preceding the month in which such family becomes ineligible 345
for such aid, because of hours of employment or income from 346
employment of the caretaker relative, shall remain eligible 347
for MO HealthNet benefits for six calendar months following 348
the month of such ineligibility as long as such family 349
includes a child as p rovided in 42 U.S.C. Section 1396r -6. 350
Each family which has received such medical assistance 351
during the entire six -month period described in this section 352
and which meets reporting requirements and income tests 353
established by the division and continues to include a child 354
as provided in 42 U.S.C. Section 1396r -6 shall receive MO 355
HealthNet benefits without fee for an additional six 356
months. The MO HealthNet division may provide by rule and 357
as authorized by annual appropriation the scope of MO 358
HealthNet coverage to be granted to such families. 359
4. When any individual has been determined to be 360
eligible for MO HealthNet benefits, such medical assistance 361
will be made available to him or her for care and services 362
furnished in or after the third mon th before the month in 363 57
CCS HCS SS SCS SBs 45 & 90
which he made application for such assistance if such 364
individual was, or upon application would have been, 365
eligible for such assistance at the time such care and 366
services were furnished; provided, further, that such 367
medical expenses remain unpaid. 368
5. The department of social services may apply to the 369
federal Department of Health and Human Services for a MO 370
HealthNet waiver amendment to the Section 1115 demonstration 371
waiver or for any additional MO HealthNet waivers neces sary 372
not to exceed one million dollars in additional costs to the 373
state, unless subject to appropriation or directed by 374
statute, but in no event shall such waiver applications or 375
amendments seek to waive the services of a rural health 376
clinic or a federally qualified health center as defined in 377
42 U.S.C. Section 1396d(l)(1) and (2) or the payment 378
requirements for such clinics and centers as provided in 42 379
U.S.C. Section 1396a(a)(15) and 1396a(bb) unless such waiver 380
application is approved by the ove rsight committee created 381
in section 208.955. A request for such a waiver so 382
submitted shall only become effective by executive order not 383
sooner than ninety days after the final adjournment of the 384
session of the general assembly to which it is submitte d, 385
unless it is disapproved within sixty days of its submission 386
to a regular session by a senate or house resolution adopted 387
by a majority vote of the respective elected members 388
thereof, unless the request for such a waiver is made 389
subject to appropriation or directed by statute. 390
6. Notwithstanding any other provision of law to the 391
contrary, in any given fiscal year, any persons made 392
eligible for MO HealthNet benefits under subdivisions (1) to 393
(22) of subsection 1 of this section shall only be eligible 394
if annual appropriations are made for such eligibility. 395 58
CCS HCS SS SCS SBs 45 & 90
This subsection shall not apply to classes of individuals 396
listed in 42 U.S.C. Section 1396a(a)(10)(A)(i). 397
7. (1) Notwithstanding any provision of law to the 398
contrary, a military service member, or an immediate family 399
member residing with such military service member, who is a 400
legal resident of this state and is eligible for MO 401
HealthNet developmental disability services, shall have his 402
or her eligibility for MO HealthNet devel opmental disability 403
services temporarily suspended for any period of time during 404
which such person temporarily resides outside of this state 405
for reasons relating to military service, but shall have his 406
or her eligibility immediately restored upon retur ning to 407
this state to reside. 408
(2) Notwithstanding any provision of law to the 409
contrary, if a military service member, or an immediate 410
family member residing with such military service member, is 411
not a legal resident of this state, but would other wise be 412
eligible for MO HealthNet developmental disability services, 413
such individual shall be deemed eligible for MO HealthNet 414
developmental disability services for the duration of any 415
time in which such individual is temporarily present in this 416
state for reasons relating to military service. 417
208.186. The state shall not provide payments, add - 1
ons, or reimbursements to health care providers through MO 2
HealthNet for medical assistance services provided to 3
persons who do not reside in this state, as determined under 4
42 CFR 435.403, or any amendments or successor regulations 5
thereto. 6
208.239. The department of social services shall 1
resume annual MO HealthNet eligibility redeterminations, 2
renewals, and postenrol lment verifications no later than 3
thirty days after the effective date of this act. 4 59
CCS HCS SS SCS SBs 45 & 90
208.662. 1. There is hereby established within the 1
department of social services the "Show -Me Healthy Babies 2
Program" as a separate children's healt h insurance program 3
(CHIP) for any low-income unborn child. The program shall 4
be established under the authority of Title XXI of the 5
federal Social Security Act, the State Children's Health 6
Insurance Program, as amended, and 42 CFR 457.1. 7
2. For an unborn child to be enrolled in the show -me 8
healthy babies program, his or her mother shall not be 9
eligible for coverage under Title XIX of the federal Social 10
Security Act, the Medicaid program, as it is administered by 11
the state, and shall not have access to affordable employer - 12
subsidized health care insurance or other affordable health 13
care coverage that includes coverage for the unborn child. 14
In addition, the unborn child shall be in a family with 15
income eligibility of no more than three hund red percent of 16
the federal poverty level, or the equivalent modified 17
adjusted gross income, unless the income eligibility is set 18
lower by the general assembly through appropriations. In 19
calculating family size as it relates to income eligibility, 20
the family shall include, in addition to other family 21
members, the unborn child, or in the case of a mother with a 22
multiple pregnancy, all unborn children. 23
3. Coverage for an unborn child enrolled in the show - 24
me healthy babies program shall include a ll prenatal care 25
and pregnancy-related services that benefit the health of 26
the unborn child and that promote healthy labor, delivery, 27
and birth. Coverage need not include services that are 28
solely for the benefit of the pregnant mother, that are 29
unrelated to maintaining or promoting a healthy pregnancy, 30
and that provide no benefit to the unborn child. However, 31 60
CCS HCS SS SCS SBs 45 & 90
the department may include pregnancy -related assistance as 32
defined in 42 U.S.C. Section 1397ll. 33
4. There shall be no waiting period be fore an unborn 34
child may be enrolled in the show -me healthy babies 35
program. In accordance with the definition of child in 42 36
CFR 457.10, coverage shall include the period from 37
conception to birth. The department shall develop a 38
presumptive eligibili ty procedure for enrolling an unborn 39
child. There shall be verification of the pregnancy. 40
5. Coverage for the child shall continue for up to one 41
year after birth, unless otherwise prohibited by law or 42
unless otherwise limited by the general assem bly through 43
appropriations. 44
6. (1) Pregnancy-related and postpartum coverage for 45
the mother shall begin on the day the pregnancy ends and 46
extend through the last day of the month that includes the 47
sixtieth day after the pregnancy ends, unless ot herwise 48
prohibited by law or unless otherwise limited by the general 49
assembly through appropriations. The department may include 50
pregnancy-related assistance as defined in 42 U.S.C. Section 51
1397ll. 52
(2) (a) Subject to approval of any necessary s tate 53
plan amendments or waivers, beginning on the effective date 54
of this act, mothers eligible to receive coverage under this 55
section shall receive medical assistance benefits during the 56
pregnancy and during the twelve -month period that begins on 57
the last day of the woman's pregnancy and ends on the last 58
day of the month in which such twelve -month period ends, 59
consistent with the provisions of 42 U.S.C. Section 60
1397gg(e)(1)(J). The department shall seek any necessary 61
state plan amendments or waive rs to implement the provisions 62
of this subdivision when the number of ineligible MO 63 61
CCS HCS SS SCS SBs 45 & 90
HealthNet participants removed from the program in 2023 64
pursuant to section 208.239 exceeds the projected number of 65
beneficiaries likely to enroll in benefits in 2023 u nder 66
this subdivision and subdivision (28) of subsection 1 of 67
section 208.151, as determined by the department, by at 68
least one hundred individuals. 69
(b) The provisions of this subdivision shall remain in 70
effect for any period of time during which the federal 71
authority under 42 U.S.C. Section 1397gg(e)(1)(J), as 72
amended, or any successor statutes or implementing 73
regulations, is in effect. 74
7. The department shall provide coverage for an unborn 75
child enrolled in the show -me healthy babies program in the 76
same manner in which the department provides coverage for 77
the children's health insurance program (CHIP) in the county 78
of the primary residence of the mother. 79
8. The department shall provide information about the 80
show-me healthy babies program to maternity homes as defined 81
in section 135.600, pregnancy resource centers as defined in 82
section 135.630, and other similar agencies and programs in 83
the state that assist unborn children and their mothers. 84
The department shall consider a llowing such agencies and 85
programs to assist in the enrollment of unborn children in 86
the program, and in making determinations about presumptive 87
eligibility and verification of the pregnancy. 88
9. Within sixty days after August 28, 2014, the 89
department shall submit a state plan amendment or seek any 90
necessary waivers from the federal Department of Health and 91
Human Services requesting approval for the show -me healthy 92
babies program. 93
10. At least annually, the department shall prepare 94
and submit a report to the governor, the speaker of the 95 62
CCS HCS SS SCS SBs 45 & 90
house of representatives, and the president pro tempore of 96
the senate analyzing and projecting the cost savings and 97
benefits, if any, to the state, counties, local communities, 98
school districts, law enf orcement agencies, correctional 99
centers, health care providers, employers, other public and 100
private entities, and persons by enrolling unborn children 101
in the show-me healthy babies program. The analysis and 102
projection of cost savings and benefits, if any, may include 103
but need not be limited to: 104
(1) The higher federal matching rate for having an 105
unborn child enrolled in the show -me healthy babies program 106
versus the lower federal matching rate for a pregnant woman 107
being enrolled in MO HealthNet or other federal programs; 108
(2) The efficacy in providing services to unborn 109
children through managed care organizations, group or 110
individual health insurance providers or premium assistance, 111
or through other nontraditional arrangements of providi ng 112
health care; 113
(3) The change in the proportion of unborn children 114
who receive care in the first trimester of pregnancy due to 115
a lack of waiting periods, by allowing presumptive 116
eligibility, or by removal of other barriers, and any 117
resulting or projected decrease in health problems and other 118
problems for unborn children and women throughout pregnancy; 119
at labor, delivery, and birth; and during infancy and 120
childhood; 121
(4) The change in healthy behaviors by pregnant women, 122
such as the cessation of the use of tobacco, alcohol, 123
illicit drugs, or other harmful practices, and any resulting 124
or projected short-term and long-term decrease in birth 125
defects; poor motor skills; vision, speech, and hearing 126
problems; breathing and respiratory probl ems; feeding and 127 63
CCS HCS SS SCS SBs 45 & 90
digestive problems; and other physical, mental, educational, 128
and behavioral problems; and 129
(5) The change in infant and maternal mortality, 130
preterm births and low birth weight babies and any resulting 131
or projected decrease in shor t-term and long-term medical 132
and other interventions. 133
11. The show-me healthy babies program shall not be 134
deemed an entitlement program, but instead shall be subject 135
to a federal allotment or other federal appropriations and 136
matching state approp riations. 137
12. Nothing in this section shall be construed as 138
obligating the state to continue the show -me healthy babies 139
program if the allotment or payments from the federal 140
government end or are not sufficient for the program to 141
operate, or if the general assembly does not appropriate 142
funds for the program. 143
13. Nothing in this section shall be construed as 144
expanding MO HealthNet or fulfilling a mandate imposed by 145
the federal government on the state. 146
209.700. 1. This section shall be known and may be 1
cited as the "Missouri Employment First Act". 2
2. As used in this section, unless the context clearly 3
requires otherwise, the following terms mean: 4
(1) "Competitive integrated employment", work that: 5
(a) Is performed on a full -time or part-time basis, 6
including self-employment, and for which a person is 7
compensated at a rate that: 8
a. Is no less than the higher of the rate specified in 9
29 U.S.C. Section 206(a)(1) or the rate required under any 10
applicable state or local minimum wage law for the place of 11
employment; 12 64
CCS HCS SS SCS SBs 45 & 90
b. Is no less than the customary rate paid by the 13
employer for the same or similar work performed by other 14
employees who are not persons with disabilities and who are 15
similarly situated in similar occupations by the same 16
employer and who have similar training, experience, and 17
skills; 18
c. In the case of a person who is self -employed, 19
yields an income that is comparable to the income received 20
by other persons who are not persons with disabilities and 21
who are self-employed in similar occupations or on similar 22
tasks and who have similar training, experience, and skills; 23
and 24
d. Is eligible for the level of benefits provided to 25
other employees; 26
(b) Is at a location: 27
a. Typically found in the community; and 28
b. Where the employee with a disability interacts for 29
the purpose of performing the duties of the position with 30
other employees within the particular work unit and the 31
entire work site and, as a ppropriate to the work performed, 32
other persons, such as customers and vendors, who are not 33
persons with disabilities, other than supervisory personnel 34
or persons who are providing services to such employee, to 35
the same extent that employees who are no t persons with 36
disabilities and who are in comparable positions interact 37
with these persons; and 38
(c) Presents, as appropriate, opportunities for 39
advancement that are similar to those for other employees 40
who are not persons with disabilities and w ho have similar 41
positions; 42 65
CCS HCS SS SCS SBs 45 & 90
(2) "Customized employment", competitive integrated 43
employment for a person with a significant disability that 44
is: 45
(a) Based on an individualized determination of the 46
unique strengths, needs, and interests of the person with a 47
significant disability; 48
(b) Designed to meet the specific abilities of the 49
person with a significant disability and the business needs 50
of the employer; and 51
(c) Carried out through flexible strategies, such as: 52
a. Job exploration by the person; and 53
b. Working with an employer to facilitate placement, 54
including: 55
(i) Customizing a job description based on current 56
employer needs or on previously unidentified and unmet 57
employer needs; 58
(ii) Developing a set of job duties, a work schedule 59
and job arrangement, and specifics of supervision, including 60
performance evaluation and review, and determining a job 61
location; 62
(iii) Using a professional representative chosen by 63
the person or self-representation, if elected, to work with 64
an employer to facilitate placement; and 65
(iv) Providing services and supports at the job 66
location; 67
(3) "Disability", a physical or mental impairment that 68
substantially limits one or more major life activities of a 69
person, as defined in the Americans with Disabilities Act of 70
1990, as amended. The term "disability" does not include 71
brief periods of intoxication caused by alcohol or drugs or 72
dependence upon or addiction to any alcohol or drug; 73 66
CCS HCS SS SCS SBs 45 & 90
(4) "Employment first", a concept to facilitate the 74
full inclusion of persons with disabilities in the workplace 75
and community in which community -based, competitive 76
integrated employment is the first and preferred outcome for 77
employment services for persons with disab ilities; 78
(5) "Employment-related services", services provided 79
to persons, including persons with disabilities, to assist 80
them in finding employment. The term "employment -related 81
services" includes, but is not limited to, resume 82
development, job fairs, and interview training; 83
(6) "Integrated setting", a setting: 84
(a) Typically found in the community; and 85
(b) Where the employee with a disability interacts for 86
the purpose of performing the duties of the position with 87
other employees within the particular work unit and the 88
entire work site and, as appropriate to the work performed, 89
other persons, such as customers and vendors, who are not 90
persons with disabilities, other than supervisory personnel 91
or persons who are providing se rvices to such employee, to 92
the same extent that employees who are not persons with 93
disabilities and who are in comparable positions interact 94
with these persons; 95
(7) "Outcome", with respect to a person entering, 96
advancing in, or retaining full -time or, if appropriate, 97
part-time competitive integrated employment, including 98
customized employment, self -employment, telecommuting, or 99
business ownership, or supported employment that is 100
consistent with a person's unique strengths, resources, 101
priorities, concerns, abilities, capabilities, interests, 102
and informed choice; 103
(8) "Sheltered workshop", the same meaning given to 104
the term in section 178.900; 105 67
CCS HCS SS SCS SBs 45 & 90
(9) "State agency", an authority, board, branch, 106
commission, committee, department, divi sion, or other 107
instrumentality of the executive branch of state government; 108
(10) "Supported employment", competitive integrated 109
employment, including customized employment, or employment 110
in an integrated setting in which persons are working toward 111
a competitive integrated employment, that is individualized 112
and customized consistent with the strengths, abilities, 113
interests, and informed choice of the persons involved who, 114
because of the nature and severity of their disabilities, 115
need intensive supported employment services and extended 116
services in order to perform the work involved; 117
(11) "Supported employment services", ongoing support 118
services, including customized employment, needed to support 119
and maintain a person with a most signifi cant disability in 120
supported employment, that: 121
(a) Are provided singly or in combination and are 122
organized and made available in such a way as to assist an 123
eligible person to achieve competitive integrated 124
employment; and 125
(b) Are based on a determination of the needs of an 126
eligible person, as specified in an individualized plan for 127
employment; 128
(12) "Working age", sixteen years of age or older; 129
(13) "Youth with a disability", any person fourteen 130
years of age or older and under eighteen years of age who 131
has a disability. 132
3. All state agencies that provide employment -related 133
services or that provide services or support to persons with 134
disabilities shall: 135 68
CCS HCS SS SCS SBs 45 & 90
(1) Develop collaborative relationships with each 136
other, confirmed by a written memorandum of understanding 137
signed by each such state agency; and 138
(2) Implement coordinated strategies to promote 139
competitive integrated employment including, but not limited 140
to, coordinated service planning, job exploration, in creased 141
job training, and internship opportunities. 142
4. All state agencies that provide employment -related 143
services or that provide services or support to persons with 144
disabilities shall: 145
(1) Implement an employment first policy by 146
considering competitive integrated employment as the first 147
and preferred outcome when planning or providing services or 148
supports to persons with disabilities who are of working age; 149
(2) Offer information on competitive integrated 150
employment to all working -age persons with disabilities. 151
The information offered shall include an explanation of the 152
relationship between a person's earned income and his or her 153
public benefits, information on Achieving a Better Life 154
Experience (ABLE) accounts, and information on accessing 155
assistive technology; 156
(3) Ensure that persons with disabilities receive the 157
opportunity to understand and explore education and training 158
as pathways to employment, including postsecondary, 159
graduate, and postgraduate education; vocat ional and 160
technical training; and other training. State agencies 161
shall not be required to fund any education or training 162
unless otherwise required by law; 163
(4) Promote the availability and accessibility of 164
individualized training designed to prep are a person with a 165
disability for the person's preferred employment; 166 69
CCS HCS SS SCS SBs 45 & 90
(5) Promote partnerships with private agencies that 167
offer supported employment services, if appropriate; 168
(6) Promote partnerships with employers to overcome 169
barriers to meeting workforce needs with the creative use of 170
technology and innovation; 171
(7) Ensure that staff members of public schools, 172
vocational service programs, and community providers receive 173
the support, guidance, and training that they need to 174
contribute to attainment of the goal of competitive 175
integrated employment for all persons with disabilities; 176
(8) Ensure that competitive integrated employment, 177
while the first and preferred outcome when planning or 178
providing services or supports to person s with disabilities 179
who are of working age, is not required of a person with a 180
disability to secure or maintain public benefits for which 181
the person is otherwise eligible; and 182
(9) At least once each year, discuss basic information 183
about competitive integrated employment with the parents or 184
guardians of a youth with a disability. If the youth with a 185
disability has been emancipated, state agencies shall 186
discuss this information with the youth with a disability. 187
The information offered shall in clude an explanation of the 188
relationship between a person's earned income and his or her 189
public benefits, information about ABLE accounts, and 190
information about accessing assistive technology. 191
5. Nothing in this section shall require a state 192
agency to perform any action that would interfere with the 193
state agency's ability to fulfill duties and requirements 194
mandated by federal law. 195
6. Nothing in this section shall be construed to limit 196
or disallow any disability benefits to which a person with a 197 70
CCS HCS SS SCS SBs 45 & 90
disability who is unable to engage in competitive integrated 198
employment would otherwise be entitled. 199
7. Nothing in this section shall be construed to 200
eliminate any supported employment services or sheltered 201
workshop settings as options. 202
8. (1) Nothing in this section shall be construed to 203
require any state agency or other employer to give a 204
preference in hiring to persons with disabilities or to 205
prohibit any employment relationship or program that is 206
otherwise permitted under app licable law. 207
(2) Any person who is employed by a state agency shall 208
meet the minimum qualifications and requirements for the 209
position in which the person is employed. 210
9. All state agencies that provide employment -related 211
services or that pro vide services or support to persons with 212
disabilities shall coordinate efforts and collaborate within 213
and among each other to ensure that state programs, 214
policies, and procedures support competitive integrated 215
employment for persons with disabilities w ho are of working 216
age. All such state agencies, when feasible, shall share 217
data and information across systems in order to track 218
progress toward full implementation of this section. All 219
such state agencies are encouraged to adopt measurable goals 220
and objectives to promote assessment of progress in 221
implementing this section. 222
10. State agencies may promulgate all necessary rules 223
and regulations for the administration of this section. Any 224
rule or portion of a rule, as that term is defined in 225
section 536.010, that is created under the authority 226
delegated in this section shall become effective only if it 227
complies with and is subject to all of the provisions of 228
chapter 536 and, if applicable, section 536.028. This 229 71
CCS HCS SS SCS SBs 45 & 90
section and chapter 536 are nonseverable and if any of the 230
powers vested with the general assembly pursuant to chapter 231
536 to review, to delay the effective date, or to disapprove 232
and annul a rule are subsequently held unconstitutional, 233
then the grant of rulemaking authority and any rule proposed 234
or adopted after August 28, 2023, shall be invalid and void. 235
210.1360. 1. Any personally identifiable information 1
regarding any child under eighteen years of age receiving 2
child care from any provider or applying for or receiving 3
any services through a state program shall not be subject to 4
disclosure except as otherwise provided by law. 5
2. This section shall not prohibit any state agency 6
from disclosing personally identifiable information to 7
governmental entities or its agents, vendors, grantees, and 8
contractors in connection to matters relating to its 9
official duties. The provisions of this section shall not 10
apply to any state, county, or municipal law enforcement 11
agency acting in its official capaci ty. 12
3. This section shall not prevent a parent or legal 13
guardian from accessing the parent's or legal guardian's 14
child's records. 15
334.104. 1. A physician may enter into collaborative 1
practice arrangements with registered profe ssional nurses. 2
Collaborative practice arrangements shall be in the form of 3
written agreements, jointly agreed -upon protocols, or 4
standing orders for the delivery of health care services. 5
Collaborative practice arrangements, which shall be in 6
writing, may delegate to a registered professional nurse the 7
authority to administer or dispense drugs and provide 8
treatment as long as the delivery of such health care 9
services is within the scope of practice of the registered 10 72
CCS HCS SS SCS SBs 45 & 90
professional nurse and is cons istent with that nurse's 11
skill, training and competence. 12
2. Collaborative practice arrangements, which shall be 13
in writing, may delegate to a registered professional nurse 14
the authority to administer, dispense or prescribe drugs and 15
provide treatment if the registered professional nurse is an 16
advanced practice registered nurse as defined in subdivision 17
(2) of section 335.016. Collaborative practice arrangements 18
may delegate to an advanced practice registered nurse, as 19
defined in section 335.0 16, the authority to administer, 20
dispense, or prescribe controlled substances listed in 21
Schedules III, IV, and V of section 195.017, and Schedule 22
II - hydrocodone; except that, the collaborative practice 23
arrangement shall not delegate the authority to administer 24
any controlled substances listed in Schedules III, IV, and V 25
of section 195.017, or Schedule II - hydrocodone for the 26
purpose of inducing sedation or general anesthesia for 27
therapeutic, diagnostic, or surgical procedures. Schedule 28
III narcotic controlled substance and Schedule II - 29
hydrocodone prescriptions shall be limited to a one hundred 30
twenty-hour supply without refill. Such collaborative 31
practice arrangements shall be in the form of written 32
agreements, jointly agreed -upon protocols or standing orders 33
for the delivery of health care services. An advanced 34
practice registered nurse may prescribe buprenorphine for up 35
to a thirty-day supply without refill for patients receiving 36
medication-assisted treatment for substance use disor ders 37
under the direction of the collaborating physician. 38
3. The written collaborative practice arrangement 39
shall contain at least the following provisions: 40 73
CCS HCS SS SCS SBs 45 & 90
(1) Complete names, home and business addresses, zip 41
codes, and telephone numbers of the collaborating physician 42
and the advanced practice registered nurse; 43
(2) A list of all other offices or locations besides 44
those listed in subdivision (1) of this subsection where the 45
collaborating physician authorized the advanced practice 46
registered nurse to prescribe; 47
(3) A requirement that there shall be posted at every 48
office where the advanced practice registered nurse is 49
authorized to prescribe, in collaboration with a physician, 50
a prominently displayed disclosure statement infor ming 51
patients that they may be seen by an advanced practice 52
registered nurse and have the right to see the collaborating 53
physician; 54
(4) All specialty or board certifications of the 55
collaborating physician and all certifications of the 56
advanced practice registered nurse; 57
(5) The manner of collaboration between the 58
collaborating physician and the advanced practice registered 59
nurse, including how the collaborating physician and the 60
advanced practice registered nurse will: 61
(a) Engage in collaborative practice consistent with 62
each professional's skill, training, education, and 63
competence; 64
(b) Maintain geographic proximity, except as specified 65
in this paragraph. The following provisions shall apply 66
with respect to this requirem ent: 67
a. Until August 28, 2025, an advanced practice 68
registered nurse providing services in a correctional 69
center, as defined in section 217.010, and his or her 70
collaborating physician shall satisfy the geographic 71 74
CCS HCS SS SCS SBs 45 & 90
proximity requirement if they pra ctice within two hundred 72
miles by road of one another; 73
b. The collaborative practice arrangement may allow 74
for geographic proximity to be waived for a maximum of 75
twenty-eight days per calendar year for rural health clinics 76
as defined by [P.L.] Pub. L. 95-210 (42 U.S.C. Section 77
1395x, as amended), as long as the collaborative practice 78
arrangement includes alternative plans as required in 79
paragraph (c) of this subdivision. This exception to 80
geographic proximity shall apply only to independent r ural 81
health clinics, provider -based rural health clinics where 82
the provider is a critical access hospital as provided in 42 83
U.S.C. Section 1395i -4, and provider-based rural health 84
clinics where the main location of the hospital sponsor is 85
greater than fifty miles from the clinic [.]; and 86
c. The collaborating physician is required to maintain 87
documentation related to this requirement and to present it 88
to the state board of registration for the healing arts when 89
requested; and 90
(c) Provide coverage during absence, incapacity, 91
infirmity, or emergency by the collaborating physician; 92
(6) A description of the advanced practice registered 93
nurse's controlled substance prescriptive authority in 94
collaboration with the physician, including a list of the 95
controlled substances the physician authorizes the nurse to 96
prescribe and documentation that it is consistent with each 97
professional's education, knowledge, skill, and competence; 98
(7) A list of all other written practice agreements o f 99
the collaborating physician and the advanced practice 100
registered nurse; 101 75
CCS HCS SS SCS SBs 45 & 90
(8) The duration of the written practice agreement 102
between the collaborating physician and the advanced 103
practice registered nurse; 104
(9) A description of the time and m anner of the 105
collaborating physician's review of the advanced practice 106
registered nurse's delivery of health care services. The 107
description shall include provisions that the advanced 108
practice registered nurse shall submit a minimum of ten 109
percent of the charts documenting the advanced practice 110
registered nurse's delivery of health care services to the 111
collaborating physician for review by the collaborating 112
physician, or any other physician designated in the 113
collaborative practice arrangement, ever y fourteen days; and 114
(10) The collaborating physician, or any other 115
physician designated in the collaborative practice 116
arrangement, shall review every fourteen days a minimum of 117
twenty percent of the charts in which the advanced practice 118
registered nurse prescribes controlled substances. The 119
charts reviewed under this subdivision may be counted in the 120
number of charts required to be reviewed under subdivision 121
(9) of this subsection. 122
4. The state board of registration for the healing 123
arts pursuant to section 334.125 and the board of nursing 124
pursuant to section 335.036 may jointly promulgate rules 125
regulating the use of collaborative practice arrangements. 126
Such rules shall be limited to specifying geographic areas 127
to be covered, the me thods of treatment that may be covered 128
by collaborative practice arrangements and the requirements 129
for review of services provided pursuant to collaborative 130
practice arrangements including delegating authority to 131
prescribe controlled substances. Any rules relating to 132
geographic proximity shall allow a collaborating physician 133 76
CCS HCS SS SCS SBs 45 & 90
and a collaborating advanced practice registered nurse to 134
practice within two hundred miles by road of one another 135
until August 28, 2025, if the nurse is providing services in 136
a correctional center, as defined in section 217.010. Any 137
rules relating to dispensing or distribution of medications 138
or devices by prescription or prescription drug orders under 139
this section shall be subject to the approval of the state 140
board of pharmacy. Any rules relating to dispensing or 141
distribution of controlled substances by prescription or 142
prescription drug orders under this section shall be subject 143
to the approval of the department of health and senior 144
services and the state board of pha rmacy. In order to take 145
effect, such rules shall be approved by a majority vote of a 146
quorum of each board. Neither the state board of 147
registration for the healing arts nor the board of nursing 148
may separately promulgate rules relating to collaborative 149
practice arrangements. Such jointly promulgated rules shall 150
be consistent with guidelines for federally funded clinics. 151
The rulemaking authority granted in this subsection shall 152
not extend to collaborative practice arrangements of 153
hospital employees providing inpatient care within hospitals 154
as defined pursuant to chapter 197 or population -based 155
public health services as defined by 20 CSR 2150 -5.100 as of 156
April 30, 2008. 157
5. The state board of registration for the healing 158
arts shall not deny, revoke, suspend or otherwise take 159
disciplinary action against a physician for health care 160
services delegated to a registered professional nurse 161
provided the provisions of this section and the rules 162
promulgated thereunder are satisfied. Upon the written 163
request of a physician subject to a disciplinary action 164
imposed as a result of an agreement between a physician and 165 77
CCS HCS SS SCS SBs 45 & 90
a registered professional nurse or registered physician 166
assistant, whether written or not, prior to August 28, 1993, 167
all records of such disciplinary licensure action and all 168
records pertaining to the filing, investigation or review of 169
an alleged violation of this chapter incurred as a result of 170
such an agreement shall be removed from the records of the 171
state board of registration for the healing arts and the 172
division of professional registration and shall not be 173
disclosed to any public or private entity seeking such 174
information from the board or the division. The state board 175
of registration for the healing arts shall take act ion to 176
correct reports of alleged violations and disciplinary 177
actions as described in this section which have been 178
submitted to the National Practitioner Data Bank. In 179
subsequent applications or representations relating to his 180
or her medical practice, a physician completing forms or 181
documents shall not be required to report any actions of the 182
state board of registration for the healing arts for which 183
the records are subject to removal under this section. 184
6. Within thirty days of any change an d on each 185
renewal, the state board of registration for the healing 186
arts shall require every physician to identify whether the 187
physician is engaged in any collaborative practice 188
agreement, including collaborative practice agreements 189
delegating the authority to prescribe controlled substances, 190
or physician assistant agreement and also report to the 191
board the name of each licensed professional with whom the 192
physician has entered into such agreement. The board may 193
make this information available to th e public. The board 194
shall track the reported information and may routinely 195
conduct random reviews of such agreements to ensure that 196
agreements are carried out for compliance under this chapter. 197 78
CCS HCS SS SCS SBs 45 & 90
7. Notwithstanding any law to the contrary, a 198
certified registered nurse anesthetist as defined in 199
subdivision (8) of section 335.016 shall be permitted to 200
provide anesthesia services without a collaborative practice 201
arrangement provided that he or she is under the supervision 202
of an anesthesiologist or other physician, dentist, or 203
podiatrist who is immediately available if needed. Nothing 204
in this subsection shall be construed to prohibit or prevent 205
a certified registered nurse anesthetist as defined in 206
subdivision (8) of section 335.016 from enteri ng into a 207
collaborative practice arrangement under this section, 208
except that the collaborative practice arrangement may not 209
delegate the authority to prescribe any controlled 210
substances listed in Schedules III, IV, and V of section 211
195.017, or Schedule II - hydrocodone. 212
8. A collaborating physician shall not enter into a 213
collaborative practice arrangement with more than six full - 214
time equivalent advanced practice registered nurses, full - 215
time equivalent licensed physician assistants, or full -time 216
equivalent assistant physicians, or any combination 217
thereof. This limitation shall not apply to collaborative 218
arrangements of hospital employees providing inpatient care 219
service in hospitals as defined in chapter 197 or population - 220
based public health services as defined by 20 CSR 2150 -5.100 221
as of April 30, 2008, or to a certified registered nurse 222
anesthetist providing anesthesia services under the 223
supervision of an anesthesiologist or other physician, 224
dentist, or podiatrist who is immediately av ailable if 225
needed as set out in subsection 7 of this section. 226
9. It is the responsibility of the collaborating 227
physician to determine and document the completion of at 228
least a one-month period of time during which the advanced 229 79
CCS HCS SS SCS SBs 45 & 90
practice registered nurse shall practice with the 230
collaborating physician continuously present before 231
practicing in a setting where the collaborating physician is 232
not continuously present. This limitation shall not apply 233
to collaborative arrangements of providers of pop ulation- 234
based public health services as defined by 20 CSR 2150 -5.100 235
as of April 30, 2008. 236
10. No agreement made under this section shall 237
supersede current hospital licensing regulations governing 238
hospital medication orders under protocols or sta nding 239
orders for the purpose of delivering inpatient or emergency 240
care within a hospital as defined in section 197.020 if such 241
protocols or standing orders have been approved by the 242
hospital's medical staff and pharmaceutical therapeutics 243
committee. 244
11. No contract or other agreement shall require a 245
physician to act as a collaborating physician for an 246
advanced practice registered nurse against the physician's 247
will. A physician shall have the right to refuse to act as 248
a collaborating physicia n, without penalty, for a particular 249
advanced practice registered nurse. No contract or other 250
agreement shall limit the collaborating physician's ultimate 251
authority over any protocols or standing orders or in the 252
delegation of the physician's authorit y to any advanced 253
practice registered nurse, but this requirement shall not 254
authorize a physician in implementing such protocols, 255
standing orders, or delegation to violate applicable 256
standards for safe medical practice established by 257
hospital's medical staff. 258
12. No contract or other agreement shall require any 259
advanced practice registered nurse to serve as a 260
collaborating advanced practice registered nurse for any 261 80
CCS HCS SS SCS SBs 45 & 90
collaborating physician against the advanced practice 262
registered nurse's will. An advanced practice registered 263
nurse shall have the right to refuse to collaborate, without 264
penalty, with a particular physician. 265
335.203. 1. There is hereby established the "Nursing 1
Education Incentive Program" within the state board of 2
nursing. 3
2. Subject to appropriation and board disbursement, 4
grants shall be awarded through the nursing education 5
incentive program to eligible institutions of higher 6
education based on criteria jointly determined by the board 7
and the department of higher education and workforce 8
development. [Grant award amounts shall not exceed one 9
hundred fifty thousand dollars. ] No campus shall receive 10
more than one grant per year. 11
3. To be considered for a grant, an eligible 12
institution of higher education shall offer a program of 13
nursing that meets the predetermined category and area of 14
need as established by the board and the department under 15
subsection 4 of this section. 16
4. The board and the department shall determine 17
categories and areas of need for designating grants to 18
eligible institutions of higher education. In establishing 19
categories and areas of need, the board and department may 20
consider criteria including, but not limited to: 21
(1) Data generated from licensu re renewal data and the 22
department of health and senior services; and 23
(2) National nursing statistical data and trends that 24
have identified nursing shortages. 25
5. The board shall be the administrative agency 26
responsible for implementation of the program established 27
under sections 335.200 to 335.203, and shall promulgate 28 81
CCS HCS SS SCS SBs 45 & 90
reasonable rules for the exercise of its functions and the 29
effectuation of the purposes of sections 335.200 to 30
335.203. The board shall, by rule, prescribe the form, 31
time, and method of filing applications and shall supervise 32
the processing of such applications. 33
6. Any rule or portion of a rule, as that term is 34
defined in section 536.010, that is created under the 35
authority delegated in this section shall become e ffective 36
only if it complies with and is subject to all of the 37
provisions of chapter 536 and, if applicable, section 38
536.028. This section and chapter 536 are nonseverable and 39
if any of the powers vested with the general assembly 40
pursuant to chapter 536 to review, to delay the effective 41
date, or to disapprove and annul a rule are subsequently 42
held unconstitutional, then the grant of rulemaking 43
authority and any rule proposed or adopted after August 28, 44
2011, shall be invalid and void. 45
335.205. The board, in addition to any other duties it 1
may have regarding licensure of nurses, shall collect, at 2
the time of any initial license application or license 3
renewal application, a nursing education incentive program 4
surcharge from each person licensed or relicensed under this 5
chapter, in the amount of one dollar per year for practical 6
nurses and five dollars per year for registered professional 7
nurses. These funds shall be deposited in the state board 8
of nursing fund described in section 335.036. 9
338.010. 1. The "practice of pharmacy" [means] 1
includes: 2
(1) The interpretation, implementation, and evaluation 3
of medical prescription orders, including any legend drugs 4
under 21 U.S.C. Section 353 [;], and the receipt, 5 82
CCS HCS SS SCS SBs 45 & 90
transmission, or handling of such orders or facilitating the 6
dispensing of such orders; 7
(2) The designing, initiating, implementing, and 8
monitoring of a medication therapeutic plan [as defined by 9
the prescription order so long as the prescription order is 10
specific to each patient for care by a pharmacist ] in 11
accordance with the provisions of this section ; 12
(3) The compounding, dispensing, labeling, and 13
administration of drugs and devices pursuant to medical 14
prescription orders [and administration of viral influenza, 15
pneumonia, shingles, hepatitis A, hepatitis B, diphtheria, 16
tetanus, pertussis, and meningitis vaccines by written 17
protocol authorized by a physician for persons at least 18
seven years of age or the age recommended by the Centers for 19
Disease Control and Prevention, whichever is higher, or the 20
administration of pneumonia, shingles, hepatitis A, 21
hepatitis B, diphtheria, tetanus, pertussis, meningitis, and 22
viral influenza vaccines by written protocol authorized by a 23
physician for a specific patient as authorized by rule ]; 24
(4) The ordering and administration of vaccines 25
approved or authorized by the U.S. Food and Drug 26
Administration, excluding vaccines for cholera, monkeypox, 27
Japanese encephalitis, typhoid, rabies, yellow fever, tick - 28
borne encephalitis, anthrax, tuberculosis, dengue, Hib, 29
polio, rotavirus, smallpox, and any vaccine approved after 30
January 1, 2023, to persons at least seven years of age or 31
the age recommended by the Centers for Disease Con trol and 32
Prevention, whichever is older, pursuant to joint 33
promulgation of rules established by the board of pharmacy 34
and the state board of registration for the healing arts 35
unless rules are established under a state of emergency as 36
described in section 44.100; 37 83
CCS HCS SS SCS SBs 45 & 90
(5) The participation in drug selection according to 38
state law and participation in drug utilization reviews; 39
(6) The proper and safe storage of drugs and devices 40
and the maintenance of proper records thereof; 41
(7) Consultation with patients and other health care 42
practitioners, and veterinarians and their clients about 43
legend drugs, about the safe and effective use of drugs and 44
devices; 45
(8) The prescribing and dispensing of any nicotine 46
replacement therapy product un der section 338.665; 47
(9) The dispensing of HIV postexposure prophylaxis 48
pursuant to section 338.730; and 49
(10) The offering or performing of those acts, 50
services, operations, or transactions necessary in the 51
conduct, operation, management and control of a pharmacy. 52
2. No person shall engage in the practice of pharmacy 53
unless he or she is licensed under the provisions of this 54
chapter. 55
3. This chapter shall not be construed to prohibit the 56
use of auxiliary personnel under the dire ct supervision of a 57
pharmacist from assisting the pharmacist in any of his or 58
her duties. This assistance in no way is intended to 59
relieve the pharmacist from his or her responsibilities for 60
compliance with this chapter and he or she will be 61
responsible for the actions of the auxiliary personnel 62
acting in his or her assistance. 63
4. This chapter shall [also] not be construed to 64
prohibit or interfere with any legally registered 65
practitioner of medicine, dentistry, or podiatry, or 66
veterinary medicine only for use in animals, or the practice 67
of optometry in accordance with and as provided in sections 68 84
CCS HCS SS SCS SBs 45 & 90
195.070 and 336.220 in the compounding, administering, 69
prescribing, or dispensing of his or her own prescriptions. 70
[2. Any pharmacist who ac cepts a prescription order 71
for a medication therapeutic plan shall have a written 72
protocol from the physician who refers the patient for 73
medication therapy services. ] 74
5. A pharmacist with a certificate of medication 75
therapeutic plan authority ma y provide medication therapy 76
services pursuant to a written protocol from a physician 77
licensed under chapter 334 to patients who have established 78
a physician-patient relationship, as described in 79
subdivision (1) of subsection 1 of section 191.1146, wit h 80
the protocol physician. The written protocol [and the 81
prescription order for a medication therapeutic plan ] 82
authorized by this section shall come only from the 83
physician [only,] and shall not come from a nurse engaged in 84
a collaborative practice ar rangement under section 334.104, 85
or from a physician assistant engaged in a collaborative 86
practice arrangement under section 334.735. 87
[3.] 6. Nothing in this section shall be construed as 88
to prevent any person, firm or corporation from owning a 89
pharmacy regulated by sections 338.210 to 338.315, provided 90
that a licensed pharmacist is in charge of such pharmacy. 91
[4.] 7. Nothing in this section shall be construed to 92
apply to or interfere with the sale of nonprescription drugs 93
and the ordinary household remedies and such drugs or 94
medicines as are normally sold by those engaged in the sale 95
of general merchandise. 96
[5.] 8. No health carrier as defined in chapter 376 97
shall require any physician with which they contract to 98
enter into a written protocol with a pharmacist for 99
medication therapeutic services. 100 85
CCS HCS SS SCS SBs 45 & 90
[6.] 9. This section shall not be construed to allow a 101
pharmacist to diagnose or independently prescribe 102
pharmaceuticals. 103
[7.] 10. The state board of registration for the 104
healing arts, under section 334.125, and the state board of 105
pharmacy, under section 338.140, shall jointly promulgate 106
rules regulating the use of protocols [for prescription 107
orders] for medication therapy services [and administration 108
of viral influenza vaccines]. Such rules shall require 109
protocols to include provisions allowing for timely 110
communication between the pharmacist and the [referring] 111
protocol physician or similar body authorized by this 112
section, and any other patient protection provisio ns deemed 113
appropriate by both boards. In order to take effect, such 114
rules shall be approved by a majority vote of a quorum of 115
each board. Neither board shall separately promulgate rules 116
regulating the use of protocols for [prescription orders 117
for] medication therapy services [and administration of 118
viral influenza vaccines ]. Any rule or portion of a rule, 119
as that term is defined in section 536.010, that is created 120
under the authority delegated in this section shall become 121
effective only if it com plies with and is subject to all of 122
the provisions of chapter 536 and, if applicable, section 123
536.028. This section and chapter 536 are nonseverable and 124
if any of the powers vested with the general assembly 125
pursuant to chapter 536 to review, to delay the effective 126
date, or to disapprove and annul a rule are subsequently 127
held unconstitutional, then the grant of rulemaking 128
authority and any rule proposed or adopted after August 28, 129
2007, shall be invalid and void. 130
[8.] 11. The state board of ph armacy may grant a 131
certificate of medication therapeutic plan authority to a 132 86
CCS HCS SS SCS SBs 45 & 90
licensed pharmacist who submits proof of successful 133
completion of a board -approved course of academic clinical 134
study beyond a bachelor of science in pharmacy, including 135
but not limited to clinical assessment skills, from a 136
nationally accredited college or university, or a 137
certification of equivalence issued by a nationally 138
recognized professional organization and approved by the 139
board of pharmacy. 140
[9.] 12. Any pharmacist who has received a certificate 141
of medication therapeutic plan authority may engage in the 142
designing, initiating, implementing, and monitoring of a 143
medication therapeutic plan as defined by a [prescription 144
order] written protocol from a physician that [is] may be 145
specific to each patient for care by a pharmacist. 146
[10.] 13. Nothing in this section shall be construed 147
to allow a pharmacist to make a therapeutic substitution of 148
a pharmaceutical prescribed by a physician unless authorized 149
by the written protocol or the physician's prescription 150
order. 151
[11.] 14. "Veterinarian", "doctor of veterinary 152
medicine", "practitioner of veterinary medicine", "DVM", 153
"VMD", "BVSe", "BVMS", "BSe (Vet Science)", "VMB", "MRCVS", 154
or an equivalent title means a person who has received a 155
doctor's degree in veterinary medicine from an accredited 156
school of veterinary medicine or holds an Educational 157
Commission for Foreign Veterinary Graduates (EDFVG) 158
certificate issued by the American Veterinary Medical 159
Association (AVMA). 160
[12.] 15. In addition to other requirements 161
established by the joint promulgation of rules by the board 162
of pharmacy and the state board of registration for the 163
healing arts: 164 87
CCS HCS SS SCS SBs 45 & 90
(1) A pharmacist shall administer vaccines by protocol 165
in accordance with treatment guidelines established by the 166
Centers for Disease Control and Prevention (CDC); 167
(2) A pharmacist who is administering a vaccine shall 168
request a patient to remain in the pharmacy a safe amount of 169
time after administering the vaccine to observe any adverse 170
reactions. Such pharmacist shall have adopted emergency 171
treatment protocols; 172
[(3)] 16. In addition to other requirements by the 173
board, a pharmacist shall receive additional training as 174
required by the board and evidenced by receiving a 175
certificate from the board upon completion, and shall 176
display the certification in his or her pharmacy where 177
vaccines are delivered. 178
[13.] 17. A pharmacist shall inform the patient that 179
the administration of [the] a vaccine will be entered into 180
the ShowMeVax system, as administered by the department of 181
health and senior services. The patient shall attest to the 182
inclusion of such information in the system by signing a 183
form provided by the pharmacist. If the patient indicates 184
that he or she does not want such information entered into 185
the ShowMeVax system, the pharmacist shall provide a written 186
report within fourteen days of administration of a vaccine 187
to the patient's health care provider, if provided by the 188
patient, containing: 189
(1) The identity of the patient; 190
(2) The identity of the vaccine or vaccines 191
administered; 192
(3) The route of administration; 193
(4) The anatomic site of the administration; 194
(5) The dose administered; and 195
(6) The date of administration. 196 88
CCS HCS SS SCS SBs 45 & 90
18. A pharmacist licensed under this chapter may order 197
and administer vaccines approved or authorized by the U.S. 198
Food and Drug Administration to address a public health 199
need, as lawfully authorized by the state or federal 200
government, or a department or agency thereof, during a 201
state or federally declared public health emergency. 202
338.012. 1. A pharmacist with a certificate of 1
medication therapeutic plan authority may provide influenz a, 2
group A streptococcus, and COVID -19 medication therapy 3
services pursuant to a statewide standing order issued by 4
the director or chief medical officer of the department of 5
health and senior services if that person is a licensed 6
physician, or a lice nsed physician designated by the 7
department of health and senior services. 8
2. The state board of registration for the healing 9
arts, pursuant to section 334.125, and the state board of 10
pharmacy, pursuant to section 338.140, shall jointly 11
promulgate rules to implement the provisions of this 12
section. Any rule or portion of a rule, as that term is 13
defined in section 536.010, that is created under the 14
authority delegated in this section shall become effective 15
only if it complies with and is subjec t to all of the 16
provisions of chapter 536 and, if applicable, section 17
536.028. This section and chapter 536 are nonseverable and 18
if any of the powers vested with the general assembly 19
pursuant to chapter 536 to review, to delay the effective 20
date, or to disapprove and annul a rule are subsequently 21
held unconstitutional, then the grant of rulemaking 22
authority and any rule proposed or adopted after August 28, 23
2023, shall be invalid and void. 24
376.1060. 1. As used in this section, t he following 1
terms shall mean: 2 89
CCS HCS SS SCS SBs 45 & 90
(1) "Contracting entity", any person or entity , 3
including a health carrier, that is engaged in the act of 4
contracting with providers for the delivery of [dental] 5
health care services [or the selling or assigning of dental 6
network plans to other health care entities ]; 7
(2) ["Identify", providing in writing, by email or 8
otherwise, to the participating provider the name, address, 9
and telephone number, to the extent possible, for any third 10
party to which the con tracting entity has granted access to 11
the health care services of the participating provider; 12
(3) "Network plan", health insurance coverage offered 13
by a health insurance issuer under which the financing and 14
delivery of dental services are provided in whole or in part 15
through a defined set of participating providers under 16
contract with the health insurance issuer ] "Health care 17
service", the same meaning given to the term in section 18
376.1350; 19
[(4)] (3) "Health carrier", the same meaning give n to 20
the term in section 376.1350. The term "health carrier" 21
shall also include any entity described in subdivision (4) 22
of section 354.700; 23
(4) "Participating provider", a provider who, under a 24
contract with a contracting entity, has agreed to p rovide 25
[dental] health care services with an expectation of 26
receiving payment, other than coinsurance, co -payments or 27
deductibles, directly or indirectly from the contracting 28
entity; 29
(5) "Provider", any person licensed under section 30
332.071; 31
(6) "Provider network contract", a contract between a 32
contracting entity and a provider that specifies the rights 33 90
CCS HCS SS SCS SBs 45 & 90
and responsibilities of the contracting entity and provides 34
for the delivery and payment of health care services; 35
(7) "Third party", a person or entity that enters into 36
a contract with a contracting entity or with another third 37
party to gain access to the health care services or 38
contractual discounts of a provider network contract. 39
"Third party" does not include an employer or o ther group 40
for whom the health carrier or contracting entity provides 41
administrative services . 42
2. A contracting entity [shall not sell, assign, or 43
otherwise] shall only grant a third party access to [the 44
dental services of] a participating [provider under a health 45
care contract unless expressly authorized by the health care 46
contract. The health care contract shall specifically 47
provide that one purpose of the contract is the selling, 48
assigning, or giving the contracting entity rights to the 49
services of the participating provider, including network 50
plans] provider's health care services or contractual 51
discounts provided in accordance with a contract between a 52
participating provider and a contracting entity and only if: 53
(1) The contract specifically states that the 54
contracting entity may enter into an agreement with a third 55
party allowing the third party to obtain the contracting 56
entity's rights and responsibilities as if the third party 57
were the contracting entity, and the contract allows the 58
provider to choose not to participate in third -party access 59
at the time the contract is entered into or renewed or when 60
there are material modifications to the contract. The third- 61
party access provision of any provider network contract 62
shall also specifically state that the contract grants third - 63
party access to the provider's health care services and that 64
the provider has the right to choose not to participate in 65 91
CCS HCS SS SCS SBs 45 & 90
third-party access to the contract or to enter into a 66
contract directly wi th the third party. A provider's 67
decision not to participate in third -party access shall not 68
permit the contracting entity to cancel or otherwise end a 69
contractual relationship with the provider. When initially 70
contracting with a provider, a contrac ting entity shall 71
accept a qualified provider even if the provider chooses not 72
to participate in the third -party access provision; 73
(2) The third party accessing the contract agrees to 74
comply with all of the contract's terms; 75
(3) The contracting entity identifies, in writing or 76
electronic form to the provider, all third parties in 77
existence as of the date the contract is entered into or 78
renewed; 79
(4) The contracting entity identifies all third 80
parties in existence in a list on its int ernet website that 81
is updated at least once every ninety days; 82
(5) The contracting entity notifies providers that a 83
new third party is accessing a provider network contract at 84
least thirty days in advance of the relationship taking 85
effect; 86
(6) The contracting entity notifies the third party of 87
the termination of a provider network contract no later than 88
thirty days from the termination date with the contracting 89
entity; 90
(7) A third party's right to a provider's discounted 91
rate ceases as of the termination date of the provider 92
network contract; 93
(8) The provider is not already a participating 94
provider of the third party; and 95
(9) The contracting entity makes available a copy of 96
the provider network contract relied on in t he adjudication 97 92
CCS HCS SS SCS SBs 45 & 90
of a claim to a participating provider within thirty days of 98
a request from the provider . 99
3. [Upon entering a contract with a participating 100
provider and upon request by a participating provider, a 101
contracting entity shall properly identify any third party 102
that has been granted access to the dental services of the 103
participating provider ] No provider shall be bound by or 104
required to perform health care services under a provider 105
network contract that has been granted to a third pa rty in 106
violation of the provisions of this section . 107
4. A contracting entity that sells, assigns, or 108
otherwise grants a third party access to [the dental 109
services of] a participating [provider] provider's health 110
care services shall maintain an int ernet website or a toll - 111
free telephone number through which the participating 112
provider may obtain information which identifies the 113
[insurance carrier] third party to be used to reimburse the 114
participating provider for the covered [dental] health care 115
services. 116
5. A contracting entity that sells, assigns, or 117
otherwise grants a third party access to a participating 118
provider's [dental] health care services shall ensure that 119
an explanation of benefits or remittance advice furnished to 120
the participating provider that delivers [dental] health 121
care services [under the health care contract ] for the third 122
party identifies the contractual source of any applicable 123
discount. 124
6. [All third parties that have contracted with a 125
contracting entity to purchase, be assigned, or otherwise be 126
granted access to the participating provider's discounted 127
rate shall comply with the participating provider's 128
contract, including all requirements to encourage access to 129 93
CCS HCS SS SCS SBs 45 & 90
the participating provider, and pay the pa rticipating 130
provider pursuant to the rates of payment and methodology 131
set forth in that contract, unless otherwise agreed to by a 132
participating provider. 133
7. A contracting entity is deemed in compliance with 134
this section when the insured's identif ication card provides 135
information which identifies the insurance carrier to be 136
used to reimburse the participating provider for the covered 137
dental services] (1) The provisions of this section shall 138
not apply if access to a provider network contract is 139
granted to any entity operating in accordance with the same 140
brand licensee program as the contracting entity or to any 141
entity that is an affiliate of the contracting entity. A 142
list of the contracting entity's affiliates shall be made 143
available to a provider on the contracting entity's website. 144
(2) The provisions of this section shall not apply to 145
a provider network contract for health care services 146
provided to beneficiaries of any state -sponsored health 147
insurance programs including, but not limited to, MO 148
HealthNet and the state children's health insurance program 149
authorized in sections 208.631 to 208.658 . 150
579.088. Notwithstanding any other provision of this 1
chapter or chapter 195 to the contrary, it shall not be 2
unlawful to manufacture, possess, sell, deliver, or use any 3
device, equipment, or other material for the purpose of 4
analyzing controlled substances to detect the presence of 5
fentanyl or any synthetic controlled substance fentanyl 6
analogue. 7
[191.500. As used in sections 191.500 to 1
191.550, unless the context clearly indicates 2
otherwise, the following terms mean: 3
(1) "Area of defined need", a community or 4
section of an urban area of this state which is 5
certified by the department of health and senior 6 94
CCS HCS SS SCS SBs 45 & 90
services as being in need of the services of a 7
physician to improve the patient -doctor ratio in 8
the area, to contribute professional physician 9
services to an area of economic impact, or to 10
contribute professional physician service s to an 11
area suffering from the effects of a natural 12
disaster; 13
(2) "Department", the department of health 14
and senior services; 15
(3) "Eligible student", a full -time 16
student accepted and enrolled in a formal course 17
of instruction leading to a degree of doctor of 18
medicine or doctor of osteopathy, including 19
psychiatry, at a participating school, or a 20
doctor of dental surgery, doctor of dental 21
medicine, or a bachelor of science degree in 22
dental hygiene; 23
(4) "Financial assistance", an a mount of 24
money paid by the state of Missouri to a 25
qualified applicant pursuant to sections 191.500 26
to 191.550; 27
(5) "Participating school", an institution 28
of higher learning within this state which 29
grants the degrees of doctor of medicine or 30
doctor of osteopathy, and which is accredited in 31
the appropriate degree program by the American 32
Medical Association or the American Osteopathic 33
Association, or a degree program by the American 34
Dental Association or the American Psychiatric 35
Association, and applicable residency programs 36
for each degree type and discipline; 37
(6) "Primary care", general or family 38
practice, internal medicine, pediatric , 39
psychiatric, obstetric and gynecological care as 40
provided to the general public by physicians 41
licensed and registered pursuant to chapter 334, 42
dental practice, or a dental hygienist licensed 43
and registered pursuant to chapter 332; 44
(7) "Resident", any natural person who has 45
lived in this state for one or more years for 46
any purpose other than the attending of an 47
educational institution located within this 48
state; 49
(8) "Rural area", a town or community 50
within this state which is not within a standard 51
metropolitan statistical area, and has a 52
population of six thousand or fewer inhabitan ts 53
as determined by the last preceding federal 54
decennial census or any unincorporated area not 55
within a standard metropolitan statistical area. ] 56
[191.505. The department of health and 1
senior services shall be the administrative 2
agency for the implementation of the program 3
established by sections 191.500 to 191.550. The 4
department shall promulgate reasonable rules and 5
regulations for the exercise of its functions in 6 95
CCS HCS SS SCS SBs 45 & 90
the effectuation of the purposes of sections 7
191.500 to 191.550. It shall prescribe the form 8
and the time and method of filing applications 9
and supervise the processing thereof. ] 10
[191.510. The department shall enter into 1
a contract with each applicant receiving a state 2
loan under sections 191 .500 to 191.550 for 3
repayment of the principal and interest and for 4
forgiveness of a portion thereof for 5
participation in the service areas as provided 6
in sections 191.500 to 191.550. ] 7
[191.515. An eligible student may apply to 1
the department for a loan under sections 191.500 2
to 191.550 only if, at the time of his 3
application and throughout the period during 4
which he receives the loan, he has been formally 5
accepted as a student in a participating school 6
in a course of study lea ding to the degree of 7
doctor of medicine or doctor of osteopathy, 8
including psychiatry, or a doctor of dental 9
surgery, a doctor of dental medicine, or a 10
bachelor of science degree in dental hygiene, 11
and is a resident of this state. ] 12
[191.520. No loan to any eligible student 1
shall exceed twenty-five thousand dollars for 2
each academic year, which shall run from August 3
first of any year through July thirty -first of 4
the following year. All loans shall be made 5
from funds appropriat ed to the medical school 6
loan and loan repayment program fund created by 7
section 191.600, by the general assembly. ] 8
[191.525. No more than twenty-five loans 1
shall be made to eligible students during the 2
first academic year this prog ram is in effect. 3
Twenty-five new loans may be made for the next 4
three academic years until a total of one 5
hundred loans are available. At least one-half 6
of the loans shall be made to students from 7
rural areas as defined in section 191.500. An 8
eligible student may receive loans for each 9
academic year he is pursuing a course of study 10
directly leading to a degree of doctor of 11
medicine or doctor of osteopathy, doctor of 12
dental surgery, or doctor of dental medicine, or 13
a bachelor of science degree in dental hygiene.] 14
[191.530. Interest at the rate of nine and 1
one-half percent per year shall be charged on 2
all loans made under sections 191.500 to 191.550 3
but one-fourth of the interest and principal of 4
the total loan at the tim e of the awarding of 5
the degree shall be forgiven for each year of 6
participation by an applicant in the practice of 7
his profession in a rural area or an area of 8
defined need. The department shall grant a 9 96
CCS HCS SS SCS SBs 45 & 90
deferral of interest and principal payments to a 10
loan recipient who is pursuing an internship or 11
a residency in primary care. The deferral shall 12
not exceed three years. The status of each loan 13
recipient receiving a deferral shall be reviewed 14
annually by the department to ensure compliance 15
with the intent of this provision. The loan 16
recipient will repay the loan beginning with the 17
calendar year following completion of his 18
internship or his primary care residency in 19
accordance with the loan contract. ] 20
[191.535. If a student ceases his study 1
prior to receiving a degree, interest at the 2
rate specified in section 191.530 shall be 3
charged on the amount received from the state 4
under the provisions of sections 191.500 to 5
191.550.] 6
[191.540. 1. The department shall 1
establish schedules and procedures for repayment 2
of the principal and interest of any loan made 3
under the provisions of sections 191.500 to 4
191.550 and not forgiven as provided in section 5
191.530. 6
2. A penalty shall be levied against a 7
person in breach of contract. Such penalty shall 8
be twice the sum of the principal and the 9
accrued interest.] 10
[191.545. When necessary to protect the 1
interest of the state in any loan transaction 2
under sections 191.500 to 191.55 0, the board may 3
institute any action to recover any amount due. ] 4
[191.550. The contracts made with the 1
participating students shall be approved by the 2
attorney general.] 3
[335.212. As used in sections 335.212 to 1
335.242, the following terms mean: 2
(1) "Board", the Missouri state board of 3
nursing; 4
(2) "Department", the Missouri department 5
of health and senior services; 6
(3) "Director", director of the Missouri 7
department of health and senior serv ices; 8
(4) "Eligible student", a resident who has 9
been accepted as a full -time student in a formal 10
course of instruction leading to an associate 11
degree, a diploma, a bachelor of science, a 12
master of science in nursing (M.S.N.), a 13
doctorate in nursing (Ph.D. or D.N.P.), or a 14
student with a master of science in nursing 15
seeking a doctorate in education (Ed.D.), or 16
leading to the completion of educational 17
requirements for a licensed practical nurse. 18
The doctoral applicant may be a part -time 19
student; 20 97
CCS HCS SS SCS SBs 45 & 90
(5) "Participating school", an institution 21
within this state which is approved by the board 22
for participation in the professional and 23
practical nursing student loan program 24
established by sections 335.212 to 335.242, 25
having a nursing depar tment and offering a 26
course of instruction based on nursing theory 27
and clinical nursing experience; 28
(6) "Qualified applicant", an eligible 29
student approved by the board for participation 30
in the professional and practical nursing 31
student loan program established by sections 32
335.212 to 335.242; 33
(7) "Qualified employment", employment on 34
a full-time basis in Missouri in a position 35
requiring licensure as a licensed practical 36
nurse or registered professional nurse in any 37
hospital as defined in section 197.020 or in any 38
agency, institution, or organization located in 39
an area of need as determined by the department 40
of health and senior services. Any forgiveness 41
of such principal and interest for any qualified 42
applicant engaged in qualifie d employment on a 43
less than full-time basis may be prorated to 44
reflect the amounts provided in this section; 45
(8) "Resident", any person who has lived 46
in this state for one or more years for any 47
purpose other than the attending of an 48
educational institution located within this 49
state.] 50
[335.215. 1. The department of health and 1
senior services shall be the administrative 2
agency for the implementation of the 3
professional and practical nursing student loan 4
program established under sections 335.212 to 5
335.242, and the nursing student loan repayment 6
program established under sections 335.245 to 7
335.259. 8
2. An advisory panel of nurses shall be 9
appointed by the director. It shall be composed 10
of not more than eleven me mbers representing 11
practical, associate degree, diploma, 12
baccalaureate and graduate nursing education, 13
community health, primary care, hospital, long - 14
term care, a consumer, and the Missouri state 15
board of nursing. The panel shall make 16
recommendations to the director on the content 17
of any rules, regulations or guidelines prior to 18
their promulgation. The panel may make 19
recommendations to the director regarding fund 20
allocations for loans and loan repayment based 21
on current nursing shortage needs. 22
3. The department of health and senior 23
services shall promulgate reasonable rules and 24
regulations for the exercise of its function 25
pursuant to sections 335.212 to 335.259. It 26 98
CCS HCS SS SCS SBs 45 & 90
shall prescribe the form, the time and method of 27
filing applications a nd supervise the 28
proceedings thereof. No rule or portion of a 29
rule promulgated under the authority of sections 30
335.212 to 335.257 shall become effective unless 31
it has been promulgated pursuant to the 32
provisions of section 536.024. 33
4. Ninety-five percent of funds loaned 34
pursuant to sections 335.212 to 335.242 shall be 35
loaned to qualified applicants who are enrolled 36
in professional nursing programs in 37
participating schools and five percent of the 38
funds loaned pursuant to sections 335.212 to 39
335.242 shall be loaned to qualified applicants 40
who are enrolled in practical nursing programs. 41
Priority shall be given to eligible students who 42
have established financial need. All loan 43
repayment funds pursuant to sections 335.245 to 44
335.259 shall be used to reimburse successful 45
associate, diploma, baccalaureate or graduate 46
professional nurse applicants' educational loans 47
who agree to serve in areas of defined need as 48
determined by the department. ] 49
[335.218. There is hereby established the 1
"Professional and Practical Nursing Student Loan 2
and Nurse Loan Repayment Fund". All fees 3
pursuant to section 335.221, general revenue 4
appropriations to the student loan or loan 5
repayment program, voluntary contributions to 6
support or match the student loan and loan 7
repayment program activities, funds collected 8
from repayment and penalties, and funds received 9
from the federal government shall be deposited 10
in the state treasury and be placed to the 11
credit of the professional and pr actical nursing 12
student loan and nurse loan repayment fund. The 13
fund shall be managed by the department of 14
health and senior services and all 15
administrative costs and expenses incurred as a 16
result of the effectuation of sections 335.212 17
to 335.259 shall be paid from this fund. ] 18
[335.221. The board, in addition to any 1
other duties it may have regarding licensure of 2
nurses, shall collect, at the time of licensure 3
or licensure renewal, an education surcharge 4
from each person lice nsed or relicensed pursuant 5
to sections 335.011 to 335.096, in the amount of 6
one dollar per year for practical nurses and 7
five dollars per year for professional nurses. 8
These funds shall be deposited in the 9
professional and practical nursing student loan 10
and nurse loan repayment fund. All expenditures 11
authorized by sections 335.212 to 335.259 shall 12
be paid from funds appropriated by the general 13
assembly from the professional and practical 14
nursing student loan and nurse loan repayment 15 99
CCS HCS SS SCS SBs 45 & 90
fund. The provisions of section 33.080 to the 16
contrary notwithstanding, money in this fund 17
shall not be transferred and placed to the 18
credit of general revenue. ] 19
[335.224. The department of health and 1
senior services shall enter into a contr act with 2
each qualified applicant receiving financial 3
assistance under the provisions of sections 4
335.212 to 335.242 for repayment of the 5
principal and interest. ] 6
[335.227. An eligible student may apply to 1
the department for financ ial assistance under 2
the provisions of sections 335.212 to 335.242 3
if, at the time of his application for a loan, 4
the eligible student has formally applied for 5
acceptance at a participating school. Receipt 6
of financial assistance is contingent upon 7
acceptance and continued enrollment at a 8
participating school. ] 9
[335.230. Financial assistance to any 1
qualified applicant shall not exceed ten 2
thousand dollars for each academic year for a 3
professional nursing program and shall not 4
exceed five thousand dollars for each academic 5
year for a practical nursing program. All 6
financial assistance shall be made from funds 7
credited to the professional and practical 8
nursing student loan and nurse loan repayment 9
fund. A qualified applicant may receive 10
financial assistance for each academic year he 11
remains a student in good standing at a 12
participating school. ] 13
[335.233. The department shall establish 1
schedules for repayment of the principal and 2
interest on any financial assistance made under 3
the provisions of sections 335.212 to 335.242. 4
Interest at the rate of nine and one -half 5
percent per annum shall be charged on all 6
financial assistance made under the provisions 7
of sections 335.212 to 335.242, but the int erest 8
and principal of the total financial assistance 9
granted to a qualified applicant at the time of 10
the successful completion of a nursing degree, 11
diploma program or a practical nursing program 12
shall be forgiven through qualified employment. ] 13
[335.236. The financial assistance 1
recipient shall repay the financial assistance 2
principal and interest beginning not more than 3
six months after completion of the degree for 4
which the financial assistance was made in 5
accordance with the repayment contract. If an 6
eligible student ceases his study prior to 7
successful completion of a degree or graduation 8
at a participating school, interest at the rate 9 100
CCS HCS SS SCS SBs 45 & 90
specified in section 335.233 shall be charged on 10
the amount of financial assi stance received from 11
the state under the provisions of sections 12
335.212 to 335.242, and repayment, in accordance 13
with the repayment contract, shall begin within 14
ninety days of the date the financial aid 15
recipient ceased to be an eligible student. All 16
funds repaid by recipients of financial 17
assistance to the department shall be deposited 18
in the professional and practical nursing 19
student loan and nurse loan repayment fund for 20
use pursuant to sections 335.212 to 335.259. ] 21
[335.239. The department shall grant a 1
deferral of interest and principal payments to a 2
financial assistance recipient who is pursuing 3
an advanced degree, special nursing program, or 4
upon special conditions established by the 5
department. The deferral shall not exceed four 6
years. The status of each deferral shall be 7
reviewed annually by the department of health 8
and senior services to ensure compliance with 9
the intent of this section. ] 10
[335.242. When necessary to protect the 1
interest of the state in any financial 2
assistance transaction under sections 335.212 to 3
335.259, the department of health and senior 4
services may institute any action to recover any 5
amount due.] 6
[335.245. As used in sections 335.245 to 1
335.259, the following terms mean: 2
(1) "Department", the Missouri department 3
of health and senior services; 4
(2) "Eligible applicant", a Missouri 5
licensed nurse who has attained either an 6
associate degree, a diploma, a bachelor of 7
science, or graduate degree in nursing from an 8
accredited institution approved by the board of 9
nursing or a student nurse in the final year of 10
a full-time baccalaureate school of nursing 11
leading to a baccalaureate degree or graduate 12
nursing program leading to a mas ter's degree in 13
nursing and has agreed to serve in an area of 14
defined need as established by the department; 15
(3) "Participating school", an institution 16
within this state which grants an associate 17
degree in nursing, grants a bachelor or master 18
of science degree in nursing or provides a 19
diploma nursing program which is accredited by 20
the state board of nursing, or a regionally 21
accredited institution in this state which 22
provides a bachelor of science completion 23
program for registered professiona l nurses; 24
(4) "Qualified employment", employment on 25
a full-time basis in Missouri in a position 26
requiring licensure as a licensed practical 27 101
CCS HCS SS SCS SBs 45 & 90
nurse or registered professional nurse in any 28
hospital as defined in section 197.020 or public 29
or nonprofit agency, institution, or 30
organization located in an area of need as 31
determined by the department of health and 32
senior services. Any forgiveness of such 33
principal and interest for any qualified 34
applicant engaged in qualified employment on a 35
less than full-time basis may be prorated to 36
reflect the amounts provided in this section. ] 37
[335.248. Sections 335.245 to 335.259 1
shall be known as the "Nursing Student Loan 2
Repayment Program". The department of health 3
and senior services shall be the administrative 4
agency for the implementation of the authority 5
established by sections 335.245 to 335.259. The 6
department shall promulgate reasonable rules and 7
regulations necessary to implement sections 8
335.245 to 335.259. Promulgated rules shall 9
include, but not be limited to, applicant 10
eligibility, selection criteria, prioritization 11
of service obligation sites and the content of 12
loan repayment contracts, including repayment 13
schedules for those in default and penalties. 14
The department shall promulgate rules regarding 15
recruitment opportunities for minority students 16
into nursing schools. Priority for student loan 17
repayment shall be given to eligible applicants 18
who have demonstrated financial need. All funds 19
collected by the department from participants 20
not meeting their contractual obligations to the 21
state shall be deposited in the professional and 22
practical nursing student loan and nurse loan 23
repayment fund for use pursuant to sections 24
335.212 to 335.259.] 25
[335.251. Upon proper verification to the 1
department by the eligible applicant of securing 2
qualified employment in this state, the 3
department shall enter into a loan repayment 4
contract with the eligible applicant to repay 5
the interest and princ ipal on the educational 6
loans of the applicant to the limit of the 7
contract, which contract shall provide for 8
instances of less than full -time qualified 9
employment consistent with the provisions of 10
section 335.233, out of any appropriation made 11
to the professional and practical nursing 12
student loan and nurse loan repayment fund. If 13
the applicant breaches the contract by failing 14
to begin or complete the qualified employment, 15
the department is entitled to recover the total 16
of the loan repayment pa id by the department 17
plus interest on the repaid amount at the rate 18
of nine and one-half percent per annum. ] 19 102
CCS HCS SS SCS SBs 45 & 90
[335.254. Sections 335.212 to 335.259 1
shall not be construed to require the department 2
to enter into contracts with individ uals who 3
qualify for nursing education loans or nursing 4
loan repayment programs when federal, state and 5
local funds are not available for such purposes. ] 6
[335.257. Successful applicants for whom 1
loan payments are made under the prov isions of 2
sections 335.245 to 335.259 shall verify to the 3
department twice each year in the manner 4
prescribed by the department that qualified 5
employment in this state is being maintained. ] 6
Section B. Because of the importance of en suring 1
healthy pregnancies and healthy women and children in 2
Missouri in the face of growing maternal mortality and to 3
ensure the integrity of the MO HealthNet program and because 4
immediate action is necessary to address the shortage of 5
health care providers in this state, the enactment of 6
sections 191.592, 208.186, and 208.239 and the repeal and 7
reenactment of sections 208.151 and 208.662 of section A of 8
this act are deemed necessary for the immediate preservation 9
of the public health, welfare, pe ace, and safety, and are 10
hereby declared to be emergency acts within the meaning of 11
the constitution, and the enactment of sections 191.592, 12
208.186, and 208.239 and the repeal and reenactment of 13
sections 208.151 and 208.662 of section A of this act sh all 14
be in full force and effect upon its passage and approval. 15
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