Missouri 2023 Regular Session

Missouri Senate Bill SB49 Compare Versions

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Old	New	Differences
1	1
2	2	FIRST REGULAR SESSION
3	3	[TRULY AGREED TO AND FINALLY PASSED ]
4	4	SENATE SUBSTITUTE NO. 2 FOR
5	5	SENATE COMMITTEE SUBSTITUTE FOR
6	6	SENATE BILLS NOS. 49, 236 &
7	7	164
8	8	102ND GENERAL ASSEMBLY
9	9	2023
10	10	0202S.20T
11	11	AN ACT
12	12	To repeal sections 208.152, 217.230, and 221.120, RSMo, and to enact in lieu thereof four new
13	13	sections relating to gender transition procedures.
14	14
15	15	Be it enacted by the General Assembly of the State of Missouri, as follows:
16	16	Section A. Sections 208.152, 217.230, and 221.120, RSMo, 1
17	17	are repealed and four new sections enacted in lieu thereof, to 2
18	18	be known as sections 191.1720, 208.152, 217.230, and 22 1.120, 3
19	19	to read as follows:4
20	20	191.1720. 1. This section shall be known and may be 1
21	21	cited as the "Missouri Save Adolescents from Experimentation 2
22	22	(SAFE) Act". 3
23	23	2. For purposes of this section, the following terms 4
24	24	mean: 5
25	25	(1) "Biological sex", the biological indication of 6
26	26	male or female in the context of reproductive potential or 7
27	27	capacity, such as sex chromosomes, naturally occurring sex 8
28	28	hormones, gonads, and nonambiguous internal and external 9
29	29	genitalia present at birth, without regard to a n 10
30	30	individual's psychological, chosen, or subjective experience 11
31	31	of gender; 12 SS#2 SCS SBs 49, 2
32	32	236 & 164
33	33	(2) "Cross-sex hormones", testosterone, estrogen, or 13
34	34	other androgens given to an individual in amounts that are 14
35	35	greater or more potent than would normally occur naturally 15
36	36	in a healthy individual of the same age and sex; 16
37	37	(3) "Gender", the psychological, behavioral, social, 17
38	38	and cultural aspects of being male or female; 18
39	39	(4) "Gender transition", the process in which an 19
40	40	individual transitions from identifying with and living as a 20
41	41	gender that corresponds to his or her biological sex to 21
42	42	identifying with and living as a gender different from his 22
43	43	or her biological sex, and may involve social, legal, or 23
44	44	physical changes; 24
45	45	(5) "Gender transition surgery", a surgi cal procedure 25
46	46	performed for the purpose of assisting an individual with a 26
47	47	gender transition, including, but not limited to: 27
48	48	(a) Surgical procedures that sterilize, including, but 28
49	49	not limited to, castration, vasectomy, hysterectomy, 29
50	50	oophorectomy, orchiectomy, or penectomy; 30
51	51	(b) Surgical procedures that artificially construct 31
52	52	tissue with the appearance of genitalia that differs from 32
53	53	the individual's biological sex, including, but not limited 33
54	54	to, metoidioplasty, phalloplasty, or vaginoplasty; or 34
55	55	(c) Augmentation mammoplasty or subcutaneous 35
56	56	mastectomy; 36
57	57	(6) "Health care provider", an individual who is 37
58	58	licensed, certified, or otherwise authorized by the laws of 38
59	59	this state to administer health care in the ordinary course 39
60	60	of the practice of his or her profession; 40
61	61	(7) "Puberty-blocking drugs", gonadotropin -releasing 41
62	62	hormone analogues or other synthetic drugs used to stop 42
63	63	luteinizing hormone secretion and follicle stimulating 43
64	64	hormone secretion, synthetic antiandrogen drugs to block the 44 SS#2 SCS SBs 49, 3
65	65	236 & 164
66	66	androgen receptor, or any other drug used to delay or 45
67	67	suppress pubertal development in children for the purpose of 46
68	68	assisting an individual with a gender transition. 47
69	69	3. A health care provider shall not knowingly perform 48
70	70	a gender transition surgery on any individual under eighteen 49
71	71	years of age. 50
72	72	4. (1) A health care provider shall not knowingly 51
73	73	prescribe or administer cross -sex hormones or puberty - 52
74	74	blocking drugs for the purpose of a gender transition for 53
75	75	any individual under eigh teen years of age. 54
76	76	(2) The provisions of this subsection shall not apply 55
77	77	to the prescription or administration of cross -sex hormones 56
78	78	or puberty-blocking drugs for any individual under eighteen 57
79	79	years of age who was prescribed or administered such 58
80	80	hormones or drugs prior to August 28, 2023, for the purpose 59
81	81	of assisting the individual with a gender transition. 60
82	82	(3) The provisions of this subsection shall expire on 61
83	83	August 28, 2027. 62
84	84	5. The performance of a gender transition surgery or 63
85	85	the prescription or administration of cross -sex hormones or 64
86	86	puberty-blocking drugs to an individual under eighteen years 65
87	87	of age in violation of this section shall be considered 66
88	88	unprofessional conduct and any health care provider doing so 67
89	89	shall have his or her license to practice revoked by the 68
90	90	appropriate licensing entity or disciplinary review board 69
91	91	with competent jurisdiction in this state. 70
92	92	6. (1) The prescription or administration of cross - 71
93	93	sex hormones or puberty -blocking drugs to an individua l 72
94	94	under eighteen years of age for the purpose of a gender 73
95	95	transition shall be considered grounds for a cause of action 74
96	96	against the health care provider. The provisions of chapter 75 SS#2 SCS SBs 49, 4
97	97	236 & 164
98	98	538 shall not apply to any action brought under this 76
99	99	subsection. 77
100	100	(2) An action brought pursuant to this subsection 78
101	101	shall be brought within fifteen years of the individual 79
102	102	injured attaining the age of twenty -one or of the date the 80
103	103	treatment of the injury at issue in the action by the 81
104	104	defendant has ceased, whichever i s later. 82
105	105	(3) An individual bringing an action under this 83
106	106	subsection shall be entitled to a rebuttable presumption 84
107	107	that the individual was harmed if the individual is 85
108	108	infertile following the prescription or administration of 86
109	109	cross-sex hormones or puberty-blocking drugs and that the 87
110	110	harm was a direct result of the hormones or drugs prescribed 88
111	111	or administered by the health care provider. Such 89
112	112	presumption may be rebutted only by clear and convincing 90
113	113	evidence. 91
114	114	(4) In any action brought pursu ant to this subsection, 92
115	115	a plaintiff may recover economic and noneconomic damages and 93
116	116	punitive damages, without limitation to the amount and no 94
117	117	less than five hundred thousand dollars in the aggregate. 95
118	118	The judgment against a defendant in an action brou ght 96
119	119	pursuant to this subsection shall be in an amount of three 97
120	120	times the amount of any economic and noneconomic damages or 98
121	121	punitive damages assessed. Any award of damages in an 99
122	122	action brought pursuant to this subsection to a prevailing 100
123	123	plaintiff shall include attorney's fees and court costs. 101
124	124	(5) An action brought pursuant to this subsection may 102
125	125	be brought in any circuit court of this state. 103
126	126	(6) No health care provider shall require a waiver of 104
127	127	the right to bring an action pursuant to thi s subsection as 105
128	128	a condition of services. The right to bring an action by or 106 SS#2 SCS SBs 49, 5
129	129	236 & 164
130	130	through an individual under the age of eighteen shall not be 107
131	131	waived by a parent or legal guardian. 108
132	132	(7) A plaintiff to an action brought under this 109
133	133	subsection may enter i nto a voluntary agreement of 110
134	134	settlement or compromise of the action, but no agreement 111
135	135	shall be valid until approved by the court. No agreement 112
136	136	allowed by the court shall include a provision regarding the 113
137	137	nondisclosure or confidentiality of the terms o f such 114
138	138	agreement unless such provision was specifically requested 115
139	139	and agreed to by the plaintiff. 116
140	140	(8) If requested by the plaintiff, any pleadings, 117
141	141	attachments, or exhibits filed with the court in any action 118
142	142	brought pursuant to this subsection, a s well as any 119
143	143	judgments issued by the court in such actions, shall not 120
144	144	include the personal identifying information of the 121
145	145	plaintiff. Such information shall be provided in a 122
146	146	confidential information filing sheet contemporaneously 123
147	147	filed with the court or entered by the court, which shall 124
148	148	not be subject to public inspection or availability. 125
149	149	7. The provisions of this section shall not apply to 126
150	150	any speech protected by the First Amendment of the United 127
151	151	States Constitution. 128
152	152	8. The provisions of this section shall not apply to 129
153	153	the following: 130
154	154	(1) Services to individuals born with a medically - 131
155	155	verifiable disorder of sex development, including, but not 132
156	156	limited to, an individual with external biological sex 133
157	157	characteristics that are irresol vably ambiguous, such as 134
158	158	those born with 46,XX chromosomes with virilization, 46,XY 135
159	159	chromosomes with undervirilization, or having both ovarian 136
160	160	and testicular tissue; 137 SS#2 SCS SBs 49, 6
161	161	236 & 164
162	162	(2) Services provided when a physician has otherwise 138
163	163	diagnosed an individual wit h a disorder of sex development 139
164	164	and determined through genetic or biochemical testing that 140
165	165	the individual does not have normal sex chromosome 141
166	166	structure, sex steroid hormone production, or sex steroid 142
167	167	hormone action; 143
168	168	(3) The treatment of any infec tion, injury, disease, 144
169	169	or disorder that has been caused by or exacerbated by the 145
170	170	performance of gender transition surgery or the prescription 146
171	171	or administration of cross -sex hormones or puberty -blocking 147
172	172	drugs regardless of whether the surgery was perfor med or the 148
173	173	hormones or drugs were prescribed or administered in 149
174	174	accordance with state and federal law; or 150
175	175	(4) Any procedure undertaken because the individual 151
176	176	suffers from a physical disorder, physical injury, or 152
177	177	physical illness that would, as ce rtified by a physician, 153
178	178	place the individual in imminent danger of death or 154
179	179	impairment of a major bodily function unless surgery is 155
180	180	performed. 156
181	181	208.152. 1. MO HealthNet payments shall be made on 1
182	182	behalf of those eligible needy person s as described in 2
183	183	section 208.151 who are unable to provide for it in whole or 3
184	184	in part, with any payments to be made on the basis of the 4
185	185	reasonable cost of the care or reasonable charge for the 5
186	186	services as defined and determined by the MO HealthNet 6
187	187	division, unless otherwise hereinafter provided, for the 7
188	188	following: 8
189	189	(1) Inpatient hospital services, except to persons in 9
190	190	an institution for mental diseases who are under the age of 10
191	191	sixty-five years and over the age of twenty -one years; 11
192	192	provided that the MO HealthNet division shall provide 12
193	193	through rule and regulation an exception process for 13 SS#2 SCS SBs 49, 7
194	194	236 & 164
195	195	coverage of inpatient costs in those cases requiring 14
196	196	treatment beyond the seventy -fifth percentile professional 15
197	197	activities study (PAS) or the MO HealthNet c hildren's 16
198	198	diagnosis length-of-stay schedule; and provided further that 17
199	199	the MO HealthNet division shall take into account through 18
200	200	its payment system for hospital services the situation of 19
201	201	hospitals which serve a disproportionate number of low - 20
202	202	income patients; 21
203	203	(2) All outpatient hospital services, payments 22
204	204	therefor to be in amounts which represent no more than 23
205	205	eighty percent of the lesser of reasonable costs or 24
206	206	customary charges for such services, determined in 25
207	207	accordance with the principles se t forth in Title XVIII A 26
208	208	and B, Public Law 89 -97, 1965 amendments to the federal 27
209	209	Social Security Act (42 U.S.C. Section 301, et seq.), but 28
210	210	the MO HealthNet division may evaluate outpatient hospital 29
211	211	services rendered under this section and deny payment for 30
212	212	services which are determined by the MO HealthNet division 31
213	213	not to be medically necessary, in accordance with federal 32
214	214	law and regulations; 33
215	215	(3) Laboratory and X-ray services; 34
216	216	(4) Nursing home services for participants, except to 35
217	217	persons with more than five hundred thousand dollars equity 36
218	218	in their home or except for persons in an institution for 37
219	219	mental diseases who are under the age of sixty -five years, 38
220	220	when residing in a hospital licensed by the department of 39
221	221	health and senior services or a nursing home licensed by the 40
222	222	department of health and senior services or appropriate 41
223	223	licensing authority of other states or government -owned and - 42
224	224	operated institutions which are determined to conform to 43
225	225	standards equivalent to licensing requireme nts in Title XIX 44
226	226	of the federal Social Security Act (42 U.S.C. Section 301, 45 SS#2 SCS SBs 49, 8
227	227	236 & 164
228	228	et seq.), as amended, for nursing facilities. The MO 46
229	229	HealthNet division may recognize through its payment 47
230	230	methodology for nursing facilities those nursing facilities 48
231	231	which serve a high volume of MO HealthNet patients. The MO 49
232	232	HealthNet division when determining the amount of the 50
233	233	benefit payments to be made on behalf of persons under the 51
234	234	age of twenty-one in a nursing facility may consider nursing 52
235	235	facilities furnishing care to persons under the age of 53
236	236	twenty-one as a classification separate from other nursing 54
237	237	facilities; 55
238	238	(5) Nursing home costs for participants receiving 56
239	239	benefit payments under subdivision (4) of this subsection 57
240	240	for those days, which shall not exceed twelve per any period 58
241	241	of six consecutive months, during which the participant is 59
242	242	on a temporary leave of absence from the hospital or nursing 60
243	243	home, provided that no such participant shall be allowed a 61
244	244	temporary leave of absence unless it is specifical ly 62
245	245	provided for in his plan of care. As used in this 63
246	246	subdivision, the term "temporary leave of absence" shall 64
247	247	include all periods of time during which a participant is 65
248	248	away from the hospital or nursing home overnight because he 66
249	249	is visiting a friend o r relative; 67
250	250	(6) Physicians' services, whether furnished in the 68
251	251	office, home, hospital, nursing home, or elsewhere; 69
252	252	(7) Subject to appropriation, up to twenty visits per 70
253	253	year for services limited to examinations, diagnoses, 71
254	254	adjustments, and manipulations and treatments of 72
255	255	malpositioned articulations and structures of the body 73
256	256	provided by licensed chiropractic physicians practicing 74
257	257	within their scope of practice. Nothing in this subdivision 75
258	258	shall be interpreted to otherwise expand MO Healt hNet 76
259	259	services; 77 SS#2 SCS SBs 49, 9
260	260	236 & 164
261	261	(8) Drugs and medicines when prescribed by a licensed 78
262	262	physician, dentist, podiatrist, or an advanced practice 79
263	263	registered nurse; except that no payment for drugs and 80
264	264	medicines prescribed on and after January 1, 2006, by a 81
265	265	licensed physician, dentist, podiatrist, or an advanced 82
266	266	practice registered nurse may be made on behalf of any 83
267	267	person who qualifies for prescription drug coverage under 84
268	268	the provisions of P.L. 108 -173; 85
269	269	(9) Emergency ambulance services and, effective 86
270	270	January 1, 1990, medically necessary transportation to 87
271	271	scheduled, physician -prescribed nonelective treatments; 88
272	272	(10) Early and periodic screening and diagnosis of 89
273	273	individuals who are under the age of twenty -one to ascertain 90
274	274	their physical or mental defec ts, and health care, 91
275	275	treatment, and other measures to correct or ameliorate 92
276	276	defects and chronic conditions discovered thereby. Such 93
277	277	services shall be provided in accordance with the provisions 94
278	278	of Section 6403 of P.L. 101 -239 and federal regulations 95
279	279	promulgated thereunder; 96
280	280	(11) Home health care services; 97
281	281	(12) Family planning as defined by federal rules and 98
282	282	regulations; provided, however, that such family planning 99
283	283	services shall not include abortions or any abortifacient 100
284	284	drug or device that is used for the purpose of inducing an 101
285	285	abortion unless such abortions are certified in writing by a 102
286	286	physician to the MO HealthNet agency that, in the 103
287	287	physician's professional judgment, the life of the mother 104
288	288	would be endangered if the fetus were car ried to term; 105
289	289	(13) Inpatient psychiatric hospital services for 106
290	290	individuals under age twenty -one as defined in Title XIX of 107
291	291	the federal Social Security Act (42 U.S.C. Section 1396d, et 108
292	292	seq.); 109 SS#2 SCS SBs 49, 10
293	293	236 & 164
294	294	(14) Outpatient surgical procedures, including 110
295	295	presurgical diagnostic services performed in ambulatory 111
296	296	surgical facilities which are licensed by the department of 112
297	297	health and senior services of the state of Missouri; except, 113
298	298	that such outpatient surgical services shall not include 114
299	299	persons who are elig ible for coverage under Part B of Title 115
300	300	XVIII, Public Law 89 -97, 1965 amendments to the federal 116
301	301	Social Security Act, as amended, if exclusion of such 117
302	302	persons is permitted under Title XIX, Public Law 89 -97, 1965 118
303	303	amendments to the federal Social Security Act, as amended; 119
304	304	(15) Personal care services which are medically 120
305	305	oriented tasks having to do with a person's physical 121
306	306	requirements, as opposed to housekeeping requirements, which 122
307	307	enable a person to be treated by his or her physician on an 123
308	308	outpatient rather than on an inpatient or residential basis 124
309	309	in a hospital, intermediate care facility, or skilled 125
310	310	nursing facility. Personal care services shall be rendered 126
311	311	by an individual not a member of the participant's family 127
312	312	who is qualified to provid e such services where the services 128
313	313	are prescribed by a physician in accordance with a plan of 129
314	314	treatment and are supervised by a licensed nurse. Persons 130
315	315	eligible to receive personal care services shall be those 131
316	316	persons who would otherwise require place ment in a hospital, 132
317	317	intermediate care facility, or skilled nursing facility. 133
318	318	Benefits payable for personal care services shall not exceed 134
319	319	for any one participant one hundred percent of the average 135
320	320	statewide charge for care and treatment in an intermed iate 136
321	321	care facility for a comparable period of time. Such 137
322	322	services, when delivered in a residential care facility or 138
323	323	assisted living facility licensed under chapter 198 shall be 139
324	324	authorized on a tier level based on the services the 140
325	325	resident requires an d the frequency of the services. A 141 SS#2 SCS SBs 49, 11
326	326	236 & 164
327	327	resident of such facility who qualifies for assistance under 142
328	328	section 208.030 shall, at a minimum, if prescribed by a 143
329	329	physician, qualify for the tier level with the fewest 144
330	330	services. The rate paid to providers for eac h tier of 145
331	331	service shall be set subject to appropriations. Subject to 146
332	332	appropriations, each resident of such facility who qualifies 147
333	333	for assistance under section 208.030 and meets the level of 148
334	334	care required in this section shall, at a minimum, if 149
335	335	prescribed by a physician, be authorized up to one hour of 150
336	336	personal care services per day. Authorized units of 151
337	337	personal care services shall not be reduced or tier level 152
338	338	lowered unless an order approving such reduction or lowering 153
339	339	is obtained from the reside nt's personal physician. Such 154
340	340	authorized units of personal care services or tier level 155
341	341	shall be transferred with such resident if he or she 156
342	342	transfers to another such facility. Such provision shall 157
343	343	terminate upon receipt of relevant waivers from the f ederal 158
344	344	Department of Health and Human Services. If the Centers for 159
345	345	Medicare and Medicaid Services determines that such 160
346	346	provision does not comply with the state plan, this 161
347	347	provision shall be null and void. The MO HealthNet division 162
348	348	shall notify the revisor of statutes as to whether the 163
349	349	relevant waivers are approved or a determination of 164
350	350	noncompliance is made; 165
351	351	(16) Mental health services. The state plan for 166
352	352	providing medical assistance under Title XIX of the Social 167
353	353	Security Act, 42 U.S.C. Se ction 301, as amended, shall 168
354	354	include the following mental health services when such 169
355	355	services are provided by community mental health facilities 170
356	356	operated by the department of mental health or designated by 171
357	357	the department of mental health as a community mental health 172
358	358	facility or as an alcohol and drug abuse facility or as a 173 SS#2 SCS SBs 49, 12
359	359	236 & 164
360	360	child-serving agency within the comprehensive children's 174
361	361	mental health service system established in section 175
362	362	630.097. The department of mental health shall establish by 176
363	363	administrative rule the definition and criteria for 177
364	364	designation as a community mental health facility and for 178
365	365	designation as an alcohol and drug abuse facility. Such 179
366	366	mental health services shall include: 180
367	367	(a) Outpatient mental health services including 181
368	368	preventive, diagnostic, therapeutic, rehabilitative, and 182
369	369	palliative interventions rendered to individuals in an 183
370	370	individual or group setting by a mental health professional 184
371	371	in accordance with a plan of treatment appropriately 185
372	372	established, implemented, mon itored, and revised under the 186
373	373	auspices of a therapeutic team as a part of client services 187
374	374	management; 188
375	375	(b) Clinic mental health services including 189
376	376	preventive, diagnostic, therapeutic, rehabilitative, and 190
377	377	palliative interventions rendered to indivi duals in an 191
378	378	individual or group setting by a mental health professional 192
379	379	in accordance with a plan of treatment appropriately 193
380	380	established, implemented, monitored, and revised under the 194
381	381	auspices of a therapeutic team as a part of client services 195
382	382	management; 196
383	383	(c) Rehabilitative mental health and alcohol and drug 197
384	384	abuse services including home and community -based 198
385	385	preventive, diagnostic, therapeutic, rehabilitative, and 199
386	386	palliative interventions rendered to individuals in an 200
387	387	individual or group setti ng by a mental health or alcohol 201
388	388	and drug abuse professional in accordance with a plan of 202
389	389	treatment appropriately established, implemented, monitored, 203
390	390	and revised under the auspices of a therapeutic team as a 204
391	391	part of client services management. As used in this 205 SS#2 SCS SBs 49, 13
392	392	236 & 164
393	393	section, mental health professional and alcohol and drug 206
394	394	abuse professional shall be defined by the department of 207
395	395	mental health pursuant to duly promulgated rules. With 208
396	396	respect to services established by this subdivision, the 209
397	397	department of social services, MO HealthNet division, shall 210
398	398	enter into an agreement with the department of mental 211
399	399	health. Matching funds for outpatient mental health 212
400	400	services, clinic mental health services, and rehabilitation 213
401	401	services for mental health and alcohol and drug abuse shall 214
402	402	be certified by the department of mental health to the MO 215
403	403	HealthNet division. The agreement shall establish a 216
404	404	mechanism for the joint implementation of the provisions of 217
405	405	this subdivision. In addition, the agreement shall 218
406	406	establish a mechanism by which rates for services may be 219
407	407	jointly developed; 220
408	408	(17) Such additional services as defined by the MO 221
409	409	HealthNet division to be furnished under waivers of federal 222
410	410	statutory requirements as provided for and authorized by the 223
411	411	federal Social Security Act (42 U.S.C. Section 301, et seq.) 224
412	412	subject to appropriation by the general assembly; 225
413	413	(18) The services of an advanced practice registered 226
414	414	nurse with a collaborative practice agreement to the extent 227
415	415	that such services are provi ded in accordance with chapters 228
416	416	334 and 335, and regulations promulgated thereunder; 229
417	417	(19) Nursing home costs for participants receiving 230
418	418	benefit payments under subdivision (4) of this subsection to 231
419	419	reserve a bed for the participant in the nursing h ome during 232
420	420	the time that the participant is absent due to admission to 233
421	421	a hospital for services which cannot be performed on an 234
422	422	outpatient basis, subject to the provisions of this 235
423	423	subdivision: 236 SS#2 SCS SBs 49, 14
424	424	236 & 164
425	425	(a) The provisions of this subdivision shall apply 237
426	426	only if: 238
427	427	a. The occupancy rate of the nursing home is at or 239
428	428	above ninety-seven percent of MO HealthNet certified 240
429	429	licensed beds, according to the most recent quarterly census 241
430	430	provided to the department of health and senior services 242
431	431	which was taken prior to when the participant is admitted to 243
432	432	the hospital; and 244
433	433	b. The patient is admitted to a hospital for a medical 245
434	434	condition with an anticipated stay of three days or less; 246
435	435	(b) The payment to be made under this subdivision 247
436	436	shall be provided for a maximum of three days per hospital 248
437	437	stay; 249
438	438	(c) For each day that nursing home costs are paid on 250
439	439	behalf of a participant under this subdivision during any 251
440	440	period of six consecutive months such participant shall, 252
441	441	during the same period of six consecutive months, be 253
442	442	ineligible for payment of nursing home costs of two 254
443	443	otherwise available temporary leave of absence days provided 255
444	444	under subdivision (5) of this subsection; and 256
445	445	(d) The provisions of this subdivision shall not apply 257
446	446	unless the nursing home receives notice from the participant 258
447	447	or the participant's responsible party that the participant 259
448	448	intends to return to the nursing home following the hospital 260
449	449	stay. If the nursing home receives such notification and 261
450	450	all other provisions of this subsection have been satisfied, 262
451	451	the nursing home shall provide notice to the participant or 263
452	452	the participant's responsible party prior to release of the 264
453	453	reserved bed; 265
454	454	(20) Prescribed medically necessary durable medical 266
455	455	equipment. An electronic web-based prior authorization 267
456	456	system using best medical evidence and care and treatment 268 SS#2 SCS SBs 49, 15
457	457	236 & 164
458	458	guidelines consistent with national standards shall be used 269
459	459	to verify medical need; 270
460	460	(21) Hospice care. As used in this subdivision, the 271
461	461	term "hospice care" means a coordinated program of active 272
462	462	professional medical attention within a home, outpatient and 273
463	463	inpatient care which treats the terminally ill patient and 274
464	464	family as a unit, employing a medically directed 275
465	465	interdisciplinary team. The program provides relief of 276
466	466	severe pain or other physical symptoms and supportive care 277
467	467	to meet the special needs arising out of physical, 278
468	468	psychological, spiritual, social, and economic stresses 279
469	469	which are experienced during the final stages of illness, 280
470	470	and during dying and bereavement and meets the Medicare 281
471	471	requirements for participation as a hospice as are provided 282
472	472	in 42 CFR Part 418. The rate of reimbursement paid by the 283
473	473	MO HealthNet division to the hospice provider for room and 284
474	474	board furnished by a nursing home to an eligible hospice 285
475	475	patient shall not be less than ninety -five percent of the 286
476	476	rate of reimbursement which would have been paid for 287
477	477	facility services in that nursing home facility for that 288
478	478	patient, in accordance with subsection (c) of Section 6 408 289
479	479	of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989); 290
480	480	(22) Prescribed medically necessary dental services. 291
481	481	Such services shall be subject to appropriations. An 292
482	482	electronic web-based prior authorization system using best 293
483	483	medical evidence and care and treatment guidelines 294
484	484	consistent with national standards shall be used to verify 295
485	485	medical need; 296
486	486	(23) Prescribed medically necessary optometric 297
487	487	services. Such services shall be subject to 298
488	488	appropriations. An electronic web-based prior authorization 299
489	489	system using best medical evidence and care and treatment 300 SS#2 SCS SBs 49, 16
490	490	236 & 164
491	491	guidelines consistent with national standards shall be used 301
492	492	to verify medical need; 302
493	493	(24) Blood clotting products -related services. For 303
494	494	persons diagnosed with a bleeding d isorder, as defined in 304
495	495	section 338.400, reliant on blood clotting products, as 305
496	496	defined in section 338.400, such services include: 306
497	497	(a) Home delivery of blood clotting products and 307
498	498	ancillary infusion equipment and supplies, including the 308
499	499	emergency deliveries of the product when medically necessary; 309
500	500	(b) Medically necessary ancillary infusion equipment 310
501	501	and supplies required to administer the blood clotting 311
502	502	products; and 312
503	503	(c) Assessments conducted in the participant's home by 313
504	504	a pharmacist, nurse, or local home health care agency 314
505	505	trained in bleeding disorders when deemed necessary by the 315
506	506	participant's treating physician; 316
507	507	(25) The MO HealthNet division shall, by January 1, 317
508	508	2008, and annually thereafter, report the status of MO 318
509	509	HealthNet provider reimbursement rates as compared to one 319
510	510	hundred percent of the Medicare reimbursement rates and 320
511	511	compared to the average dental reimbursement rates paid by 321
512	512	third-party payors licensed by the state. The MO HealthNet 322
513	513	division shall, by July 1, 2008, provide to the general 323
514	514	assembly a four-year plan to achieve parity with Medicare 324
515	515	reimbursement rates and for third -party payor average dental 325
516	516	reimbursement rates. Such plan shall be subject to 326
517	517	appropriation and the division shall include in its annual 327
518	518	budget request to the governor the necessary funding needed 328
519	519	to complete the four -year plan developed under this 329
520	520	subdivision. 330
521	521	2. Additional benefit payments for medical assistance 331
522	522	shall be made on behalf of those eligible needy children , 332 SS#2 SCS SBs 49, 17
523	523	236 & 164
524	524	pregnant women and blind persons with any payments to be 333
525	525	made on the basis of the reasonable cost of the care or 334
526	526	reasonable charge for the services as defined and determined 335
527	527	by the MO HealthNet division, unless otherwise hereinafter 336
528	528	provided, for the following: 337
529	529	(1) Dental services; 338
530	530	(2) Services of podiatrists as defined in section 339
531	531	330.010; 340
532	532	(3) Optometric services as described in section 341
533	533	336.010; 342
534	534	(4) Orthopedic devices or other prosthetics, including 343
535	535	eye glasses, dentures, h earing aids, and wheelchairs; 344
536	536	(5) Hospice care. As used in this subdivision, the 345
537	537	term "hospice care" means a coordinated program of active 346
538	538	professional medical attention within a home, outpatient and 347
539	539	inpatient care which treats the terminally ill patient and 348
540	540	family as a unit, employing a medically directed 349
541	541	interdisciplinary team. The program provides relief of 350
542	542	severe pain or other physical symptoms and supportive care 351
543	543	to meet the special needs arising out of physical, 352
544	544	psychological, spiritua l, social, and economic stresses 353
545	545	which are experienced during the final stages of illness, 354
546	546	and during dying and bereavement and meets the Medicare 355
547	547	requirements for participation as a hospice as are provided 356
548	548	in 42 CFR Part 418. The rate of reimbursemen t paid by the 357
549	549	MO HealthNet division to the hospice provider for room and 358
550	550	board furnished by a nursing home to an eligible hospice 359
551	551	patient shall not be less than ninety -five percent of the 360
552	552	rate of reimbursement which would have been paid for 361
553	553	facility services in that nursing home facility for that 362
554	554	patient, in accordance with subsection (c) of Section 6408 363
555	555	of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989); 364 SS#2 SCS SBs 49, 18
556	556	236 & 164
557	557	(6) Comprehensive day rehabilitation services 365
558	558	beginning early posttrauma as part of a coordinated system 366
559	559	of care for individuals with disabling impairments. 367
560	560	Rehabilitation services must be based on an individualized, 368
561	561	goal-oriented, comprehensive and coordinated treatment plan 369
562	562	developed, implemented, and monitored through an 370
563	563	interdisciplinary assessment designed to restore an 371
564	564	individual to optimal level of physical, cognitive, and 372
565	565	behavioral function. The MO HealthNet division shall 373
566	566	establish by administrative rule the definition and criteria 374
567	567	for designation of a comprehensiv e day rehabilitation 375
568	568	service facility, benefit limitations and payment 376
569	569	mechanism. Any rule or portion of a rule, as that term is 377
570	570	defined in section 536.010, that is created under the 378
571	571	authority delegated in this subdivision shall become 379
572	572	effective only if it complies with and is subject to all of 380
573	573	the provisions of chapter 536 and, if applicable, section 381
574	574	536.028. This section and chapter 536 are nonseverable and 382
575	575	if any of the powers vested with the general assembly 383
576	576	pursuant to chapter 536 to review, to delay the effective 384
577	577	date, or to disapprove and annul a rule are subsequently 385
578	578	held unconstitutional, then the grant of rulemaking 386
579	579	authority and any rule proposed or adopted after August 28, 387
580	580	2005, shall be invalid and void. 388
581	581	3. The MO HealthNet division may require any 389
582	582	participant receiving MO HealthNet benefits to pay part of 390
583	583	the charge or cost until July 1, 2008, and an additional 391
584	584	payment after July 1, 2008, as defined by rule duly 392
585	585	promulgated by the MO HealthNet division, for all covered 393
586	586	services except for those services covered under 394
587	587	subdivisions (15) and (16) of subsection 1 of this section 395
588	588	and sections 208.631 to 208.657 to the extent and in the 396 SS#2 SCS SBs 49, 19
589	589	236 & 164
590	590	manner authorized by Title XIX of the federal Social 397
591	591	Security Act (42 U.S.C. Section 13 96, et seq.) and 398
592	592	regulations thereunder. When substitution of a generic drug 399
593	593	is permitted by the prescriber according to section 338.056, 400
594	594	and a generic drug is substituted for a name -brand drug, the 401
595	595	MO HealthNet division may not lower or delete the 402
596	596	requirement to make a co -payment pursuant to regulations of 403
597	597	Title XIX of the federal Social Security Act. A provider of 404
598	598	goods or services described under this section must collect 405
599	599	from all participants the additional payment that may be 406
600	600	required by the MO HealthNet division under authority 407
601	601	granted herein, if the division exercises that authority, to 408
602	602	remain eligible as a provider. Any payments made by 409
603	603	participants under this section shall be in addition to and 410
604	604	not in lieu of payments made by the sta te for goods or 411
605	605	services described herein except the participant portion of 412
606	606	the pharmacy professional dispensing fee shall be in 413
607	607	addition to and not in lieu of payments to pharmacists. A 414
608	608	provider may collect the co -payment at the time a service is 415
609	609	provided or at a later date. A provider shall not refuse to 416
610	610	provide a service if a participant is unable to pay a 417
611	611	required payment. If it is the routine business practice of 418
612	612	a provider to terminate future services to an individual 419
613	613	with an unclaimed deb t, the provider may include uncollected 420
614	614	co-payments under this practice. Providers who elect not to 421
615	615	undertake the provision of services based on a history of 422
616	616	bad debt shall give participants advance notice and a 423
617	617	reasonable opportunity for payment. A provider, 424
618	618	representative, employee, independent contractor, or agent 425
619	619	of a pharmaceutical manufacturer shall not make co -payment 426
620	620	for a participant. This subsection shall not apply to other 427
621	621	qualified children, pregnant women, or blind persons. If 428 SS#2 SCS SBs 49, 20
622	622	236 & 164
623	623	the Centers for Medicare and Medicaid Services does not 429
624	624	approve the MO HealthNet state plan amendment submitted by 430
625	625	the department of social services that would allow a 431
626	626	provider to deny future services to an individual with 432
627	627	uncollected co-payments, the denial of services shall not be 433
628	628	allowed. The department of social services shall inform 434
629	629	providers regarding the acceptability of denying services as 435
630	630	the result of unpaid co -payments. 436
631	631	4. The MO HealthNet division shall have the right to 437
632	632	collect medication samples from participants in order to 438
633	633	maintain program integrity. 439
634	634	5. Reimbursement for obstetrical and pediatric 440
635	635	services under subdivision (6) of subsection 1 of this 441
636	636	section shall be timely and sufficient to enlist enough 442
637	637	health care providers so that care and services are 443
638	638	available under the state plan for MO HealthNet benefits at 444
639	639	least to the extent that such care and services are 445
640	640	available to the general population in the geographic area, 446
641	641	as required under subparagraph (a)(30)(A) of 42 U.S.C. 447
642	642	Section 1396a and federal regulations promulgated thereunder. 448
643	643	6. Beginning July 1, 1990, reimbursement for services 449
644	644	rendered in federally funded health centers shall be in 450
645	645	accordance with the provisions of subsection 6402(c) and 451
646	646	Section 6404 of P.L. 101-239 (Omnibus Budget Reconciliation 452
647	647	Act of 1989) and federal regulations promulgated thereunder. 453
648	648	7. Beginning July 1, 1990, the department of social 454
649	649	services shall provide notification and referral of children 455
650	650	below age five, and pregnant, breast-feeding, or postpartum 456
651	651	women who are determined to be eligible for MO HealthNet 457
652	652	benefits under section 208.151 to the special supplemental 458
653	653	food programs for women, infants and children administered 459
654	654	by the department of health and seni or services. Such 460 SS#2 SCS SBs 49, 21
655	655	236 & 164
656	656	notification and referral shall conform to the requirements 461
657	657	of Section 6406 of P.L. 101 -239 and regulations promulgated 462
658	658	thereunder. 463
659	659	8. Providers of long-term care services shall be 464
660	660	reimbursed for their costs in accordance with the provisions 465
661	661	of Section 1902 (a)(13)(A) of the Social Security Act, 42 466
662	662	U.S.C. Section 1396a, as amended, and regulations 467
663	663	promulgated thereunder. 468
664	664	9. Reimbursement rates to long -term care providers 469
665	665	with respect to a total change in ownership, at arm's 470
666	666	length, for any facility previously licensed and certified 471
667	667	for participation in the MO HealthNet program shall not 472
668	668	increase payments in excess of the increase that would 473
669	669	result from the application of Section 1902 (a)(13)(C) of 474
670	670	the Social Security Act, 42 U.S.C. Section 1396a (a)(13)(C). 475
671	671	10. The MO HealthNet division may enroll qualified 476
672	672	residential care facilities and assisted living facilities, 477
673	673	as defined in chapter 198, as MO HealthNet personal care 478
674	674	providers. 479
675	675	11. Any income earned by individuals eligible for 480
676	676	certified extended employment at a sheltered workshop under 481
677	677	chapter 178 shall not be considered as income for purposes 482
678	678	of determining eligibility under this section. 483
679	679	12. If the Missouri Medicaid audit and compliance unit 484
680	680	changes any interpretation or application of the 485
681	681	requirements for reimbursement for MO HealthNet services 486
682	682	from the interpretation or application that has been applied 487
683	683	previously by the state in any audit of a MO HealthNet 488
684	684	provider, the Missouri Medicaid audit and compliance unit 489
685	685	shall notify all affected MO HealthNet providers five 490
686	686	business days before such change shall take effect. Failure 491
687	687	of the Missouri Medicaid audit and compliance unit to notify 492 SS#2 SCS SBs 49, 22
688	688	236 & 164
689	689	a provider of such change shall entitle t he provider to 493
690	690	continue to receive and retain reimbursement until such 494
691	691	notification is provided and shall waive any liability of 495
692	692	such provider for recoupment or other loss of any payments 496
693	693	previously made prior to the five business days after such 497
694	694	notice has been sent. Each provider shall provide the 498
695	695	Missouri Medicaid audit and compliance unit a valid email 499
696	696	address and shall agree to receive communications 500
697	697	electronically. The notification required under this 501
698	698	section shall be delivered in writing b y the United States 502
699	699	Postal Service or electronic mail to each provider. 503
700	700	13. Nothing in this section shall be construed to 504
701	701	abrogate or limit the department's statutory requirement to 505
702	702	promulgate rules under chapter 536. 506
703	703	14. Beginning July 1, 2016, and subject to 507
704	704	appropriations, providers of behavioral, social, and 508
705	705	psychophysiological services for the prevention, treatment, 509
706	706	or management of physical health problems shall be 510
707	707	reimbursed utilizing the behavior assessment and 511
708	708	intervention reimbursement codes 96150 to 96154 or their 512
709	709	successor codes under the Current Procedural Terminology 513
710	710	(CPT) coding system. Providers eligible for such 514
711	711	reimbursement shall include psychologists. 515
712	712	15. There shall be no payments made under this section 516
713	713	for gender transition surgeries, cross -sex hormones, or 517
714	714	puberty-blocking drugs, as such terms are defined in section 518
715	715	191.1720, for the purpose of a gender transition. 519
716	716	217.230. The director shall arrange for necessary 1
717	717	health care services for offenders confined in correctional 2
718	718	centers, which shall not include any gender transition 3
719	719	surgery, as defined in section 191.1720 . 4 SS#2 SCS SBs 49, 23
720	720	236 & 164
721	721	221.120. 1. If any prisoner confined in the county 1
722	722	jail is sick and in the judgment of the jai ler, requires the 2
723	723	attention of a physician, dental care, or medicine, the 3
724	724	jailer shall procure the necessary medicine, dental care or 4
725	725	medical attention necessary or proper to maintain the health 5
726	726	of the prisoner; provided, that this shall not include an y 6
727	727	gender transition surgery, as defined in section 191.1720 . 7
728	728	The costs of such medicine, dental care, or medical 8
729	729	attention shall be paid by the prisoner through any health 9
730	730	insurance policy as defined in subsection 3 of this section, 10
731	731	from which the prisoner is eligible to receive benefits. If 11
732	732	the prisoner is not eligible for such health insurance 12
733	733	benefits then the prisoner shall be liable for the payment 13
734	734	of such medical attention, dental care, or medicine, and the 14
735	735	assets of such prisoner may be su bject to levy and execution 15
736	736	under court order to satisfy such expenses in accordance 16
737	737	with the provisions of section 221.070, and any other 17
738	738	applicable law. The county commission of the county may at 18
739	739	times authorize payment of certain medical costs that the 19
740	740	county commission determines to be necessary and 20
741	741	reasonable. As used in this section, the term "medical 21
742	742	costs" includes the actual costs of medicine, dental care or 22
743	743	other medical attention and necessary costs associated with 23
744	744	such medical care su ch as transportation, guards and 24
745	745	inpatient care. 25
746	746	2. The county commission may, in their discretion, 26
747	747	employ a physician by the year, to attend such prisoners, 27
748	748	and make such reasonable charge for his service and 28
749	749	medicine, when required, to be taxed and collected as 29
750	750	provided by law. 30
751	751	3. As used in this section, the following terms mean: 31 SS#2 SCS SBs 49, 24
752	752	236 & 164
753	753	(1) "Assets", property, tangible or intangible, real 32
754	754	or personal, belonging to or due a prisoner or a former 33
755	755	prisoner, including income or payments to s uch prisoner from 34
756	756	Social Security, workers' compensation, veterans' 35
757	757	compensation, pension benefits, previously earned salary or 36
758	758	wages, bonuses, annuities, retirement benefits, compensation 37
759	759	paid to the prisoner per work or services performed while a 38
760	760	prisoner or from any other source whatsoever, including any 39
761	761	of the following: 40
762	762	(a) Money or other tangible assets received by the 41
763	763	prisoner as a result of a settlement of a claim against the 42
764	764	state, any agency thereof, or any claim against an employee 43
765	765	or independent contractor arising from and in the scope of 44
766	766	the employee's or contractor's official duties on behalf of 45
767	767	the state or any agency thereof; 46
768	768	(b) A money judgment received by the prisoner from the 47
769	769	state as a result of a civil action in which the state, an 48
770	770	agency thereof or any state employee or independent 49
771	771	contractor where such judgment arose from a claim arising 50
772	772	from the conduct of official duties on behalf of the state 51
773	773	by the employee or subcontractor or for any agency of the 52
774	774	state; 53
775	775	(c) A current stream of income from any source 54
776	776	whatsoever, including a salary, wages, disability benefits, 55
777	777	retirement benefits, pension benefits, insurance or annuity 56
778	778	benefits, or similar payments; and 57
779	779	(2) "Health insurance policy", any g roup insurance 58
780	780	policy providing coverage on an expense -incurred basis, any 59
781	781	group service or indemnity contract issued by a not -for- 60
782	782	profit health services corporation or any self -insured group 61
783	783	health benefit plan of any type or description. 62
784	784	