SECONDREGULARSESSION
HOUSEBILLNO.2215
102NDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEBROWN(16).
4770H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Toamendchapter191,RSMo,byaddingtheretosevennewsectionsrelatingtoalternative
therapiesforveterans.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Chapter191,RSMo,isamendedbyaddingtheretosevennewsections,to
2beknownassections191.2600,191.2605,191.2610,191.2615,191.2620,191.2625,and
3191.2630,toreadasfollows:
191.2600.Sections191.2600to191.2630shallbeknownandmaybecitedasthe
2"VeteransTraumaticBrainInjuryTreatmentandRecoveryAct".
191.2605.Asusedinsections191.2600to191.2630,unlessthecontextindicates
2otherwise,thefollowingtermsmean:
3 (1)"Alternativetherapies",anytherapiesforaconditionthatarenotconsidered
4thestandardorconventionaltherapiesforthatconditionincluding,butnotlimitedto,
5hyperbaricoxygentherapy;
6 (2)"Commission",theMissouriveteranscommission;
7 (3)"Facility",apublicorprivatehealthclinic,outpatienthealthclinic,
8communityhealthcenter,hospital,orotherfacilityauthorizedunderrulesofthe
9departmentofhealthandseniorservicestoprovidehyperbaricoxygentherapyunder
10sections191.2600to191.2630;
11 (4)"Fund",theveteranstraumaticbraininjurytreatmentandrecoveryfund
12establishedinsection191.2615;
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 13 (5)"Healthcarepractitioner",apersonwhoislicensedtoprovidemedicalor
14otherhealthcareinthisstateandwhohasprescriptiveauthorityincluding,butnot
15limitedto,aphysician;
16 (6)"Hyperbaricoxygentherapy"or"therapy",treatmentforposttraumatic
17stressdisorderortraumaticbraininjurythatisbasedonavalidprescriptionfroma
18healthcarepractitionerandthatisdeliveredthrough:
19 (a)AhyperbaricchamberapprovedbytheUnitedStatesFoodandDrug
20Administration;or
21 (b)AhyperbaricoxygendevicethatisapprovedbytheUnitedStatesFoodand
22DrugAdministration;
23 (7)"Physician",apersonlicensedtopracticemedicineinthisstateunder
24chapter334;
25 (8)"Posttraumaticstressdisorder",amentalhealthconditionthatistriggered
26byaterrifyingevent,suchasbyeitherexperiencingorwitnessingalife-threatening
27event,including,butnotlimitedto,militarysexualtrauma,orasasecondarysequelato
28bodytrauma;
29 (9)"Traumaticbraininjury",anacquiredinjurytothebrain.Theterm
30"traumaticbraininjury"doesnotincludebraindysfunctioncausedbyacongenitalor
31degenerativedisorderorbirthtrauma;
32 (10)"Veteran",anindividualwhohasserved:
33 (a)InanactiveorreservecomponentoftheArmy,Navy,AirForce,Marine
34Corps,SpaceForce,orCoastGuardoftheUnitedStates;
35 (b)IntheNationalGuardofanystate;or
36 (c)Onactiveduty,otherthanfortraining,inanycomponentoftheArmed
37ForcesoftheUnitedStatesforaperiodofonehundredeightydaysormore,unless
38releasedearlierbecauseofservice-connecteddisability,andwhowasdischargedor
39releasedfromtheArmedForcesoftheUnitedStatesunderotherthandishonorable
40conditions.
191.2610.Anyfacilityinthisstatethatprovideshyperbaricoxygentherapytoa
2veteranshallbeeligibleforreimbursementforsuchtherapyfromthecommissionifthe
3followingconditionsaresatisfied:
4 (1)Theveteranreceivingthetherapyhasbeendiagnosed,byahealthcare
5practitioner,withposttraumaticstressdisorderoratraumaticbraininjuryandhas
6demonstratedthatheorshepreviouslysoughtservicesforposttraumaticstressdisorder
7oratraumaticbraininjurythroughtheVeteransHealthAdministrationservice
8deliverysystemor,ifavailabletotheveteran,throughtheprivatehealthinsurance
9system;
HB2215 2 10 (2)Theveteranreceivingthetherapyvoluntarilyagreedtothetherapy;
11 (3)Thefacilitycomplieswithapplicablefirecodes,oversightrequirements,and
12anytreatmentprotocolsrequiredundersections191.2600to191.2630;
13 (4)Theveteranreceivingthetherapyresideswithinthisstate;
14 (5)Anyhyperbaricchamberusedtotreattheveteranmeetstheminimum
15standardsforpatientsestablishedbytheUnitedStatesFoodandDrugAdministration;
16 (6)ThefacilitycomplieswiththefederalHealthInsuranceandPortability
17AccountabilityActof1996fortheveteranreceivingthetherapy;
18 (7)Thefacility'streatmentprotocolsforhyperbaricoxygentherapyarealigned
19withthemedicalstandardsdemonstratedinpublishedclinicaltrialsforhyperbaric
20oxygentherapythatoccurredunderthedirectionofaninstitutionalreviewboard;
21 (8)Thehyperbaricoxygentherapyisdeliveredsolelybyhealthcare
22practitionersinaccordancewithfederalandstatelaw;
23 (9)Beforeprovidinghyperbaricoxygentherapytotheveteran,thefacility
24establishedatreatmentplanconsistentwiththerequirementsofsections191.2600to
25191.2630;
26 (10)Aprescriptionorderforhyperbaricoxygentherapywasissuedbyahealth
27carepractitionerbeforethefacilityprovidedthetherapy;
28 (11)Thefacilityverifiedthatboththefacilityandtheveteranmetthe
29requirementsundersections191.2600to191.2630forreimbursementbeforeproceeding
30withthetherapy;
31 (12)Beforeprovidingthetherapy,thefacilityestimatedthecostsofthetherapy,
32includingthecostsofcognitivetestingtobeconductedbeforeandafterthetherapy;
33 (13)Thefacilityretainsintheveteran'shealthcarefileinformationonthetype
34ofcognitivetestingperformedaswellastheresultsofthecognitivetesting;
35 (14)Theveteranisnotchargedorbilledforthetherapybythefacilityorany
36otherentityandisnotliableforthecostsofthetherapyoranyexpensesincurredin
37accordancewithsections191.2600to191.2630;
38 (15)Thefacilityandanyhealthcarepractitionersinvolvedinthehyperbaric
39oxygentherapyagreetocooperatewiththecommissiontoprovideanannualdata
40summarytreatmentreportsufficienttoassesstheefficacyofalternativetreatment
41modalitiesfortreatingveteranswithposttraumaticstressdisorderandtraumaticbrain
42injuries;and
43 (16)Thefacilityreceivesadvanceapprovalfromthecommissionasdescribedin
44section191.2615.
191.2615.1.(1)Thereisherebycreatedinthestatetreasurythe"Veterans
2TraumaticBrainInjuryTreatmentandRecoveryFund".Thefundshallconsistofany
HB2215 3 3appropriations,gifts,bequests,orpublicorprivatedonationstosuchfund.Thestate
4treasurershallbecustodianofthefund.Inaccordancewithsections30.170and30.180,
5thestatetreasurermayapprovedisbursements.Thefundshallbeadedicatedfundand,
6uponappropriation,moneysinthisfundshallbeusedsolelyforreimbursementsto
7facilitiesforhyperbaricoxygentherapyprovidedtoveterans,foradministrative
8expensesincurredbythecommissionindistributingsuchreimbursements,andfor
9studiesontheuseofalternativetherapiestotreatveteranswithposttraumaticstress
10disorderandtraumaticbraininjuries.
11 (2)Notwithstandingtheprovisionsofsection33.080tothecontrary,anymoneys
12remaininginthefundattheendofthebienniumshallnotreverttothecreditofthe
13generalrevenuefund.
14 (3)Thestatetreasurershallinvestmoneysinthefundinthesamemanneras
15otherfundsareinvested.Anyinterestandmoneysearnedonsuchinvestmentsshallbe
16creditedtothefund.
17 2.Anyfacilitythatintendstoseekreimbursementfromthefundforhyperbaric
18oxygentherapyprovidedtoaveteranshallrequestadvanceapprovalfromthe
19commissionforreimbursementbeforeprovidingsuchtherapy.Uponapprovalbythe
20commission,thecommissionshallsetasidetheappropriateamountoffundstoensure
21fullpaymentfortheveteran'stherapy.Ifmoneysremaininginthefundareinsufficient
22toensurefullpayment,thecommissionshalldenythefacility'srequestforadvance
23approval.
24 3.Ifattheendofthesix-monthperiodimmediatelyfollowingthedatethe
25commissionapprovedthefacility'srequestforadvanceapprovalthefacilityhasnot
26submittedanybillstothecommissionfortheveteranorprovidedanytherapyforthe
27veteran,thecommissionshallnotifytheveteranandthefacilitythatthefunding
28reservedfortheveteranshallexpirewithinthirtydaysifthefacilityfailstonotifythe
29commissionthattherapyisscheduledorcontinued.Ifthefacilityfailstonotifythe
30commissionthattherapyisscheduledorcontinuedwithinthirtydays,thecommission
31shallreleasethefundsreservedfortheveteranandmakethemavailableforanother
32veteran'stherapyundersections191.2600to191.2630.
33 4.Afterreceivingadvanceapprovalfromthecommissionandproviding
34hyperbaricoxygentherapytoaveteraninaccordancewithsections191.2600to
35191.2630,thefacilityshallnotbilltheveteranforthetherapybutshallsubmitthebill
36forthetherapytothecommission.
37 5.Thecommissionshallpaythebillforthetherapyreceivedinaccordancewith
38subsection4ofthissectionfromthefundwithinforty-fivedaysofreceipt.Ifthecostsof
39thetherapyexceedtheavailabilityofmoneysremaininginthefund,thefacilityshallnot
HB2215 4 40holdtheveteranresponsibleforanypayment,andthecommissionshallnothaveany
41obligationtomakepaymentstothefacilityinanamountthatexceedstheamountthat
42wassetasideuponadvanceapprovalasdescribedinsubsection2ofthissection.
43 6.Thecommissionshallseekreimbursementforpaymentsmadetofacilitiesfor
44treatingveteranswithhyperbaricoxygentherapyfromanyofthefollowingentities
45basedontheefficacyoftreatmentsasdemonstratedinthehealingoftraumaticbrain
46injuriesthroughhyperbaricoxygentherapybycognitivetesting,brainscans,orother
47assessmentprotocolsmedicallyacceptedbytheUnitedStatesFoodandDrug
48AdministrationortheUnitedStatesDepartmentofDefenseundertheWarRisk
49InsuranceAct,asamended:
50 (1)TheTricareprogramoftheUnitedStatesDepartmentofDefense;
51 (2)Appropriatefederalagencies,includingtheVeteransHealthAdministration;
52and
53 (3)Anyotherresponsiblethird-partypayer.
54 7.Thedepartmentofhealthandseniorservicesshallawardfundstoentitiesto
55studytheuseofalternativetherapiestotreatveteranswithposttraumaticstress
56disorderandtraumaticbraininjuries.
191.2620.1.Anyfacilitymayapprovehyperbaricoxygentherapyforaveteran
2inaccordancewithsections191.2600to191.2630.
3 2.Alicensingboardshallnotrevoke,failtorenew,suspend,ortakeanyaction
4againstahealthcarepractitionerbasedsolelyonthehealthcarepractitioner's
5recommendationstoaveteranregardingaccesstoortreatmentwithhyperbaricoxygen
6therapy.
7 3.Nostateagencyshalltakeanyaction,orassistinanyaction,againstahealth
8carepractitioner'sMedicareorMedicaidcertificationbasedsolelyonthehealthcare
9practitioner'srecommendationthataveteranhaveaccesstohyperbaricoxygentherapy.
10 4.Noofficialemployeeoragentofthestateshallblockorattempttoblockaccess
11tohyperbaricoxygentherapybyaveteranwhomeetsallrequirementstoreceivesuch
12therapyundersections191.2600to191.2630.
13 5.Counseling,advice,orrecommendationsprovidedbyahealthcare
14practitionerconsistentwiththemedicalstandardsofcareshallnotbeconsidereda
15violationofsections191.2600to191.2630.
16 6.Hyperbaricoxygentherapymaybeusedunderthedirectionofan
17institutionalreviewboardwithanationalclinicaltrialnumberforthepurposeof
18collectingclinicaltrialdata.
191.2625.1.Anyfacilitythatreceivesreimbursementfromthefundshall:
HB2215 5 2 (1)Providereportsonindividualveteransandgroupsofveteranstothe
3commissiononmeasuredhealthimprovementsfromacceptedandapprovedcognitive
4testingprotocols,brainimaging,orothermedicalassessmentsapprovedbytheindustry,
5theUnitedStatesFoodandDrugAdministration,theUnitedStatesDepartmentof
6Defense,Tricare,ortheCentersforMedicareandMedicaidServicesconductedbefore
7andaftertherapy;and
8 (2)Submitanannualreporttothecommissionwiththefollowinginformation:
9 (a)Thenumberofveteranswhoreceivedhyperbaricoxygentherapyatthe
10facility;
11 (b)Thedemographicsoftheveteranswhoreceivedhyperbaricoxygentherapy
12atthefacility;
13 (c)Thenumberofactualhyperbaricoxygentherapydivesbyveterans
14completedatthefacility;
15 (d)Cognitivetestresultsofveteranswhoreceivedhyperbaricoxygentherapyat
16thefacility;and
17 (e)Anytestimonialsprovidedbyveteransvoluntarily.
18 2.(1)BeforeJanuaryfirsteachyear,thecommissionshallprepareareport
19detailingeachtreatmentofhyperbaricoxygentherapyprovidedtoaveteranin
20accordancewithsections191.2600to191.2630,theprovidertypeforeachtreatment
21provided,thenumberofveteranstreatedorserved,thetreatmentoutcomesforthe
22veteranstreatedorserved,andadetailedaccountingofthemoneysusedinthefund
23duringtheimmediatelyprecedingfiscalyear.
24 (2)Thecommissionshallsubmitthereportpreparedundersubdivision(1)of
25thissubsectiontothegovernor,thepresidentprotemporeofthesenate,thespeakerof
26thehouseofrepresentatives,andthedirectorofthedepartmentofhealthandsenior
27services.
28 3.BeforeJanuarythirtietheachyear,thedepartmentofhealthandsenior
29servicesshallsubmittothegovernorareportcontaining:
30 (1)Findingsandrecommendationsrelatedtotheadministrationofsections
31191.2600to191.2630;
32 (2)Findingsandrecommendationsfromanystudiesfundedundersection
33191.2615regardingtheefficacyofalternativetherapiestotreatposttraumaticstress
34disorderandtraumaticbraininjuries;and
35 (3)Recommendationsonbudgetary,legislative,orregulatorychangesneededto
36expandaccesstoalternativetherapiesforveteranswithposttraumaticstressdisorder
37andtraumaticbraininjuries.
HB2215 6 191.2630.Thecommissionandthedepartmentofhealthandseniorservicesshall
2jointlypromulgateallnecessaryrulesandregulationsfortheadministrationofsections
3191.2600to191.2630.Anyruleorportionofarule,asthattermisdefinedinsection
4536.010,thatiscreatedundertheauthoritydelegatedinthissectionshallbecome
5effectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsofchapter536and,
6ifapplicable,section536.028.Thissectionandchapter536arenonseverableandifany
7ofthepowersvestedwiththegeneralassemblypursuanttochapter536toreview,to
8delaytheeffectivedate,ortodisapproveandannularulearesubsequentlyheld
9unconstitutional,thenthegrantofrulemakingauthorityandanyruleproposedor
10adoptedafterAugust28,2024,shallbeinvalidandvoid.
âś”
HB2215 7