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Missouri House Bill HB1304

Missouri 2025 Regular Session

Missouri House Bill HB1304 Compare Versions

Only one version of the bill is available at this time.
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11 FIRSTREGULARSESSION
22 HOUSEBILLNO.1304
33 103RDGENERALASSEMBLY
44 INTRODUCEDBYREPRESENTATIVEAUNE.
55 2712H.02I JOSEPHENGLER,ChiefClerk
66 ANACT
77 Torepealsections188.015,188.017,188.020,188.021,188.027,188.030,188.033,188.038,
88 188.039,188.047,188.052,188.056,188.057,188.058,188.075,188.080,188.230,
99 188.375,192.665,192.667,197.150,197.152,197.158,197.160,197.162,197.165,
1010 197.200,197.205,197.215,197.220,197.225,197.230,197.235,197.240,197.285,
1111 197.287,197.289,197.293,197.295,334.100,334.245,334.735,574.200,and
1212 595.027,RSMo,andtoenactinlieuthereoftwenty-fivenewsectionsrelatingto
1313 abortion.
1414 BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
1515 SectionA.Sections188.015,188.017,188.020,188.021,188.027,188.030,188.033,
1616 2188.038,188.039,188.047,188.052,188.056,188.057,188.058,188.075,188.080,188.230,
1717 3188.375,192.665,192.667,197.150,197.152,197.158,197.160,197.162,197.165,197.200,
1818 4197.205,197.215,197.220,197.225,197.230,197.235,197.240,197.285,197.287,197.289,
1919 5197.293,197.295,334.100,334.245,334.735,574.200,and595.027,RSMo,arerepealedand
2020 6twenty-fivenewsectionsenactedinlieuthereof,tobeknownassections188.015,192.665,
2121 7192.667,197.150,197.152,197.158,197.160,197.162,197.165,197.200,197.205,197.215,
2222 8197.220,197.225,197.230,197.235,197.240,197.285,197.287,197.289,197.293,197.295,
2323 9334.100,334.735,and595.027,toreadasfollows:
2424 188.015.Asusedinthischapter,thefollowingtermsmean:
2525 2 (1)"Abortion":
2626 3 (a)Theactofusingorprescribinganyinstrument,device,medicine,drug,orany
2727 4othermeansorsubstancewiththeintentto[destroythelifeof]terminateanembryoorfetus
2828 5[inhisorhermother'swomb]; or
2929 EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
3030 intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 6 (b)Theintentionalterminationof[the]apregnancy[ofamother] byusingor
3131 7prescribinganyinstrument,device,medicine,drug,orothermeansorsubstancewithan
3232 8intentionotherthantoincreasetheprobabilityofalivebirthortoremovea[deadunborn
3333 9child] deceasedembryoorfetus;
3434 10 (2)["Abortionfacility",aclinic,physician'soffice,oranyotherplaceorfacilityin
3535 11whichabortionsareperformedorinducedotherthanahospital;
3636 12 (3)]"Affiliate",apersonwhoorentitythatentersinto,withanabortionfacility,a
3737 13legalrelationshipcreatedorgovernedbyatleastonewritteninstrument,includinga
3838 14certificateofformation,afranchiseagreement,standardsofaffiliation,bylaws,oralicense,
3939 15thatdemonstrates:
4040 16 (a)Commonownership,management,orcontrolbetweenthepartiestothe
4141 17relationship;
4242 18 (b)Afranchisegrantedbythepersonorentitytotheaffiliate;or
4343 19 (c)Thegrantingorextensionofalicenseorotheragreementauthorizingtheaffiliate
4444 20tousetheotherperson'sorentity'sbrandname,trademark,servicemark,orotherregistered
4545 21identificationmark;
4646 22 [(4)](3)"Conception",thefertilizationoftheovumofafemalebyaspermofamale;
4747 23 [(5)](4)"Department",thedepartmentofhealthandseniorservices;
4848 24 [(6)"DownSyndrome",thesamemeaningasdefinedinsection191.923;
4949 25 (7)](5)"Gestationalage",lengthofpregnancyasmeasuredfromthefirstdayofthe
5050 26woman'slastmenstrualperiod;
5151 27 [(8)](6)"Medicalemergency",aconditionwhich,basedonreasonablemedical
5252 28judgment,socomplicatesthemedicalconditionofapregnantwomanastonecessitatethe
5353 29immediateabortionofherpregnancytoavertthedeathofthepregnantwomanorforwhicha
5454 30delaywillcreateaseriousriskofsubstantialandirreversiblephysicalimpairmentofamajor
5555 31bodilyfunctionofthepregnantwoman;
5656 32 [(9)](7)"Physician",anypersonlicensedtopracticemedicineinthisstatebythe
5757 33stateboardofregistrationforthehealingarts;
5858 34 [(10)] (8)"Reasonablemedicaljudgment",amedicaljudgmentthatwouldbemade
5959 35byareasonablyprudentphysician,knowledgeableaboutthecaseandthetreatment
6060 36possibilitieswithrespecttothemedicalconditionsinvolved[;
6161 37 (11)"Unbornchild",theoffspringofhumanbeingsfromthemomentofconception
6262 38untilbirthandateverystageofitsbiologicaldevelopment,includingthehumanconceptus,
6363 39zygote,morula,blastocyst,embryo,andfetus;
6464 40 (12)"Viability"or"viable",thatstageoffetaldevelopmentwhenthelifeofthe
6565 41unbornchildmaybecontinuedindefinitelyoutsidethewombbynaturalorartificiallife-
6666 42supportivesystems;
6767 HB1304 2 43 (13)"Viablepregnancy"or"viableintrauterinepregnancy",inthefirsttrimesterof
6868 44pregnancy,anintrauterinepregnancythatcanpotentiallyresultinalivebornbaby].
6969 192.665.Asusedinthissection,section192.667,andsections197.150to197.165,
7070 2thefollowingtermsmean:
7171 3 (1)"Chargedata",informationsubmittedbyhealthcareprovidersoncurrentcharges
7272 4forleadingproceduresanddiagnoses;
7373 5 (2)"Chargesbypayer",informationsubmittedbyhospitalsonamountbilledto
7474 6Medicare,Medicaid,othergovernmentsourcesandallnongovernmentsourcescombinedas
7575 7onedataelement;
7676 8 (3)"Department",thedepartmentofhealthandseniorservices;
7777 9 (4)"Financialdata",informationsubmittedbyhospitalsdrawnfromfinancial
7878 10statementswhichincludesthebalancesheet,incomestatement,charitycareandbaddebtand
7979 11chargesbypayer,preparedinaccordancewithgenerallyacceptedaccountingprinciples;
8080 12 (5)"Healthcareprovider",hospitalsasdefinedinsection197.020andambulatory
8181 13surgicalcenters[andabortionfacilities] asdefinedinsection197.200;
8282 14 (6)"Nosocomialinfection",asdefinedbythefederalCentersforDiseaseControland
8383 15Preventionandappliedtoinfectionswithinhospitals,ambulatorysurgicalcenters,[abortion
8484 16facilities,] andotherfacilities;
8585 17 (7)"Nosocomialinfectionincidencerate",arisk-adjustedmeasurementofnewcases
8686 18ofnosocomialinfectionsbyprocedureordevicewithinapopulationoveragivenperiodof
8787 19time,withsuchmeasurementsdefinedbyruleofthedepartmentpursuanttosubsection3of
8888 20section192.667forusebyallhospitals,ambulatorysurgicalcenters,[abortionfacilities,] and
8989 21otherfacilitiesincomplyingwiththerequirementsoftheMissourinosocomialinfection
9090 22controlactof2004;
9191 23 (8)"Otherfacility",atypeoffacilitydeterminedtobeasourceofinfectionsand
9292 24designatedbyruleofthedepartmentpursuanttosubsection11ofsection192.667;
9393 25 (9)"Patientabstractdata",datasubmittedbyhospitalswhichincludesbutisnot
9494 26limitedtodateofbirth,sex,race,zipcode,countyofresidence,admissiondate,discharge
9595 27date,principalandotherdiagnoses,includingexternalcauses,principalandotherprocedures,
9696 28proceduredates,totalbilledcharges,dispositionofthepatientandexpectedsourceof
9797 29paymentwithsourcescategorizedaccordingtoMedicare,Medicaid,othergovernment,
9898 30workers'compensation,allcommercialpayorscodedwithacommoncode,self-pay,no
9999 31chargeandother.
100100 192.667.1.Allhealthcareprovidersshallatleastannuallyprovidetothedepartment
101101 2chargedataasrequiredbythedepartment.Allhospitalsshallatleastannuallyprovidepatient
102102 3abstractdataandfinancialdataasrequiredbythedepartment.Hospitalsasdefinedinsection
103103 4197.020shallreportpatientabstractdataforoutpatientsandinpatients.Ambulatorysurgical
104104 HB1304 3 5centers[andabortionfacilities] asdefinedinsection197.200shallprovidepatientabstract
105105 6datatothedepartment.Thedepartmentshallspecifybyrulethetypesofinformationwhich
106106 7shallbesubmittedandthemethodofsubmission.
107107 8 2.Thedepartmentshallcollectdataontheincidenceofhealthcare-associated
108108 9infectionsfromhospitals,ambulatorysurgicalcenters,[abortionfacilities,] andotherfacilities
109109 10asnecessarytogeneratethereportsrequiredbythissection.Hospitals,ambulatorysurgical
110110 11centers,[abortionfacilities,] andotherfacilitiesshallprovidesuchdataincompliancewith
111111 12thissection.Inordertostreamlinegovernmentandtoeliminateduplicativereporting
112112 13requirements,iftheCentersforMedicareandMedicaidServices,oritssuccessorentity,
113113 14requireshospitalstosubmithealthcare-associatedinfectiondata,thenhospitalsandthe
114114 15departmentshallnotberequiredtocomplywiththehealthcare-associatedinfectiondata
115115 16reportingrequirementsofsubsections2to17ofthissectionapplicabletohospitals,except
116116 17thatthedepartmentshallpostalinkonitswebsitetopubliclyreporteddatabyhospitalson
117117 18theCentersforMedicareandMedicaidServices'HospitalComparewebsite,oritssuccessor.
118118 19 3.Thedepartmentshallpromulgaterulesspecifyingthestandardsandproceduresfor
119119 20thecollection,analysis,riskadjustment,andreportingoftheincidenceofhealthcare-
120120 21associatedinfectionsandthetypesofinfectionsandprocedurestobemonitoredpursuantto
121121 22subsection13ofthissection.Inpromulgatingsuchrules,thedepartmentshall:
122122 23 (1)Usemethodologiesandsystemsfordatacollectionestablishedbythefederal
123123 24CentersforDiseaseControlandPrevention'sNationalHealthcareSafetyNetwork,orits
124124 25successor;and
125125 26 (2)Considerthefindingsandrecommendationsoftheinfectioncontroladvisory
126126 27panelestablishedpursuanttosection197.165.
127127 28 4.ByJanuary1,2017,theinfectioncontroladvisorypanelcreatedbysection197.165
128128 29shallmakerecommendationstothedepartmentregardingtheCentersforMedicareand
129129 30MedicaidServices'healthcare-associatedinfectiondatacollection,analysis,andpublic
130130 31reportingrequirementsforhospitals,ambulatorysurgicalcenters,andotherfacilitiesinthe
131131 32federalCentersforDiseaseControlandPrevention'sNationalHealthcareSafetyNetwork,or
132132 33itssuccessor,inlieuofallorpartofthedatacollection,analysis,andpublicreporting
133133 34requirementsofthissection.Theadvisorypanelrecommendationsshalladdresswhich
134134 35hospitalsshallberequiredasaconditionoflicensuretousetheNationalHealthcareSafety
135135 36Networkfordatacollection;theuseoftheNationalHealthcareSafetyNetworkforrisk
136136 37adjustmentandanalysisofhospitalsubmitteddata;andtheuseoftheCentersforMedicare
137137 38andMedicaidServices'HospitalComparewebsite,oritssuccessor,forpublicreportingofthe
138138 39incidenceofhealthcare-associatedinfectionmetrics.Theadvisorypanelshallconsiderthe
139139 40followingfactorsindevelopingitsrecommendation:
140140 HB1304 4 41 (1)Whetherthepublicisaffordedthesameorgreateraccesstofacility-specific
141141 42infectioncontrolindicatorsandmetrics;
142142 43 (2)Whetherthedataprovidedtothepublicissubjecttothesameorgreateraccuracy
143143 44ofriskadjustment;
144144 45 (3)Whetherthepublicisprovidedwiththesameorgreaterspecificityofreportingof
145145 46infectionsbytypeoffacilityinfectionsandprocedures;
146146 47 (4)Whetherthedataissubjecttothesameorgreaterlevelofconfidentialityofthe
147147 48identityofanindividualpatient;
148148 49 (5)WhethertheNationalHealthcareSafetyNetwork,oritssuccessor,hasthe
149149 50capacitytoreceive,analyze,andreporttherequireddataforallfacilities;
150150 51 (6)WhetherthecosttoimplementtheNationalHealthcareSafetyNetworkinfection
151151 52datacollectionandreportingsystemisthesameorless.
152152 53 5.Afterconsideringtherecommendationsoftheinfectioncontroladvisorypanel,and
153153 54providedthattherequirementsofsubsection13ofthissectioncanbemet,thedepartment
154154 55shallimplementguidelinesfromthefederalCentersforDiseaseControlandPrevention's
155155 56NationalHealthcareSafetyNetwork,oritssuccessor.Itshallbeaconditionoflicensurefor
156156 57hospitalsthatmeettheminimumpublicreportingrequirementsoftheNationalHealthcare
157157 58SafetyNetworkandtheCentersforMedicareandMedicaidServicestoparticipateinthe
158158 59NationalHealthcareSafetyNetwork,oritssuccessor.Suchhospitalsshallpermitthe
159159 60NationalHealthcareSafetyNetwork,oritssuccessor,todisclosefacility-specificinfection
160160 61datatothedepartmentasrequiredunderthissection,andasnecessarytoprovidethepublic
161161 62reportsrequiredbythedepartment.Itshallbeaconditionoflicensureforanyambulatory
162162 63surgicalcenter[orabortionfacility] whichdoesnotvoluntarilyparticipateintheNational
163163 64HealthcareSafetyNetwork,oritssuccessor,tosubmitfacility-specificdatatothedepartment
164164 65asrequiredunderthissection,andasnecessarytoprovidethepublicreportsrequiredbythe
165165 66department.
166166 67 6.Thedepartmentshallnotrequiretheresubmissionofdatawhichhasbeen
167167 68submittedtothedepartmentofhealthandseniorservicesorthedepartmentofsocialservices
168168 69underanyotherprovisionoflaw.Thedepartmentofhealthandseniorservicesshallaccept
169169 70datasubmittedbyassociationsorrelatedorganizationsonbehalfofhealthcareprovidersby
170170 71enteringintobindingagreementsnegotiatedwithsuchassociationsorrelatedorganizationsto
171171 72obtaindatarequiredpursuanttosection192.665andthissection.Ahealthcareprovidershall
172172 73submittherequiredinformationtothedepartmentofhealthandseniorservices:
173173 74 (1)Iftheproviderdoesnotsubmittherequireddatathroughsuchassociationsor
174174 75relatedorganizations;
175175 HB1304 5 76 (2)IfnobindingagreementhasbeenreachedwithinninetydaysofAugust28,1992,
176176 77betweenthedepartmentofhealthandseniorservicesandsuchassociationsorrelated
177177 78organizations;or
178178 79 (3)Ifabindingagreementhasexpiredformorethanninetydays.
179179 80 7.Informationobtainedbythedepartmentundertheprovisionsofsection192.665
180180 81andthissectionshallnotbepublicinformation.Reportsandstudiespreparedbythe
181181 82departmentbaseduponsuchinformationshallbepublicinformationandmayidentify
182182 83individualhealthcareproviders.Thedepartmentofhealthandseniorservicesmayauthorize
183183 84theuseofthedatabyotherresearchorganizationspursuanttotheprovisionsofsection
184184 85192.067.Thedepartmentshallnotuseorreleaseanyinformationprovidedundersection
185185 86192.665andthissectionwhichwouldenableanypersontodetermineanyhealthcare
186186 87provider'snegotiateddiscountswithspecificpreferredproviderorganizationsorother
187187 88managedcareorganizations.Thedepartmentshallnotreleasedatainaformwhichcouldbe
188188 89usedtoidentifyapatient.AnyviolationofthissubsectionisaclassAmisdemeanor.
189189 90 8.Thedepartmentshallundertakeareasonablenumberofstudiesandpublish
190190 91information,includingatleastanannualconsumerguide,incollaborationwithhealthcare
191191 92providers,businesscoalitionsandconsumersbasedupontheinformationobtainedpursuantto
192192 93theprovisionsofsection192.665andthissection.Thedepartmentshallallowallhealthcare
193193 94providersandassociationsandrelatedorganizationswhohavesubmitteddatawhichwillbe
194194 95usedinanypublicationtoreviewandcommentonthepublicationpriortoitspublicationor
195195 96releaseforgeneraluse.Thepublicationshallbemadeavailabletothepublicforareasonable
196196 97charge.
197197 98 9.Anyhealthcareproviderwhichcontinuallyandsubstantially,asthesetermsare
198198 99definedbyrule,failstocomplywiththeprovisionsofthissectionshallnotbeallowedto
199199 100participateinanyprogramadministeredbythestateortoreceiveanymoneysfromthestate.
200200 101 10.Ahospital,asdefinedinsection197.020,aggrievedbythedepartment's
201201 102determinationofineligibilityforstatemoneyspursuanttosubsection9ofthissectionmay
202202 103appealasprovidedinsection197.071.Anambulatorysurgicalcenter[orabortionfacility] as
203203 104definedinsection197.200aggrievedbythedepartment'sdeterminationofineligibilityfor
204204 105statemoneyspursuanttosubsection9ofthissectionmayappealasprovidedinsection
205205 106197.221.
206206 107 11.Thedepartmentofhealthmaypromulgaterulesprovidingforcollectionofdata
207207 108andpublicationoftheincidenceofhealthcare-associatedinfectionsforothertypesofhealth
208208 109facilitiesdeterminedtobesourcesofinfections;exceptthat,physicians'officesshallbe
209209 110exemptfromreportinganddisclosureofsuchinfections.
210210 HB1304 6 111 12.ByJanuary1,2017,theadvisorypanelshallrecommendandthedepartmentshall
211211 112adoptinregulationwithaneffectivedateofnolaterthanJanuary1,2018,therequirements
212212 113forthereportingofthefollowingtypesofinfectionsasspecifiedinthissubsection:
213213 114 (1)Infectionsassociatedwithaminimumoffoursurgicalproceduresforhospitals
214214 115andaminimumoftwosurgicalproceduresforambulatorysurgicalcentersthatmeetthe
215215 116followingcriteria:
216216 117 (a)Areusuallyassociatedwithanelectivesurgicalprocedure.An"electivesurgical
217217 118procedure"isaplanned,nonemergencysurgicalprocedurethatmaybeeithermedically
218218 119requiredsuchasahipreplacementoroptionalsuchasbreastaugmentation;
219219 120 (b)Demonstrateahighpriorityaspectsuchasaffectingalargenumberofpatients,
220220 121havingasubstantialimpactforasmallerpopulation,orbeingassociatedwithsubstantialcost,
221221 122morbidity,ormortality;or
222222 123 (c)AreinfectionsforwhichreportsarecollectedbytheNationalHealthcareSafety
223223 124Networkoritssuccessor;
224224 125 (2)Centralline-relatedbloodstreaminfections;
225225 126 (3)Healthcare-associatedinfectionsspecifiedforreportingbyhospitals,ambulatory
226226 127surgicalcenters,andotherhealthcarefacilitiesbytherulesoftheCentersforMedicareand
227227 128MedicaidServicestothefederalCentersforDiseaseControlandPrevention'sNational
228228 129HealthcareSafetyNetwork,oritssuccessor;and
229229 130 (4)Othercategoriesofinfectionsthatmaybeestablishedbyrulebythedepartment.
230230 131
231231 132Thedepartment,inconsultationwiththeadvisorypanel,shallbeauthorizedtocollectand
232232 133reportdataonsubsetsofeachtypeofinfectiondescribedinthissubsection.
233233 134 13.Inconsultationwiththeinfectioncontroladvisorypanelestablishedpursuantto
234234 135section197.165,thedepartmentshalldevelopanddisseminatetothepublicreportsbasedon
235235 136datacompiledforaperiodoftwelvemonths.Suchreportsshallbeupdatedquarterlyand
236236 137shallshowforeachhospital,ambulatorysurgicalcenter,[abortionfacility,]andotherfacility
237237 138metricsonrisk-adjustedhealthcare-associatedinfectionsunderthissection.
238238 139 14.Thetypesofinfectionsundersubsection12ofthissectiontobepubliclyreported
239239 140shallbedeterminedbythedepartmentbyruleandshallbeconsistentwiththeinfections
240240 141trackedbytheNationalHealthcareSafetyNetwork,oritssuccessor.
241241 142 15.Reportspublishedpursuanttosubsection13ofthissectionshallbepublishedand
242242 143readilyaccessibleonthedepartment'sinternetwebsite.Thereportsshallbedistributedat
243243 144leastannuallytothegovernorandmembersofthegeneralassembly.Thedepartmentshall
244244 145makesuchreportsavailabletothepublicforaperiodofatleasttwoyears.
245245 146 16.TheHospitalIndustryDataInstituteshallpublishareportofMissourihospitals'[,]
246246 147andambulatorysurgicalcenters'[, andabortionfacilities'] compliancewithstandardized
247247 HB1304 7 148qualityofcaremeasuresestablishedbythefederalCentersforMedicareandMedicaid
248248 149Servicesforpreventionofinfectionsrelatedtosurgicalprocedures.IftheHospitalIndustry
249249 150DataInstitutefailstodosobyJuly31,2008,andannuallythereafter,thedepartmentshallbe
250250 151authorizedtocollectinformationfromtheCentersforMedicareandMedicaidServicesor
251251 152fromhospitals[,] andambulatorysurgicalcenters[, andabortionfacilities] andpublishsuch
252252 153informationinaccordancewiththissection.
253253 154 17.Thedatacollectedorpublishedpursuanttothissectionshallbeavailabletothe
254254 155departmentforpurposesoflicensinghospitals[,] andambulatorysurgicalcenters[, and
255255 156abortionfacilities] pursuanttochapter197.
256256 157 18.Thedepartmentshallpromulgaterulestoimplementtheprovisionsofsection
257257 158192.131andsections197.150to197.160.Anyruleorportionofarule,asthattermis
258258 159definedinsection536.010,thatiscreatedundertheauthoritydelegatedinthissectionshall
259259 160becomeeffectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsofchapter536
260260 161and,ifapplicable,section536.028.Thissectionandchapter536arenonseverableandifany
261261 162ofthepowersvestedwiththegeneralassemblypursuanttochapter536toreview,todelaythe
262262 163effectivedate,ortodisapproveandannularulearesubsequentlyheldunconstitutional,then
263263 164thegrantofrulemakingauthorityandanyruleproposedoradoptedafterAugust28,2004,
264264 165shallbeinvalidandvoid.
265265 166 19.NolaterthanAugust28,2017,eachhospital,excludingmentalhealthfacilitiesas
266266 167definedinsection632.005,andeachambulatorysurgicalcenter[andabortionfacility] as
267267 168definedinsection197.200,shallinconsultationwithitsmedicalstaffestablishan
268268 169antimicrobialstewardshipprogramforevaluatingthejudicioususeofantimicrobials,
269269 170especiallyantibioticsthatarethelastlineofdefenseagainstresistantinfections.The
270270 171hospital'sstewardshipprogramandtheresultsoftheprogramshallbemonitoredand
271271 172evaluatedbyhospitalqualityimprovementdepartmentsandshallbeavailableupon
272272 173inspectiontothedepartment.Ataminimum,theantimicrobialstewardshipprogramshallbe
273273 174designedtoevaluatethathospitalizedpatientsreceive,inaccordancewithacceptedmedical
274274 175standardsofpractice,theappropriateantimicrobial,attheappropriatedose,attheappropriate
275275 176time,andfortheappropriateduration.
276276 177 20.Hospitalsdescribedinsubsection19ofthissectionshallmeettheNational
277277 178HealthcareSafetyNetworkrequirementsforreportingantimicrobialusageorresistanceby
278278 179usingtheCentersforDiseaseControlandPrevention'sAntimicrobialUseandResistance
279279 180(AUR)ModulewhenconditionsofparticipationpromulgatedbytheCentersforMedicare
280280 181andMedicaidServicesrequiringtheelectronicreportingofantibioticuseorantibiotic
281281 182resistancebyhospitalsbecomeeffective.Whensuchantimicrobialusageorresistance
282282 183reportingtakeseffect,hospitalsshallauthorizetheNationalHealthcareSafetyNetwork,orits
283283 184successor,todisclosetothedepartmentfacility-specificinformationreportedtotheAUR
284284 HB1304 8 185Module.Facility-specificdataonantibioticusageandresistancecollectedunderthis
285285 186subsectionshallnotbedisclosedtothepublic,butthedepartmentmayreleasecase-specific
286286 187informationtootherfacilities,physicians,andthepublicifthedepartmentdeterminesona
287287 188case-by-casebasisthatthereleaseofsuchinformationisnecessarytoprotectpersonsina
288288 189publichealthemergency.Nothinginthissectionshallprohibitahospitalfromvoluntarily
289289 190reportingantibioticuseorantibioticresistancedatathroughtheNationalHealthcareSafety
290290 191Network,oritssuccessor,priortotheeffectivedateoftheconditionsofparticipation
291291 192requiringthereporting.
292292 193 21.ThedepartmentshallmakeareporttothegeneralassemblybeginningJanuary1,
293293 1942018,andoneveryJanuaryfirstthereafterontheincidence,type,anddistributionof
294294 195antimicrobial-resistantinfectionsidentifiedinthestateandwithinregionsofthestate.
295295 197.150.Thedepartmentshallrequirethateachhospital,ambulatorysurgicalcenter,
296296 2[abortionfacility,]andotherfacilityhaveinplaceproceduresformonitoringandenforcing
297297 3compliancewithinfectioncontrolregulationsandstandards.Suchproceduresshallbe
298298 4coordinatedwithadministrativestaff,personnelstaff,andthequalityimprovementprogram.
299299 5Suchproceduresshallinclude,ataminimum,requirementsforthefacility'sinfectioncontrol
300300 6programtoconductsurveillanceofpersonnelwithaportionofthesurveillancetobedonein
301301 7suchmannerthatemployeesandmedicalstaffareobservedwithouttheirknowledgeofsuch
302302 8observation,providedthatthisunobservedsurveillancerequirementshallnotbeconsideredto
303303 9begroundsforlicensureenforcementactionbythedepartmentuntilthedepartment
304304 10establishesclearandverifiablecriteriafordeterminingcompliance.Suchsurveillancealso
305305 11mayincludemonitoringoftherateofuseofhandhygieneproducts.
306306 197.152.1.Infectioncontrolofficersasdefinedinfederalregulationandother
307307 2hospital[,] andambulatorysurgicalcenter[, andabortionfacility] employeesshallbe
308308 3protectedagainstretaliationbythehospital[,] orambulatorysurgicalcenter[, orabortion
309309 4facility] forreportinginfectioncontrolconcernspursuanttosection197.285andshallbe
310310 5entitledtothefullbenefitsofthatsection.Suchinfectioncontrolofficersshallreportany
311311 6interferenceintheperformanceoftheirdutiesbytheirsupervisorstothehospital[,] or
312312 7ambulatorysurgicalcenter[, orabortionfacility] complianceofficerestablishedbyand
313313 8empoweredtoactpursuanttosection197.285.
314314 9 2.Infectioncontrolofficersasdefinedinfederalregulationshallalsohavethe
315315 10authoritytoorderthecessationofapracticethatfallsoutsideacceptedpracticesasdefinedby
316316 11appropriatestateandfederalregulatoryagencies,accreditationorganizations,orthestandards
317317 12adoptedbytheCentersforDiseaseControlandPreventionortheAssociationof
318318 13ProfessionalsinInfectionControlandEpidemiology.Thehospital[,] orambulatory
319319 14surgicalcenter[, orabortionfacility] mayrequirethatsuchacessationorderofaninfection
320320 15controlofficerbeendorsedbythehospital[,] orambulatorysurgicalcenter[, orabortion
321321 HB1304 9 16facility] chiefexecutiveofficerorhisorherdesigneebeforetakingeffect.Thehospital[,] or
322322 17ambulatorysurgicalcenter[, orabortionfacility] infectioncontrolcommitteeshallconveneas
323323 18soonaspossibletoreviewsuchcessationorderandmayoverruleorsustainthedirectiveof
324324 19theinfectioncontrolofficer.Thedepartmentshallpromulgaterulesgoverningdocumentation
325325 20ofsuchevents.
326326 21 3.Membersofthemedicalstaffwhoreportingoodfaithinfectioncontrolconcernsto
327327 22thehospital[,] orambulatorysurgicalcenter[, orabortionfacility] administrationormedical
328328 23staffleadershipshallnotbesubjecttoretaliationordiscriminationfordoingso.Nothingin
329329 24thissectionshallpreventorshieldmedicalstaffmembersfrombeingsubjecttoprofessional
330330 25reviewactionsforsubstandardcareorbreachofstandardsestablishedinhospitalpolicy,
331331 26rules,ormedicalstaffbylaws.
332332 197.158.Everyhospital[,] andambulatorysurgerycenter[, andabortionfacility]
333333 2shall,beginningJune1,2006,provideeachpatientanopportunitytosubmittothehospital[,]
334334 3orambulatorysurgicalcenter[, orabortionfacility] administrationcomplaints,comments,
335335 4andsuggestionsrelatedtothecaretheyreceivedortheirpersonalobservationsrelatedtothe
336336 5qualityofcareprovided.Thedepartmentshallpromulgaterulestoimplementthissection.
337337 197.160.Thedepartmentofhealthandseniorservicesshallhaveaccesstoalldata
338338 2andinformationheldbyhospitals,ambulatorysurgicalcenters,[abortionfacilities,] andother
339339 3facilitiesrelatedtotheirinfectioncontrolpractices,rates,ortreatmentsofinfections.Failure
340340 4toprovidesuchaccessshallbegroundsforfullorpartiallicensuresuspensionorrevocation
341341 5pursuanttosection197.293,sections197.010to197.100,orsections197.200to197.240.If
342342 6thedepartmentdeterminesthatthehospital,ambulatorysurgicalcenter,[abortionfacility,]or
343343 7otherfacilityiswillfullyimpedingaccesstosuchinformation,thedepartmentshallbe
344344 8authorizedtodirectallstateagenciestosuspendalloraportionofstatepaymentstosuch
345345 9entityuntilsuchtimeasthedesiredinformationisobtainedbythedepartment.
346346 197.162.Thedepartmentshallinitslicensureofhospitals[,] andambulatorysurgical
347347 2centers[, andabortionfacilities] givespecialattentiontoinfectioncontrolpracticesandshall
348348 3directhospitals[,] andambulatorysurgicalcenters[, andabortionfacilities] tosetquantifiable
349349 4measuresofperformanceforreducingtheincidenceofnosocomialinfectionsinMissouri.
350350 5Thedepartmentshallprepareanannualreportoninfectioncontrolstandardsandcompliance,
351351 6whichshallbesharedwiththegovernorandthegeneralassembly.
352352 197.165.1.Thedepartmentshallappointan"InfectionControlAdvisoryPanel"for
353353 2thepurposesofimplementingsections192.131and192.667.
354354 3 2.Membersoftheinfectioncontroladvisorypanelshallinclude:
355355 4 (1)Twopublicmembers;
356356 5 (2)Threeboard-certifiedorboard-eligiblephysicianslicensedpursuanttochapter
357357 6334whoareaffiliatedwithaMissourihospitalormedicalschool,activemembersofthe
358358 HB1304 10 7SocietyforHealthCareEpidemiologyofAmerica,andhavedemonstratedinterestand
359359 8expertiseinhealthfacilityinfectioncontrol;
360360 9 (3)Onephysicianlicensedpursuanttochapter334whoisactiveinthepracticeof
361361 10medicineinMissouriandwhoholdsmedicalstaffprivilegesataMissourihospital;
362362 11 (4)Fourinfectioncontrolpractitionerscertifiedbythecertificationboardofinfection
363363 12controlandepidemiology,atleasttwoofwhomshallbepracticinginaruralhospitalor
364364 13settingandatleasttwoofwhomshallberegisteredprofessionalnurseslicensedunderchapter
365365 14335;
366366 15 (5)Amedicalstatisticianwithanadvanceddegreeinsuchspecialty;
367367 16 (6)Aclinicalmicrobiologistwithanadvanceddegreeinsuchspecialty;
368368 17 (7)Threeemployeesofthedepartment,representingthefunctionsofhospital[,] and
369369 18ambulatorysurgicalcenter[, andabortionfacility] licensure,epidemiologyandhealthdata
370370 19analysis,whoshallserveasexofficiononvotingmembersofthepanel.
371371 20 3.Reasonableexpensesofthepanelshallbepaidfromprivatedonationsmade
372372 21specificallyforthatpurposetothe"InfectionControlAdvisoryPanelFund",whichishereby
373373 22createdinthestatetreasury.Ifsuchdonationsarenotreceivedfromprivatesources,thenthe
374374 23provisionsofthisactshallbeimplementedwithouttheadvisorypanel.
375375 197.200.Asusedinsections197.200to197.240,unlessthecontextclearlyindicates
376376 2otherwise,thefollowingtermsmean:
377377 3 (1)["Abortionfacility",assuchtermisdefinedinsection188.015;
378378 4 (2)]"Ambulatorysurgicalcenter",anypublicorprivateestablishmentoperated
379379 5primarilyforthepurposeofperformingsurgicalproceduresorprimarilyforthepurposeof
380380 6performingchildbirths,andwhichdoesnotprovideservicesorotheraccommodationsfor
381381 7patientstostaymorethantwenty-threehourswithintheestablishment,provided,however,
382382 8thatnothinginthisdefinitionshallbeconstruedtoincludetheofficesofdentistscurrently
383383 9licensedpursuanttochapter332;
384384 10 [(3)](2)"Dentist",anypersoncurrentlylicensedtopracticedentistrypursuantto
385385 11chapter332;
386386 12 [(4)](3)"Department",thedepartmentofhealthandseniorservices;
387387 13 [(5)](4)"Governmentalunit",anycity,countyorotherpoliticalsubdivisionofthis
388388 14state,oranydepartment,division,boardorotheragencyofanypoliticalsubdivisionofthis
389389 15state;
390390 16 [(6)](5)"Person",anyindividual,firm,partnership,corporation,company,or
391391 17associationandthelegalsuccessorsthereof;
392392 18 [(7)](6)"Physician",anypersoncurrentlylicensedtopracticemedicinepursuantto
393393 19chapter334;
394394 HB1304 11 20 [(8)](7)"Podiatrist",anypersoncurrentlylicensedtopracticepodiatrypursuantto
395395 21chapter330.
396396 197.205.1.Nopersonorgovernmentalunitactingseverallyorjointlywithanyother
397397 2personorgovernmentalunitshallestablish,conductormaintainanambulatorysurgical
398398 3center[orabortionfacility] inthisstatewithoutalicenseundersections197.200to197.240
399399 4issuedbythedepartmentofhealthandseniorservices.
400400 5 2.Nothinginsections197.200to197.240shallbeconstruedtoimpairorabridgethe
401401 6authorityofagovernmentalunittolicenseambulatorysurgicalcenters[orabortionfacilities],
402402 7providedthatanyordinanceofagovernmentalunitshallrequirecompliancewithallrules,
403403 8regulations,andstandardsadoptedbythedepartmenttoimplementtheprovisionsofsections
404404 9197.200to197.240.
405405 197.215.1.Uponreceiptofanapplicationforalicense,thedepartmentofhealthand
406406 2seniorservicesshallissuealicenseiftheapplicantandambulatorysurgicalcenterfacilities
407407 3[orabortionfacilities] meettherequirementsestablishedundersections197.200to197.240,
408408 4andhaveprovidedaffirmativeevidencethat:
409409 5 (1)Eachmemberofthesurgicalstaffisaphysician,dentistorpodiatristcurrently
410410 6licensedtopracticeinMissouri[, andeachpersonauthorizedtoperformorinduceabortionsis
411411 7aphysiciancurrentlylicensedtopracticeinMissouri];
412412 8 (2)Surgicalproceduresinambulatorysurgicalcentersshallbeperformedonlyby
413413 9physicians,dentistsorpodiatrists,whoatthetimeareprivilegedtoperformsurgical
414414 10proceduresinatleastonelicensedhospitalinthecommunityinwhichtheambulatory
415415 11surgicalcenterislocated,thusprovidingassurancetothepublicthatpatientstreatedinthe
416416 12centershallreceivecontinuityofcareshouldtheservicesofahospitalberequired;
417417 13alternatively,applicantshallsubmitacopyofacurrentworkingagreementwithatleastone
418418 14licensedhospitalinthecommunityinwhichtheambulatorysurgicalcenterislocated,
419419 15guaranteeingthetransferandadmittanceofpatientsforemergencytreatmentwhenever
420420 16necessary;
421421 17 (3)Continuousphysicianservicesorregisteredprofessionalnursingservicesare
422422 18providedwheneverapatientisinthefacility;
423423 19 (4)Adequatemedicalrecordsforeachpatientaretobemaintained.
424424 20 2.Uponreceiptofanapplicationforalicense,ortherenewalthereof,thedepartment
425425 21shallissueorrenewthelicenseiftheapplicantandprogrammeettherequirements
426426 22establishedundersections197.200to197.240.Eachlicenseshallbeissuedonlyforthe
427427 23personsandpremisesnamedintheapplication.Alicense,unlesssoonersuspendedor
428428 24revoked,shallbeissuedforaperiodofoneyear.
429429 25 3.Eachlicenseshallbeissuedonlyforthepremisesandpersonsorgovernmental
430430 26unitsnamedintheapplication,andshallnotbetransferableorassignableexceptwiththe
431431 HB1304 12 27writtenconsentofthedepartment.Licensesshallbepostedinaconspicuousplaceonthe
432432 28licensedpremises.
433433 29 4.If,duringtheperiodinwhichanambulatorysurgicalcenterlicense[oranabortion
434434 30facilitylicense] isineffect,thelicenseholderoroperatorlegallytransfersoperational
435435 31responsibilitiesbyanyprocesstoanotherpersonasdefinedinsection197.200,anapplication
436436 32shallbemadefortheissuanceofanewlicensetobecomeeffectiveonthetransferdate.
437437 197.220.Thedepartmentofhealthandseniorservicesmaydeny,suspendorrevokea
438438 2licenseinanycaseinwhichthedepartmentfindsthattherehasbeenasubstantialfailureto
439439 3complywiththerequirementsofsections197.200to197.240,orinanycaseinwhichthe
440440 4directorofthedepartmentmakesafindingthat:
441441 5 (1)Theapplicant,oriftheapplicantisafirm,partnershiporassociation,anyofits
442442 6members,orifacorporation,anyofitsofficersordirectors,orthepersondesignatedto
443443 7manageorsupervisethefacility,hasbeenfinallyadjudicatedandfoundguilty,orentereda
444444 8pleaofguiltyornolocontendere,inacriminalprosecutionunderthelawsofanystateorof
445445 9theUnitedStates,foranyoffensereasonablyrelatedtothequalifications,functions,orduties
446446 10ofanambulatorysurgicalcenter[orofanabortionfacility], orforanyoffenseanessential
447447 11elementofwhichisfraud,dishonesty,oranactofviolence,orforanyoffenseinvolving
448448 12moralturpitude,whetherornotsentenceisimposed;
449449 13 (2)Thelicensurestatusorrecordoftheapplicant,oriftheapplicantisafirm,
450450 14partnershiporassociation,ofanyofitsmembers,orifacorporation,ofanyofitsofficersor
451451 15directors,orofthepersondesignatedtomanageorsupervisethefacility,fromanyotherstate,
452452 16federaldistrictorland,territoryorcommonwealthoftheUnitedStates,orofanyforeign
453453 17countrywheretheapplicanthasdonebusinessinasimilarcapacityindicatesthatgrantinga
454454 18licensetotheapplicantwouldbedetrimentaltotheinterestsofthepublic.
455455 197.225.1.Thedepartmentofhealthandseniorservicesmayadoptsuchreasonable
456456 2rules,regulations,andstandardsforthetypesofservicesprovidedasarenecessarytocarry
457457 3outtheprovisionsofsections197.200to197.240,andtoassurequalitypatientcareand
458458 4patientsafety,whichshallinclude,butnotbelimitedto:
459459 5 (1)Constructionofthefacilityincluding,butnotlimitedto,plumbing,heating,
460460 6lighting,andventilationwhichshouldinsurethehealth,safety,comfort,andprivacyof
461461 7patientsandprotectionfromfirehazard;
462462 8 (2)Number,qualifications,andorganizationofallpersonnel,havingresponsibility
463463 9foranypartofthecareprovidedtothepatients;
464464 10 (3)Equipmentessentialtothehealth,welfare,andsafetyofthepatients;
465465 11 (4)Facilities,programs,andservicestobeprovidedinconnectionwiththecareof
466466 12patientsinambulatorysurgicalcenters;and
467467 HB1304 13 13 (5)Proceduresforpeerreviewandforreceivingandinvestigatingcomplaints
468468 14regardinganyambulatorysurgicalcenteroranyphysician,dentist,podiatrist,nurse,assistant,
469469 15manager,supervisor,oremployeepracticingorworkinginanysuchfacility.
470470 16 2.Thedepartmentofhealthandseniorservicesmayadoptseparaterules,regulations,
471471 17orstandardstoapplytoambulatorysurgicalcenters[andtoapplytoabortionfacilities].
472472 18 [3.Abortionfacilitiesshallberequiredtomaintainawrittenprotocolformanaging
473473 19medicalemergenciesandthetransferofpatientsrequiringfurtheremergencycaretoa
474474 20hospitalwithinareasonabledistancefromtheabortionfacility.]
475475 197.230.1.Thedepartmentofhealthandseniorservicesshallmake,orcausetobe
476476 2made,suchinspectionsandinvestigationsasitdeemsnecessary.Thedepartmentmay
477477 3delegateitspowersanddutiestoinvestigateandinspectambulatorysurgicalcenters[or
478478 4abortionfacilities] toanofficialofapoliticalsubdivisionhavingapopulationofatleastfour
479479 5hundredfiftythousandifsuchpoliticalsubdivisionisdeemedqualifiedbythedepartmentto
480480 6inspectandinvestigateambulatorysurgicalcenters.Theofficialsodesignatedshallsubmita
481481 7writtenreportofhisorherfindingstothedepartmentandthedepartmentmayacceptthe
482482 8recommendationsofsuchofficialifitdeterminesthatthefacilityinspectedmeetsminimum
483483 9standardsestablishedpursuanttosections197.200to197.240.
484484 10 2.[Inthecaseofanyabortionfacility,thedepartmentshallmakeorcausetobemade
485485 11anunannouncedon-siteinspectionandinvestigationatleastannually.Suchon-site
486486 12inspectionandinvestigationshallinclude,butnotbelimitedto,thefollowingareas:
487487 13 (1)Compliancewithallstatutoryandregulatoryrequirementsforanabortionfacility,
488488 14includingrequirementsthatthefacilitymaintainadequatestaffingandequipmenttorespond
489489 15tomedicalemergencies;
490490 16 (2)Compliancewiththeprovisionsofchapter188;and
491491 17 (3)Compliancewiththerequirementinsection197.215thatcontinuousphysician
492492 18servicesorregisteredprofessionalnursingservicesbeprovidedwheneverapatientisinthe
493493 19facility.
494494 20 3.]Inspection,investigation,andqualityassurancereportsshallbemadeavailableto
495495 21thepublic.Anyportionofareportmayberedactedwhenmadepubliclyavailableifsuch
496496 22portionwoulddiscloseinformationthatisnotsubjecttodisclosureunderthelaw.
497497 197.235.1.Anypersonoperating,conducting,managing,orestablishingan
498498 2ambulatorysurgicalcenter[orabortionfacility] withoutalicenserequiredbysections
499499 3197.200to197.240isguiltyofaclassAmisdemeanorand,uponconviction,shallbesubject
500500 4toafineofnotmorethanfivehundreddollars.Eachdayofcontinuingviolationshall
501501 5constituteaseparateoffense.
502502 6 2.Theattorneygeneralshallrepresentthedepartmentofhealthandseniorservices
503503 7andshallinstituteanactioninthenameofthestateforinjunctiveorotherreliefagainstany
504504 HB1304 14 8personorgovernmentalunittorestrainorpreventtheestablishment,conduct,management,
505505 9oroperationofanambulatorysurgicalcenter[orabortionfacility] withoutalicenseissued
506506 10pursuanttotheprovisionsofsections197.200to197.240.
507507 11 3.Anypersonoperating,conducting,managing,orestablishinganambulatory
508508 12surgicalcenter[orabortionfacility] who,inthecourseofadvertising,promoting,or
509509 13otherwisepublicizingtheactivities,business,location,oranyothermatterconcerningthe
510510 14operationsofsaidambulatorysurgicalcenter[orabortionfacility], usesoremploysinany
511511 15mannerthewords"State,Missouri,StateofMissouri,DepartmentofHealthandSenior
512512 16Services,theinitials'Mo.',"oranyemblemofthestateofMissouriorthedepartmentof
513513 17healthandseniorservices,forthepurposeofconveyingorinanymannerreasonably
514514 18calculatedtoconveythefalseimpressionthatthestateofMissourioranydepartment,agency,
515515 19bureau,orinstrumentalitythereofisinvolvedinthebusinessofsaidambulatorysurgical
516516 20center[orabortionfacility], ortookpartinsaidadvertisement,promotion,publicity,orother
517517 21statement,shallbesubjecttoafineofonehundreddollarsperdayforeachdayduringthe
518518 22periodbeginningwiththedaysaidadvertisement,promotion,publication,orstatementfirst
519519 23appearsandendingonthedayonwhichitiswithdrawn.
520520 197.240.AfterSeptember28,1975,noindividualorgrouphealthinsurancepolicyof
521521 2insuranceprovidingcoverageonanexpenseincurredbasis,norindividualorgroupserviceor
522522 3indemnitytypecontractissuedbyanonprofitcorporation,noranyself-insuredgrouphealth
523523 4benefitplanortrust,ofanykindordescription,shallbeissuedorpaymentacceptedtherefor
524524 5inrenewalorcontinuationthereofunlesscoverageforanyserviceperformedinan
525525 6ambulatorysurgicalcenter[orabortionfacility] isprovidedforthereinifsuchservicewould
526526 7havebeencoveredunderthetermsofthepolicyorcontractasaneligibleinpatientservice,
527527 8exceptasprovidedinsection376.805.Nothinginthissectionshallapplytoagroupcontract,
528528 9planortrustwhichprovideshealthcareandsurgicalcaredirectlytoitsmembersandtheir
529529 10dependents.Nothinginthissectionshallbeconstruedtomandatecoverageunderan
530530 11individualorgrouphealthinsurancepolicyofinsuranceprovidingcoverageonanexpense-
531531 12incurredbasis,oranindividualorgroupserviceorindemnitytypecontractissuedbya
532532 13nonprofitcorporation,oranyself-insuredgrouphealthbenefitplanortrust,ofanykindor
533533 14description,toprovidehealthinsuranceforserviceswhichareusuallyperformedina
534534 15physician'soffice.
535535 197.285.1.Hospitals[,] andambulatorysurgicalcenters[, andabortionfacilities]
536536 2shallestablishandimplementawrittenpolicyadoptedbyeachhospital[,] andambulatory
537537 3surgicalcenter[, andabortionfacility] relatingtotheprotectionsforemployeeswhodisclose
538538 4informationpursuanttosubsection2ofthissection.Thispolicyshallincludeatimeframe
539539 5forcompletionofinvestigationsrelatedtocomplaints,nottoexceedthirtydays,andamethod
540540 6fornotifyingthecomplainantofthedispositionoftheinvestigation.Thispolicyshallbe
541541 HB1304 15 7submittedtothedepartmentofhealthandseniorservicestoverifyimplementation.Ata
542542 8minimum,suchpolicyshallincludethefollowingprovisions:
543543 9 (1)Nosupervisororindividualwithauthoritytohireorfireinahospital[,] or
544544 10ambulatorysurgicalcenter[, orabortionfacility] shallprohibitemployeesfromdisclosing
545545 11informationpursuanttosubsection2ofthissection;
546546 12 (2)Nosupervisororindividualwithauthoritytohireorfireinahospital[,] or
547547 13ambulatorysurgicalcenter[, orabortionfacility] shalluseorthreatentousehisorher
548548 14supervisoryauthoritytoknowinglydiscriminateagainst,dismiss,penalizeorinanyway
549549 15retaliateagainstorharassanemployeebecausetheemployeeingoodfaithreportedor
550550 16disclosedanyinformationpursuanttosubsection2ofthissection,orinanywayattemptto
551551 17dissuade,preventorinterferewithanemployeewhowishestoreportordisclosesuch
552552 18information;
553553 19 (3)Establishaprogramtoidentifyacomplianceofficerwhoisadesignatedperson
554554 20responsibleforadministeringthereportingandinvestigationprocessandanalternateperson
555555 21shouldtheprimarydesigneebeimplicatedinthereport.
556556 22 2.Thissectionshallapplytoinformationdisclosedorreportedingoodfaithbyan
557557 23employeeconcerning:
558558 24 (1)Allegedfacilitymismanagementorfraudulentactivity;
559559 25 (2)Allegedviolationsofapplicablefederalorstatelawsoradministrativerules
560560 26concerningpatientcare,patientsafetyorfacilitysafety;or
561561 27 (3)Theabilityofemployeestosuccessfullyperformtheirassignedduties.
562562 28
563563 29Allinformationdisclosed,collectedandmaintainedpursuanttothissubsectionandpursuant
564564 30tothewrittenpolicyrequirementsofthissectionshallbeaccessibletothedepartmentof
565565 31healthandseniorservicesatalltimesandshallbereviewedbythedepartmentofhealthand
566566 32seniorservicesatleastannually.Complainantsshallbenotifiedofthedepartmentofhealth
567567 33andseniorservices'accesstosuchinformationandofthecomplainant'srighttonotifythe
568568 34departmentofhealthandseniorservicesofanyinformationconcerningallegedviolationsof
569569 35applicablefederalorstatelawsoradministrativerulesconcerningpatientcare,patientsafety
570570 36orfacilitysafety.
571571 37 3.Priortoanydisclosuretoindividualsoragenciesotherthanthedepartmentof
572572 38healthandseniorservices,employeeswishingtomakeadisclosurepursuanttotheprovisions
573573 39ofthissectionshallfirstreporttotheindividualorindividualsdesignatedbythehospital[,] or
574574 40ambulatorysurgicalcenter[, orabortionfacility] pursuanttosubsection1ofthissection.
575575 41 4.Ifthecomplianceofficer,compliancecommitteeormanagementofficialdiscovers
576576 42credibleevidenceofmisconductfromanysourceand,afterareasonableinquiry,hasreason
577577 43tobelievethatthemisconductmayviolatecriminal,civiloradministrativelaw,thenthe
578578 HB1304 16 44hospital[,] orambulatorysurgicalcenter[, orabortionfacility] shallreporttheexistenceof
579579 45misconducttotheappropriategovernmentalauthoritywithinareasonableperiod,butnot
580580 46morethansevendaysafterdeterminingthatthereiscredibleevidenceofaviolation.
581581 47 5.Reportsmadetothedepartmentofhealthandseniorservicesshallbesubjecttothe
582582 48provisionsofsection197.477,providedthattherestrictionsofsection197.477shallnotbe
583583 49construedtolimittheemployee'sabilitytosubpoenafromtheoriginalsourcetheinformation
584584 50reportedtothedepartmentpursuanttothissection.
585585 51 6.Eachwrittenpolicyshallallowemployeesmakingareportwhowishtoremain
586586 52anonymoustodoso,andshallincludesafeguardstoprotecttheconfidentialityofthe
587587 53employeemakingthereport,theconfidentialityofpatientsandtheintegrityofdata,
588588 54informationandmedicalrecords.
589589 55 7.Eachhospital[,] andambulatorysurgicalcenter[, andabortionfacility] shall,
590590 56withinforty-eighthoursofthereceiptofareport,notifytheemployeethathisorherreport
591591 57hasbeenreceivedandisbeingreviewed.
592592 197.287.ByJuly1,2001,allhospitalsandambulatorysurgicalcenters[, andbyJuly
593593 21,2018,allabortionfacilities] shallprovidetrainingprograms,withmeasurableminimal
594594 3trainingoutcomesrelatingtoqualityofpatientcareandpatientsafety,toallunlicensedstaff
595595 4providingpatientcareintheirfacilitywithinninetydaysofthebeginningdateof
596596 5employment.Standardsforsuchtrainingshallbeestablishedbythedepartmentofhealthand
597597 6seniorservicesbyrule.Itshallbearequirementofhospital[,] andambulatorysurgicalcenter
598598 7[,andabortionfacility] licensurepursuanttothischapterthatallhospitals[,] andambulatory
599599 8surgicalcenters[, andabortionfacilities] submitdocumentationtothedepartmentofhealth
600600 9andseniorservicesonthetrainingprogramused.
601601 197.289.1.Allhospitals[,] andambulatorysurgicalcenters[, andabortionfacilities]
602602 2shalldevelopandimplementamethodologywhichensuresadequatenursestaffingthatwill
603603 3meettheneedsofpatients.Ataminimum,thereshallbeondutyatalltimesasufficient
604604 4numberoflicensedregisterednursestoprovidepatientcarerequiringthejudgmentandskills
605605 5ofalicensedregisterednurseandtooverseetheactivitiesofallnursingpersonnel.
606606 6 2.Thereshallbesufficientlicensedandancillarynursingpersonnelondutyoneach
607607 7nursingunittomeettheneedsofeachpatientinaccordancewithacceptedstandardsof
608608 8qualitypatientcare.
609609 197.293.1.Inadditiontothepowersestablishedinsections197.070and197.220,
610610 2thedepartmentofhealthandseniorservicesshallusethefollowingstandardsforenforcing
611611 3hospital[,] andambulatorysurgicalcenter[, andabortionfacility] licensureregulations
612612 4promulgatedtoenforcetheprovisionsofsections197.010to197.120,sections197.150to
613613 5197.165,andsections197.200to197.240:
614614 HB1304 17 6 (1)Uponnotificationofadeficiencyinmeetingregulatorystandards,thehospital[,]
615615 7orambulatorysurgicalcenter[, orabortionfacility] shalldevelopandimplementaplanof
616616 8correctionapprovedbythedepartmentwhichincludes,butisnotlimitedto,thespecifictype
617617 9ofcorrectiveactiontobetakenandanestimatedtimetocompletesuchaction;
618618 10 (2)Iftheplanasimplementeddoesnotcorrectthedeficiency,thedepartmentmay
619619 11either:
620620 12 (a)Directthehospital[,] orambulatorysurgicalcenter[, orabortionfacility] to
621621 13developandimplementaplanofcorrectionpursuanttosubdivision(1)ofthissubsection;or
622622 14 (b)Requirethehospital[,] orambulatorysurgicalcenter[, orabortionfacility] to
623623 15implementaplanofcorrectiondevelopedbythedepartment;
624624 16 (3)Ifthereisacontinuingdeficiencyafterimplementationoftheplanofcorrection
625625 17pursuanttosubdivision(2)ofthissubsectionandthehospital[,] orambulatorysurgicalcenter
626626 18[,orabortionfacility] hashadanopportunitytocorrectsuchdeficiency,thedepartmentmay
627627 19restrictnewinpatientadmissionsoroutpatiententrantstotheserviceorservicesaffectedby
628628 20suchdeficiency;
629629 21 (4)Ifthereisacontinuingdeficiencyafterthedepartmentrestrictsnewinpatient
630630 22admissionsoroutpatiententrantstotheserviceorservicespursuanttosubdivision(3)ofthis
631631 23subsectionandthehospital[,] orambulatorysurgicalcenter[, orabortionfacility] hashadan
632632 24opportunitytocorrectsuchdeficiency,thedepartmentmaysuspendoperationsinallorpartof
633633 25theserviceorservicesaffectedbysuchdeficiency;
634634 26 (5)Ifthereisacontinuingdeficiencyaftersuspensionofoperationspursuantto
635635 27subdivision(4)ofthissubsection,thedepartmentmaydeny,suspendorrevokethehospital's
636636 28[,]orambulatorysurgicalcenter's[, orabortionfacility's] licensepursuanttosection197.070
637637 29orsection197.220.
638638 30 2.Notwithstandingtheprovisionsofsubsection1ofthissectiontothecontrary,ifa
639639 31deficiencyinmeetinglicensurestandardspresentsanimmediateandseriousthreattothe
640640 32patients'healthandsafety,thedepartmentmay,basedonthescopeandseverityofthe
641641 33deficiency,restrictaccesstotheserviceorservicesaffectedbythedeficiencyuntilthe
642642 34hospital[,] orambulatorysurgicalcenter[, orabortionfacility] hasdevelopedand
643643 35implementedanapprovedplanofcorrection.Decisionsastowhetheradeficiency
644644 36constitutesanimmediateandseriousthreattothepatients'healthandsafetyshallbemadein
645645 37accordancewithguidelinesestablishedpursuanttoregulationofthedepartmentofhealthand
646646 38seniorservicesandsuchdecisionsshallbeapprovedbythebureauofhealthfacilitylicensing
647647 39inthedepartmentofhealthandseniorservices,oritssuccessoragency,orbyaperson
648648 40authorizedbytheregulationstoapprovesuchdecisionsintheabsenceofthedirector.
649649 197.295.1.Ahospital[,] orambulatorysurgicalcenter[, orabortionfacility]
650650 2aggrievedbyadecisionofthedepartmentpursuanttotheprovisionsofparagraph(b)of
651651 HB1304 18 3subdivision(2)andsubdivisions(3),(4)and(5)ofsubsection1ofsection197.293may
652652 4appealsuchdecisiontotheadministrativehearingcommissionpursuanttosection197.071or
653653 5section197.221,andseekjudicialreviewpursuanttosection621.145.Anappealofanaction
654654 6torestrictnewinpatientadmissionsoroutpatiententrants,suspendoperationsorrevokea
655655 7licenseshallbeheardonanexpeditedbasisbytheadministrativehearingcommission.The
656656 8hospital[,] orambulatorysurgicalcenter[, orabortionfacility] mayapplytothe
657657 9administrativehearingcommissionforanordertostayorsuspendanysuchdepartmental
658658 10actionpendingthecommission'sfindingsandrulingasauthorizedbysection621.035.
659659 11 2.Ifboththedepartmentandthehospital[,] orambulatorysurgicalcenter[, or
660660 12abortionfacility] agreetodoso,priortoanappealtotheadministrativehearingcommission
661661 13pursuanttosection197.071orsection197.221,anofficialactionofthedepartmentmade
662662 14pursuanttosections197.010to197.120orsections197.200to197.240maybeappealedtoa
663663 15departmentalhearingofficer.Thedepartmentofhealthandseniorservicesshallpromulgate
664664 16rulesspecifyingthequalificationsofsuchahearingofficer,establishprocedurestoensure
665665 17impartialdecisionsandprovideforcomparableappealremedieswhenadepartmentalhearing
666666 18officerisunavailable.
667667 334.100.1.Theboardmayrefusetoissueorrenewanycertificateofregistrationor
668668 2authority,permitorlicenserequiredpursuanttothischapterforoneoranycombinationof
669669 3causesstatedinsubsection2ofthissection.Theboardshallnotifytheapplicantinwritingof
670670 4thereasonsfortherefusalandshalladvisetheapplicantoftheapplicant'srighttofilea
671671 5complaintwiththeadministrativehearingcommissionasprovidedbychapter621.Asan
672672 6alternativetoarefusaltoissueorrenewanycertificate,registrationorauthority,theboard
673673 7may,atitsdiscretion,issuealicensewhichissubjecttoprobation,restrictionorlimitationto
674674 8anapplicantforlicensureforanyoneoranycombinationofcausesstatedinsubsection2of
675675 9thissection.Theboard'sorderofprobation,limitationorrestrictionshallcontainastatement
676676 10ofthedisciplineimposed,thebasistherefor,thedatesuchactionshallbecomeeffective,anda
677677 11statementthattheapplicanthasthirtydaystorequestinwritingahearingbeforethe
678678 12administrativehearingcommission.Iftheboardissuesaprobationary,limitedorrestricted
679679 13licensetoanapplicantforlicensure,eitherpartymayfileawrittenpetitionwiththe
680680 14administrativehearingcommissionwithinthirtydaysoftheeffectivedateoftheprobationary,
681681 15limitedorrestrictedlicenseseekingreviewoftheboard'sdetermination.Ifnowrittenrequest
682682 16forahearingisreceivedbytheadministrativehearingcommissionwithinthethirty-day
683683 17period,therighttoseekreviewoftheboard'sdecisionshallbeconsideredaswaived.
684684 18 2.Theboardmaycauseacomplainttobefiledwiththeadministrativehearing
685685 19commissionasprovidedbychapter621againstanyholderofanycertificateofregistrationor
686686 20authority,permitorlicenserequiredbythischapteroranypersonwhohasfailedtorenewor
687687 HB1304 19 21hassurrenderedtheperson'scertificateofregistrationorauthority,permitorlicenseforany
688688 22oneoranycombinationofthefollowingcauses:
689689 23 (1)Useofanycontrolledsubstance,asdefinedinchapter195,oralcoholicbeverage
690690 24toanextentthatsuchuseimpairsaperson'sabilitytoperformtheworkofanyprofession
691691 25licensedorregulatedbythischapter;
692692 26 (2)Thepersonhasbeenfinallyadjudicatedandfoundguilty,orenteredapleaof
693693 27guiltyornolocontendere,inacriminalprosecutionunderthelawsofanystateorofthe
694694 28UnitedStates,foranyoffensereasonablyrelatedtothequalifications,functionsordutiesof
695695 29anyprofessionlicensedorregulatedpursuanttothischapter,foranyoffenseinvolvingfraud,
696696 30dishonestyoranactofviolence,orforanyoffenseinvolvingmoralturpitude,whetherornot
697697 31sentenceisimposed;
698698 32 (3)Useoffraud,deception,misrepresentationorbriberyinsecuringanycertificateof
699699 33registrationorauthority,permitorlicenseissuedpursuanttothischapterorinobtaining
700700 34permissiontotakeanyexaminationgivenorrequiredpursuanttothischapter;
701701 35 (4)Misconduct,fraud,misrepresentation,dishonesty,unethicalconductor
702702 36unprofessionalconductintheperformanceofthefunctionsordutiesofanyprofession
703703 37licensedorregulatedbythischapter,including,butnotlimitedto,thefollowing:
704704 38 (a)Obtainingorattemptingtoobtainanyfee,charge,tuitionorothercompensation
705705 39byfraud,deceptionormisrepresentation;willfullyandcontinuallyoverchargingor
706706 40overtreatingpatients;orchargingforvisitstothephysician'sofficewhichdidnotoccur
707707 41unlesstheserviceswerecontractedforinadvance,orforserviceswhichwerenotrenderedor
708708 42documentedinthepatient'srecords;
709709 43 (b)Attempting,directlyorindirectly,bywayofintimidation,coercionordeception,
710710 44toobtainorretainapatientordiscouragetheuseofasecondopinionorconsultation;
711711 45 (c)Willfullyandcontinuallyperforminginappropriateorunnecessarytreatment,
712712 46diagnostictestsormedicalorsurgicalservices;
713713 47 (d)Delegatingprofessionalresponsibilitiestoapersonwhoisnotqualifiedby
714714 48training,skill,competency,age,experienceorlicensuretoperformsuchresponsibilities;
715715 49 (e)Misrepresentingthatanydisease,ailmentorinfirmitycanbecuredbyamethod,
716716 50procedure,treatment,medicineordevice;
717717 51 (f)Performingorprescribingmedicalserviceswhichhavebeendeclaredbyboard
718718 52ruletobeofnomedicalorosteopathicvalue;
719719 53 (g)Finaldisciplinaryactionbyanyprofessionalmedicalorosteopathicassociationor
720720 54societyorlicensedhospitalormedicalstaffofsuchhospitalinthisoranyotherstateor
721721 55territory,whetheragreedtovoluntarilyornot,andincluding,butnotlimitedto,anyremoval,
722722 56suspension,limitation,orrestrictionoftheperson'slicenseorstafforhospitalprivileges,
723723 57failuretorenewsuchprivilegesorlicenseforcause,orotherfinaldisciplinaryaction,ifthe
724724 HB1304 20 58actionwasinanywayrelatedtounprofessionalconduct,professionalincompetence,
725725 59malpracticeoranyotherviolationofanyprovisionofthischapter;
726726 60 (h)Signingablankprescriptionform;ordispensing,prescribing,administeringor
727727 61otherwisedistributinganydrug,controlledsubstanceorothertreatmentwithoutsufficient
728728 62examinationincludingfailingtoestablishavalidphysician-patientrelationshippursuantto
729729 63section334.108,orforotherthanmedicallyacceptedtherapeuticorexperimentalor
730730 64investigativepurposesdulyauthorizedbyastateorfederalagency,ornotinthecourseof
731731 65professionalpractice,ornotingoodfaithtorelievepainandsuffering,ornottocurean
732732 66ailment,physicalinfirmityordisease,exceptasauthorizedinsection334.104;
733733 67 (i)Exercisinginfluencewithinaphysician-patientrelationshipforpurposesof
734734 68engagingapatientinsexualactivity;
735735 69 (j)Beinglistedonanystateorfederalsexualoffenderregistry;
736736 70 (k)Terminatingthemedicalcareofapatientwithoutadequatenoticeorwithout
737737 71makingotherarrangementsforthecontinuedcareofthepatient;
738738 72 (l)Failingtofurnishdetailsofapatient'smedicalrecordstoothertreatingphysicians
739739 73orhospitalsuponproperrequest;orfailingtocomplywithanyotherlawrelatingtomedical
740740 74records;
741741 75 (m)Failureofanyapplicantorlicenseetocooperatewiththeboardduringany
742742 76investigation;
743743 77 (n)Failuretocomplywithanysubpoenaorsubpoenaducestecumfromtheboardor
744744 78anorderoftheboard;
745745 79 (o)Failuretotimelypaylicenserenewalfeesspecifiedinthischapter;
746746 80 (p)Violatingaprobationagreement,order,orothersettlementagreementwiththis
747747 81boardoranyotherlicensingagency;
748748 82 (q)Failingtoinformtheboardofthephysician'scurrentresidenceandbusiness
749749 83address;
750750 84 (r)Advertisingbyanapplicantorlicenseewhichisfalseormisleading,orwhich
751751 85violatesanyruleoftheboard,orwhichclaimswithoutsubstantiationthepositivecureofany
752752 86disease,orprofessionalsuperioritytoorgreaterskillthanthatpossessedbyanyother
753753 87physician.Anapplicantorlicenseeshallalsobeinviolationofthisprovisioniftheapplicant
754754 88orlicenseehasafinancialinterestinanyorganization,corporationorassociationwhichissues
755755 89orconductssuchadvertising;
756756 90 (s)Anyotherconductthatisunethicalorunprofessionalinvolvingaminor;
757757 91 (5)Anyconductorpracticewhichisormightbeharmfulordangeroustothemental
758758 92orphysicalhealthofapatientorthepublic;orincompetency,grossnegligenceorrepeated
759759 93negligenceintheperformanceofthefunctionsordutiesofanyprofessionlicensedor
760760 94regulatedbythischapter.Forthepurposesofthissubdivision,"repeatednegligence"means
761761 HB1304 21 95thefailure,onmorethanoneoccasion,tousethatdegreeofskillandlearningordinarilyused
762762 96underthesameorsimilarcircumstancesbythememberoftheapplicant'sorlicensee's
763763 97profession;
764764 98 (6)Violationof,orattemptingtoviolate,directlyorindirectly,orassistingor
765765 99enablinganypersontoviolate,anyprovisionofthischapterorchapter324,orofanylawful
766766 100ruleorregulationadoptedpursuanttothischapterorchapter324;
767767 101 (7)Impersonationofanypersonholdingacertificateofregistrationorauthority,
768768 102permitorlicenseorallowinganypersontousehisorhercertificateofregistrationor
769769 103authority,permit,licenseordiplomafromanyschool;
770770 104 (8)Revocation,suspension,restriction,modification,limitation,reprimand,warning,
771771 105censure,probationorotherfinaldisciplinaryactionagainsttheholderoforapplicantfora
772772 106licenseorotherrighttopracticeanyprofessionregulatedbythischapterbyanotherstate,
773773 107territory,federalagencyorcountry,whetherornotvoluntarilyagreedtobythelicenseeor
774774 108applicant,including,butnotlimitedto,thedenialoflicensure,surrenderofthelicense,
775775 109allowingthelicensetoexpireorlapse,ordiscontinuingorlimitingthepracticeofmedicine
776776 110whilesubjecttoaninvestigationorwhileactuallyunderinvestigationbyanylicensing
777777 111authority,medicalfacility,branchoftheArmedForcesoftheUnitedStatesofAmerica,
778778 112insurancecompany,court,agencyofthestateorfederalgovernment,oremployer;
779779 113 (9)Apersonisfinallyadjudgedincapacitatedordisabledbyacourtofcompetent
780780 114jurisdiction;
781781 115 (10)Assistingorenablinganypersontopracticeoroffertopracticeanyprofession
782782 116licensedorregulatedbythischapterwhoisnotregisteredandcurrentlyeligibletopractice
783783 117pursuanttothischapter;orknowinglyperforminganyactwhichinanywayaids,assists,
784784 118procures,advises,orencouragesanypersontopracticemedicinewhoisnotregisteredand
785785 119currentlyeligibletopracticepursuanttothischapter.Aphysicianwhoworksinaccordance
786786 120withstandingordersorprotocolsorinaccordancewiththeprovisionsofsection334.104
787787 121shallnotbeinviolationofthissubdivision;
788788 122 (11)Issuanceofacertificateofregistrationorauthority,permitorlicensebasedupon
789789 123amaterialmistakeoffact;
790790 124 (12)Failuretodisplayavalidcertificateorlicenseifsorequiredbythischapteror
791791 125anyrulepromulgatedpursuanttothischapter;
792792 126 (13)Violationofthedruglawsorrulesandregulationsofthisstate,includingbutnot
793793 127limitedtoanyprovisionofchapter195,anyotherstate,orthefederalgovernment;
794794 128 (14)Knowinglymaking,orcausingtobemade,oraiding,orabettinginthemaking
795795 129of,afalsestatementinanybirth,deathorothercertificateordocumentexecutedin
796796 130connectionwiththepracticeoftheperson'sprofession;
797797 131 (15)Knowinglymakingafalsestatement,orallyorinwritingtotheboard;
798798 HB1304 22 132 (16)Solicitingpatronageinpersonorbyagentsorrepresentatives,orbyanyother
799799 133meansormanner,undertheperson'sownnameorunderthenameofanotherpersonor
800800 134concern,actualorpretended,insuchamannerastoconfuse,deceive,ormisleadthepublicas
801801 135totheneedornecessityfororappropriatenessofhealthcareservicesforallpatients,orthe
802802 136qualificationsofanindividualpersonorpersonstodiagnose,render,orperformhealthcare
803803 137services;
804804 138 (17)Using,orpermittingtheuseof,theperson'snameunderthedesignationof
805805 139"Doctor","Dr.","M.D.",or"D.O.",oranysimilardesignationwithreferencetothe
806806 140commercialexploitationofanygoods,waresormerchandise;
807807 141 (18)Knowinglymakingorcausingtobemadeafalsestatementormisrepresentation
808808 142ofamaterialfact,withintenttodefraud,forpaymentpursuanttotheprovisionsofchapter
809809 143208orchapter630orforpaymentfromTitleXVIIIorTitleXIXoftheSocialSecurityAct;
810810 144 (19)Failureorrefusaltoproperlyguardagainstcontagious,infectiousor
811811 145communicablediseasesorthespreadthereof;maintaininganunsanitaryofficeor
812812 146performingprofessionalservicesunderunsanitaryconditions;orfailuretoreportthe
813813 147existenceofanunsanitaryconditionintheofficeofaphysicianorinanyhealthcarefacility
814814 148totheboard,inwriting,withinthirtydaysafterthediscoverythereof;
815815 149 (20)Anycandidateforlicensureorpersonlicensedtopracticeasaphysicaltherapist,
816816 150payingorofferingtopayareferralfeeorevaluatingortreatingapatientinamanner
817817 151inconsistentwithsection334.506;
818818 152 (21)Anycandidateforlicensureorpersonlicensedtopracticeasaphysicaltherapist,
819819 153treatingorattemptingtotreatailmentsorotherhealthconditionsofhumanbeingsotherthan
820820 154byprofessionalphysicaltherapyandasauthorizedbysections334.500to334.620;
821821 155 (22)Anypersonlicensedtopracticeasaphysicianorsurgeon,requiring,asa
822822 156conditionofthephysician-patientrelationship,thatthepatientreceiveprescribeddrugs,
823823 157devicesorotherprofessionalservicesdirectlyfromfacilitiesofthatphysician'sofficeorother
824824 158entitiesunderthatphysician'sownershiporcontrol.Aphysicianshallprovidethepatient
825825 159withaprescriptionwhichmaybetakentothefacilityselectedbythepatientandaphysician
826826 160knowinglyfailingtodisclosetoapatientonaformapprovedbytheadvisorycommissionfor
827827 161professionalphysicaltherapistsasestablishedbysection334.625whichisdatedandsigned
828828 162byapatientorguardianacknowledgingthatthepatientorguardianhasreadandunderstands
829829 163thatthephysicianhasapecuniaryinterestinaphysicaltherapyorrehabilitationservice
830830 164providingprescribedtreatmentandthattheprescribedtreatmentisavailableonacompetitive
831831 165basis.Thissubdivisionshallnotapplytoareferralbyonephysiciantoanotherphysician
832832 166withinagroupofphysicianspracticingtogether;
833833 167 (23)Apatternofpersonaluseorconsumptionofanycontrolledsubstanceunlessitis
834834 168prescribed,dispensedoradministeredbyanotherphysicianwhoisauthorizedbylawtodoso;
835835 HB1304 23 169 (24)Habitualintoxicationordependenceonalcohol,evidenceofwhichmayinclude
836836 170morethanonealcohol-relatedenforcementcontactasdefinedbysection302.525;
837837 171 (25)Failuretocomplywithatreatmentprogramoranaftercareprogramenteredinto
838838 172aspartofaboardorder,settlementagreementorlicensee'sprofessionalhealthprogram;
839839 173 (26)Revocation,suspension,limitation,probation,orrestrictionofanykind
840840 174whatsoeverofanycontrolledsubstanceauthority,whetheragreedtovoluntarilyornot,or
841841 175voluntaryterminationofacontrolledsubstanceauthoritywhileunderinvestigation[;
842842 176 (27)Foraphysiciantooperate,conduct,manage,orestablishanabortionfacility,or
843843 177foraphysiciantoperformanabortioninanabortionfacility,ifsuchfacilitycomesunderthe
844844 178definitionofanambulatorysurgicalcenterpursuanttosections197.200to197.240,andsuch
845845 179facilityhasfailedtoobtainorrenewalicenseasanambulatorysurgicalcenter].
846846 180 3.Collaborativepracticearrangements,protocolsandstandingordersshallbein
847847 181writingandsignedanddatedbyaphysicianpriortotheirimplementation.
848848 182 4.Afterthefilingofsuchcomplaintbeforetheadministrativehearingcommission,
849849 183theproceedingsshallbeconductedinaccordancewiththeprovisionsofchapter621.Upona
850850 184findingbytheadministrativehearingcommissionthatthegrounds,providedinsubsection2
851851 185ofthissection,fordisciplinaryactionaremet,theboardmay,singlyorincombination,warn,
852852 186censureorplacethepersonnamedinthecomplaintonprobationonsuchtermsand
853853 187conditionsastheboarddeemsappropriateforaperiodnottoexceedtenyears,ormay
854854 188suspendtheperson'slicense,certificateorpermitforaperiodnottoexceedthreeyears,or
855855 189restrictorlimittheperson'slicense,certificateorpermitforanindefiniteperiodoftime,or
856856 190revoketheperson'slicense,certificate,orpermit,oradministerapublicorprivatereprimand,
857857 191ordenytheperson'sapplicationforalicense,orpermanentlywithholdissuanceofalicenseor
858858 192requirethepersontosubmittothecare,counselingortreatmentofphysiciansdesignatedby
859859 193theboardattheexpenseoftheindividualtobeexamined,orrequirethepersontoattendsuch
860860 194continuingeducationalcoursesandpasssuchexaminationsastheboardmaydirect.
861861 195 5.Inanyorderofrevocation,theboardmayprovidethatthepersonmaynotapplyfor
862862 196reinstatementoftheperson'slicenseforaperiodoftimerangingfromtwotosevenyears
863863 197followingthedateoftheorderofrevocation.Allstayordersshalltollthistimeperiod.
864864 198 6.Beforerestoringtogoodstandingalicense,certificateorpermitissuedpursuantto
865865 199thischapterwhichhasbeeninarevoked,suspendedorinactivestateforanycauseformore
866866 200thantwoyears,theboardmayrequiretheapplicanttoattendsuchcontinuingmedical
867867 201educationcoursesandpasssuchexaminationsastheboardmaydirect.
868868 202 7.Inanyinvestigation,hearingorotherproceedingtodeterminealicensee'sor
869869 203applicant'sfitnesstopractice,anyrecordrelatingtoanypatientofthelicenseeorapplicant
870870 204shallbediscoverablebytheboardandadmissibleintoevidence,regardlessofanystatutoryor
871871 205commonlawprivilegewhichsuchlicensee,applicant,recordcustodianorpatientmight
872872 HB1304 24 206otherwiseinvoke.Inaddition,nosuchlicensee,applicant,orrecordcustodianmaywithhold
873873 207recordsortestimonybearinguponalicensee'sorapplicant'sfitnesstopracticeontheground
874874 208ofprivilegebetweensuchlicensee,applicantorrecordcustodianandapatient.
875875 209 8.Theactoflawfullydispensing,prescribing,administering,orotherwise
876876 210distributingivermectintabletsorhydroxychloroquinesulfatetabletsforhumanuseshall
877877 211notbegroundsfordenial,suspension,revocation,orotherdisciplinaryactionbytheboard.
878878 334.735.1.Asusedinsections334.735to334.749,thefollowingtermsmean:
879879 2 (1)"Applicant",anyindividualwhoseekstobecomelicensedasaphysician
880880 3assistant;
881881 4 (2)"Certification"or"registration",aprocessbyacertifyingentitythatgrants
882882 5recognitiontoapplicantsmeetingpredeterminedqualificationsspecifiedbysuchcertifying
883883 6entity;
884884 7 (3)"Certifyingentity",thenongovernmentalagencyorassociationwhichcertifiesor
885885 8registersindividualswhohavecompletedacademicandtrainingrequirements;
886886 9 (4)"Collaborativepracticearrangement",writtenagreements,jointlyagreedupon
887887 10protocols,orstandingorders,allofwhichshallbeinwriting,forthedeliveryofhealthcare
888888 11services;
889889 12 (5)"Department",thedepartmentofcommerceandinsuranceoradesignatedagency
890890 13thereof;
891891 14 (6)"License",adocumentissuedtoanapplicantbytheboardacknowledgingthatthe
892892 15applicantisentitledtopracticeasaphysicianassistant;
893893 16 (7)"Physicianassistant",apersonwhohasgraduatedfromaphysicianassistant
894894 17programaccreditedbytheAccreditationReviewCommissiononEducationforthePhysician
895895 18Assistantoritssuccessoragency,priorto2001,ortheCommitteeonAlliedHealthEducation
896896 19andAccreditationortheCommissiononAccreditationofAlliedHealthEducationPrograms,
897897 20whohaspassedthecertifyingexaminationadministeredbytheNationalCommissionon
898898 21CertificationofPhysicianAssistantsandhasactivecertificationbytheNationalCommission
899899 22onCertificationofPhysicianAssistantswhoprovideshealthcareservicesdelegatedbya
900900 23licensedphysician.Apersonwhohasbeenemployedasaphysicianassistantforthreeyears
901901 24priortoAugust28,1989,whohaspassedtheNationalCommissiononCertificationof
902902 25PhysicianAssistantsexamination,andhasactivecertificationoftheNationalCommissionon
903903 26CertificationofPhysicianAssistants;
904904 27 (8)"Recognition",theformalprocessofbecomingacertifyingentityasrequiredby
905905 28theprovisionsofsections334.735to334.749.
906906 29 2.Thescopeofpracticeofaphysicianassistantshallconsistonlyofthefollowing
907907 30servicesandprocedures:
908908 31 (1)Takingpatienthistories;
909909 HB1304 25 32 (2)Performingphysicalexaminationsofapatient;
910910 33 (3)Performingorassistingintheperformanceofroutineofficelaboratoryandpatient
911911 34screeningprocedures;
912912 35 (4)Performingroutinetherapeuticprocedures;
913913 36 (5)Recordingdiagnosticimpressionsandevaluatingsituationscallingforattentionof
914914 37aphysiciantoinstitutetreatmentprocedures;
915915 38 (6)Instructingandcounselingpatientsregardingmentalandphysicalhealthusing
916916 39proceduresreviewedandapprovedbyacollaboratingphysician;
917917 40 (7)Assistingthesupervisingphysicianininstitutionalsettings,includingreviewing
918918 41oftreatmentplans,orderingoftestsanddiagnosticlaboratoryandradiologicalservices,and
919919 42orderingoftherapies,usingproceduresreviewedandapprovedbyalicensedphysician;
920920 43 (8)Assistinginsurgery;and
921921 44 (9)Performingsuchothertasksnotprohibitedbylawunderthecollaborativepractice
922922 45arrangementwithalicensedphysicianasthephysicianassistanthasbeentrainedandis
923923 46proficienttoperform.
924924 47 3.[Physicianassistantsshallnotperformorprescribeabortions.
925925 48 4.]Physicianassistantsshallnotprescribeanydrug,medicine,deviceortherapy
926926 49unlesspursuanttoacollaborativepracticearrangementinaccordancewiththelaw,nor
927927 50prescribelenses,prismsorcontactlensesfortheaid,relieforcorrectionofvisionorthe
928928 51measurementofvisualpowerorvisualefficiencyofthehumaneye,noradministerormonitor
929929 52generalorregionalblockanesthesiaduringdiagnostictests,surgeryorobstetricprocedures.
930930 53Prescribingofdrugs,medications,devicesortherapiesbyaphysicianassistantshallbe
931931 54pursuanttoacollaborativepracticearrangementwhichisspecifictotheclinicalconditions
932932 55treatedbythesupervisingphysicianandthephysicianassistantshallbesubjecttothe
933933 56following:
934934 57 (1)Aphysicianassistantshallonlyprescribecontrolledsubstancesinaccordance
935935 58withsection334.747;
936936 59 (2)Thetypesofdrugs,medications,devicesortherapiesprescribedbyaphysician
937937 60assistantshallbeconsistentwiththescopesofpracticeofthephysicianassistantandthe
938938 61collaboratingphysician;
939939 62 (3)Allprescriptionsshallconformwithstateandfederallawsandregulationsand
940940 63shallincludethename,addressandtelephonenumberofthephysicianassistant;
941941 64 (4)Aphysicianassistant,oradvancedpracticeregisterednurseasdefinedinsection
942942 65335.016mayrequest,receiveandsignfornoncontrolledprofessionalsamplesandmay
943943 66distributeprofessionalsamplestopatients;and
944944 67 (5)Aphysicianassistantshallnotprescribeanydrugs,medicines,devicesor
945945 68therapiesthecollaboratingphysicianisnotqualifiedorauthorizedtoprescribe.
946946 HB1304 26 69 [5.]4.Aphysicianassistantshallclearlyidentifyhimselforherselfasaphysician
947947 70assistantandshallnotuseorpermittobeusedinthephysicianassistant'sbehalftheterms
948948 71"doctor","Dr."or"doc"norholdhimselforherselfoutinanywaytobeaphysicianor
949949 72surgeon.Nophysicianassistantshallpracticeorattempttopracticewithoutphysician
950950 73collaborationorinanylocationwherethecollaboratingphysicianisnotimmediately
951951 74availableforconsultation,assistanceandintervention,exceptasotherwiseprovidedinthis
952952 75section,andinanemergencysituation,norshallanyphysicianassistantbillapatient
953953 76independentlyordirectlyforanyservicesorprocedurebythephysicianassistant;exceptthat,
954954 77nothinginthissubsectionshallbeconstruedtoprohibitaphysicianassistantfromenrolling
955955 78withathird-partyplanorthedepartmentofsocialservicesasaMOHealthNetorMedicaid
956956 79providerwhileactingunderacollaborativepracticearrangementbetweenthephysicianand
957957 80physicianassistant.
958958 81 [6.]5.Thelicensingofphysicianassistantsshalltakeplacewithinprocesses
959959 82establishedbythestateboardofregistrationforthehealingartsthroughruleandregulation.
960960 83Theboardofhealingartsisauthorizedtoestablishrulespursuanttochapter536establishing
961961 84licensingandrenewalprocedures,collaboration,collaborativepracticearrangements,fees,
962962 85andaddressingsuchothermattersasarenecessarytoprotectthepublicanddisciplinethe
963963 86profession.Anapplicationforlicensingmaybedeniedorthelicenseofaphysicianassistant
964964 87maybesuspendedorrevokedbytheboardinthesamemannerandforviolationofthe
965965 88standardsassetforthbysection334.100,orsuchotherstandardsofconductsetbytheboard
966966 89byruleorregulation.Personslicensedpursuanttotheprovisionsofchapter335shallnotbe
967967 90requiredtobelicensedasphysicianassistants.Allapplicantsforphysicianassistantlicensure
968968 91whocompleteaphysicianassistanttrainingprogramafterJanuary1,2008,shallhavea
969969 92master'sdegreefromaphysicianassistantprogram.
970970 93 [7.]6.Atalltimesthephysicianisresponsiblefortheoversightoftheactivitiesof,
971971 94andacceptsresponsibilityfor,healthcareservicesrenderedbythephysicianassistant.
972972 95 [8.]7.(1)Aphysicianmayenterintocollaborativepracticearrangementswith
973973 96physicianassistants.Collaborativepracticearrangements,whichshallbeinwriting,may
974974 97delegatetoaphysicianassistanttheauthoritytoprescribe,administer,ordispensedrugsand
975975 98providetreatmentwhichiswithintheskill,training,andcompetenceofthephysician
976976 99assistant.Collaborativepracticearrangementsmaydelegatetoaphysicianassistant,as
977977 100definedinsection334.735,theauthoritytoadminister,dispense,orprescribecontrolled
978978 101substanceslistedinSchedulesIII,IV,andVofsection195.017,andScheduleII-
979979 102hydrocodone.ScheduleIIInarcoticcontrolledsubstancesandScheduleII-hydrocodone
980980 103prescriptionsshallbelimitedtoaonehundredtwenty-hoursupplywithoutrefill.Such
981981 104collaborativepracticearrangementsshallbeintheformofawrittenarrangement,jointly
982982 105agreed-uponprotocols,orstandingordersforthedeliveryofhealthcareservices.
983983 HB1304 27 106 (2)Notwithstandinganyotherprovisionofthissectiontothecontrary,acollaborative
984984 107practicearrangementmaydelegatetoaphysicianassistanttheauthoritytoadminister,
985985 108dispense,orprescribeScheduleIIcontrolledsubstancesforhospicepatients;provided,that
986986 109thephysicianassistantisemployedbyahospiceprovidercertifiedpursuanttochapter197
987987 110andthephysicianassistantisprovidingcaretohospicepatientspursuanttoacollaborative
988988 111practicearrangementthatdesignatesthecertifiedhospiceasalocationwherethephysician
989989 112assistantisauthorizedtopracticeandprescribe.
990990 113 [9.]8.Thewrittencollaborativepracticearrangementshallcontainatleastthe
991991 114followingprovisions:
992992 115 (1)Completenames,homeandbusinessaddresses,zipcodes,andtelephonenumbers
993993 116ofthecollaboratingphysicianandthephysicianassistant;
994994 117 (2)Alistofallotherofficesorlocations,otherthanthoselistedinsubdivision(1)of
995995 118thissubsection,wherethecollaboratingphysicianhasauthorizedthephysicianassistantto
996996 119prescribe;
997997 120 (3)Arequirementthatthereshallbepostedateveryofficewherethephysician
998998 121assistantisauthorizedtoprescribe,incollaborationwithaphysician,aprominentlydisplayed
999999 122disclosurestatementinformingpatientsthattheymaybeseenbyaphysicianassistantand
10001000 123havetherighttoseethecollaboratingphysician;
10011001 124 (4)Allspecialtyorboardcertificationsofthecollaboratingphysicianandall
10021002 125certificationsofthephysicianassistant;
10031003 126 (5)Themannerofcollaborationbetweenthecollaboratingphysicianandthe
10041004 127physicianassistant,includinghowthecollaboratingphysicianandthephysicianassistant
10051005 128will:
10061006 129 (a)Engageincollaborativepracticeconsistentwitheachprofessional'sskill,training,
10071007 130education,andcompetence;
10081008 131 (b)Maintaingeographicproximity,asdeterminedbytheboardofregistrationforthe
10091009 132healingarts;and
10101010 133 (c)Providecoverageduringabsence,incapacity,infirmity,oremergencyofthe
10111011 134collaboratingphysician;
10121012 135 (6)Alistofallotherwrittencollaborativepracticearrangementsofthecollaborating
10131013 136physicianandthephysicianassistant;
10141014 137 (7)Thedurationofthewrittenpracticearrangementbetweenthecollaborating
10151015 138physicianandthephysicianassistant;
10161016 139 (8)Adescriptionofthetimeandmannerofthecollaboratingphysician'sreviewof
10171017 140thephysicianassistant'sdeliveryofhealthcareservices.Thedescriptionshallinclude
10181018 141provisionsthatthephysicianassistantshallsubmitaminimumoftenpercentofthecharts
10191019 142documentingthephysicianassistant'sdeliveryofhealthcareservicestothecollaborating
10201020 HB1304 28 143physicianforreviewbythecollaboratingphysician,oranyotherphysiciandesignatedinthe
10211021 144collaborativepracticearrangement,everyfourteendays.Reviewsmaybeconducted
10221022 145electronically;
10231023 146 (9)Thecollaboratingphysician,oranyotherphysiciandesignatedinthe
10241024 147collaborativepracticearrangement,shallrevieweveryfourteendaysaminimumoftwenty
10251025 148percentofthechartsinwhichthephysicianassistantprescribescontrolledsubstances.The
10261026 149chartsreviewedunderthissubdivisionmaybecountedinthenumberofchartsrequiredtobe
10271027 150reviewedundersubdivision(8)ofthissubsection;
10281028 151 (10)Astatementthatnocollaborationrequirementsinadditiontothefederallaw
10291029 152shallberequiredforaphysician-physicianassistantteamworkinginacertifiedcommunity
10301030 153behavioralhealthclinicasdefinedbyPub.L.113-93,oraruralhealthclinicunderthefederal
10311031 154RuralHealthServicesAct,Pub.L.95-210,asamended,orafederallyqualifiedhealthcenter
10321032 155asdefinedin42U.S.C.Section1395x,asamended;and
10331033 156 (11)Ifacollaborativepracticearrangementisusedinclinicalsituationswherea
10341034 157collaboratingphysicianassistantprovideshealthcareservicesthatincludethediagnosisand
10351035 158initiationoftreatmentforacutelyorchronicallyillorinjuredpersons,thenthecollaborating
10361036 159physicianoranyotherphysiciandesignatedinthecollaborativepracticearrangementshallbe
10371037 160presentforsufficientperiodsoftime,atleastonceeverytwoweeks,exceptinextraordinary
10381038 161circumstancesthatshallbedocumented,toparticipateinachartreviewandtoprovide
10391039 162necessarymedicaldirection,medicalservices,consultations,andsupervisionofthehealth
10401040 163carestaff.
10411041 164 [10.]9.Thestateboardofregistrationforthehealingartsundersection334.125may
10421042 165promulgaterulesregulatingtheuseofcollaborativepracticearrangements.
10431043 166 [11.]10.Thestateboardofregistrationforthehealingartsshallnotdeny,revoke,
10441044 167suspend,orotherwisetakedisciplinaryactionagainstacollaboratingphysicianforhealthcare
10451045 168servicesdelegatedtoaphysicianassistant,providedthattheprovisionsofthissectionandthe
10461046 169rulespromulgatedthereunderaresatisfied.
10471047 170 [12.]11.Withinthirtydaysofanychangeandoneachrenewal,thestateboardof
10481048 171registrationforthehealingartsshallrequireeveryphysiciantoidentifywhetherthephysician
10491049 172isengagedinanycollaborativepracticearrangement,includingcollaborativepractice
10501050 173arrangementsdelegatingtheauthoritytoprescribecontrolledsubstances,andalsoreportto
10511051 174theboardthenameofeachphysicianassistantwithwhomthephysicianhasenteredintosuch
10521052 175arrangement.Theboardmaymakesuchinformationavailabletothepublic.Theboardshall
10531053 176trackthereportedinformationandmayroutinelyconductrandomreviewsofsuch
10541054 177arrangementstoensurethatthearrangementsarecarriedoutincompliancewiththischapter.
10551055 178 [13.]12.Thecollaboratingphysicianshalldetermineanddocumentthecompletionof
10561056 179aperiodoftimeduringwhichthephysicianassistantshallpracticewiththecollaborating
10571057 HB1304 29 180physiciancontinuouslypresentbeforepracticinginasettingwherethecollaborating
10581058 181physicianisnotcontinuouslypresent.Thislimitationshallnotapplytocollaborative
10591059 182arrangementsofprovidersofpopulation-basedpublichealthservicesasdefinedby20CSR
10601060 1832150-5.100asofApril30,2009.
10611061 184 [14.]13.Nocontractorotherarrangementshallrequireaphysiciantoactasa
10621062 185collaboratingphysicianforaphysicianassistantagainstthephysician'swill.Aphysician
10631063 186shallhavetherighttorefusetoactasasupervisingphysician,withoutpenalty,foraparticular
10641064 187physicianassistant.Nocontractorotheragreementshalllimitthecollaboratingphysician's
10651065 188ultimateauthorityoveranyprotocolsorstandingordersorinthedelegationofthephysician's
10661066 189authoritytoanyphysicianassistant.Nocontractorotherarrangementshallrequireany
10671067 190physicianassistanttocollaboratewithanyphysicianagainstthephysicianassistant'swill.A
10681068 191physicianassistantshallhavetherighttorefusetocollaborate,withoutpenalty,witha
10691069 192particularphysician.
10701070 193 [15.]14.Physicianassistantsshallfilewiththeboardacopyoftheircollaborating
10711071 194physicianform.
10721072 195 [16.]15.Nophysicianshallbedesignatedtoserveasacollaboratingphysicianfor
10731073 196morethansixfull-timeequivalentlicensedphysicianassistants,full-timeequivalent
10741074 197advancedpracticeregisterednurses,orfull-timeequivalentassistantphysicians,orany
10751075 198combinationthereof.Thislimitationshallnotapplytophysicianassistantcollaborative
10761076 199practicearrangementsofhospitalemployeesprovidinginpatientcareserviceinhospitalsas
10771077 200definedinchapter197,ortoacertifiedregisterednurseanesthetistprovidinganesthesia
10781078 201servicesunderthesupervisionofananesthesiologistorotherphysician,dentist,orpodiatrist
10791079 202whoisimmediatelyavailableifneededassetoutinsubsection7ofsection334.104.
10801080 203 [17.]16.Noarrangementmadeunderthissectionshallsupercedecurrenthospital
10811081 204licensingregulationsgoverninghospitalmedicationordersunderprotocolsorstandingorders
10821082 205forthepurposeofdeliveringinpatientoremergencycarewithinahospital,asdefinedin
10831083 206section197.020,ifsuchprotocolsorstandingordershavebeenapprovedbythehospital's
10841084 207medicalstaffandpharmaceuticaltherapeuticscommittee.
10851085 595.027.1.Uponrequestbythedepartmentforverificationofinjuriesofvictims,
10861086 2medicalprovidersshallsubmittheinformationrequestedbythedepartmentwithintwenty
10871087 3workingdaysoftherequestatnocosttothefund.
10881088 4 2.Forpurposesofthissection,"medicalproviders"meansphysicians,dentists,
10891089 5clinicalpsychologists,optometrists,podiatrists,registerednurses,physician'sassistants,
10901090 6chiropractors,physicaltherapists,hospitals,ambulatorysurgicalcenters,[abortionfacilities,]
10911091 7andnursinghomes.
10921092 8 3.Failuretosubmittheinformationasrequiredbythissectionshallbeaninfraction.
10931093 HB1304 30 [188.017.1.Thissectionshallbeknownandmaybecitedasthe
10941094 2 "RighttoLifeoftheUnbornChildAct".
10951095 3 2.Notwithstandinganyotherprovisionoflawtothecontrary,no
10961096 4 abortionshallbeperformedorinduceduponawoman,exceptincasesof
10971097 5 medicalemergency.Anypersonwhoknowinglyperformsorinducesan
10981098 6 abortionofanunbornchildinviolationofthissubsectionshallbeguiltyofa
10991099 7 classBfelony,aswellassubjecttosuspensionorrevocationofhisorher
11001100 8 professionallicensebyhisorherprofessionallicensingboard.Awomanupon
11011101 9 whomanabortionisperformedorinducedinviolationofthissubsectionshall
11021102 10 notbeprosecutedforaconspiracytoviolatetheprovisionsofthissubsection.
11031103 11 3.Itshallbeanaffirmativedefenseforanypersonallegedtohave
11041104 12 violatedtheprovisionsofsubsection2ofthissectionthattheperson
11051105 13 performedorinducedanabortionbecauseofamedicalemergency.The
11061106 14 defendantshallhavetheburdenofpersuasionthatthedefenseismore
11071107 15 probablytruethannot.
11081108 16 4.Theenactmentofthissectionshallonlybecomeeffectiveupon
11091109 17 notificationtotherevisorofstatutesbyanopinionbytheattorneygeneralof
11101110 18 Missouri,aproclamationbythegovernorofMissouri,ortheadoptionofa
11111111 19 concurrentresolutionbytheMissourigeneralassemblythat:
11121112 20 (1)TheUnitedStatesSupremeCourthasoverruled,inwholeorin
11131113 21 part,Roev.Wade,410U.S.113(1973),restoringorgrantingtothestateof
11141114 22 Missouritheauthoritytoregulateabortiontotheextentsetforthinthis
11151115 23 section,andthatasaresult,itisreasonablyprobablethatthissectionwouldbe
11161116 24 upheldbythecourtasconstitutional;
11171117 25 (2)AnamendmenttotheConstitutionoftheUnitedStateshasbeen
11181118 26 adoptedthathastheeffectofrestoringorgrantingtothestateofMissourithe
11191119 27 authoritytoregulateabortiontotheextentsetforthinthissection;or
11201120 28 (3)TheUnitedStatesCongresshasenactedalawthathastheeffectof
11211121 29 restoringorgrantingtothestateofMissouritheauthoritytoregulateabortion
11221122 30 totheextentsetforthinthissection.]
11231123 [188.020.Nopersonshallperformorinduceanabortionexcepta
11241124 2 physician.]
11251125 [188.021.1.WhenRU-486(mifepristone)oranydrugorchemicalis
11261126 2 usedforthepurposeofinducinganabortion,theinitialdoseofthedrugor
11271127 3 chemicalshallbeadministeredinthesameroomandinthephysicalpresence
11281128 4 ofthephysicianwhoprescribed,dispensed,orotherwiseprovidedthedrugor
11291129 5 chemicaltothepatient.Thephysicianinducingtheabortion,oraperson
11301130 6 actingonsuchphysician'sbehalf,shallmakeallreasonableeffortstoensure
11311131 7 thatthepatientreturnsaftertheadministrationoruseofRU-486oranydrugor
11321132 8 chemicalforafollow-upvisitunlesssuchterminationofthepregnancyhas
11331133 9 alreadybeenconfirmedandthepatient'smedicalconditionhasbeenassessed
11341134 10 byalicensedphysicianpriortodischarge.
11351135 11 2.WhentheFoodandDrugAdministrationlabelofanydrugor
11361136 12 chemicalusedforthepurposeofinducinganabortionincludesanyclinical
11371137 13 studyinwhichmorethanonepercentofthoseadministeredthedrugor
11381138 14 chemicalrequiredsurgicalinterventionafteritsadministration,nophysician
11391139 HB1304 31 15 mayprescribeoradministersuchdrugorchemicaltoanypatientwithoutfirst
11401140 16 obtainingapprovalfromthedepartmentofhealthandseniorservicesofa
11411141 17 complicationplanfromthephysicianforadministrationofthedrugor
11421142 18 chemicaltoanypatient.Thecomplicationplanshallincludeanyinformation
11431143 19 deemednecessarybythedepartmenttoensurethesafetyofanypatient
11441144 20 sufferingcomplicationsasaresultoftheadministrationofthedrugor
11451145 21 chemicalinquestion.Nocomplicationplanshallberequiredwherethe
11461146 22 patientisadministeredthedruginamedicalemergencyatahospitalandis
11471147 23 thentreatedasaninpatientatahospitalundermedicalmonitoringbythe
11481148 24 hospitaluntiltheabortioniscompleted.
11491149 25 3.Thedepartmentmayadoptrules,regulations,andstandards
11501150 26 governingcomplicationplanstoensurethatpatientsundergoingabortions
11511151 27 inducedbydrugsorchemicalshaveaccesstosafeandreliablecare.Anyrule
11521152 28 orportionofarule,asthattermisdefinedinsection536.010,thatiscreated
11531153 29 undertheauthoritydelegatedinthissectionshallbecomeeffectiveonlyifit
11541154 30 complieswithandissubjecttoalloftheprovisionsofchapter536and,if
11551155 31 applicable,section536.028.Thissectionandchapter536arenonseverable
11561156 32 andifanyofthepowersvestedwiththegeneralassemblypursuanttochapter
11571157 33 536toreview,todelaytheeffectivedate,ortodisapproveandannularuleare
11581158 34 subsequentlyheldunconstitutional,thenthegrantofrulemakingauthorityand
11591159 35 anyruleproposedoradoptedafterOctober24,2017,shallbeinvalidand
11601160 36 void.]
11611161 [188.027.1.Exceptincasesofmedicalemergency,noabortionshall
11621162 2 beperformedorinducedonawomanwithouthervoluntaryandinformed
11631163 3 consent,givenfreelyandwithoutcoercion.Consenttoanabortionis
11641164 4 voluntaryandinformedandgivenfreelyandwithoutcoercionif,andonlyif,
11651165 5 atleastseventy-twohourspriortotheabortion:
11661166 6 (1)Thephysicianwhoistoperformorinducetheabortion,aqualified
11671167 7 professional,orthereferringphysicianhasinformedthewomanorally,
11681168 8 reducedtowriting,andinperson,ofthefollowing:
11691169 9 (a)Thenameofthephysicianwhowillperformorinducethe
11701170 10 abortion;
11711171 11 (b)Medicallyaccurateinformationthatareasonablepatientwould
11721172 12 considermaterialtothedecisionofwhetherornottoundergotheabortion,
11731173 13 including:
11741174 14 a.Adescriptionoftheproposedabortionmethod;
11751175 15 b.Theimmediateandlong-termmedicalriskstothewoman
11761176 16 associatedwiththeproposedabortionmethodincluding,butnotlimitedto,
11771177 17 infection,hemorrhage,cervicaltearoruterineperforation,harmtosubsequent
11781178 18 pregnanciesortheabilitytocarryasubsequentchildtoterm,andpossible
11791179 19 adversepsychologicaleffectsassociatedwiththeabortion;and
11801180 20 c.Theimmediateandlong-termmedicalriskstothewoman,inlight
11811181 21 oftheanesthesiaandmedicationthatistobeadministered,theunbornchild's
11821182 22 gestationalage,andthewoman'smedicalhistoryandmedicalcondition;
11831183 23 (c)Alternativestotheabortionwhichshallincludemakingthewoman
11841184 24 awarethatinformationandmaterialsshallbeprovidedtoherdetailingsuch
11851185 25 alternativestotheabortion;
11861186 HB1304 32 26 (d)Astatementthatthephysicianperformingorinducingtheabortion
11871187 27 isavailableforanyquestionsconcerningtheabortion,togetherwiththe
11881188 28 telephonenumberthatthephysicianmaybelaterreachedtoanswerany
11891189 29 questionsthatthewomanmayhave;
11901190 30 (e)Thelocationofthehospitalthatoffersobstetricalorgynecological
11911191 31 carelocatedwithinthirtymilesofthelocationwheretheabortionisperformed
11921192 32 orinducedandatwhichthephysicianperformingorinducingtheabortionhas
11931193 33 clinicalprivilegesandwherethewomanmayreceivefollow-upcarebythe
11941194 34 physicianifcomplicationsarise;
11951195 35 (f)Thegestationalageoftheunbornchildatthetimetheabortionisto
11961196 36 beperformedorinduced;and
11971197 37 (g)Theanatomicalandphysiologicalcharacteristicsoftheunborn
11981198 38 childatthetimetheabortionistobeperformedorinduced;
11991199 39 (2)Thephysicianwhoistoperformorinducetheabortionora
12001200 40 qualifiedprofessionalhaspresentedthewoman,inperson,printedmaterials
12011201 41 providedbythedepartment,whichdescribetheprobableanatomicaland
12021202 42 physiologicalcharacteristicsoftheunbornchildattwo-weekgestational
12031203 43 incrementsfromconceptiontofullterm,includingcolorphotographsor
12041204 44 imagesofthedevelopingunbornchildattwo-weekgestationalincrements.
12051205 45 Suchdescriptionsshallincludeinformationaboutbrainandheartfunctions,
12061206 46 thepresenceofexternalmembersandinternalorgansduringtheapplicable
12071207 47 stagesofdevelopmentandinformationonwhentheunbornchildisviable.
12081208 48 Theprintedmaterialsshallprominentlydisplaythefollowingstatement:"The
12091209 49 lifeofeachhumanbeingbeginsatconception.Abortionwillterminatethelife
12101210 50 ofaseparate,unique,livinghumanbeing.";
12111211 51 (3)Thephysicianwhoistoperformorinducetheabortion,aqualified
12121212 52 professional,orthereferringphysicianhaspresentedthewoman,inperson,
12131213 53 printedmaterialsprovidedbythedepartment,whichdescribethevarious
12141214 54 surgicalanddrug-inducedmethodsofabortionrelevanttothestageof
12151215 55 pregnancy,aswellastheimmediateandlong-termmedicalriskscommonly
12161216 56 associatedwitheachabortionmethodincluding,butnotlimitedto,infection,
12171217 57 hemorrhage,cervicaltearoruterineperforation,harmtosubsequent
12181218 58 pregnanciesortheabilitytocarryasubsequentchildtoterm,andthe
12191219 59 possibleadversepsychologicaleffectsassociatedwithanabortion;
12201220 60 (4)Thephysicianwhoistoperformorinducetheabortionora
12211221 61 qualifiedprofessionalshallprovidethewomanwiththeopportunitytoviewat
12221222 62 leastseventy-twohourspriortotheabortionanactiveultrasoundoftheunborn
12231223 63 childandheartheheartbeatoftheunbornchildiftheheartbeatisaudible.The
12241224 64 womanshallbeprovidedwithageographicallyindexedlistmaintainedbythe
12251225 65 departmentofhealthcareproviders,facilities,andclinicsthatperform
12261226 66 ultrasounds,includingthosethatofferultrasoundservicesfreeofcharge.Such
12271227 67 materialsshallprovidecontactinformationforeachprovider,facility,orclinic
12281228 68 includingtelephonenumbersand,ifavailable,websiteaddresses.Shouldthe
12291229 69 womandecidetoobtainanultrasoundfromaprovider,facility,orclinicother
12301230 70 thantheabortionfacility,thewomanshallbeofferedareasonabletimeto
12311231 71 obtaintheultrasoundexaminationbeforethedateandtimesetforperforming
12321232 72 orinducinganabortion.Thepersonconductingtheultrasoundshallensure
12331233 73 thattheactiveultrasoundimageisofaqualityconsistentwithstandard
12341234 HB1304 33 74 medicalpracticeinthecommunity,containsthedimensionsoftheunborn
12351235 75 child,andaccuratelyportraysthepresenceofexternalmembersandinternal
12361236 76 organs,ifpresentorviewable,oftheunbornchild.Theauscultationoffetal
12371237 77 hearttonemustalsobeofaqualityconsistentwithstandardmedicalpractice
12381238 78 inthecommunity.Ifthewomanchoosestoviewtheultrasoundorhearthe
12391239 79 heartbeatorbothattheabortionfacility,theviewingorhearingorbothshall
12401240 80 beprovidedtoherattheabortionfacilityatleastseventy-twohourspriorto
12411241 81 theabortionbeingperformedorinduced;
12421242 82 (5)Theprintedmaterialsprovidedbythedepartmentshallinclude
12431243 83 informationonthepossibilityofanabortioncausingpainintheunbornchild.
12441244 84 Thisinformationshallinclude,butneednotbelimitedto,thefollowing:
12451245 85 (a)Unbornchildrenasearlyaseightweeksgestationalagestartto
12461246 86 showspontaneousmovementsandunbornchildrenatthisstageinpregnancy
12471247 87 showreflexresponsestotouch;
12481248 88 (b)Intheunbornchild,theareaaroundhisorhermouthandlipsisthe
12491249 89 firstpartoftheunbornchild'sbodytorespondtotouchandbyfourteenweeks
12501250 90 gestationalagemostoftheunbornchild'sbodyisresponsivetotouch;
12511251 91 (c)Painreceptorsontheunbornchild'sskindeveloparoundhisorher
12521252 92 mouthataroundseventoeightweeksgestationalage,aroundthepalmsofhis
12531253 93 orherhandsattentotenandahalfweeks,ontheabdominalwallatfifteen
12541254 94 weeks,andoverallofhisorherbodyatsixteenweeksgestationalage;
12551255 95 (d)Beginningatsixteenweeksgestationalageandlater,itispossible
12561256 96 forpaintobetransmittedfromreceptorstothecortexoftheunbornchild's
12571257 97 brain,wherethinkingandperceivingoccur;
12581258 98 (e)Whenaphysicianperformsalife-savingsurgery,heorshe
12591259 99 providesanesthesiatounbornchildrenasyoungassixteenweeksgestational
12601260 100 ageinordertoalleviatetheunbornchild'spain;and
12611261 101 (f)Adescriptionoftheactualstepsintheabortionproceduretobe
12621262 102 performedorinducedandatwhichstepstheabortionprocedurecouldbe
12631263 103 painfultotheunbornchild;
12641264 104 (6)Thephysicianwhoistoperformorinducetheabortionora
12651265 105 qualifiedprofessionalhaspresentedthewoman,inperson,printedmaterials
12661266 106 providedbythedepartmentexplainingtothewomanalternativestoabortion
12671267 107 shemaywishtoconsider.Suchmaterialsshall:
12681268 108 (a)Identifyonageographicalbasispublicandprivateagencies
12691269 109 availabletoassistawomanincarryingherunbornchildtoterm,andtoassist
12701270 110 herincaringforherdependentchildorplacingherchildforadoption,
12711271 111 includingagenciescommonlyknownandgenerallyreferredtoaspregnancy
12721272 112 resourcecenters,crisispregnancycenters,maternityhomes,andadoption
12731273 113 agencies.Suchmaterialsshallprovideacomprehensivelistbygeographical
12741274 114 areaoftheagencies,adescriptionoftheservicestheyoffer,andthetelephone
12751275 115 numbersandaddressesoftheagencies;providedthatsuchmaterialsshallnot
12761276 116 includeanyprograms,services,organizations,oraffiliatesoforganizations
12771277 117 thatperformorinduce,orassistintheperformingorinducingof,abortionsor
12781278 118 thatreferforabortions;
12791279 119 (b)ExplaintheMissourialternativestoabortionservicesprogram
12801280 120 undersection188.325,andanyotherprogramsandservicesavailableto
12811281 121 pregnantwomenandmothersofnewbornchildrenofferedbypublicorprivate
12821282 HB1304 34 122 agencieswhichassistawomanincarryingherunbornchildtotermandassist
12831283 123 herincaringforherdependentchildorplacingherchildforadoption,
12841284 124 includingbutnotlimitedtoprenatalcare;maternalhealthcare;newbornor
12851285 125 infantcare;mentalhealthservices;professionalcounselingservices;housing
12861286 126 programs;utilityassistance;transportationservices;food,clothing,and
12871287 127 suppliesrelatedtopregnancy;parentingskills;educationalprograms;job
12881288 128 trainingandplacementservices;drugandalcoholtestingandtreatment;and
12891289 129 adoptionassistance;
12901290 130 (c)IdentifythestatewebsitefortheMissourialternativestoabortion
12911291 131 servicesprogramundersection188.325,andanytoll-freenumberestablished
12921292 132 bythestateoperatedinconjunctionwiththeprogram;
12931293 133 (d)Prominentlydisplaythestatement:"Therearepublicandprivate
12941294 134 agencieswillingandabletohelpyoucarryyourchildtoterm,andtoassist
12951295 135 youandyourchildafteryourchildisborn,whetheryouchoosetokeepyour
12961296 136 childorplacehimorherforadoption.ThestateofMissouriencouragesyou
12971297 137 tocontactthoseagenciesbeforemakingafinaldecisionaboutabortion.State
12981298 138 lawrequiresthatyourphysicianoraqualifiedprofessionalgiveyouthe
12991299 139 opportunitytocallagencieslikethesebeforeyouundergoanabortion.";
13001300 140 (7)Thephysicianwhoistoperformorinducetheabortionora
13011301 141 qualifiedprofessionalhaspresentedthewoman,inperson,printedmaterials
13021302 142 providedbythedepartmentexplainingthatthefatheroftheunbornchildis
13031303 143 liabletoassistinthesupportofthechild,evenininstanceswherehehas
13041304 144 offeredtopayfortheabortion.Suchmaterialsshallincludeinformationon
13051305 145 thelegaldutiesandsupportobligationsofthefatherofachild,including,but
13061306 146 notlimitedto,childsupportpayments,andthefactthatpaternitymaybe
13071307 147 establishedbythefather'snameonabirthcertificateorstatementofpaternity,
13081308 148 orbycourtaction.Suchprintedmaterialsshallalsostatethatmore
13091309 149 informationconcerningpaternityestablishmentandchildsupportservicesand
13101310 150 enforcementmaybeobtainedbycallingthefamilysupportdivisionwithinthe
13111311 151 Missouridepartmentofsocialservices;and
13121312 152 (8)Thephysicianwhoistoperformorinducetheabortionora
13131313 153 qualifiedprofessionalshallinformthewomanthatsheisfreetowithholdor
13141314 154 withdrawherconsenttotheabortionatanytimewithoutaffectingherrightto
13151315 155 futurecareortreatmentandwithoutthelossofanystateorfederallyfunded
13161316 156 benefitstowhichshemightotherwisebeentitled.
13171317 157 2.Allinformationrequiredtobeprovidedtoawomanconsidering
13181318 158 abortionbysubsection1ofthissectionshallbepresentedtothewoman
13191319 159 individually,inthephysicalpresenceofthewomanandinaprivateroom,to
13201320 160 protectherprivacy,tomaintaintheconfidentialityofherdecision,toensure
13211321 161 thattheinformationfocusesonherindividualcircumstances,toensureshehas
13221322 162 anadequateopportunitytoaskquestions,andtoensurethatsheisnotavictim
13231323 163 ofcoercedabortion.Shouldawomanbeunabletoreadmaterialsprovidedto
13241324 164 her,theyshallbereadtoher.Shouldawomanneedaninterpreterto
13251325 165 understandtheinformationpresentedinthewrittenmaterials,aninterpreter
13261326 166 shallbeprovidedtoher.Shouldawomanaskquestionsconcerninganyofthe
13271327 167 informationormaterials,answersshallbeprovidedinalanguageshecan
13281328 168 understand.
13291329 HB1304 35 169 3.Noabortionshallbeperformedorinducedunlessanduntilthe
13301330 170 womanuponwhomtheabortionistobeperformedorinducedcertifiesin
13311331 171 writingonachecklistformprovidedbythedepartmentthatshehasbeen
13321332 172 presentedalltheinformationrequiredinsubsection1ofthissection,thatshe
13331333 173 hasbeenprovidedtheopportunitytoviewanactiveultrasoundimageofthe
13341334 174 unbornchildandheartheheartbeatoftheunbornchildifitisaudible,andthat
13351335 175 shefurthercertifiesthatshegiveshervoluntaryandinformedconsent,freely
13361336 176 andwithoutcoercion,totheabortionprocedure.
13371337 177 4.Nophysicianshallperformorinduceanabortionunlessanduntil
13381338 178 thephysicianhasobtainedfromthewomanhervoluntaryandinformed
13391339 179 consentgivenfreelyandwithoutcoercion.Ifthephysicianhasreasonto
13401340 180 believethatthewomanisbeingcoercedintohavinganabortion,thephysician
13411341 181 orqualifiedprofessionalshallinformthewomanthatservicesareavailablefor
13421342 182 herandshallprovideherwithprivateaccesstoatelephoneandinformation
13431343 183 aboutsuchservices,includingbutnotlimitedtothefollowing:
13441344 184 (1)Rapecrisiscenters,asdefinedinsection455.003;
13451345 185 (2)Sheltersforvictimsofdomesticviolence,asdefinedinsection
13461346 186 455.200;and
13471347 187 (3)Ordersofprotection,pursuanttochapter455.
13481348 188 5.Thephysicianwhoistoperformorinducetheabortionshall,at
13491349 189 leastseventy-twohourspriortosuchprocedure,informthewomanorallyand
13501350 190 inpersonof:
13511351 191 (1)Theimmediateandlong-termmedicalriskstothewoman
13521352 192 associatedwiththeproposedabortionmethodincluding,butnotlimitedto,
13531353 193 infection,hemorrhage,cervicaltearoruterineperforation,harmtosubsequent
13541354 194 pregnanciesortheabilitytocarryasubsequentchildtoterm,andpossible
13551355 195 adversepsychologicaleffectsassociatedwiththeabortion;and
13561356 196 (2)Theimmediateandlong-termmedicalriskstothewoman,inlight
13571357 197 oftheanesthesiaandmedicationthatistobeadministered,theunbornchild's
13581358 198 gestationalage,andthewoman'smedicalhistoryandmedicalconditions.
13591359 199 6.Nophysicianshallperformorinduceanabortionunlessanduntil
13601360 200 thephysicianhasreceivedandsignedacopyoftheformprescribedin
13611361 201 subsection3ofthissection.Thephysicianshallretainacopyoftheformin
13621362 202 thepatient'smedicalrecord.
13631363 203 7.Intheeventofamedicalemergency,thephysicianwhoperformed
13641364 204 orinducedtheabortionshallclearlycertifyinwritingthenatureand
13651365 205 circumstancesofthemedicalemergency.Thiscertificationshallbesignedby
13661366 206 thephysicianwhoperformedorinducedtheabortion,andshallbemaintained
13671367 207 undersection188.060.
13681368 208 8.Nopersonorentityshallrequire,obtain,oracceptpaymentforan
13691369 209 abortionfromoronbehalfofapatientuntilatleastseventy-twohourshave
13701370 210 passedsincethetimethattheinformationrequiredbysubsection1ofthis
13711371 211 sectionhasbeenprovidedtothepatient.Nothinginthissubsectionshall
13721372 212 prohibitapersonorentityfromnotifyingthepatientthatpaymentforthe
13731373 213 abortionwillberequiredaftertheseventy-two-hourperiodhasexpiredifshe
13741374 214 voluntarilychoosestohavetheabortion.
13751375 215 9.Theterm"qualifiedprofessional"asusedinthissectionshallrefer
13761376 216 toaphysician,physicianassistant,registerednurse,licensedpracticalnurse,
13771377 HB1304 36 217 psychologist,licensedprofessionalcounselor,orlicensedsocialworker,
13781378 218 licensedorregisteredunderchapter334,335,or337,actingunderthe
13791379 219 supervisionofthephysicianperformingorinducingtheabortion,andacting
13801380 220 withinthecourseandscopeofhisorherauthorityprovidedbylaw.The
13811381 221 provisionsofthissectionshallnotbeconstruedtoinanywayexpandthe
13821382 222 authorityotherwiseprovidedbylawrelatingtothelicensure,registration,or
13831383 223 scopeofpracticeofanysuchqualifiedprofessional.
13841384 224 10.ByNovember30,2010,thedepartmentshallproducethewritten
13851385 225 materialsandformsdescribedinthissection.Anywrittenmaterialsproduced
13861386 226 shallbeprintedinatypefacelargeenoughtobeclearlylegible.All
13871387 227 informationshallbepresentedinanobjective,unbiasedmannerdesignedto
13881388 228 conveyonlyaccuratescientificandmedicalinformation.Thedepartment
13891389 229 shallfurnishthewrittenmaterialsandformsatnocostandinsufficient
13901390 230 quantitytoanypersonwhoperformsorinducesabortions,ortoanyhospitalor
13911391 231 facilitythatprovidesabortions.Thedepartmentshallmakeallinformation
13921392 232 requiredbysubsection1ofthissectionavailabletothepublicthroughits
13931393 233 departmentwebsite.Thedepartmentshallmaintainatoll-free,twenty-four-
13941394 234 hourhotlinetelephonenumberwhereacallercanobtaininformationona
13951395 235 regionalbasisconcerningtheagenciesandservicesdescribedinsubsection1
13961396 236 ofthissection.Noidentifyinginformationregardingpersonswhousethe
13971397 237 websiteshallbecollectedormaintained.Thedepartmentshallmonitorthe
13981398 238 websiteonaregularbasistopreventtamperingandcorrectanyoperational
13991399 239 deficiencies.
14001400 240 11.Inordertopreservethecompellinginterestofthestatetoensure
14011401 241 thatthechoicetoconsenttoanabortionisvoluntaryandinformed,andgiven
14021402 242 freelyandwithoutcoercion,thedepartmentshallusetheproceduresfor
14031403 243 adoptionofemergencyrulesundersection536.025inordertopromulgateall
14041404 244 necessaryrules,forms,andothernecessarymaterialtoimplementthissection
14051405 245 byNovember30,2010.
14061406 246 12.Iftheprovisionsinsubsections1and8ofthissectionrequiringa
14071407 247 seventy-two-hourwaitingperiodforanabortionareevertemporarilyor
14081408 248 permanentlyrestrainedorenjoinedbyjudicialorder,thenthewaitingperiod
14091409 249 foranabortionshallbetwenty-fourhours;provided,however,thatifsuch
14101410 250 temporaryorpermanentrestrainingorderorinjunctionisstayedordissolved,
14111411 251 orotherwiseceasestohaveeffect,thewaitingperiodforanabortionshallbe
14121412 252 seventy-twohours.]
14131413 [188.030.1.Exceptinthecaseofamedicalemergency,noabortion
14141414 2 ofaviableunbornchildshallbeperformedorinducedunlesstheabortionis
14151415 3 necessarytopreservethelifeofthepregnantwomanwhoselifeisendangered
14161416 4 byaphysicaldisorder,physicalillness,orphysicalinjury,includingalife-
14171417 5 endangeringphysicalconditioncausedbyorarisingfromthepregnancyitself,
14181418 6 orwhencontinuationofthepregnancywillcreateaseriousriskofsubstantial
14191419 7 andirreversiblephysicalimpairmentofamajorbodilyfunctionofthe
14201420 8 pregnantwoman.Forpurposesofthissection,"majorbodilyfunction"
14211421 9 includes,butisnotlimitedto,functionsoftheimmunesystem,normalcell
14221422 10 growth,digestive,bowel,bladder,neurological,brain,respiratory,circulatory,
14231423 11 endocrine,andreproductivefunctions.
14241424 HB1304 37 12 2.Exceptinthecaseofamedicalemergency:
14251425 13 (1)Priortoperformingorinducinganabortionuponawoman,the
14261426 14 physicianshalldeterminethegestationalageoftheunbornchildinamanner
14271427 15 consistentwithacceptedobstetricalandneonatalpracticesandstandards.In
14281428 16 makingsuchdetermination,thephysicianshallmakesuchinquiriesofthe
14291429 17 pregnantwomanandperformorcausetobeperformedsuchmedical
14301430 18 examinations,imagingstudies,andtestsasareasonablyprudentphysician,
14311431 19 knowledgeableaboutthemedicalfactsandconditionsofboththewomanand
14321432 20 theunbornchildinvolved,wouldconsidernecessarytoperformandconsider
14331433 21 inmakinganaccuratediagnosiswithrespecttogestationalage;
14341434 22 (2)Ifthephysiciandeterminesthatthegestationalageoftheunborn
14351435 23 childistwentyweeksormore,priortoperformingorinducinganabortion
14361436 24 uponthewoman,thephysicianshalldetermineiftheunbornchildisviableby
14371437 25 usingandexercisingthatdegreeofcare,skill,andproficiencycommonly
14381438 26 exercisedbyaskillful,careful,andprudentphysician.Inmakingthis
14391439 27 determinationofviability,thephysicianshallperformorcausetobe
14401440 28 performedsuchmedicalexaminationsandtestsasarenecessarytomakea
14411441 29 findingofthegestationalage,weight,andlungmaturityoftheunbornchild
14421442 30 andshallentersuchfindingsanddeterminationofviabilityinthemedical
14431443 31 recordofthewoman;
14441444 32 (3)Ifthephysiciandeterminesthatthegestationalageoftheunborn
14451445 33 childistwentyweeksormore,andfurtherdeterminesthattheunbornchildis
14461446 34 notviableandperformsorinducesanabortionuponthewoman,thephysician
14471447 35 shallreportsuchfindingsanddeterminationsandthereasonsforsuch
14481448 36 determinationstothehealthcarefacilityinwhichtheabortionisperformed
14491449 37 andtothestateboardofregistrationforthehealingarts,andshallentersuch
14501450 38 findingsanddeterminationsinthemedicalrecordsofthewomanandinthe
14511451 39 individualabortionreportsubmittedtothedepartmentundersection188.052;
14521452 40 (4)(a)Ifthephysiciandeterminesthattheunbornchildisviable,the
14531453 41 physicianshallnotperformorinduceanabortionuponthewomanunlessthe
14541454 42 abortionisnecessarytopreservethelifeofthepregnantwomanorthata
14551455 43 continuationofthepregnancywillcreateaseriousriskofsubstantialand
14561456 44 irreversiblephysicalimpairmentofamajorbodilyfunctionofthewoman.
14571457 45 (b)Beforeaphysicianmayproceedwithperformingorinducingan
14581458 46 abortionuponawomanwhenithasbeendeterminedthattheunbornchildis
14591459 47 viable,thephysicianshallfirstcertifyinwritingthemedicalthreatposedto
14601460 48 thelifeofthepregnantwoman,orthemedicalreasonsthatcontinuationofthe
14611461 49 pregnancywouldcauseaseriousriskofsubstantialandirreversiblephysical
14621462 50 impairmentofamajorbodilyfunctionofthepregnantwoman.Upon
14631463 51 completionoftheabortion,thephysicianshallreportthereasonsand
14641464 52 determinationsfortheabortionofaviableunbornchildtothehealthcare
14651465 53 facilityinwhichtheabortionisperformedandtothestateboardofregistration
14661466 54 forthehealingarts,andshallentersuchfindingsanddeterminationsinthe
14671467 55 medicalrecordofthewomanandintheindividualabortionreportsubmittedto
14681468 56 thedepartmentundersection188.052.
14691469 57 (c)Beforeaphysicianmayproceedwithperformingorinducingan
14701470 58 abortionuponawomanwhenithasbeendeterminedthattheunbornchildis
14711471 59 viable,thephysicianwhoistoperformtheabortionshallobtaintheagreement
14721472 HB1304 38 60 ofasecondphysicianwithknowledgeofacceptedobstetricalandneonatal
14731473 61 practicesandstandardswhoshallconcurthattheabortionisnecessaryto
14741474 62 preservethelifeofthepregnantwoman,orthatcontinuationofthepregnancy
14751475 63 wouldcauseaseriousriskofsubstantialandirreversiblephysicalimpairment
14761476 64 ofamajorbodilyfunctionofthepregnantwoman.Thissecondphysician
14771477 65 shallalsoreportsuchreasonsanddeterminationstothehealthcarefacilityin
14781478 66 whichtheabortionistobeperformedandtothestateboardofregistrationfor
14791479 67 thehealingarts,andshallentersuchfindingsanddeterminationsinthe
14801480 68 medicalrecordofthewomanandtheindividualabortionreportsubmittedto
14811481 69 thedepartmentundersection188.052.Thesecondphysicianshallnothave
14821482 70 anylegalorfinancialaffiliationorrelationshipwiththephysicianperforming
14831483 71 orinducingtheabortion,exceptthatsuchprohibitionshallnotapplyto
14841484 72 physicianswhoselegalorfinancialaffiliationorrelationshipisaresultof
14851485 73 beingemployedbyorhavingstaffprivilegesatthesamehospitalastheterm
14861486 74 "hospital"isdefinedinsection197.020.
14871487 75 (d)Anyphysicianwhoperformsorinducesanabortionuponawoman
14881488 76 whenithasbeendeterminedthattheunbornchildisviableshallutilizethe
14891489 77 availablemethodortechniqueofabortionmostlikelytopreservethelifeor
14901490 78 healthoftheunbornchild.Incaseswherethemethodortechniqueofabortion
14911491 79 mostlikelytopreservethelifeorhealthoftheunbornchildwouldpresenta
14921492 80 greaterrisktothelifeorhealthofthewomanthananotherlegallypermitted
14931493 81 andavailablemethodortechnique,thephysicianmayutilizesuchother
14941494 82 methodortechnique.Inallcaseswherethephysicianperformsanabortion
14951495 83 uponaviableunbornchild,thephysicianshallcertifyinwritingtheavailable
14961496 84 methodortechniquesconsideredandthereasonsforchoosingthemethodor
14971497 85 techniqueemployed.
14981498 86 (e)Nophysicianshallperformorinduceanabortionuponawoman
14991499 87 whenithasbeendeterminedthattheunbornchildisviableunlessthereisin
15001500 88 attendanceaphysicianotherthanthephysicianperformingorinducingthe
15011501 89 abortionwhoshalltakecontrolofandprovideimmediatemedicalcarefora
15021502 90 childbornasaresultoftheabortion.Duringtheperformanceoftheabortion,
15031503 91 thephysicianperformingit,andsubsequenttotheabortion,thephysician
15041504 92 requiredtobeinattendance,shalltakeallreasonablestepsinkeepingwith
15051505 93 goodmedicalpractice,consistentwiththeprocedureused,topreservethelife
15061506 94 orhealthoftheviableunbornchild;providedthatitdoesnotposeanincreased
15071507 95 risktothelifeofthewomanordoesnotposeanincreasedriskofsubstantial
15081508 96 andirreversiblephysicalimpairmentofamajorbodilyfunctionofthewoman.
15091509 97 3.Anypersonwhoknowinglyperformsorinducesanabortionofan
15101510 98 unbornchildinviolationoftheprovisionsofthissectionisguiltyofaclassD
15111511 99 felony,and,uponafindingofguiltorpleaofguilty,shallbeimprisonedfora
15121512 100 termofnotlessthanoneyear,and,notwithstandingtheprovisionsofsection
15131513 101 558.002,shallbefinednotlessthantenthousandnormorethanfiftythousand
15141514 102 dollars.
15151515 103 4.Anyphysicianwhopleadsguiltytoorisfoundguiltyofperforming
15161516 104 orinducinganabortionofanunbornchildinviolationofthissectionshallbe
15171517 105 subjecttosuspensionorrevocationofhisorherlicensetopracticemedicinein
15181518 106 thestateofMissouribythestateboardofregistrationforthehealingartsunder
15191519 107 theprovisionsofsections334.100and334.103.
15201520 HB1304 39 108 5.AnyhospitallicensedinthestateofMissourithatknowinglyallows
15211521 109 anabortionofanunbornchildtobeperformedorinducedinviolationofthis
15221522 110 sectionmaybesubjecttosuspensionorrevocationofitslicenseunderthe
15231523 111 provisionsofsection197.070.
15241524 112 6.AnyabortionfacilitylicensedinthestateofMissourithat
15251525 113 knowinglyallowsanabortionofanunbornchildtobeperformedorinducedin
15261526 114 violationofthissectionmaybesubjecttosuspensionorrevocationofits
15271527 115 licenseundertheprovisionsofsection197.220.
15281528 116 7.Awomanuponwhomanabortionisperformedorinducedin
15291529 117 violationofthissectionshallnotbeprosecutedforaconspiracytoviolatethe
15301530 118 provisionsofthissection.
15311531 119 8.Nothinginthissectionshallbeconstruedascreatingorrecognizing
15321532 120 arighttoabortion,norisittheintentionofthissectiontomakelawfulany
15331533 121 abortionthatiscurrentlyunlawful.
15341534 122 9.Itistheintentofthelegislaturethatthissectionbeseverableas
15351535 123 notedinsection1.140.Intheeventthatanysection,subsection,subdivision,
15361536 124 paragraph,sentence,orclauseofthissectionbedeclaredinvalidunderthe
15371537 125 ConstitutionoftheUnitedStatesortheConstitutionoftheStateofMissouri,it
15381538 126 istheintentofthelegislaturethattheremainingprovisionsofthissection
15391539 127 remaininforceandeffectasfarascapableofbeingcarriedintoexecutionas
15401540 128 intendedbythelegislature.
15411541 129 10.Thegeneralassemblymay,byconcurrentresolution,appointone
15421542 130 ormoreofitsmemberswhosponsoredorco-sponsoredthisactinhisorher
15431543 131 officialcapacitytointerveneasamatterofrightinanycaseinwhichthe
15441544 132 constitutionalityofthislawischallenged.]
15451545 [188.033.Wheneveranabortionfacilityorafamilyplanningagency
15461546 2 locatedinthisstate,oranyofitsagentsoremployeesactingwithinthescope
15471547 3 ofhisorherauthorityoremployment,providestoawomanconsideringan
15481548 4 abortionthename,address,telephonenumber,orwebsiteofanabortion
15491549 5 providerthatislocatedoutsideofthestate,suchabortionfacilityorfamily
15501550 6 planningagencyoritsagentsoremployeesshallalsoprovidetosuchwoman
15511551 7 theprintedmaterialsproducedbythedepartmentundersection188.027.Ifthe
15521552 8 name,address,telephonenumber,orwebsiteofsuchabortionproviderisnot
15531553 9 providedtosuchwomaninperson,suchprintedmaterialsshallbeofferedto
15541554 10 her,andifshechooses,senttosuchwomanatnocosttoherthesamedayoras
15551555 11 soonaspossibleeitherelectronicallyorbyU.S.mailovernightdelivery
15561556 12 serviceorbyotherovernightorsame-daydeliveryservicetoanaddressof
15571557 13 suchwoman'schoosing.Thedepartmentshallfurnishsuchprintedmaterials
15581558 14 atnocostandinsufficientquantitiestoabortionfacilitiesandfamilyplanning
15591559 15 agencieslocatedwithinthestate.]
15601560 [188.038.1.Thegeneralassemblyofthisstatefindsthat:
15611561 2 (1)Removingvestigesofanypastbiasordiscriminationagainst
15621562 3 pregnantwomen,theirpartners,andtheirfamilymembers,includingtheir
15631563 4 unbornchildren,isanimportanttaskforthoseinthelegal,medical,social
15641564 5 services,andhumanservicesprofessions;
15651565 HB1304 40 6 (2)Endinganycurrentbiasordiscriminationagainstpregnantwomen,
15661566 7 theirpartners,andtheirfamilymembers,includingtheirunbornchildren,isa
15671567 8 legitimatepurposeofgovernmentinordertoguaranteethatthosewho"are
15681568 9 endowedbytheirCreatorwithcertainunalienableRights"canenjoy"Life,
15691569 10 LibertyandthepursuitofHappiness";
15701570 11 (3)Thehistoricalrelationshipofbiasordiscriminationbysome
15711571 12 familyplanningprogramsandpoliciestowardspoorandminoritypopulations,
15721572 13 including,butnotlimitedto,thenonconsensualsterilizationofmentallyill,
15731573 14 poor,minority,andimmigrantwomenandothercoercivefamilyplanning
15741574 15 programsandpolicies,mustberejected;
15751575 16 (4)AmongMissouriresidents,therateofblackorAfrican-American
15761576 17 womenwhoundergoabortionsissignificantlyhigher,aboutthreeandone-half
15771577 18 timeshigher,thantherateofwhitewomenwhoundergoabortions.Among
15781578 19 Missouriresidents,therateofblackorAfrican-Americanwomenwho
15791579 20 undergorepeatabortionsissignificantlyhigher,aboutoneandone-halftimes
15801580 21 higher,thantherateofwhitewomenwhoundergorepeatabortions;
15811581 22 (5)Performingorinducinganabortionbecauseofthesexofthe
15821582 23 unbornchildisrepugnanttothevaluesofequalityoffemalesandmalesand
15831583 24 thesameopportunitiesforgirlsandboys,andfurthersafalsemindsetof
15841584 25 femaleinferiority;
15851585 26 (6)Governmenthasalegitimateinterestinpreventingtheabortionof
15861586 27 unbornchildrenwithDownSyndromebecauseitisaformofbiasordisability
15871587 28 discriminationandvictimizesthedisabledunbornchildathisorhermost
15881588 29 vulnerablestage.EliminatingunbornchildrenwithDownSyndromeraises
15891589 30 graveconcernsforthelivesofthosewhodolivewithdisabilities.Itsendsa
15901590 31 messageofdwindlingsupportfortheiruniquechallenges,fostersafalsesense
15911591 32 thatdisabilityissomethingthatcouldhavebeenavoidable,andislikelyto
15921592 33 increasethestigmaassociatedwithdisability.
15931593 34 2.Nopersonshallperformorinduceanabortiononawomanifthe
15941594 35 personknowsthatthewomanisseekingtheabortionsolelybecauseofa
15951595 36 prenataldiagnosis,test,orscreeningindicatingDownSyndromeorthe
15961596 37 potentialofDownSyndromeinanunbornchild.
15971597 38 3.Nopersonshallperformorinduceanabortiononawomanifthe
15981598 39 personknowsthatthewomanisseekingtheabortionsolelybecauseofthesex
15991599 40 orraceoftheunbornchild.
16001600 41 4.Anyphysicianorotherpersonwhoperformsorinducesorattempts
16011601 42 toperformorinduceanabortionprohibitedbythissectionshallbesubjectto
16021602 43 allapplicablecivilpenaltiesunderthischapterincluding,butnotlimitedto,
16031603 44 sections188.065and188.085.]
16041604 [188.039.1.Forpurposesofthissection,"medicalemergency"means
16051605 2 aconditionwhich,onthebasisofthephysician'sgoodfaithclinicaljudgment,
16061606 3 socomplicatesthemedicalconditionofapregnantwomanastonecessitate
16071607 4 theimmediateabortionofherpregnancytoavertherdeathorforwhicha
16081608 5 delaywillcreateaseriousriskofsubstantialandirreversibleimpairmentofa
16091609 6 majorbodilyfunction.
16101610 7 2.Exceptinthecaseofmedicalemergency,nopersonshallperformor
16111611 8 induceanabortionunlessatleastseventy-twohourspriortheretothephysician
16121612 HB1304 41 9 whoistoperformorinducetheabortion,aqualifiedprofessional,orthe
16131613 10 referringphysicianhasconferredwiththepatientanddiscussedwithherthe
16141614 11 indicatorsandcontraindicators,andriskfactorsincludinganyphysical,
16151615 12 psychological,orsituationalfactorsfortheproposedprocedureandtheuseof
16161616 13 medications,includingbutnotlimitedtomifepristone,inlightofhermedical
16171617 14 historyandmedicalcondition.Foranabortionperformedoranabortion
16181618 15 inducedbyadrugordrugs,suchconferenceshalltakeplaceatleastseventy-
16191619 16 twohourspriortothewritingorcommunicationofthefirstprescriptionfor
16201620 17 suchdrugordrugsinconnectionwithinducinganabortion.Onlyonesuch
16211621 18 conferenceshallberequiredforeachabortion.
16221622 19 3.Thepatientshallbeevaluatedbythephysicianwhoistoperformor
16231623 20 inducetheabortion,aqualifiedprofessional,orthereferringphysicianduring
16241624 21 theconferenceforindicatorsandcontraindicators,riskfactorsincludingany
16251625 22 physical,psychological,orsituationalfactorswhichwouldpredisposethe
16261626 23 patienttoorincreasetheriskofexperiencingoneormoreadversephysical,
16271627 24 emotional,orotherhealthreactionstotheproposedprocedureordrugordrugs
16281628 25 ineithertheshortorlongtermascomparedwithwomenwhodonotpossess
16291629 26 suchriskfactors.
16301630 27 4.Attheendoftheconference,andifthewomanchoosestoproceed
16311631 28 withtheabortion,thephysicianwhoistoperformorinducetheabortion,a
16321632 29 qualifiedprofessional,orthereferringphysicianshallsignandshallcausethe
16331633 30 patienttosignawrittenstatementthatthewomangaveherinformedconsent
16341634 31 freelyandwithoutcoercionafterthephysicianorqualifiedprofessionalhad
16351635 32 discussedwithhertheindicatorsandcontraindicators,andriskfactors,
16361636 33 includinganyphysical,psychological,orsituationalfactors.Allsuch
16371637 34 executedstatementsshallbemaintainedaspartofthepatient'smedicalfile,
16381638 35 subjecttotheconfidentialitylawsandrulesofthisstate.
16391639 36 5.Thedirectorofthedepartmentofhealthandseniorservicesshall
16401640 37 disseminateamodelformthatphysiciansorqualifiedprofessionalsmayuseas
16411641 38 thewrittenstatementrequiredbythissection,butanylackorunavailabilityof
16421642 39 suchamodelformshallnotaffectthedutiesofthephysicianorqualified
16431643 40 professionalsetforthinsubsections2to4ofthissection.
16441644 41 6.Asusedinthissection,theterm"qualifiedprofessional"shallrefer
16451645 42 toaphysician,physicianassistant,registerednurse,licensedpracticalnurse,
16461646 43 psychologist,licensedprofessionalcounselor,orlicensedsocialworker,
16471647 44 licensedorregisteredunderchapter334,335,or337,actingunderthe
16481648 45 supervisionofthephysicianperformingorinducingtheabortion,andacting
16491649 46 withinthecourseandscopeofhisorherauthorityprovidedbylaw.The
16501650 47 provisionsofthissectionshallnotbeconstruedtoinanywayexpandthe
16511651 48 authorityotherwiseprovidedbylawrelatingtothelicensure,registration,or
16521652 49 scopeofpracticeofanysuchqualifiedprofessional.
16531653 50 7.Iftheprovisionsinsubsection2ofthissectionrequiringaseventy-
16541654 51 two-hourwaitingperiodforanabortionareevertemporarilyorpermanently
16551655 52 restrainedorenjoinedbyjudicialorder,thenthewaitingperiodforanabortion
16561656 53 shallbetwenty-fourhours;provided,however,thatifsuchtemporaryor
16571657 54 permanentrestrainingorderorinjunctionisstayedordissolved,orotherwise
16581658 55 ceasestohaveeffect,thewaitingperiodforanabortionshallbeseventy-two
16591659 56 hours.]
16601660 HB1304 42 [188.047.1.Alltissue,exceptthattissueneededforpurposes
16611661 2 describedinsubsection5ofthissection,removedatthetimeofabortionshall
16621662 3 besubmittedwithinfivedaystoaboard-eligibleorcertifiedpathologistfor
16631663 4 grossandhistopathologicalexamination.Thepathologistshallfileacopyof
16641664 5 thetissuereportwiththestatedepartmentofhealthandseniorservices,and
16651665 6 shallprovidewithinseventy-twohoursacopyofthereporttotheabortion
16661666 7 facilityorhospitalinwhichtheabortionwasperformedorinduced.The
16671667 8 pathologist'sreportshallbemadeapartofthepatient'spermanentrecord.If
16681668 9 thepathologicalexaminationfailstoidentifyevidenceofacompleted
16691669 10 abortion,thepathologistshallnotifytheabortionfacilityorhospitalwithin
16701670 11 twenty-fourhours.
16711671 12 2.Thedepartmentshallreconcileeachnoticeofabortionwithits
16721672 13 correspondingtissuereport.Ifthedepartmentdoesnotreceivethenoticeof
16731673 14 abortionorthetissuereport,thedepartmentshallmakeaninquiryofthe
16741674 15 abortionfacilityorhospital.Aftersuchinquiry,ifthehospitalorabortion
16751675 16 facilityhasnotsatisfactorilyrespondedtosaidinquiryandthedepartment
16761676 17 findsthattheabortionfacilityorhospitalwheretheabortionwasperformedor
16771677 18 inducedwasnotincompliancewiththeprovisionsofthissection,the
16781678 19 departmentshallconsidersuchnoncomplianceadeficiencyrequiringan
16791679 20 unscheduledinspectionofthefacilitytoensurethedeficiencyisremedied,
16801680 21 subjecttotheprovisionsofchapter197regardinglicensesuspensions,
16811681 22 reviews,andappeals.
16821682 23 3.BeginningJanuary1,2018,thedepartmentshallmakeanannual
16831683 24 reporttothegeneralassembly.Thereportshallincludethenumberofany
16841684 25 deficienciesandinquiriesbythedepartmentofeachabortionfacilityinthe
16851685 26 calendaryearandwhetheranydeficiencieswereremediedand,foreach
16861686 27 abortionfacility,aggregatedde-identifieddataaboutthetotalnumberof
16871687 28 abortionsperformedatthefacility,theterminationproceduresused,the
16881688 29 numberandtypeofcomplicationsreportedforeachtypeoftermination
16891689 30 procedure,whetherthedepartmentreceivedthetissuereportforeachabortion,
16901690 31 andtheexistenceandnature,ifany,ofanyinconsistenciesorconcerns
16911691 32 betweentheabortionreportssubmittedundersection188.052andthetissue
16921692 33 reportsubmittedunderthissection.Thereportshallnotcontainanypersonal
16931693 34 patientinformationthedisclosureofwhichisprohibitedbystateorfederal
16941694 35 law.
16951695 36 4.Allreportsprovidedbythedepartmenttothegeneralassembly
16961696 37 underthissectionshallmaintainconfidentialityofallpersonalinformationof
16971697 38 patients,facilitypersonnel,andfacilityphysicians.
16981698 39 5.Nothinginthissectionshallprohibittheutilizationoffetalorgans
16991699 40 ortissueresultingfromanabortionformedicalorscientificpurposesto
17001700 41 determinethecauseorcausesofanyanomaly,illness,death,orgenetic
17011701 42 conditionofthefetus,thepaternityofthefetus,orforlawenforcement
17021702 43 purposes.
17031703 44 6.Thedepartmentmayadoptrules,regulations,andstandards
17041704 45 governingthereportsrequiredunderthissection.Indoingso,thedepartment
17051705 46 shallensurethatthesereportscontainallinformationnecessarytoensure
17061706 47 compliancewithallapplicablelawsandregulations.Anyruleorportionofa
17071707 HB1304 43 48 rule,asthattermisdefinedinsection536.010,thatiscreatedunderthe
17081708 49 authoritydelegatedinthissectionshallbecomeeffectiveonlyifitcomplies
17091709 50 withandissubjecttoalloftheprovisionsofchapter536and,ifapplicable,
17101710 51 section536.028.Thissectionandchapter536arenonseverableandifanyof
17111711 52 thepowersvestedwiththegeneralassemblypursuanttochapter536toreview,
17121712 53 todelaytheeffectivedate,ortodisapproveandannularulearesubsequently
17131713 54 heldunconstitutional,thenthegrantofrulemakingauthorityandanyrule
17141714 55 proposedoradoptedafterOctober24,2017,shallbeinvalidandvoid.]
17151715 [188.052.1.Anindividualabortionreportforeachabortion
17161716 2 performedorinduceduponawomanshallbecompletedbythephysicianwho
17171717 3 performedorinducedtheabortion.Abortionreportsshallinclude,butnotbe
17181718 4 limitedto,acertificationthatthephysiciandoesnothaveanyknowledgethat
17191719 5 thewomansoughttheabortionsolelybecauseofaprenataldiagnosis,test,or
17201720 6 screeningindicatingDownSyndromeorthepotentialofDownSyndromein
17211721 7 theunbornchildandacertificationthatthephysiciandoesnothaveany
17221722 8 knowledgethatthewomansoughttheabortionsolelybecauseofthesexor
17231723 9 raceoftheunbornchild.
17241724 10 2.Anindividualcomplicationreportforanypost-abortioncare
17251725 11 performeduponawomanshallbecompletedbythephysicianprovidingsuch
17261726 12 post-abortioncare.Thisreportshallinclude:
17271727 13 (1)Thedateoftheabortion;
17281728 14 (2)Thenameandaddressoftheabortionfacilityorhospitalwherethe
17291729 15 abortionwasperformedorinduced;
17301730 16 (3)Thenatureoftheabortioncomplicationdiagnosedortreated.
17311731 17 3.Allabortionreportsshallbesignedbytheattendingphysicianwho
17321732 18 performedorinducedtheabortionandsubmittedtothedepartmentwithin
17331733 19 forty-fivedaysfromthedateoftheabortion.Allcomplicationreportsshallbe
17341734 20 signedbythephysicianprovidingthepost-abortioncareandsubmittedtothe
17351735 21 departmentwithinforty-fivedaysfromthedateofthepost-abortioncare.
17361736 22 4.Acopyoftheabortionreportshallbemadeapartofthemedical
17371737 23 recordofthepatientoftheabortionfacilityorhospitalinwhichtheabortion
17381738 24 wasperformedorinduced.
17391739 25 5.Thedepartmentshallberesponsibleforcollectingallabortion
17401740 26 reportsandcomplicationreportsandcollatingandevaluatingalldatagathered
17411741 27 therefromandshallannuallypublishastatisticalreportbasedonsuchdata
17421742 28 fromabortionsperformedorinducedinthepreviouscalendaryear.]
17431743 [188.056.1.Notwithstandinganyotherprovisionoflawtothe
17441744 2 contrary,noabortionshallbeperformedorinduceduponawomanateight
17451745 3 weeksgestationalageorlater,exceptincasesofmedicalemergency.Any
17461746 4 personwhoknowinglyperformsorinducesanabortionofanunbornchildin
17471747 5 violationofthissubsectionshallbeguiltyofaclassBfelony,aswellas
17481748 6 subjecttosuspensionorrevocationofhisorherprofessionallicensebyhisor
17491749 7 herprofessionallicensingboard.Awomanuponwhomanabortionis
17501750 8 performedorinducedinviolationofthissubsectionshallnotbeprosecutedfor
17511751 9 aconspiracytoviolatetheprovisionsofthissection.
17521752 HB1304 44 10 2.Itshallbeanaffirmativedefenseforanypersonallegedtohave
17531753 11 violatedtheprovisionsofsubsection1ofthissectionthattheperson
17541754 12 performedorinducedanabortionbecauseofamedicalemergency.The
17551755 13 defendantshallhavetheburdenofpersuasionthatthedefenseismore
17561756 14 probablytruethannot.
17571757 15 3.Prosecutionunderthissectionshallbarprosecutionundersection
17581758 16 188.057,188.058,or188.375ifprosecutionundersuchsectionswouldviolate
17591759 17 theprovisionsofAmendmentVtotheConstitutionoftheUnitedStatesor
17601760 18 ArticleI,Section19oftheConstitutionofMissouri.
17611761 19 4.Ifanyoneormoreprovisions,subsections,sentences,clauses,
17621762 20 phrases,orwordsofthissectionortheapplicationthereoftoanyperson,
17631763 21 circumstance,orperiodofgestationalageisfoundtobeunenforceable,
17641764 22 unconstitutional,orinvalidbyacourtofcompetentjurisdiction,thesameis
17651765 23 herebydeclaredtobeseverableandthebalanceofthesectionshallremain
17661766 24 effectivenotwithstandingsuchunenforceability,unconstitutionality,or
17671767 25 invalidity.Thegeneralassemblyherebydeclaresthatitwouldhavepassed
17681768 26 thissection,andeachprovision,subsection,sentence,clause,phrase,orword
17691769 27 thereof,irrespectiveofthefactthatanyoneormoreprovisions,subsections,
17701770 28 sentences,clauses,phrases,orwordsofthesection,ortheapplicationofthe
17711771 29 sectiontoanyperson,circumstance,orperiodofgestationalage,wouldbe
17721772 30 declaredunenforceable,unconstitutional,orinvalid.]
17731773 [188.057.1.Notwithstandinganyotherprovisionoflawtothe
17741774 2 contrary,noabortionshallbeperformedorinduceduponawomanatfourteen
17751775 3 weeksgestationalageorlater,exceptincasesofmedicalemergency.Any
17761776 4 personwhoknowinglyperformsorinducesanabortionofanunbornchildin
17771777 5 violationofthissubsectionshallbeguiltyofaclassBfelony,aswellas
17781778 6 subjecttosuspensionorrevocationofhisorherprofessionallicensebyhisor
17791779 7 herprofessionallicensingboard.Awomanuponwhomanabortionis
17801780 8 performedorinducedinviolationofthissubsectionshallnotbeprosecutedfor
17811781 9 aconspiracytoviolatetheprovisionsofthissection.
17821782 10 2.Itshallbeanaffirmativedefenseforanypersonallegedtohave
17831783 11 violatedtheprovisionsofsubsection1ofthissectionthattheperson
17841784 12 performedorinducedanabortionbecauseofamedicalemergency.The
17851785 13 defendantshallhavetheburdenofpersuasionthatthedefenseismore
17861786 14 probablytruethannot.
17871787 15 3.Prosecutionunderthissectionshallbarprosecutionunder
17881788 16 section188.056,188.058,or188.375ifprosecutionundersuchsections
17891789 17 wouldviolatetheprovisionsofAmendmentVtotheConstitutionofthe
17901790 18 UnitedStatesorArticleI,Section19oftheConstitutionofMissouri.
17911791 19 4.Ifanyoneormoreprovisions,subsections,sentences,clauses,
17921792 20 phrases,orwordsofthissectionortheapplicationthereoftoanyperson,
17931793 21 circumstance,orperiodofgestationalageisfoundtobeunenforceable,
17941794 22 unconstitutional,orinvalidbyacourtofcompetentjurisdiction,thesameis
17951795 23 herebydeclaredtobeseverableandthebalanceofthesectionshallremain
17961796 24 effectivenotwithstandingsuchunenforceability,unconstitutionality,or
17971797 25 invalidity.Thegeneralassemblyherebydeclaresthatitwouldhavepassed
17981798 26 thissection,andeachprovision,subsection,sentence,clause,phrase,orword
17991799 HB1304 45 27 thereof,irrespectiveofthefactthatanyoneormoreprovisions,subsections,
18001800 28 sentences,clauses,phrases,orwordsofthesection,ortheapplicationofthe
18011801 29 sectiontoanyperson,circumstance,orperiodofgestationalage,wouldbe
18021802 30 declaredunenforceable,unconstitutional,orinvalid.]
18031803 [188.058.1.Notwithstandinganyotherprovisionoflawtothe
18041804 2 contrary,noabortionshallbeperformedorinduceduponawomanateighteen
18051805 3 weeksgestationalageorlater,exceptincasesofmedicalemergency.Any
18061806 4 personwhoknowinglyperformsorinducesanabortionofanunbornchildin
18071807 5 violationofthissubsectionshallbeguiltyofaclassBfelony,aswellas
18081808 6 subjecttosuspensionorrevocationofhisorherprofessionallicensebyhisor
18091809 7 herprofessionallicensingboard.Awomanuponwhomanabortionis
18101810 8 performedorinducedinviolationofthissectionshallnotbeprosecutedfora
18111811 9 conspiracytoviolatetheprovisionsofthissection.
18121812 10 2.Itshallbeanaffirmativedefenseforanypersonallegedtohave
18131813 11 violatedtheprovisionsofsubsection1ofthissectionthattheperson
18141814 12 performedorinducedanabortionbecauseofamedicalemergency.The
18151815 13 defendantshallhavetheburdenofpersuasionthatthedefenseismore
18161816 14 probablytruethannot.
18171817 15 3.Prosecutionunderthissectionshallbarprosecutionundersection
18181818 16 188.056,188.057,or188.375ifprosecutionundersuchsectionswouldviolate
18191819 17 theprovisionsofAmendmentVtotheConstitutionoftheUnitedStatesor
18201820 18 ArticleI,Section19oftheConstitutionofMissouri.
18211821 19 4.Ifanyoneormoreprovisions,subsections,sentences,clauses,
18221822 20 phrases,orwordsofthissectionortheapplicationthereoftoanyperson,
18231823 21 circumstance,orperiodofgestationalageisfoundtobeunenforceable,
18241824 22 unconstitutional,orinvalidbyacourtofcompetentjurisdiction,thesameis
18251825 23 herebydeclaredtobeseverableandthebalanceofthesectionshallremain
18261826 24 effectivenotwithstandingsuchunenforceability,unconstitutionality,or
18271827 25 invalidity.Thegeneralassemblyherebydeclaresthatitwouldhavepassed
18281828 26 thissection,andeachprovision,subsection,sentence,clause,phrase,orword
18291829 27 thereof,irrespectiveofthefactthatanyoneormoreprovisions,subsections,
18301830 28 sentences,clauses,phrases,orwordsofthesection,ortheapplicationofthe
18311831 29 sectiontoanyperson,circumstance,orperiodofgestationalage,wouldbe
18321832 30 declaredunenforceable,unconstitutional,orinvalid.]
18331833 [188.075.1.Anypersonwhocontrarytotheprovisionsofsections
18341834 2 188.010to188.085knowinglyperforms,induces,oraidsintheperformance
18351835 3 orinducingofanyabortionorknowinglyfailstoperformanyactionrequired
18361836 4 bysections188.010to188.085shallbeguiltyofaclassAmisdemeanor,
18371837 5 unlessadifferentpenaltyisprovidedforinstatelaw,and,uponconviction,
18381838 6 shallbepunishedasprovidedbylaw.
18391839 7 2.Itshallbeanaffirmativedefenseforanypersonallegedtohave
18401840 8 violatedanyprovisionofthischapterthatthepersonperformedanactionor
18411841 9 didnotperformanactionbecauseofamedicalemergency.Thisaffirmative
18421842 10 defenseshallbeavailableincriminal,civil,andadministrativeactionsor
18431843 11 proceedings.Thedefendantshallhavetheburdenofpersuasionthatthe
18441844 12 defenseismoreprobablytruethannot.
18451845 HB1304 46 13 3.Theattorneygeneralshallhaveconcurrentoriginaljurisdiction
18461846 14 throughoutthestate,alongwitheachprosecutingattorneyandcircuitattorney
18471847 15 withintheirrespectivejurisdictions,tocommenceactionsforaviolationof
18481848 16 anyprovisionofthischapter,foraviolationofanystatelawontheuseof
18491849 17 publicfundsforanabortion,orforaviolationofanystatelawwhichregulates
18501850 18 anabortionfacilityorapersonwhoperformsorinducesanabortion.The
18511851 19 attorneygeneral,orprosecutingattorneyorcircuitattorneywithintheir
18521852 20 respectivejurisdictions,mayseekinjunctiveorotherreliefagainstanyperson
18531853 21 who,orentitywhich,isinviolationofanyprovisionofthischapter,misuses
18541854 22 publicfundsforanabortion,orviolatesanystatelawwhichregulatesan
18551855 23 abortionfacilityorapersonwhoperformsorinducesanabortion.]
18561856 [188.080.Anypersonwhoisnotaphysicianwhoperformsorinduces
18571857 2 orattemptstoperformorinduceanabortiononanotherisguiltyofaclassB
18581858 3 felony,and,uponconviction,shallbepunishedasprovidedbylaw.Any
18591859 4 physicianperformingorinducinganabortionwhodoesnothaveclinical
18601860 5 privilegesatahospitalwhichoffersobstetricalorgynecologicalcarelocated
18611861 6 withinthirtymilesofthelocationatwhichtheabortionisperformedor
18621862 7 inducedshallbeguiltyofaclassAmisdemeanor,and,uponconvictionshall
18631863 8 bepunishedasprovidedbylaw.]
18641864 [188.230.Nothinginthisactisintendedtoauthorizeanyoneother
18651865 2 thanaphysiciantoperformanabortion.]
18661866 [188.375.1.Thissectionshallbeknownandmaybecitedasthe
18671867 2 "Late-TermPain-CapableUnbornChildProtectionAct".
18681868 3 2.Asusedinthissection,thephrase"late-termpain-capableunborn
18691869 4 child"shallmeananunbornchildattwentyweeksgestationalageorlater.
18701870 5 3.Notwithstandinganyotherprovisionoflawtothecontrary,no
18711871 6 abortionshallbeperformedorinduceduponawomancarryingalate-term
18721872 7 pain-capableunbornchild,exceptincasesofmedicalemergency.Anyperson
18731873 8 whoknowinglyperformsorinducesanabortionofalate-termpain-capable
18741874 9 unbornchildinviolationofthissubsectionshallbeguiltyofaclassBfelony,
18751875 10 aswellassubjecttosuspensionorrevocationofhisorherprofessionallicense
18761876 11 byhisorherprofessionallicensingboard.Awomanuponwhomanabortion
18771877 12 isperformedorinducedinviolationofthissubsectionshallnotbeprosecuted
18781878 13 foraconspiracytoviolatetheprovisionsofthissubsection.
18791879 14 4.Itshallbeanaffirmativedefenseforanypersonallegedtohave
18801880 15 violatedtheprovisionsofsubsection3ofthissectionthattheperson
18811881 16 performedorinducedanabortionbecauseofamedicalemergency.The
18821882 17 defendantshallhavetheburdenofpersuasionthatthedefenseismore
18831883 18 probablytruethannot.
18841884 19 5.Prosecutionundersubsection3ofthissectionshallbarprosecution
18851885 20 undersection188.056,188.057,or188.058ifprosecutionundersuchsections
18861886 21 wouldviolatetheprovisionsofAmendmentVtotheConstitutionofthe
18871887 22 UnitedStatesorArticleI,Section19oftheConstitutionofMissouri.
18881888 23 6.Whenincasesofmedicalemergencyaphysicianperformsor
18891889 24 inducesanabortionuponawomaninherthirdtrimestercarryingalate-term
18901890 HB1304 47 25 pain-capableunbornchild,thephysicianshallutilizetheavailablemethodor
18911891 26 techniqueofabortionmostlikelytopreservethelifeorhealthoftheunborn
18921892 27 child.Incaseswherethemethodortechniqueofabortionmostlikelyto
18931893 28 preservethelifeorhealthoftheunbornchildwouldpresentagreaterriskto
18941894 29 thelifeorhealthofthewomanthananotherlegallypermittedandavailable
18951895 30 methodortechnique,thephysicianmayutilizesuchothermethodor
18961896 31 technique.Inallcaseswherethephysicianperformsorinducesanabortion
18971897 32 uponawomanduringherthirdtrimestercarryingalate-termpain-capable
18981898 33 unbornchild,thephysicianshallcertifyinwritingtheavailablemethodor
18991899 34 techniquesconsideredandthereasonsforchoosingthemethodortechnique
19001900 35 employed.
19011901 36 7.Whenincasesofmedicalemergencyaphysicianperformsor
19021902 37 inducesanabortionuponawomanduringherthirdtrimestercarryingalate-
19031903 38 termpain-capableunbornchild,thereshallbeinattendanceaphysicianother
19041904 39 thanthephysicianperformingorinducingtheabortionwhoshalltakecontrol
19051905 40 ofandprovideimmediatemedicalcareforachildbornasaresultofthe
19061906 41 abortion.
19071907 42 8.Anyphysicianwhoknowinglyviolatesanyoftheprovisionsof
19081908 43 subsection6or7ofthissectionshallbeguiltyofaclassDfelony,aswellas
19091909 44 subjecttosuspensionorrevocationofhisorherprofessionallicensebyhisor
19101910 45 herprofessionallicensingboard.Awomanuponwhomanabortionis
19111911 46 performedorinducedinviolationofsubsection6or7ofthissectionshallnot
19121912 47 beprosecutedforaconspiracytoviolatetheprovisionsofthosesubsections.
19131913 48 9.Ifanyoneormoreprovisions,subsections,sentences,clauses,
19141914 49 phrases,orwordsofthissectionortheapplicationthereoftoanyperson,
19151915 50 circumstance,orperiodofgestationalageisfoundtobeunenforceable,
19161916 51 unconstitutional,orinvalidbyacourtofcompetentjurisdiction,thesameis
19171917 52 herebydeclaredtobeseverableandthebalanceofthesectionshallremain
19181918 53 effectivenotwithstandingsuchunenforceability,unconstitutionality,or
19191919 54 invalidity.Thegeneralassemblyherebydeclaresthatitwouldhavepassed
19201920 55 thissection,andeachprovision,subsection,sentence,clause,phrase,orword
19211921 56 thereof,irrespectiveofthefactthatanyoneormoreprovisions,subsections,
19221922 57 sentences,clauses,phrases,orwordsofthesection,ortheapplicationofthe
19231923 58 sectiontoanyperson,circumstance,orperiodofgestationalage,wouldbe
19241924 59 declaredunenforceable,unconstitutional,orinvalid.]
19251925 [334.245.1.Notwithstandinganyotherprovisionoflawtothe
19261926 2 contrarythatmayallowapersontoprovideservicesrelatingtopregnancy,
19271927 3 includingprenatal,delivery,andpostpartumservices,nopersonotherthana
19281928 4 licensedphysicianisauthorizedtoperformorinduceanabortion.
19291929 5 2.Anypersonwhoviolatestheprovisionsofthissectionisguiltyofa
19301930 6 classBfelony.]
19311931 [574.200.1.Apersoncommitstheoffenseofinterferencewith
19321932 2 medicalassistanceifheorshe,whileservinginhisorhercapacityasan
19331933 3 employeeofanabortionfacility:
19341934 4 (1)Knowinglyordersorrequestsmedicalpersonneltodeviatefrom
19351935 5 anyapplicablestandardofcareorordinarypracticewhileprovidingmedical
19361936 HB1304 48 6 assistancetoapatientforreasonsunrelatedtothepatient'shealthorwelfare;
19371937 7 or
19381938 8 (2)Knowinglyattemptstopreventmedicalpersonnelfromproviding
19391939 9 medicalassistancetoapatientinaccordancewithallapplicablestandardsof
19401940 10 careorordinarypracticeforreasonsunrelatedtothepatient'shealthor
19411941 11 welfare.
19421942 12 2.TheoffenseofinterferencewithmedicalassistanceisaclassA
19431943 13 misdemeanor.
19441944 14 3.Forpurposesofthissection,theterm"medicalpersonnel"shall
19451945 15 include,butnotbelimitedto,thefollowing:
19461946 16 (1)Physiciansandsurgeonslicensedunderchapter334;
19471947 17 (2)Nurseslicensedunderchapter335;
19481948 18 (3)Emergencymedicalservicespersonnelasdefinedinsection
19491949 19 190.600;or
19501950 20 (4)Anypersonoperatingunderthesupervisionofsuchmedical
19511951 21 personnel.]
19521952 âś”
19531953 HB1304 49