FIRSTREGULARSESSION
HOUSEBILLNO.1561
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEGALLICK.
3165H.01I JOSEPHENGLER,ChiefClerk
ANACT
Torepealsection190.241,RSMo,andtoenactinlieuthereofonenewsectionrelatingto
traumacenterdesignations.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section190.241,RSMo,isrepealedandonenewsectionenactedinlieu
2thereof,tobeknownassection190.241,toreadasfollows:
190.241.1.Exceptasprovidedforinsubsection4ofthissection,thedepartment
2shalldesignateahospitalasanadult,pediatricoradultandpediatrictraumacenterwhena
3hospital,uponproperapplicationsubmittedbythehospitalandsitereview,hasbeenfoundby
4thedepartmenttomeettheapplicableleveloftraumacentercriteriafordesignationin
5accordancewithrulesadoptedbythedepartmentasprescribedbysection190.185.Site
6reviewmayoccuron-siteorbyanyreasonablemeansofcommunication,orbyany
7combinationthereof.Suchrulesshallincludedesignationasatraumacenterwithoutsite
8reviewifsuchhospitalisverifiedbyanationalverifyingordesignatingbodyatthelevel
9whichcorrespondstoalevelapprovedinrule.Indevelopingtraumacenterdesignation
10criteria,thedepartmentshalluse,asitdeemspracticable,peer-reviewedandevidence-based
11clinicalresearchandguidelinesincluding,butnotlimitedto,themostrecentguidelinesofthe
12AmericanCollegeofSurgeons.Thedepartmentshallnotdenyaqualifiedhospital
13designationasalevelI,II,orIIItraumacenterbasedsolelyonthedistanceormileage
14betweentraumacenters.
15 2.Exceptasprovidedforinsubsection4ofthissection,thedepartmentshall
16designateahospitalasaSTEMIorstrokecenterwhensuchhospital,uponproperapplication
17andsitereview,hasbeenfoundbythedepartmenttomeettheapplicablelevelofSTEMIor
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 18strokecentercriteriafordesignationinaccordancewithrulesadoptedbythedepartmentas
19prescribedbysection190.185.Sitereviewmayoccuron-siteorbyanyreasonablemeansof
20communication,orbyanycombinationthereof.IndevelopingSTEMIcenterandstroke
21centerdesignationcriteria,thedepartmentshalluse,asitdeemspracticable,peer-reviewed
22andevidence-basedclinicalresearchandguidelinesincluding,butnotlimitedto,themost
23recentguidelinesoftheAmericanCollegeofCardiology,theAmericanHeartAssociation,or
24theAmericanStrokeAssociation.SuchrulesshallincludedesignationasaSTEMIcenteror
25strokecenterwithoutsitereviewifsuchhospitaliscertifiedbyanationalbody.
26 3.Thedepartmentofhealthandseniorservicesshall,notlessthanonceeverythree
27years,conductasitereviewofeverytrauma,STEMI,andstrokecenterthroughappropriate
28departmentpersonneloraqualifiedcontractor,withtheexceptionoftraumacenters,STEMI
29centers,andstrokecentersdesignatedpursuanttosubsection4ofthissection;however,this
30provisionisnotintendedtolimitthedepartment'sabilitytoconductacomplaintinvestigation
31pursuanttosubdivision(3)ofsubsection2ofsection197.080ofanytrauma,STEMI,or
32strokecenter.Sitereviewsshallbecoordinatedforthedifferenttypesofcenterstotheextent
33practicablewithhospitallicensureinspectionsconductedunderchapter197.Nopersonshall
34beaqualifiedcontractorforpurposesofthissubsectionwhohasasubstantialconflictof
35interestintheoperationofanytrauma,STEMI,orstrokecenterunderreview.The
36departmentmaydeny,placeonprobation,suspendorrevokesuchdesignationinanycasein
37whichithasdeterminedtherehasbeenasubstantialfailuretocomplywiththeprovisionsof
38thischapteroranyrulesorregulationspromulgatedpursuanttothischapter.Centersthatare
39placedonprobationarystatusshallberequiredtodemonstratecompliancewiththeprovisions
40ofthischapterandanyrulesorregulationspromulgatedunderthischapterwithintwelve
41monthsofthedateofthereceiptofthenoticeofprobationarystatus,unlessotherwise
42providedbyasettlementagreementwithadurationofamaximumofeighteenmonths
43betweenthedepartmentandthedesignatedcenter.Ifthedepartmentofhealthandsenior
44serviceshasdeterminedthatahospitalisnotincompliancewithsuchprovisionsor
45regulations,itmayconductadditionalannouncedorunannouncedsitereviewsofthehospital
46toverifycompliance.Ifatrauma,STEMI,orstrokecenterfailstwoconsecutivesitereviews
47becauseofsubstantialnoncompliancewithstandardsprescribedbysections190.001to
48190.245orrulesadoptedbythedepartmentpursuanttosections190.001to190.245,its
49centerdesignationshallberevoked.
50 4.(1)Insteadofapplyingfortrauma,STEMI,orstrokecenterdesignationunder
51subsection1or2ofthissection,ahospitalmayapplyfortrauma,STEMI,orstrokecenter
52designationunderthissubsection.Uponreceiptofanapplicationonaformprescribedbythe
53department,thedepartmentshalldesignatesuchhospitalatastatelevelthatcorrespondstoa
54similarnationaldesignationassetforthinrulespromulgatedbythedepartment.Therules
HB1561 2 55shallbebasedonstandardsofnationallyrecognizedorganizationsandtherecommendations
56ofthetime-criticaldiagnosisadvisorycommittee.
57 (2)Exceptasprovidedbysubsection5ofthissection,thedepartmentshallnot
58requirecompliancewithanyadditionalstandardsforestablishingorrenewingtrauma,
59STEMI,orstrokedesignationsunderthissubsection.Thedesignationshallcontinueifsuch
60hospitalremainscertifiedorverified.Thedepartmentmayremoveahospital'sdesignationas
61atraumacenter,STEMIcenter,orstrokecenterifthehospitalrequestsremovalofthe
62designationorthedepartmentdeterminesthatthecertificateorverificationthatqualifiedthe
63hospitalforthedesignationunderthissubsectionhasbeensuspendedorrevoked.Any
64decisionmadebythedepartmenttowithdrawitsdesignationofacenterpursuanttothis
65subsectionthatisbasedontherevocationorsuspensionofacertificationorverificationbya
66certifyingorverifyingorganizationshallnotbesubjecttojudicialreview.Thedepartment
67shallreporttothecertifyingorverifyingorganizationanycomplaintitreceivesrelatedtothe
68centerdesignatedpursuanttothissubsection.Thedepartmentshallalsoadvisethe
69complainantwhichorganizationcertifiedorverifiedthecenterandprovidethenecessary
70contactinformationshouldthecomplainantwishtopursueacomplaintwiththecertifyingor
71verifyingorganization.
72 5.Anyhospitalreceivingdesignationasatraumacenter,STEMIcenter,orstroke
73centerpursuanttosubsection4ofthissectionshall:
74 (1)Withinthirtydaysofanychangesorreceiptofacertificateorverification,submit
75tothedepartmentproofofcertificationorverificationandthenamesandcontactinformation
76ofthecenter'smedicaldirectorandtheprogrammanager;and
77 (2)Participateinlocalandregionalemergencymedicalservicessystemsforpurposes
78ofprovidingtraining,sharingclinicaleducationalresources,andcollaboratingonimproving
79patientoutcomes.
80
81AnyhospitalreceivingdesignationasalevelIIIstrokecenterpursuanttosubsection4ofthis
82sectionshallhaveaformalagreementwithalevelIorlevelIIstrokecenterforphysician
83consultativeservicesforevaluationofstrokepatientsforthrombolytictherapyandthecareof
84thepatientpost-thrombolytictherapy.
85 6.Hospitalsdesignatedasatraumacenter,STEMIcenter,orstrokecenterbythe
86departmentshallsubmitdatabyoneofthefollowingmethods:
87 (1)Enteringhospitaldataintoastateregistry;or
88 (2)Enteringhospitaldataintoanationalregistryordatabank.Ahospitalsubmitting
89datapursuanttothissubdivisionshallnotberequiredtocollectandsubmitanyadditional
90trauma,STEMI,orstrokecenterdataelements.Nohospitalsubmittingdatatoanationaldata
91registryordatabankunderthissubdivisionshallwithholdauthorizationforthedepartmentto
HB1561 3 92accesssuchdatathroughsuchnationaldataregistryordatabank.Nothinginthissubdivision
93shallbeconstruedasrequiringduplicativedataentrybyahospitalthatisotherwise
94complyingwiththeprovisionsofthissubsection.Failureofthedepartmenttoobtainaccess
95todatasubmittedtoanationaldataregistryordatabankshallnotbeconstruedashospital
96noncomplianceunderthissubsection.
97 7.Whencollectingandanalyzingdatapursuanttotheprovisionsofthissection,the
98departmentshallcomplywiththefollowingrequirements:
99 (1)Namesofanyhealthcareprofessionals,asdefinedinsection376.1350,shallnot
100besubjecttodisclosure;
101 (2)Thedatashallnotbedisclosedinamannerthatpermitstheidentificationofan
102individualpatientorencounter;
103 (3)Thedatashallbeusedfortheevaluationandimprovementofhospitaland
104emergencymedicalservices'trauma,stroke,andSTEMIcare;and
105 (4)Trauma,STEMI,andstrokecenterdataelementsshallconformtonational
106registryordatabankdataelements,andincludepublisheddetailedmeasurespecifications,
107datacodinginstructions,andpatientpopulationinclusionandexclusioncriteriatoensuredata
108reliabilityandvalidity.
109 8.Thedepartmentshallnothaveauthoritytoestablishadditionaleducation
110requirementsforphysicianswhoareemergencymedicineboard-certifiedorboard-eligible
111throughtheAmericanBoardofEmergencyMedicine(ABEM)ortheAmericanOsteopathic
112BoardofEmergencyMedicine(AOBEM)andwhoarepracticingintheemergency
113departmentofafacilitydesignatedasatraumacenter,STEMIcenter,orstrokecenterbythe
114departmentunderthissection.Thedepartmentshalldeemtheeducationrequirements
115promulgatedbyABEMorAOBEMtomeetthestandardsfordesignationsunderthissection.
116Educationrequirementsfornon-ABEMornon-AOBEMcertifiedphysicians,nurses,and
117otherproviderswhoprovidecareatafacilitydesignatedasatraumacenter,STEMIcenter,or
118strokecenterbythedepartmentunderthissectionshallmirrorbutnotexceedthose
119establishedbynationaldesignatingorverifyingbodiesoftraumacenters,STEMIcenters,or
120strokecenters.
121 9.Thedepartmentofhealthandseniorservicesmayestablishappropriatefeesto
122offsetonlythecostsoftrauma,STEMI,andstrokecentersurveys.
123 10.NohospitalshallholditselfouttothepublicasaSTEMIcenter,strokecenter,
124adulttraumacenter,pediatrictraumacenter,oranadultandpediatrictraumacenterunlessit
125isdesignatedassuchbythedepartmentofhealthandseniorservices.
126 11.Anypersonaggrievedbyanactionofthedepartmentofhealthandseniorservices
127affectingthetrauma,STEMI,orstrokecenterdesignationpursuanttothischapter,including
128therevocation,thesuspension,orthegrantingof,refusaltogrant,orfailuretorenewa
HB1561 4 129designation,mayseekadeterminationthereonbytheadministrativehearingcommission
130underchapter621.Itshallnotbeaconditiontosuchdeterminationthatthepersonaggrieved
131seekareconsideration,arehearing,orexhaustanyotherprocedurewithinthedepartment.
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