FIRSTREGULARSESSION
HOUSEBILLNO.222
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVESCHULTE.
0551H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsection196.990,RSMo,andtoenactinlieuthereoftwonewsectionsrelatingto
allergiesinchildcarefacilities.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section196.990,RSMo,isrepealedandtwonewsectionsenactedinlieu
2thereof,tobeknownassections196.990and210.225,toreadasfollows:
196.990.1.Asusedinthissection,thefollowingtermsshallmean:
2 (1)"Administer",thedirectapplicationofanepinephrineauto-injectortothebodyof
3anindividual;
4 (2)"Authorizedentity",anyentityororganizationatorinconnectionwithwhich
5allergenscapableofcausinganaphylaxismaybepresentincluding,butnotlimitedto,
6qualifiedfirstresponders,assuchtermisdefinedinsection321.621,restaurants,recreation
7camps,youthsportsleagues,childcarefacilities,amusementparks,andsportsarenas.
8"Authorizedentity"shallnotincludeanypublicschoolorpubliccharterschool;
9 (3)"Epinephrineauto-injector",asingle-usedeviceusedfortheautomaticinjection
10ofapremeasureddoseofepinephrineintothehumanbody;
11 (4)"Physician",aphysicianlicensedinthisstateunderchapter334;
12 (5)"Provide",thesupplyofoneormoreepinephrineauto-injectorstoanindividual;
13 (6)"Self-administration",aperson'sdiscretionaryuseofanepinephrineauto-injector.
14 2.Aphysicianmayprescribeepinephrineauto-injectorsinthenameofanauthorized
15entityforuseinaccordancewiththissection,andpharmacists,physicians,andotherpersons
16authorizedtodispenseprescriptionmedicationsmaydispenseepinephrineauto-injectors
17underaprescriptionissuedinthenameofanauthorizedentity.
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 18 3.Anauthorizedentitymayacquireandstockasupplyofepinephrineauto-injectors
19underaprescriptionissuedinaccordancewiththissection.Suchepinephrineauto-injectors
20shallbestoredinalocationreadilyaccessibleinanemergencyandinaccordancewiththe
21epinephrineauto-injector'sinstructionsforuseandanyadditionalrequirementsestablishedby
22thedepartmentofhealthandseniorservicesbyrule.Anauthorizedentityshalldesignate
23employeesoragentswhohavecompletedthetrainingrequiredunderthissectiontobe
24responsibleforthestorage,maintenance,andgeneraloversightofepinephrineauto-injectors
25acquiredbytheauthorizedentity.
26 4.Anauthorizedentitythatacquiresasupplyofepinephrineauto-injectorsundera
27prescriptionissuedinaccordancewiththissectionshallensurethat:
28 (1)Expectedepinephrineauto-injectorusersreceivetraininginrecognizing
29symptomsofsevereallergicreactionsincludinganaphylaxisandtheuseofepinephrine
30auto-injectorsfromanationallyrecognizedorganizationexperiencedintraininglaypersonsin
31emergencyhealthtreatmentoranotherentityorpersonapprovedbythedepartmentofhealth
32andseniorservices;
33 (2)Allepinephrineauto-injectorsaremaintainedandstoredaccordingtothe
34epinephrineauto-injector'sinstructionsforuse;
35 (3)Anypersonwhoprovidesoradministersanepinephrineauto-injectortoan
36individualwhothepersonbelievesingoodfaithisexperiencinganaphylaxisactivatesthe
37emergencymedicalservicessystemassoonaspossible;and
38 (4)Aproperreviewofallsituationsinwhichanepinephrineauto-injectorisusedto
39renderemergencycareisconducted.
40 5.Anyauthorizedentitythatacquiresasupplyofepinephrineauto-injectorsundera
41prescriptionissuedinaccordancewiththissectionshallnotifytheemergency
42communicationsdistrictortheambulancedispatchcenteroftheprimaryproviderof
43emergencymedicalserviceswheretheepinephrineauto-injectorsaretobelocatedwithinthe
44entity'sfacility.
45 6.Nopersonshallprovideoradministeranepinephrineauto-injectortoany
46individualwhoisundereighteenyearsofagewithouttheverbalconsentofaparentor
47guardianwhoispresentatthetimewhenprovisionoradministrationoftheepinephrineauto-
48injectorisneeded.Provided,however,thatapersonmayprovideoradministeran
49epinephrineauto-injectortosuchanindividualwithouttheconsentofaparentorguardianif
50theparentorguardianisnotphysicallypresentandthepersonreasonablybelievesthe
51individualshallbeinimminentdangerwithouttheprovisionoradministrationofthe
52epinephrineauto-injector.
HB222 2 53 7.Thefollowingpersonsandentitiesshallnotbeliableforanyinjuriesorrelated
54damagesthatresultfromtheadministrationorself-administrationofanepinephrineauto-
55injectorinaccordancewiththissectionthatmayconstituteordinarynegligence:
56 (1)Anauthorizedentitythatpossessesandmakesavailableepinephrineauto-
57injectorsanditsemployees,agents,andothertrainedpersons;
58 (2)Anypersonwhousesanepinephrineauto-injectormadeavailableunderthis
59section;
60 (3)Aphysicianthatprescribesepinephrineauto-injectorstoanauthorizedentity;or
61 (4)Anypersonorentitythatconductsthetrainingdescribedinthissection.
62
63Suchimmunitydoesnotapplytoactsoromissionsconstitutingarecklessdisregardforthe
64safetyofothersorwillfulorwantonconduct.Theadministrationofanepinephrineauto-
65injectorinaccordancewiththissectionshallnotbeconsideredthepracticeofmedicine.The
66immunityfromliabilityprovidedunderthissubsectionisinadditiontoandnotinlieuofthat
67providedundersection537.037.Anauthorizedentitylocatedinthisstateshallnotbeliable
68foranyinjuriesorrelateddamagesthatresultfromtheprovisionoradministrationofan
69epinephrineauto-injectorbyitsemployeesoragentsoutsideofthisstateiftheentityorits
70employeeoragentisnotliableforsuchinjuriesorrelateddamagesunderthelawsofthestate
71inwhichsuchprovisionoradministrationoccurred.Notrainedpersonwhoisincompliance
72withthissectionandwhoingoodfaithandexercisingreasonablecarefailstoadministeran
73epinephrineauto-injectorshallbeliableforsuchfailure.
74 8.Allbasiclifesupportambulancesandstretchervansoperatedinthestateshallbe
75equippedwithepinephrineauto-injectorsandbestaffedbyatleastoneindividualtrainedin
76theuseofepinephrineauto-injectors.
77 9.Theprovisionsofthissectionshallapplyinallcountieswithinthestateandany
78citynotwithinacounty.
79 10.Nothinginthissectionshallbeconstruedassupersedingtheprovisionsofsection
80167.630.
210.225.1.Thissectionshallbeknownandmaybecitedas"Elijah'sLaw".
2 2.(1)BeforeJuly1,2027,eachlicensedchildcareprovidershalladoptapolicy
3onallergypreventionandresponsewithprioritygiventoaddressingpotentiallydeadly
4food-borneallergies.Suchpolicyshallcontain,butshallnotbelimitedto,thefollowing
5elements:
6 (a)Distinguishingbetweenbuilding-wide,room-level,andindividualapproaches
7toallergypreventionandmanagement;
8 (b)Providinganage-appropriateresponsetobuilding-levelandroom-level
9allergyeducationandprevention;
HB222 3 10 (c)Describingtheroleofchildcarefacilitystaffindetermininghowtomanage
11anallergyproblem,whetherthroughaplanpreparedforachildunderSection504of
12theRehabilitationActof1973,asamended,forachildwithanallergythathasbeen
13determinedtobeadisability,anindividualizedhealthplanforachildwhohasan
14allergythatisnotdisabling,oranotherallergymanagementplan;
15 (d)Describingtheroleofotherchildrenandparentsincooperatingtoprevent
16andmitigateallergies;
17 (e)Addressingconfidentialityissuesinvolvedwithsharingmedicalinformation,
18includingspecifyingwhenparentalpermissionisrequiredtomakemedicalinformation
19available;and
20 (f)Coordinatingwiththedepartmentofelementaryandsecondaryeducation,
21localhealthauthorities,andotherappropriateentitiestoensureefficientpromulgation
22ofaccurateinformationandtoensurethatexistingchildcarefacilitysafetyand
23environmentalpoliciesdonotconflict.
24 (2)Suchpoliciesmaycontaininformationfromorlinkstochildcarefacility
25allergypreventioninformationfurnishedbytheFoodAllergy&AnaphylaxisNetwork
26orequivalentorganizationwithamedicaladvisoryboardthathasallergyspecialists.
27 3.Thedepartmentofelementaryandsecondaryeducationshall,incooperation
28withanyappropriateprofessionalassociation,developamodelpolicyorpoliciesbefore
29July1,2026.
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HB222 4