FIRSTREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
HOUSEBILLNOS.222&580
103RDGENERALASSEMBLY
0551H.02C JOSEPHENGLER,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",thedirectapplicationofanepinephrine[auto-injector] delivery
3devicetothebodyofanindividual;
4 (2)"Authorizedentity",anyentityororganizationatorinconnectionwithwhich
5allergenscapableofcausinganaphylaxismaybepresentincluding,butnotlimitedto,
6qualifiedfirstresponders,assuchtermisdefinedinsection321.621,restaurants,recreation
7camps,youthsportsleagues,childcarefacilities,amusementparks,andsportsarenas.
8"Authorizedentity"shallnotincludeanypublicschoolorpubliccharterschool;
9 (3)"Epinephrine[auto-injector] deliverydevice", asingle-usedeviceusedforthe
10[automaticinjection] deliveryofapremeasureddoseofepinephrineintothehumanbody;
11 (4)"Physician",aphysicianlicensedinthisstateunderchapter334;
12 (5)"Provide",thesupplyofoneormoreepinephrine[auto-injectors] delivery
13devicestoanindividual;
14 (6)"Self-administration",aperson'sdiscretionaryuseofanepinephrine[auto-
15injector] deliverydevice.
16 2.Aphysicianmayprescribeepinephrine[auto-injectors] deliverydevicesinthe
17nameofanauthorizedentityforuseinaccordancewiththissection,andpharmacists,
18physicians,andotherpersonsauthorizedtodispenseprescriptionmedicationsmaydispense
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 19epinephrine[auto-injectors] deliverydevicesunderaprescriptionissuedinthenameofan
20authorizedentity.
21 3.Anauthorizedentitymayacquireandstockasupplyofepinephrine[auto-
22injectors] deliverydevicesunderaprescriptionissuedinaccordancewiththissection.Such
23epinephrine[auto-injectors] deliverydevicesshallbestoredinalocationreadilyaccessible
24inanemergencyandinaccordancewiththeepinephrine[auto-injector's] deliverydevice's
25instructionsforuseandanyadditionalrequirementsestablishedbythedepartmentofhealth
26andseniorservicesbyrule.Anauthorizedentityshalldesignateemployeesoragentswho
27havecompletedthetrainingrequiredunderthissectiontoberesponsibleforthestorage,
28maintenance,andgeneraloversightofepinephrine[auto-injectors] deliverydevicesacquired
29bytheauthorizedentity.
30 4.Anauthorizedentitythatacquiresasupplyofepinephrine[auto-injectors] delivery
31devicesunderaprescriptionissuedinaccordancewiththissectionshallensurethat:
32 (1)Expectedepinephrine[auto-injector] deliverydeviceusersreceivetrainingin
33recognizingsymptomsofsevereallergicreactionsincludinganaphylaxisandtheuseof
34epinephrine[auto-injectors] deliverydevicesfromanationallyrecognizedorganization
35experiencedintraininglaypersonsinemergencyhealthtreatmentoranotherentityorperson
36approvedbythedepartmentofhealthandseniorservices;
37 (2)Allepinephrine[auto-injectors] deliverydevicesaremaintainedandstored
38accordingtotheepinephrine[auto-injector's] deliverydevice'sinstructionsforuse;
39 (3)Anypersonwhoprovidesoradministersanepinephrine[auto-injector] delivery
40devicetoanindividualwhothepersonbelievesingoodfaithisexperiencinganaphylaxis
41activatestheemergencymedicalservicessystemassoonaspossible;and
42 (4)Aproperreviewofallsituationsinwhichanepinephrine[auto-injector] delivery
43deviceisusedtorenderemergencycareisconducted.
44 5.Anyauthorizedentitythatacquiresasupplyofepinephrine[auto-injectors]
45deliverydevicesunderaprescriptionissuedinaccordancewiththissectionshallnotifythe
46emergencycommunicationsdistrictortheambulancedispatchcenteroftheprimaryprovider
47ofemergencymedicalserviceswheretheepinephrine[auto-injectors] deliverydevicesareto
48belocatedwithintheentity'sfacility.
49 6.Nopersonshallprovideoradministeranepinephrine[auto-injector] delivery
50devicetoanyindividualwhoisundereighteenyearsofagewithouttheverbalconsentofa
51parentorguardianwhoispresentatthetimewhenprovisionoradministrationofthe
52epinephrine[auto-injector] deliverydeviceisneeded.Provided,however,thatapersonmay
53provideoradministeranepinephrine[auto-injector] deliverydevicetosuchanindividual
54withouttheconsentofaparentorguardianiftheparentorguardianisnotphysicallypresent
HCSHBs222&580 2 55andthepersonreasonablybelievestheindividualshallbeinimminentdangerwithoutthe
56provisionoradministrationoftheepinephrine[auto-injector] deliverydevice.
57 7.Thefollowingpersonsandentitiesshallnotbeliableforanyinjuriesorrelated
58damagesthatresultfromtheadministrationorself-administrationofanepinephrine[auto-
59injector] deliverydeviceinaccordancewiththissectionthatmayconstituteordinary
60negligence:
61 (1)Anauthorizedentitythatpossessesandmakesavailableepinephrine[auto-
62injectors] deliverydevicesanditsemployees,agents,andothertrainedpersons;
63 (2)Anypersonwhousesanepinephrine[auto-injector] deliverydevicemade
64availableunderthissection;
65 (3)Aphysicianthatprescribesepinephrine[auto-injectors] deliverydevicestoan
66authorizedentity;or
67 (4)Anypersonorentitythatconductsthetrainingdescribedinthissection.
68
69Suchimmunitydoesnotapplytoactsoromissionsconstitutingarecklessdisregardforthe
70safetyofothersorwillfulorwantonconduct.Theadministrationofanepinephrine[auto-
71injector] deliverydeviceinaccordancewiththissectionshallnotbeconsideredthepractice
72ofmedicine.Theimmunityfromliabilityprovidedunderthissubsectionisinadditiontoand
73notinlieuofthatprovidedundersection537.037.Anauthorizedentitylocatedinthisstate
74shallnotbeliableforanyinjuriesorrelateddamagesthatresultfromtheprovisionor
75administrationofanepinephrine[auto-injector] deliverydevicebyitsemployeesoragents
76outsideofthisstateiftheentityoritsemployeeoragentisnotliableforsuchinjuriesor
77relateddamagesunderthelawsofthestateinwhichsuchprovisionoradministration
78occurred.Notrainedpersonwhoisincompliancewiththissectionandwhoingoodfaithand
79exercisingreasonablecarefailstoadministeranepinephrine[auto-injector] deliverydevice
80shallbeliableforsuchfailure.
81 8.Allbasiclifesupportambulancesandstretchervansoperatedinthestateshallbe
82equippedwithepinephrine[auto-injectors] deliverydevicesandbestaffedbyatleastone
83individualtrainedintheuseofepinephrine[auto-injectors] deliverydevices.
84 9.Theprovisionsofthissectionshallapplyinallcountieswithinthestateandany
85citynotwithinacounty.
86 10.Nothinginthissectionshallbeconstruedassupersedingtheprovisionsofsection
87167.630.
210.225.1.Thissectionshallbeknownandmaybecitedas"Elijah'sLaw".
2 2.(1)BeforeJuly1,2027,eachlicensedchildcareprovidershalladoptapolicy
3onallergypreventionandresponsewithprioritygiventoaddressingpotentiallydeadly
HCSHBs222&580 3 4food-borneallergies.Suchpolicyshallcontain,butshallnotbelimitedto,thefollowing
5elements:
6 (a)Distinguishingbetweenbuilding-wide,room-level,andindividualapproaches
7toallergypreventionandmanagement;
8 (b)Providinganage-appropriateresponsetobuilding-levelandroom-level
9allergyeducationandprevention;
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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