FIRSTREGULARSESSION
HOUSEBILLNO.255
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEBOSLEY.
0629H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsection193.145,RSMo,andtoenactinlieuthereofsixnewsectionsrelatingto
healthcare.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section193.145,RSMo,isrepealedandsixnewsectionsenactedinlieu
2thereof,tobeknownassections192.1005,192.1010,192.1015,192.1020,193.145,and
3197.178,toreadasfollows:
192.1005.Sections192.1005to192.1020shallbeknownandmaybecitedasthe
2"MissouriDignityinPregnancyandChildbirthAct".
192.1010.Forpurposesofsections192.1005to192.1020,thefollowingterms
2mean:
3 (1)"Implicitbias",abiasinjudgmentorbehaviorthatresultsfromsubtle
4cognitiveprocesses,includingimplicitprejudiceandimplicitstereotypesthatoften
5operateatalevelbelowconsciousawarenessandwithoutintentionalcontrol;
6 (2)"Implicitprejudice",prejudicialnegativefeelingsorbeliefsaboutagroup
7thatapersonholdswithoutbeingawareofsuchfeelingsorbeliefs;
8 (3)"Implicitstereotypes",theunconsciousattributionsofparticularqualitiesto
9amemberofacertainsocialgroup.Implicitstereotypesareinfluencedbyexperience
10andarebasedonlearningassociationsbetweenvariousqualitiesandsocialcategories,
11includingraceandgender;
12 (4)"Perinatalcare",theprovisionofcareduringpregnancy,labor,delivery,and
13postpartumandneonatalperiods;
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 14 (5)"Pregnancy-relateddeath",thedeathofapersonwhilepregnantorwithin
15threehundredsixty-fivedaysoftheendofapregnancy,regardlessofthedurationor
16siteofthepregnancy,fromanycauserelatedto,oraggravatedby,thepregnancyorits
17management,butnotfromaccidentalorincidentalcauses.
192.1015.1.Anyhospital,clinic,orotherhealthcarefacilitythatprovides
2perinatalcareshallimplementanevidence-basedimplicitbiasprogramforallhealth
3careprovidersinvolvedintheperinatalcareofpatientswithinthatfacility.
4 2.Animplicitbiasprogramimplementedundersubsection1ofthissectionshall
5includeallofthefollowing:
6 (1)Identificationofpreviousorcurrentunconsciousbiasesandmisinformation;
7 (2)Identificationofpersonal,interpersonal,institutional,structural,and
8culturalbarrierstoinclusion;
9 (3)Correctivemeasurestodecreaseimplicitbiasattheinterpersonaland
10institutionallevels,includingongoingpoliciesandpracticesforthatpurpose;
11 (4)Informationontheeffects,including,butnotlimitedto,ongoingpersonal
12effects,ofhistoricalandcontemporaryexclusionandoppressionofminority
13communities;
14 (5)Informationaboutculturalidentityacrossracialorethnicgroups;
15 (6)Informationaboutcommunicatingmoreeffectivelyacrossidentities,
16includingracial,ethnic,religious,andgenderidentities;
17 (7)Discussiononpowerdynamicsandorganizationaldecision-making;
18 (8)Discussiononhealthinequitieswithintheperinatalcarefield,including
19informationonhowimplicitbiasimpactsmaternalandinfanthealthoutcomes;
20 (9)Perspectivesofdiverse,localconstituencygroupsandexpertsonparticular
21racial,identity,cultural,andprovider-communityrelationsissuesinthecommunity;
22and
23 (10)Informationonreproductivejustice.
24 3.(1)Ahealthcareproviderdescribedinsubsection1ofthissectionshall
25completeinitialbasictrainingthroughtheimplicitbiasprogrambasedonthe
26componentsdescribedinsubsection2ofthissection.
27 (2)Uponcompletionoftheinitialbasictraining,ahealthcareprovidershall
28completearefreshercourseundertheimplicitbiasprogrameverytwoyearsthereafter,
29oronamorefrequentbasisifdeemednecessarybythefacility,inordertokeepcurrent
30withchangingracial,identity,andculturaltrendsandbestpracticesindecreasing
31interpersonalandinstitutionalimplicitbias.
32 4.Afacilitydescribedinsubsection1ofthissectionshallprovideacertificateof
33trainingcompletiontoanotherfacilityoratrainingattendeeuponrequest.Afacility
HB255 2 34mayacceptacertificateofcompletionfromanotherfacilitydescribedinsubsection1of
35thissectiontosatisfythetrainingrequirementdescribedinsubsection3ofthissection
36forahealthcareproviderwhoworksinmorethanonefacility.
37 5.Notwithstandingsubsections1to4ofthissection,ifaphysicianinvolvedin
38theperinatalcareofpatientsisnotdirectlyemployedbyafacility,thefacilityshalloffer
39thetrainingtothephysician.
192.1020.1.Thedepartmentofhealthandseniorservicesshalltrackdataon
2severematernalmorbidityincluding,butnotlimitedto,allofthefollowinghealth
3conditions:
4 (1)Obstetrichemorrhage;
5 (2)Hypertension;
6 (3)Preeclampsiaandeclampsia;
7 (4)Venousthromboembolism;
8 (5)Sepsis;
9 (6)Cerebrovascularaccident;and
10 (7)Amnioticfluidembolism.
11 2.Thedataonseverematernalmorbiditycollectedundersubsection1ofthis
12sectionshallbepublishedatleastonceeverythreeyearsafterallofthefollowinghave
13occurred:
14 (1)Thedatahasbeenaggregatedbystateregionsasdefinedbythedepartment
15ofhealthandseniorservicestoensuredatareflectshowregionalizedcaresystemsareor
16shouldbecollaboratingtoimprovematernalhealthoutcomesorothersmallerregional
17sortingbasedonstandardstatisticalmethodsforaccuratedisseminationofpublic
18healthdatawithoutriskingaconfidentialityorotherdisclosurebreach;and
19 (2)Thedatahasbeendisaggregatedbyracialandethnicidentity.
20 3.Thedepartmentofhealthandseniorservicesshalltrackdataonpregnancy-
21relateddeathsincluding,butnotlimitedto,alloftheconditionslistedinsubsection1of
22thissection,indirectobstetricdeaths,andothermaternaldisorderspredominantly
23relatedtopregnancyandcomplicationspredominantlyrelatedtothepuerperium.
24 4.Thedataonpregnancy-relateddeathscollectedundersubsection3ofthis
25sectionshallbepublished,atleastonceeverythreeyears,afterallofthefollowinghave
26occurred:
27 (1)Thedatahasbeenaggregatedbystateregionsasdefinedbythedepartment
28ofhealthandseniorservicestoensuredatareflectshowregionalizedcaresystemsareor
29shouldbecollaboratingtoimprovematernalhealthoutcomesorothersmallerregional
30sortingbasedonstandardstatisticalmethodsforaccuratedisseminationofpublic
31healthdatawithoutriskingaconfidentialityorotherdisclosurebreach;and
HB255 3 32 (2)Thedatahasbeendisaggregatedbyracialandethnicidentity.
193.145.1.Acertificateofdeathforeachdeathwhichoccursinthisstateshallbe
2filedwiththelocalregistrar,orasotherwisedirectedbythestateregistrar,withinfivedays
3afterdeathandshallberegisteredifsuchcertificatehasbeencompletedandfiledpursuantto
4thissection.Alldataprovidersinthedeathregistrationprocess,including,butnotlimitedto,
5thestateregistrar,localregistrars,thestatemedicalexaminer,countymedicalexaminers,
6coroners,funeraldirectorsorpersonsactingassuch,embalmers,sheriffs,attending
7physiciansandresidentphysicians,physicianassistants,assistantphysicians,advanced
8practiceregisterednurses,andthechiefmedicalofficersoflicensedhealthcarefacilities,and
9otherpublicorprivateinstitutionsprovidingmedicalcare,treatment,orconfinementto
10persons,shallberequiredtouseandutilizeanyelectronicdeathregistrationsystemrequired
11andadoptedundersubsection1ofsection193.265withinsixmonthsofthesystembeing
12certifiedbythedirectorofthedepartmentofhealthandseniorservices,orthedirector's
13designee,tobeoperationalandavailabletoalldataprovidersinthedeathregistrationprocess.
14 2.Iftheplaceofdeathisunknownbutthedeadbodyisfoundinthisstate,the
15certificateofdeathshallbecompletedandfiledpursuanttotheprovisionsofthissection.
16Theplacewherethebodyisfoundshallbeshownastheplaceofdeath.Thedateofdeath
17shallbethedateonwhichtheremainswerefound.
18 3.WhendeathoccursinamovingconveyanceintheUnitedStatesandthebodyis
19firstremovedfromtheconveyanceinthisstate,thedeathshallberegisteredinthisstateand
20theplacewherethebodyisfirstremovedshallbeconsideredtheplaceofdeath.Whena
21deathoccursonamovingconveyancewhileininternationalwatersorairspaceorinaforeign
22countryoritsairspaceandthebodyisfirstremovedfromtheconveyanceinthisstate,the
23deathshallberegisteredinthisstatebutthecertificateshallshowtheactualplaceofdeathif
24suchplacemaybedetermined.
25 4.Thefuneraldirectororpersoninchargeoffinaldispositionofthedeadbodyshall
26filethecertificateofdeath.Thefuneraldirectororpersoninchargeofthefinaldispositionof
27thedeadbodyshallobtainorverifyandenterintotheelectronicdeathregistrationsystem:
28 (1)Thepersonaldatafromthenextofkinorthebestqualifiedpersonorsource
29available;
30 (2)Themedicalcertificationfromthepersonresponsibleforsuchcertificationif
31designatedtodosoundersubsection5ofthissection;[and]
32 (3)Informationindicatingwhetherthedecedentwaspregnantatthetimeof
33death,orwithinayearpriortothedeath,ifknown,asdeterminedbyobservation,
34autopsy,orreviewofthemedicalrecord.Theelectronicdeathregistrationsystemshall
35captureadditionalinformationregardingthepregnancystatusofthedecedent
36consistentwiththedataelementsontheU.S.StandardCertificateofDeath.This
HB255 4 37subdivisionshallnotbeinterpretedtorequiretheperformanceofapregnancytestona
38decedentortorequireareviewofmedicalrecordsinordertodeterminepregnancy;and
39 (4)Anyotherinformationordatathatmayberequiredtobeplacedonadeath
40certificateorenteredintotheelectronicdeathcertificatesystemincluding,butnotlimitedto,
41thenameandlicensenumberoftheembalmer.
42 5.Themedicalcertificationshallbecompleted,attestedtoitsaccuracyeitherby
43signatureoranelectronicprocessapprovedbythedepartment,andreturnedtothefuneral
44directororpersoninchargeoffinaldispositionwithinseventy-twohoursafterdeathbythe
45physician,physicianassistant,assistantphysician,oradvancedpracticeregisterednursein
46chargeofthepatient'scarefortheillnessorconditionwhichresultedindeath.Intheabsence
47ofthephysician,physicianassistant,assistantphysician,oradvancedpracticeregistered
48nurseorwiththephysician's,physicianassistant's,assistantphysician's,oradvancedpractice
49registerednurse'sapprovalthecertificatemaybecompletedandattestedtoitsaccuracyeither
50bysignatureoranapprovedelectronicprocessbythephysician'sassociatephysician,the
51chiefmedicalofficeroftheinstitutioninwhichdeathoccurred,orthephysicianwho
52performedanautopsyuponthedecedent,providedsuchindividualhasaccesstothemedical
53historyofthecase,viewsthedeceasedatorafterdeathanddeathisduetonaturalcauses.
54Thepersonauthorizedtocompletethemedicalcertificationmay,inwriting,designateany
55otherpersontoenterthemedicalcertificationinformationintotheelectronicdeath
56registrationsystemifthepersonauthorizedtocompletethemedicalcertificatehasphysically
57orbyelectronicprocesssignedastatementstatingthecauseofdeath.Anypersons
58completingthemedicalcertificationorenteringdataintotheelectronicdeathregistration
59systemshallbeimmunefromcivilliabilityforsuchcertificationcompletion,dataentry,or
60determinationofthecauseofdeath,absentgrossnegligenceorwillfulmisconduct.Thestate
61registrarmayapprovealternatemethodsofobtainingandprocessingthemedicalcertification
62andfilingthedeathcertificate.TheSocialSecuritynumberofanyindividualwhohasdied
63shallbeplacedintherecordsrelatingtothedeathandrecordedonthedeathcertificate.
64 6.Whendeathoccursfromnaturalcausesmorethanthirty-sixhoursafterthe
65decedentwaslasttreatedbyaphysician,physicianassistant,assistantphysician,oradvanced
66practiceregisterednurse,thecaseshallbereferredtothecountymedicalexaminerorcoroner
67orphysicianorlocalregistrarforinvestigationtodetermineandcertifythecauseofdeath.If
68thedeathisdeterminedtobeofanaturalcause,themedicalexaminerorcoronerorlocal
69registrarshallreferthecertificateofdeathtotheattendingphysician,physicianassistant,
70assistantphysician,oradvancedpracticeregisterednurseforsuchcertification.Ifthe
71attendingphysician,physicianassistant,assistantphysician,oradvancedpracticeregistered
72nurserefusesorisotherwiseunavailable,themedicalexaminerorcoronerorlocalregistrar
HB255 5 73shallattesttotheaccuracyofthecertificateofdeatheitherbysignatureoranapproved
74electronicprocesswithinthirty-sixhours.
75 7.Ifthecircumstancessuggestthatthedeathwascausedbyotherthannaturalcauses,
76themedicalexaminerorcoronershalldeterminethecauseofdeathandshall,eitherby
77signatureoranapprovedelectronicprocess,completeandattesttotheaccuracyofthe
78medicalcertificationwithinseventy-twohoursaftertakingchargeofthecase.
79 8.Ifthecauseofdeathcannotbedeterminedwithinseventy-twohoursafterdeath,
80theattendingmedicalexaminer,coroner,attendingphysician,physicianassistant,assistant
81physician,advancedpracticeregisterednurse,orlocalregistrarshallgivethefuneraldirector,
82orpersoninchargeoffinaldispositionofthedeadbody,noticeofthereasonforthedelay,
83andfinaldispositionofthebodyshallnotbemadeuntilauthorizedbythemedicalexaminer,
84coroner,attendingphysician,physicianassistant,assistantphysician,advancedpractice
85registerednurse,orlocalregistrar.
86 9.Whenadeathispresumedtohaveoccurredwithinthisstatebutthebodycannotbe
87located,adeathcertificatemaybepreparedbythestateregistraruponreceiptofanorderofa
88courtofcompetentjurisdictionwhichshallincludethefindingoffactsrequiredtocomplete
89thedeathcertificate.Suchadeathcertificateshallbemarked"Presumptive",showonitsface
90thedateofregistration,andidentifythecourtandthedateofdecree.
91 10.(1)Thedepartmentofhealthandseniorservicesshallnotifyallphysicians,
92physicianassistants,assistantphysicians,andadvancedpracticeregisterednurseslicensed
93underchapters334and335oftherequirementsregardingtheuseoftheelectronicvital
94recordssystemprovidedforinthissection.
95 (2)OnorbeforeAugust30,2015,thedepartmentofhealthandseniorservices,
96divisionofcommunityandpublichealthshallcreateaworkinggroupcomprisedof
97representationfromtheMissourielectronicvitalrecordssystemusersandrecipientsofdeath
98certificatesusedforprofessionalpurposestoevaluatetheMissourielectronicvitalrecords
99system,developrecommendationstoimprovetheefficiencyandusabilityofthesystem,and
100toreportsuchfindingsandrecommendationstothegeneralassemblynolaterthanJanuary1,
1012016.
102 11.Notwithstandinganyprovisionoflawtothecontrary,ifacoronerordeputy
103coronerisnotcurrentwithoriswithouttheapprovedtrainingunderchapter58,the
104departmentofhealthandseniorservicesshallprohibitsuchcoronerfromattestingtothe
105accuracyofacertificateofdeath.Nopersonelectedorappointedtotheofficeofcoronercan
106assumesuchelectedofficeuntilthetraining,asestablishedbythecoronerstandardsand
107trainingcommissionundertheprovisionsofsection58.035,hasbeencompletedanda
108certificateofcompletionhasbeenissued.Intheeventacoronercannotfulfillhisorher
109dutiesorisnolongerqualifiedtoattesttotheaccuracyofadeathcertificate,thesheriffofthe
HB255 6 110countyshallappointamedicalprofessionaltoattestdeathcertificatesuntilsuchtimeasthe
111coronercanresumehisorherdutiesoranothercoronerisappointedorelectedtotheoffice.
197.178.1.Eachhospitalshallprovideeachpatient,uponadmissionorassoon
2thereafterasreasonablypracticable,writteninformationregardingthefollowingrights
3ofthepatient:
4 (1)Therighttobeinformedofcontinuinghealthcarerequirementsfollowing
5dischargefromthehospital;
6 (2)Therighttobeinformedthat,ifthepatientsoauthorizes,afriendorfamily
7membermaybeprovidedinformationaboutthepatient'scontinuinghealthcare
8requirementsfollowingdischargefromthehospital;
9 (3)Therighttoparticipateactivelyindecisionsregardingmedicalcare.Tothe
10extentpermittedbylaw,participationshallincludetherighttorefusetreatment;
11 (4)Therighttoappropriatepainassessmentandtreatment;
12 (5)Therighttobefreeofdiscriminationonthebasisofanyprotectedstatusas
13setforthinchapter213;and
14 (6)Therighttoinformationonhowtofileacomplaintwiththefollowing:
15 (a)Thedepartmentofhealthandseniorservices;
16 (b)TheMissouricommissiononhumanrights;and
17 (c)Thestateboardofregistrationforthehealingarts.
18 2.Ahospitalmayincludetheinformationrequiredbythissectionwithother
19noticestothepatientregardingpatientrights.Ifahospitalchoosestoincludethis
20informationalongwithexistingnoticestothepatientregardingpatientrights,any
21newlyrequiredinformationshallbeprovidedwhenthehospitalexhaustsitsexisting
22inventoryofwrittenmaterialsandprintsnewwrittenmaterials.
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HB255 7