EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
SENATE BILL NO. 548
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BLACK.
1678S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 190.053, 190.098, 190.101, 190.109, 191.648, 195.417, 196.990, 208.152,
210.030, 332.081, 335.081, 338.010, and 579.060, RSMo, and to enact in lieu thereof
sixteen new sections relating to health care, with penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 190.053, 190.098, 190.1 01, 190.109, 1
191.648, 195.417, 196.990, 208.152, 210.030, 332.081, 335.081, 2
338.010, and 579.060, RSMo, are repealed and sixteen new 3
sections enacted in lieu thereof, to be known as sections 4
190.053, 190.076, 190.098, 190.101, 190.109, 190.112, 190.166, 5
191.648, 195.417, 196.990, 208.152, 210.030, 332.081, 335.081, 6
338.010, and 579.060, to read as follows:7
190.053. 1. All members of the board of directors of 1
an ambulance district first elected on or after January 1, 2
2008, shall attend and complete an educational seminar or 3
conference or other suitable training on the role and duties 4
of a board member of an ambulance district. The training 5
required under this section shall be offered by a statewide 6
association organized for the benefit of ambul ance districts 7
or be approved by the state advisory council on emergency 8
medical services. Such training shall include, at a minimum: 9
(1) Information relating to the roles and duties of an 10
ambulance district director; 11
(2) A review of all state statutes and regulations 12
relevant to ambulance districts; 13 SB 548 2
(3) State ethics laws; 14
(4) State sunshine laws, chapter 610; 15
(5) Financial and fiduciary responsibility; 16
(6) State laws relating to the setting of tax rates; 17
and 18
(7) State laws relating to revenue limitations. 19
2. [If any ambulance district board member fails to 20
attend a training session within twelve months after taking 21
office, the board member shall not be compensated for 22
attendance at meetings thereafter until the board member has 23
completed such training session. If any ambulance district 24
board member fails to attend a training session within 25
twelve months of taking office regardless of whether the 26
board member received an attendance fee for a traini ng 27
session, the board member shall be ineligible to run for 28
reelection for another term of office until the board member 29
satisfies the training requirement of this section; however, 30
this requirement shall only apply to board members elected 31
after August 28, 2022] All members of the board of directors 32
of an ambulance district shall complete three hours of 33
continuing education for each term of office. The 34
continuing education shall be offered by a statewide 35
association organized for the benefit of a mbulance districts 36
or be approved by the state advisory council on emergency 37
medical services. 38
3. Any ambulance district board member who fails to 39
complete the initial training and continuing education 40
requirements on or before the anniversary da te of the 41
member's election or appointment as required under this 42
section shall immediately be disqualified from office. Upon 43
such disqualification, the member's position shall be deemed 44
vacant without further process or declaration. The vacancy 45 SB 548 3
shall be filled in the manner provided for in section 46
190.052. 47
190.076. In addition to the annual audit required 1
under section 190.075, each ambulance district shall, at 2
least once every three years, arrange for a certified public 3
accountant or a firm of certified public accountants to 4
audit the records and accounts of the district. The audit 5
shall be made freely available to the public on the 6
district's website or by other electronic means. 7
190.098. 1. In order for a person to be eligible for 1
certification by the department as a community paramedic, an 2
individual shall: 3
(1) Be currently [certified] licensed as a paramedic; 4
(2) Successfully complete or have successfully 5
completed a community parame dic certification program from a 6
college, university, or educational institution that has 7
been approved by the department or accredited by a national 8
accreditation organization approved by the department; and 9
(3) Complete an application form appro ved by the 10
department. 11
2. [A community paramedic shall practice in accordance 12
with protocols and supervisory standards established by the 13
medical director. A community paramedic shall provide 14
services of a health care plan if the plan has been 15
developed by the patient's physician or by an advanced 16
practice registered nurse through a collaborative practice 17
arrangement with a physician or a physician assistant 18
through a collaborative practice arrangement with a 19
physician and there is no duplic ation of services to the 20
patient from another provider. 21
3. Any ambulance service shall enter into a written 22
contract to provide community paramedic services in another 23 SB 548 4
ambulance service area, as that term is defined in section 24
190.100. The contract that is agreed upon may be for an 25
indefinite period of time, as long as it includes at least a 26
sixty-day cancellation notice by either ambulance service. ] 27
As used in this section, the term "community paramedic 28
services" shall mean services provided by any entity that 29
employs licensed paramedics who are certified by the 30
department as community paramedics for services that are: 31
(1) Provided in a nonemergent setting that is 32
independent of an emergency telephone service, 911 system, 33
or emergency summons; 34
(2) Consistent with the training and education 35
requirements described in subdivision (2) of subsection 1 of 36
this section, the scope of skill and practice for community 37
paramedics, and the supervisory standard approved by the 38
entity's medical director; and 39
(3) Reflected and documented in the entity's medical 40
director-approved patient care plans or protocols in 41
accordance with the provisions of section 190.142. 42
3. (1) Any ambulance service that seeks to provide 43
community paramedic services outside of the ambulance 44
service's service area: 45
(a) Shall have a memorandum of understanding (MOU) 46
regarding the provision of such services with the ambulance 47
service in that service area if that ambulance service is 48
already providing community paramedic services; or 49
(b) Shall not be required to have a MOU with the 50
ambulance service in that service area if that ambulance 51
service is not already providing community paramedic 52
services, provided that the ambulance service seeking to 53
provide such services shall provide notification to the 54 SB 548 5
other ambulance service of the community paramedic services 55
to be provided. 56
(2) Any emergency medical response agency (EMRA) that 57
seeks to provide community paramedic services wit hin its 58
designated response service area may do so if the ground 59
ambulance service area within which the EMRA operates does 60
not already provide such services. If the ground ambulance 61
service does provide community paramedic services, then the 62
ground ambulance service may enter into a MOU with the EMRA 63
in order to coordinate programs and avoid service 64
duplication. If the EMRA provides community paramedic 65
services in the ground ambulance service's service area 66
prior to the provision of such service s by the ground 67
ambulance service, then the EMRA and the ground ambulance 68
service shall enter into a MOU for the coordination of 69
services. 70
(3) Any community paramedic program shall notify the 71
appropriate local ambulance service when providing ser vices 72
within the service area of an ambulance service. 73
(4) The department shall promulgate rules and 74
regulations for the purpose of recognizing which community 75
paramedic services entities have met the standards necessary 76
to provide community para medic services, including, but not 77
limited to, physician medical oversight, training, patient 78
record retention, formal relationships with primary care 79
services as needed, and quality improvement policies. 80
Community paramedic services entities shall be certified by 81
the department, allowing such entities to provide community 82
paramedic services for a period of five years. 83
4. A community paramedic is subject to the provisions 84
of sections 190.001 to 190.245 and rules promulgated under 85
sections 190.001 to 190.245. 86 SB 548 6
5. No person shall hold himself or herself out as a 87
community paramedic or provide the services of a community 88
paramedic unless such person is certified by the department. 89
6. The medical director shall approve the 90
implementation of the community paramedic program. 91
7. Any rule or portion of a rule, as that term is 92
defined in section 536.010, that is created under the 93
authority delegated in this section shall become effective 94
only if it complies with and is subject to all of the 95
provisions of chapter 536 and, if applicable, section 96
536.028. This section and chapter 536 are nonseverable and 97
if any of the powers vested with the general assembly 98
pursuant to chapter 536 to review, to delay the effective 99
date, or to disapprove and annul a rule are subsequently 100
held unconstitutional, then the grant of rulemaking 101
authority and any rule proposed or adopted after August 28, 102
2013, shall be invalid and void. 103
190.101. 1. There is hereby established a "S tate 1
Advisory Council on Emergency Medical Services" which shall 2
consist of [sixteen] no more than twenty-three members[, one 3
of which shall be a resident of a city not within a 4
county]. The members of the council shall be appointed [by 5
the governor with the advice and consent of the senate ] 6
pursuant to subsection 2 of this section and shall serve 7
terms of four years. The [governor shall designate one of 8
the members as chairperson ] council members shall annually 9
select a chairperson, along with o ther officers as the 10
council deems necessary . The chairperson may appoint 11
subcommittees that include noncouncil members. 12
2. Council members shall be appointed as follows: 13 SB 548 7
(1) The director of the department of health and 14
senior services shal l make appointments to the council from 15
the recommendations provided by the following: 16
(a) The statewide professional association 17
representing ambulance service managers; 18
(b) The statewide professional association 19
representing EMT's and para medics; 20
(c) The statewide professional association 21
representing ambulance districts; 22
(d) The statewide professional association 23
representing fire chiefs; 24
(e) The statewide professional association 25
representing fire protection districts ; 26
(f) The statewide professional association 27
representing firefighters; 28
(g) The statewide professional association 29
representing emergency nurses; 30
(h) The statewide professional association 31
representing the air ambulance industry; 32
(i) The statewide professional association 33
representing emergency medicine physicians; 34
(j) The statewide association representing hospitals; 35
and 36
(k) The statewide association representing pediatric 37
emergency professionals; 38
(2) The director of health and senior services shall 39
appoint a member to the council with a background in mobile 40
integrated healthcare -community paramedicine (MIH -CP); 41
(3) Each regional EMS advisory committee shall appoint 42
one member; and 43
(4) The time-critical diagnosis advisory committee 44
established under section 190.257 shall appoint one member. 45 SB 548 8
3. The state EMS medical directors advisory committee 46
and the regional EMS advisory committees will be recognized 47
as subcommittees of the state advisory council on emergency 48
medical services. 49
[3.] 4. The council shall have geographical 50
representation and representation from appropriate areas of 51
expertise in emergency medical services including 52
volunteers, professional organizations involved i n emergency 53
medical services, EMT's, paramedics, nurses, firefighters, 54
physicians, ambulance service administrators, hospital 55
administrators and other health care providers concerned 56
with emergency medical services. [The regional EMS advisory 57
committees shall serve as a resource for the identification 58
of potential members of the state advisory council on 59
emergency medical services. 60
4.] 5. The state EMS medical director, as described 61
under section 190.103, shall serve as an ex officio member 62
of the council. 63
[5.] 6. The members of the council and subcommittees 64
shall serve without compensation except that members of the 65
council shall, subject to appropriations, be reimbursed for 66
reasonable travel expenses and meeting expenses related to 67
the functions of the council. 68
[6.] 7. The purpose of the council is to make 69
recommendations to the governor, the general assembly, and 70
the department on policies, plans, procedures and proposed 71
regulations on how to improve the statewide emergen cy 72
medical services system. The council shall advise the 73
governor, the general assembly, and the department on all 74
aspects of the emergency medical services system. 75
[7.] 8. (1) There is hereby established a standing 76
subcommittee of the council to monitor the implementation of 77 SB 548 9
the recognition of the EMS personnel licensure interstate 78
compact under sections 190.900 to 190.939, the interstate 79
commission for EMS personnel practice, and the involvement 80
of the state of Missouri. The subcommittee shall meet at 81
least biannually and receive reports from the Missouri 82
delegate to the interstate commission for EMS personnel 83
practice. The subcommittee shall consist of at least seven 84
members appointed by the chair of the council, to include at 85
least two members as recommended by the Missouri state 86
council of firefighters and one member as recommended by the 87
Missouri Association of Fire Chiefs. The subcommittee may 88
submit reports and recommendations to the council, the 89
department of health and se nior services, the general 90
assembly, and the governor regarding the participation of 91
Missouri with the recognition of the EMS personnel licensure 92
interstate compact. 93
(2) The subcommittee shall formally request a public 94
hearing for any rule propos ed by the interstate commission 95
for EMS personnel practice in accordance with subsection 7 96
of section 190.930. The hearing request shall include the 97
request that the hearing be presented live through the 98
internet. The Missouri delegate to the interst ate 99
commission for EMS personnel practice shall be responsible 100
for ensuring that all hearings, notices of, and related 101
rulemaking communications as required by the compact be 102
communicated to the council and emergency medical services 103
personnel under the provisions of subsections 4, 5, 6, and 8 104
of section 190.930. 105
(3) The department of health and senior services shall 106
not establish or increase fees for Missouri emergency 107
medical services personnel licensure in accordance with this 108
chapter for the purpose of creating the funds necessary for 109 SB 548 10
payment of an annual assessment under subdivision (3) of 110
subsection 5 of section 190.924. 111
[8.] 9. The council shall consult with the time - 112
critical diagnosis advisory committee, as described under 113
section 190.257, regarding time -critical diagnosis. 114
190.109. 1. The department shall, within a reasonable 1
time after receipt of an application, cause such 2
investigation as the department deems necessary to be made 3
of the applicant for a ground ambulance license. 4
2. Any person that owned and operated a licensed 5
ambulance on December 31, 1997, shall receive an ambulance 6
service license from the department, unless suspended, 7
revoked or terminated, for that ambulance service area which 8
was, on December 31, 1997, described and filed with the 9
department as the primary service area for its licensed 10
ambulances on August 28, 1998, provided that the person 11
makes application and adheres to the rules and regulations 12
promulgated by the department pursuant to sections 190.001 13
to 190.245. 14
3. The department shall issue a new ground ambulance 15
service license to an ambulance service that is not 16
currently licensed by the department, or is currently 17
licensed by the department and is seeking to expand its 18
ambulance service area, except as provided in subsection 4 19
of this section, to be valid for a period of five years, 20
unless suspended, revoked or terminated, when the director 21
finds that the applicant meets the requirements of ambu lance 22
service licensure established pursuant to sections 190.100 23
to 190.245 and the rules adopted by the department pursuant 24
to sections 190.001 to 190.245. In order to be considered 25
for a new ambulance service license, an ambulance service 26
shall submit to the department a letter of endorsement from 27 SB 548 11
each ambulance district or fire protection district that is 28
authorized to provide ambulance service, or from each 29
municipality not within an ambulance district or fire 30
protection district that is autho rized to provide ambulance 31
service, in which the ambulance service proposes to 32
operate. If an ambulance service proposes to operate in 33
unincorporated portions of a county not within an ambulance 34
district or fire protection district that is authorized to 35
provide ambulance service, in order to be considered for a 36
new ambulance service license, the ambulance service shall 37
submit to the department a letter of endorsement from the 38
county. Any letter of endorsement required pursuant to this 39
section shall verify that the political subdivision has 40
conducted a public hearing regarding the endorsement and 41
that the governing body of the political subdivision has 42
adopted a resolution approving the endorsement. The letter 43
of endorsement shall affirmativel y state that the proposed 44
ambulance service: 45
(1) Will provide a benefit to public health that 46
outweighs the associated costs; 47
(2) Will maintain or enhance the public's access to 48
ambulance services; 49
(3) Will maintain or improve the publ ic health and 50
promote the continued development of the regional emergency 51
medical service system; 52
(4) Has demonstrated the appropriate expertise in the 53
operation of ambulance services; and 54
(5) Has demonstrated the financial resources necessa ry 55
for the operation of the proposed ambulance service. 56
4. A contract between a political subdivision and a 57
licensed ambulance service for the provision of ambulance 58
services for that political subdivision shall expand, 59 SB 548 12
without further action by the department, the ambulance 60
service area of the licensed ambulance service to include 61
the jurisdictional boundaries of the political subdivision. 62
The termination of the aforementioned contract shall result 63
in a reduction of the licensed ambulance se rvice's ambulance 64
service area by removing the geographic area of the 65
political subdivision from its ambulance service area, 66
except that licensed ambulance service providers may provide 67
ambulance services as are needed at and around the state 68
fair grounds for protection of attendees at the state fair. 69
5. The department shall renew a ground ambulance 70
service license if the applicant meets the requirements 71
established pursuant to sections 190.001 to 190.245, and the 72
rules adopted by the departme nt pursuant to sections 190.001 73
to 190.245. 74
6. The department shall promulgate rules relating to 75
the requirements for a ground ambulance service license 76
including, but not limited to: 77
(1) Vehicle design, specification, operation and 78
maintenance standards; 79
(2) Equipment requirements; 80
(3) Staffing requirements; 81
(4) Five-year license renewal; 82
(5) Records and forms; 83
(6) Medical control plans; 84
(7) Medical director qualifications; 85
(8) Standards for medical communications; 86
(9) Memorandums of understanding with emergency 87
medical response agencies that provide advanced life support; 88
(10) Quality improvement committees; [and] 89
(11) Response time, patient care and transportation 90
standards; 91 SB 548 13
(12) Participation with regional EMS advisory 92
committees; and 93
(13) Ambulance service administrator qualifications . 94
7. Application for a ground ambulance service license 95
shall be made upon such forms as prescribed by the 96
department in rules adopted pursuant to sections 190.001 to 97
190.245. The application form shall contain such 98
information as the department deems necessary to make a 99
determination as to whether the ground ambulance service 100
meets all the requirements of sections 190.001 to 190.245 101
and rules promulgated pursuant to sections 190.001 to 102
190.245. 103
190.112. 1. Each ambulance service licensed under 1
this chapter shall identify to the department the individual 2
serving as the ambulance service administrator who is 3
responsible for the operations and staffing of the ambulance 4
service. The ambulance service administrator shall be 5
required to have achieved basic training of at least forty 6
hours regarding the operations of an ambulance service and 7
two hours of annual continuing education. The training 8
required under this section shall be offered by a statewide 9
association organized for the benefit of ambulance districts 10
or be approved by the state advisory council on emergency 11
medical services and shall include the following: 12
(1) Basic principles of accounting and economics; 13
(2) State and federal laws applicable to ambulance 14
services; 15
(3) Regulatory requirements applicable to ambulance 16
services; 17
(4) Human resources management an d laws; 18
(5) Grant writing, contracts, and fundraising; 19 SB 548 14
(6) State sunshine laws in chapter 610, as well as 20
applicable ethics requirements; and 21
(7) Volunteer and community involvement. 22
2. Ambulance service administrators serving in t his 23
capacity as of August 28, 2025, shall have until January 1, 24
2027, to demonstrate compliance with the provisions of this 25
section. 26
190.166. 1. In addition to the provisions of section 1
190.165, the department of health and senior services may 2
refuse to issue, deny renewal of, or suspend a license 3
required pursuant to section 190.109, or take other 4
corrective actions as described in this section, based on 5
the following considerations: 6
(1) The license holder is determined t o be financially 7
insolvent; 8
(2) The ambulance service has inadequate personnel to 9
operate the ambulance service to provide for basic emergency 10
operations, determined by the ability to staff a minimum of 11
one ambulance unit twenty -four hours per day, seven days per 12
week, with at least two licensed emergency medical 13
technicians and a reasonable plan and schedule for the 14
services of a second ambulance; 15
(3) The ambulance service requires an inordinate 16
amount of mutual aid from neighboring ser vices, such as more 17
than ten percent of the total runs in the service area in 18
any given month, or than would be considered prudent and 19
thus cannot provide an appropriate level of emergency 20
response for the service area as would be considered prudent 21
by the typical ground ambulance services operator; 22
(4) The principal manager, board members, or other 23
executives are determined to be criminally liable for 24
actions related to the license or service provided; 25 SB 548 15
(5) The license holder or principal manager, board 26
members, or other executives are determined by the Centers 27
for Medicare and Medicaid Services to be ineligible for 28
participation in Medicare; 29
(6) The license holder or principal manager, board 30
members, or other executives are dete rmined by the MO 31
HealthNet division to be ineligible for participation in MO 32
HealthNet; 33
(7) The ambulance service administrator has failed to 34
meet the required qualifications or failed to complete the 35
training required pursuant to section 190.112 ; and 36
(8) Three or more board members have failed to 37
complete required training pursuant to section 190.053 if 38
the ambulance service is an ambulance district. 39
2. If the department makes a determination of 40
insolvency or insufficiency of opera tions of a license 41
holder under subsection 1 of this section, then the 42
department may require the license holder to submit a 43
corrective plan within fifteen days and require 44
implementation of the corrective plan within thirty days. 45
3. The department shall be required to provide notice 46
of any determination by the department of insolvency or 47
insufficiency of operations of a license holder to other 48
license holders operating in the license holder's vicinity, 49
members of the general assembly who repr esent the license 50
holder's service area, the governing officials of any county 51
or municipal entity in the license holder's service area, 52
the appropriate regional emergency medical services advisory 53
committee, and the state advisory council on emergency 54
medical services. 55
4. The department shall immediately engage with other 56
license holders in the area to determine the extent to which 57 SB 548 16
ground ambulance service may be provided to the affected 58
service area during the time in which the license holde r is 59
unable to provide adequate services, including any long -term 60
service arrangements. The nature of the agreement between 61
the license holder and other license holders providing 62
services to the affected area may include an agreement to 63
provide services, a joint powers agreement, formal 64
consideration, or some payment for services rendered. 65
5. Any license holder who provides assistance in the 66
service area of another license holder whose license has 67
been suspended under this section shall have the right to 68
seek reasonable compensation from the license holder whose 69
license to operate has been suspended for all calls, stand - 70
by time, and responses to medical emergencies during such 71
time as the license remains suspended. The reasonable 72
compensation shall not be limited to those expenses incurred 73
in actual responses, but may also include reasonable 74
expenses to maintain ambulance service, including, but not 75
limited to, the daily operation costs of maintaining the 76
service, personnel wages and benefits, equipment purchases 77
and maintenance, and other costs incurred in the operation 78
of a ground ambulance service. The license holder providing 79
assistance shall be entitled to an award of costs and 80
reasonable attorney fees in any action to enforc e the 81
provisions of this subsection. 82
191.648. 1. As used in this section, the following 1
terms mean: 2
(1) "Designated sexually transmitted infection", 3
chlamydia, gonorrhea, trichomoniasis, or any other sexually 4
transmitted infection designated as appropriate for 5
expedited partner therapy by the department of health and 6
senior services or for which expedited partner therapy was 7 SB 548 17
recommended in the most recent Centers for Disease Control 8
and Prevention guidelines for the preven tion or treatment of 9
sexually transmitted infections; 10
(2) "Expedited partner therapy" [means], the practice 11
of treating the sex partners of persons with [chlamydia or 12
gonorrhea] designated sexually transmitted infections 13
without an intervening me dical evaluation or professional 14
prevention counseling ; 15
(3) "Health care professional", a member of any 16
profession regulated by chapter 334 or 335 authorized to 17
prescribe medications . 18
2. Any licensed [physician] health care professional 19
may, but shall not be required to, utilize expedited partner 20
therapy for the management of the partners of persons with 21
[chlamydia or gonorrhea ] designated sexually transmitted 22
infections. Notwithstanding the requirements of 20 CSR 23
2150- 5.020 (5) or any other law to the contrary, a licensed 24
[physician] health care professional utilizing expedited 25
partner therapy may prescribe and dispense medications for 26
the treatment of [chlamydia or gonorrhea ] a designated 27
sexually transmitted infection for an individual who is the 28
partner of a person with [chlamydia or gonorrhea ] a 29
designated sexually transmitted infection and who does not 30
have an established [physician/patient] relationship with 31
such [physician. Any antibiotic medications prescribed and 32
dispensed for the treatment of chlamydia or gonorrhea under 33
this section shall be in pill form ] health care professional . 34
3. Any licensed [physician] health care professional 35
utilizing expedited partner therapy for the management of 36
the partners with [chlamydia or gonorrhea ] designated 37
sexually transmitted infections shall provide explanation 38
and guidance to [a] each patient [diagnosed with chlamydia 39 SB 548 18
or gonorrhea] of the preventative measures that can be taken 40
by the patient to stop the [spread] transmission of such 41
[diagnosis] infection. 42
4. Any licensed [physician] health care professional 43
utilizing expedited partner therapy for the management of 44
partners of persons with [chlamydia or gonorrhea ] designated 45
sexually transmitted infections under this section shall 46
have immunity from any civil liability that may otherwise 47
result by reason of such actions, unless such [physician] 48
health care professional acts negligently, recklessly, in 49
bad faith, or with malicious purpose. 50
5. The department of health and senior services and 51
the division of professional registration within the 52
department of commerce and insurance shall by rule develop 53
guidelines for the implementation of subsection 2 of this 54
section. Any rule or portion of a rule , as that term is 55
defined in section 536.010, that is created under the 56
authority delegated in this section shall become effective 57
only if it complies with and is subject to all of the 58
provisions of chapter 536 and, if applicable, section 59
536.028. This section and chapter 536 are nonseverable and 60
if any of the powers vested with the general assembly 61
pursuant to chapter 536 to review, to delay the effective 62
date, or to disapprove and annul a rule are subsequently 63
held unconstitutional, then the gra nt of rulemaking 64
authority and any rule proposed or adopted after August 28, 65
2010, shall be invalid and void. 66
195.417. 1. The limits specified in this section 1
shall not apply to any quantity of such product, mixture, or 2
preparation which must be dispensed, sold, or distributed in 3
a pharmacy pursuant to a valid prescription. 4 SB 548 19
2. Within any thirty-day period, no person shall sell, 5
dispense, or otherwise provide to the same individual, and 6
no person shall purchase, receive, or otherwise acquire more 7
than the following amount: any number of packages of any 8
drug product containing any detectable amount of ephedrine, 9
phenylpropanolamine, or pseudoephedrine, or any of their 10
salts or optical isomers, or salts of optical isomers, 11
either as: 12
(1) The sole active ingredient; or 13
(2) One of the active ingredients of a combination 14
drug; or 15
(3) A combination of any of the products specified in 16
subdivisions (1) and (2) of this subsection; 17
in any total amount greater t han seven and two-tenths grams, 18
without regard to the number of transactions. 19
3. Within any twenty-four-hour period, no pharmacist, 20
intern pharmacist, or registered pharmacy technician shall 21
sell, dispense, or otherwise provide to the same individ ual, 22
and no person shall purchase, receive, or otherwise acquire 23
more than the following amount: any number of packages of 24
any drug product containing any detectable amount of 25
ephedrine, phenylpropanolamine, or pseudoephedrine, or any 26
of their salts or optical isomers, or salts of optical 27
isomers, either as: 28
(1) The sole active ingredient; or 29
(2) One of the active ingredients of a combination 30
drug; or 31
(3) A combination of any of the products specified in 32
subdivisions (1) and (2) o f this subsection; 33 SB 548 20
in any total amount greater than three and six -tenths grams 34
without regard to the number of transactions. 35
4. Within any twelve-month period, no person shall 36
sell, dispense, or otherwise provide to the same individual, 37
and no person shall purchase, receive, or otherwise acquire 38
more than the following amount: any number of packages of 39
any drug product containing any detectable amount of 40
ephedrine, phenylpropanolamine, or pseudoephedrine, or any 41
of their salts or optical isome rs, or salts of optical 42
isomers, either as: 43
(1) The sole active ingredient; or 44
(2) One of the active ingredients of a combination 45
drug; or 46
(3) A combination of any of the products specified in 47
subdivisions (1) and (2) of this subsectio n; 48
in any total amount greater than [forty-three] sixty-one and 49
two-tenths grams, without regard to the number of 50
transactions. 51
5. All packages of any compound, mixture, or 52
preparation containing any detectable quantity of ephedrine, 53
phenylpropanolamine, or pseudoephedrine, or any of their 54
salts or optical isomers, or salts of optical isomers, 55
except those that are excluded from Schedule V in subsection 56
17 or 18 of section 195.017, shall be offered for sale only 57
from behind a pharmacy counter where the public is not 58
permitted, and only by a registered pharmacist or registered 59
pharmacy technician under section 195.017. 60
6. Each pharmacy shall submit information regarding 61
sales of any compound, mixture, or preparation as specified 62
in this section in accordance with transmission methods and 63
frequency established by the department by regulation. 64 SB 548 21
7. No prescription shall be required for the 65
dispensation, sale, or distribution of any drug product 66
containing any detectable amount of e phedrine, 67
phenylpropanolamine, or pseudoephedrine, or any of their 68
salts or optical isomers, or salts of optical isomers, in an 69
amount within the limits described in subsections 2, 3, and 70
4 of this section. The superintendent of the Missouri state 71
highway patrol shall report to the revisor of statutes and 72
the general assembly by February first when the statewide 73
number of methamphetamine laboratory seizure incidents 74
exceeds three hundred incidents in the previous calendar 75
year. The provisions of this subsection shall expire on 76
April first of the calendar year in which the revisor of 77
statutes receives such notification. 78
8. This section shall supersede and preempt any local 79
ordinances or regulations, including any ordinances or 80
regulations enacted by any political subdivision of the 81
state. This section shall not apply to the sale of any 82
animal feed products containing ephedrine or any naturally 83
occurring or herbal ephedra or extract of ephedra. 84
9. Any local ordinances or regulatio ns enacted by any 85
political subdivision of the state prior to August 28, 2020, 86
requiring a prescription for the dispensation, sale, or 87
distribution of any drug product containing any detectable 88
amount of ephedrine, phenylpropanolamine, or 89
pseudoephedrine, or any of their salts or optical isomers, 90
or salts of optical isomers, in an amount within the limits 91
described in subsections 2, 3, and 4 of this section shall 92
be void and of no effect and no such political subdivision 93
shall maintain or enforce s uch ordinance or regulation. 94
10. All logs, records, documents, and electronic 95
information maintained for the dispensing of these products 96 SB 548 22
shall be open for inspection and copying by municipal, 97
county, and state or federal law enforcement officers whose 98
duty it is to enforce the controlled substances laws of this 99
state or the United States. 100
11. All persons who dispense or offer for sale 101
pseudoephedrine and ephedrine products, except those that 102
are excluded from Schedule V in subsection 17 or 18 of 103
section 195.017, shall ensure that all such products are 104
located only behind a pharmacy counter where the public is 105
not permitted. 106
12. The penalty for a knowing or reckless violation of 107
this section is found in section 579.060. 108
196.990. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Administer", the direct application of an 3
epinephrine auto-injector to the body of an individual; 4
(2) "Authorized entity", any entity or organizat ion at 5
or in connection with which allergens capable of causing 6
anaphylaxis may be present including, but not limited to, 7
qualified first responders, as such term is defined in 8
section 321.621, facilities licensed under chapter 198, 9
restaurants, recreation camps, youth sports leagues, 10
amusement parks, and sports arenas. "Authorized entity" 11
shall not include any public school or public charter school; 12
(3) "Epinephrine auto-injector", a single-use device 13
used for the automatic injection of a pr emeasured dose of 14
epinephrine into the human body; 15
(4) "Physician", a physician licensed in this state 16
under chapter 334; 17
(5) "Provide", the supply of one or more epinephrine 18
auto-injectors to an individual; 19 SB 548 23
(6) "Self-administration", a person's discretionary 20
use of an epinephrine auto -injector. 21
2. A physician may prescribe epinephrine auto - 22
injectors in the name of an authorized entity for use in 23
accordance with this section, and pharmacists, physicians, 24
and other persons auth orized to dispense prescription 25
medications may dispense epinephrine auto -injectors under a 26
prescription issued in the name of an authorized entity. 27
3. An authorized entity may acquire and stock a supply 28
of epinephrine auto-injectors under a presc ription issued in 29
accordance with this section. Such epinephrine auto - 30
injectors shall be stored in a location readily accessible 31
in an emergency and in accordance with the epinephrine auto - 32
injector's instructions for use and any additional 33
requirements established by the department of health and 34
senior services by rule. An authorized entity shall 35
designate employees or agents who have completed the 36
training required under this section to be responsible for 37
the storage, maintenance, and general ov ersight of 38
epinephrine auto-injectors acquired by the authorized entity. 39
4. An authorized entity that acquires a supply of 40
epinephrine auto-injectors under a prescription issued in 41
accordance with this section shall ensure that: 42
(1) Expected epinephrine auto-injector users receive 43
training in recognizing symptoms of severe allergic 44
reactions including anaphylaxis and the use of epinephrine 45
auto-injectors from a nationally recognized organization 46
experienced in training laypersons in emerg ency health 47
treatment or another entity or person approved by the 48
department of health and senior services; 49 SB 548 24
(2) All epinephrine auto -injectors are maintained and 50
stored according to the epinephrine auto -injector's 51
instructions for use; 52
(3) Any person who provides or administers an 53
epinephrine auto-injector to an individual who the person 54
believes in good faith is experiencing anaphylaxis activates 55
the emergency medical services system as soon as possible; 56
and 57
(4) A proper review of all situations in which an 58
epinephrine auto-injector is used to render emergency care 59
is conducted. 60
5. Any authorized entity that acquires a supply of 61
epinephrine auto-injectors under a prescription issued in 62
accordance with this section shall n otify the emergency 63
communications district or the ambulance dispatch center of 64
the primary provider of emergency medical services where the 65
epinephrine auto-injectors are to be located within the 66
entity's facility. 67
6. No person shall provide or administer an 68
epinephrine auto-injector to any individual who is under 69
eighteen years of age without the verbal consent of a parent 70
or guardian who is present at the time when provision or 71
administration of the epinephrine auto -injector is needed. 72
Provided, however, that a person may provide or administer 73
an epinephrine auto-injector to such an individual without 74
the consent of a parent or guardian if the parent or 75
guardian is not physically present and the person reasonably 76
believes the individua l shall be in imminent danger without 77
the provision or administration of the epinephrine auto - 78
injector. 79
7. The following persons and entities shall not be 80
liable for any injuries or related damages that result from 81 SB 548 25
the administration or self -administration of an epinephrine 82
auto-injector in accordance with this section that may 83
constitute ordinary negligence: 84
(1) An authorized entity that possesses and makes 85
available epinephrine auto -injectors and its employees, 86
agents, and other traine d persons; 87
(2) Any person who uses an epinephrine auto -injector 88
made available under this section; 89
(3) A physician that prescribes epinephrine auto - 90
injectors to an authorized entity; or 91
(4) Any person or entity that conducts the trainin g 92
described in this section. 93
Such immunity does not apply to acts or omissions 94
constituting a reckless disregard for the safety of others 95
or willful or wanton conduct. The administration of an 96
epinephrine auto-injector in accordance with this section 97
shall not be considered the practice of medicine. The 98
immunity from liability provided under this subsection is in 99
addition to and not in lieu of that provided under section 100
537.037. An authorized entity located in this state shall 101
not be liable for any injuries or related damages that 102
result from the provision or administration of an 103
epinephrine auto-injector by its employees or agents outside 104
of this state if the entity or its employee or agent is not 105
liable for such injuries or related damages under the laws 106
of the state in which such provision or administration 107
occurred. No trained person who is in compliance with this 108
section and who in good faith and exercising reasonable care 109
fails to administer an epinephrine auto -injector shall be 110
liable for such failure. 111 SB 548 26
8. All basic life support ambulances and stretcher 112
vans operated in the state shall be equipped with 113
epinephrine auto-injectors and be staffed by at least one 114
individual trained in the use of epinephrine auto -injectors. 115
9. The provisions of this section shall apply in all 116
counties within the state and any city not within a county. 117
10. Nothing in this section shall be construed as 118
superseding the provisions of section 167.630. 119
208.152. 1. MO HealthNet payments shall be made on 1
behalf of those eligible needy persons as described in 2
section 208.151 who are unable to provide for it in whole or 3
in part, with any payments to be made on the basis of the 4
reasonable cost of the care or reasonable charge for the 5
services as defined and determined by the MO HealthNet 6
division, unless otherwise hereinafter provided, for the 7
following: 8
(1) Inpatient hospital services, except to persons in 9
an institution for mental diseases who are under the age of 10
sixty-five years and over the age of twenty -one years; 11
provided that the MO HealthNet division shall provide 12
through rule and regulation an exception process for 13
coverage of inpatient costs in those cases requiring 14
treatment beyond the seventy -fifth percentile professional 15
activities study (PAS) or the MO HealthNet children's 16
diagnosis length-of-stay schedule; and provided further that 17
the MO HealthNet division shall take into account through 18
its payment system for hospital services the situ ation of 19
hospitals which serve a disproportionate number of low - 20
income patients; 21
(2) All outpatient hospital services, payments 22
therefor to be in amounts which represent no more than 23
eighty percent of the lesser of reasonable costs or 24 SB 548 27
customary charges for such services, determined in 25
accordance with the principles set forth in Title XVIII A 26
and B, Public Law 89 -97, 1965 amendments to the federal 27
Social Security Act (42 U.S.C. Section 301, et seq.), but 28
the MO HealthNet division may evaluate outpatient hospital 29
services rendered under this section and deny payment for 30
services which are determined by the MO HealthNet division 31
not to be medically necessary, in accordance with federal 32
law and regulations; 33
(3) Laboratory and X-ray services; 34
(4) Nursing home services for participants, except to 35
persons with more than five hundred thousand dollars equity 36
in their home or except for persons in an institution for 37
mental diseases who are under the age of sixty -five years, 38
when residing in a hospital licensed by the department of 39
health and senior services or a nursing home licensed by the 40
department of health and senior services or appropriate 41
licensing authority of other states or government -owned and - 42
operated institutions whic h are determined to conform to 43
standards equivalent to licensing requirements in Title XIX 44
of the federal Social Security Act (42 U.S.C. Section [301] 45
1396, et seq.), as amended, for nursing facilities. The MO 46
HealthNet division may recognize through its payment 47
methodology for nursing facilities those nursing facilities 48
which serve a high volume of MO HealthNet patients. The MO 49
HealthNet division when determining the amount of the 50
benefit payments to be made on behalf of persons under the 51
age of twenty-one in a nursing facility may consider nursing 52
facilities furnishing care to persons under the age of 53
twenty-one as a classification separate from other nursing 54
facilities; 55 SB 548 28
(5) Nursing home costs for participants receiving 56
benefit payments under subdivision (4) of this subsection 57
for those days, which shall not exceed twelve per any period 58
of six consecutive months, during which the participant is 59
on a temporary leave of absence from the hospital or nursing 60
home, provided that no such participant shall be allowed a 61
temporary leave of absence unless it is specifically 62
provided for in his plan of care. As used in this 63
subdivision, the term "temporary leave of absence" shall 64
include all periods of time during which a participant is 65
away from the hospital or nursing home overnight because he 66
is visiting a friend or relative; 67
(6) Physicians' services, whether furnished in the 68
office, home, hospital, nursing home, or elsewhere, 69
provided, that no funds shall be expended to any ab ortion 70
facility, as defined in section 188.015, or to any 71
affiliate, as defined in section 188.015, of such abortion 72
facility; 73
(7) Subject to appropriation, up to twenty visits per 74
year for services limited to examinations, diagnoses, 75
adjustments, and manipulations and treatments of 76
malpositioned articulations and structures of the body 77
provided by licensed chiropractic physicians practicing 78
within their scope of practice. Nothing in this subdivision 79
shall be interpreted to otherwise expand MO HealthNet 80
services; 81
(8) Drugs and medicines when prescribed by a licensed 82
physician, dentist, podiatrist, or an advanced practice 83
registered nurse; except that no payment for drugs and 84
medicines prescribed on and after January 1, 2006, by a 85
licensed physician, dentist, podiatrist, or an advanced 86
practice registered nurse may be made on behalf of any 87 SB 548 29
person who qualifies for prescription drug coverage under 88
the provisions of P.L. 108 -173; 89
(9) Emergency ambulance services and, effective 90
January 1, 1990, medically necessary transportation to 91
scheduled, physician -prescribed nonelective treatments; 92
(10) Early and periodic screening and diagnosis of 93
individuals who are under the age of twenty -one to ascertain 94
their physical or ment al defects, and health care, 95
treatment, and other measures to correct or ameliorate 96
defects and chronic conditions discovered thereby. Such 97
services shall be provided in accordance with the provisions 98
of Section 6403 of P.L. 101 -239 and federal regula tions 99
promulgated thereunder; 100
(11) Home health care services; 101
(12) Family planning as defined by federal rules and 102
regulations; provided, that no funds shall be expended to 103
any abortion facility, as defined in section 188.015, or to 104
any affiliate, as defined in section 188.015, of such 105
abortion facility; and further provided, however, that such 106
family planning services shall not include abortions or any 107
abortifacient drug or device that is used for the purpose of 108
inducing an abortion unl ess such abortions are certified in 109
writing by a physician to the MO HealthNet agency that, in 110
the physician's professional judgment, the life of the 111
mother would be endangered if the fetus were carried to term; 112
(13) Inpatient psychiatric hospital services for 113
individuals under age twenty -one as defined in Title XIX of 114
the federal Social Security Act (42 U.S.C. Section 1396d, et 115
seq.); 116
(14) Outpatient surgical procedures, including 117
presurgical diagnostic services performed in ambulatory 118
surgical facilities which are licensed by the department of 119 SB 548 30
health and senior services of the state of Missouri; except, 120
that such outpatient surgical services shall not include 121
persons who are eligible for coverage under Part B of Title 122
XVIII, Public Law 89-97, 1965 amendments to the federal 123
Social Security Act, as amended, if exclusion of such 124
persons is permitted under Title XIX, Public Law 89 -97, 1965 125
amendments to the federal Social Security Act, as amended; 126
(15) Personal care services whi ch are medically 127
oriented tasks having to do with a person's physical 128
requirements, as opposed to housekeeping requirements, which 129
enable a person to be treated by his or her physician on an 130
outpatient rather than on an inpatient or residential basis 131
in a hospital, intermediate care facility, or skilled 132
nursing facility. Personal care services shall be rendered 133
by an individual not a member of the participant's family 134
who is qualified to provide such services where the services 135
are prescribed by a physician in accordance with a plan of 136
treatment and are supervised by a licensed nurse. Persons 137
eligible to receive personal care services shall be those 138
persons who would otherwise require placement in a hospital, 139
intermediate care facility, or ski lled nursing facility. 140
Benefits payable for personal care services shall not exceed 141
for any one participant one hundred percent of the average 142
statewide charge for care and treatment in an intermediate 143
care facility for a comparable period of time. Such 144
services, when delivered in a residential care facility or 145
assisted living facility licensed under chapter 198 shall be 146
authorized on a tier level based on the services the 147
resident requires and the frequency of the services. A 148
resident of such facility who qualifies for assistance under 149
section 208.030 shall, at a minimum, if prescribed by a 150
physician, qualify for the tier level with the fewest 151 SB 548 31
services. The rate paid to providers for each tier of 152
service shall be set subject to appropriatio ns. Subject to 153
appropriations, each resident of such facility who qualifies 154
for assistance under section 208.030 and meets the level of 155
care required in this section shall, at a minimum, if 156
prescribed by a physician, be authorized up to one hour of 157
personal care services per day. Authorized units of 158
personal care services shall not be reduced or tier level 159
lowered unless an order approving such reduction or lowering 160
is obtained from the resident's personal physician. Such 161
authorized units of per sonal care services or tier level 162
shall be transferred with such resident if he or she 163
transfers to another such facility. Such provision shall 164
terminate upon receipt of relevant waivers from the federal 165
Department of Health and Human Services. If the Centers for 166
Medicare and Medicaid Services determines that such 167
provision does not comply with the state plan, this 168
provision shall be null and void. The MO HealthNet division 169
shall notify the revisor of statutes as to whether the 170
relevant waivers are approved or a determination of 171
noncompliance is made; 172
(16) Mental health services. The state plan for 173
providing medical assistance under Title XIX of the Social 174
Security Act, 42 U.S.C. Section [301] 1396, et seq., as 175
amended, shall include t he following mental health services 176
when such services are provided by community mental health 177
facilities operated by the department of mental health or 178
designated by the department of mental health as a community 179
mental health facility or as an alcoho l and drug abuse 180
facility or as a child -serving agency within the 181
comprehensive children's mental health service system 182
established in section 630.097. The department of mental 183 SB 548 32
health shall establish by administrative rule the definition 184
and criteria for designation as a community mental health 185
facility and for designation as an alcohol and drug abuse 186
facility. Such mental health services shall include: 187
(a) Outpatient mental health services including 188
preventive, diagnostic, therapeutic, reha bilitative, and 189
palliative interventions rendered to individuals in an 190
individual or group setting by a mental health professional 191
in accordance with a plan of treatment appropriately 192
established, implemented, monitored, and revised under the 193
auspices of a therapeutic team as a part of client services 194
management; 195
(b) Clinic mental health services including 196
preventive, diagnostic, therapeutic, rehabilitative, and 197
palliative interventions rendered to individuals in an 198
individual or group settin g by a mental health professional 199
in accordance with a plan of treatment appropriately 200
established, implemented, monitored, and revised under the 201
auspices of a therapeutic team as a part of client services 202
management; 203
(c) Rehabilitative mental he alth and alcohol and drug 204
abuse services including home and community -based 205
preventive, diagnostic, therapeutic, rehabilitative, and 206
palliative interventions rendered to individuals in an 207
individual or group setting by a mental health or alcohol 208
and drug abuse professional in accordance with a plan of 209
treatment appropriately established, implemented, monitored, 210
and revised under the auspices of a therapeutic team as a 211
part of client services management. As used in this 212
section, mental health profe ssional and alcohol and drug 213
abuse professional shall be defined by the department of 214
mental health pursuant to duly promulgated rules. With 215 SB 548 33
respect to services established by this subdivision, the 216
department of social services, MO HealthNet division, shall 217
enter into an agreement with the department of mental 218
health. Matching funds for outpatient mental health 219
services, clinic mental health services, and rehabilitation 220
services for mental health and alcohol and drug abuse shall 221
be certified by the department of mental health to the MO 222
HealthNet division. The agreement shall establish a 223
mechanism for the joint implementation of the provisions of 224
this subdivision. In addition, the agreement shall 225
establish a mechanism by which rates for servi ces may be 226
jointly developed; 227
(17) Such additional services as defined by the MO 228
HealthNet division to be furnished under waivers of federal 229
statutory requirements as provided for and authorized by the 230
federal Social Security Act (42 U.S.C. Secti on 301, et seq.) 231
subject to appropriation by the general assembly; 232
(18) The services of an advanced practice registered 233
nurse with a collaborative practice agreement to the extent 234
that such services are provided in accordance with chapters 235
334 and 335, and regulations promulgated thereunder; 236
(19) Nursing home costs for participants receiving 237
benefit payments under subdivision (4) of this subsection to 238
reserve a bed for the participant in the nursing home during 239
the time that the participa nt is absent due to admission to 240
a hospital for services which cannot be performed on an 241
outpatient basis, subject to the provisions of this 242
subdivision: 243
(a) The provisions of this subdivision shall apply 244
only if: 245
a. The occupancy rate of t he nursing home is at or 246
above ninety-seven percent of MO HealthNet certified 247 SB 548 34
licensed beds, according to the most recent quarterly census 248
provided to the department of health and senior services 249
which was taken prior to when the participant is admitte d to 250
the hospital; and 251
b. The patient is admitted to a hospital for a medical 252
condition with an anticipated stay of three days or less; 253
(b) The payment to be made under this subdivision 254
shall be provided for a maximum of three days per hospi tal 255
stay; 256
(c) For each day that nursing home costs are paid on 257
behalf of a participant under this subdivision during any 258
period of six consecutive months such participant shall, 259
during the same period of six consecutive months, be 260
ineligible for payment of nursing home costs of two 261
otherwise available temporary leave of absence days provided 262
under subdivision (5) of this subsection; and 263
(d) The provisions of this subdivision shall not apply 264
unless the nursing home receives notice from th e participant 265
or the participant's responsible party that the participant 266
intends to return to the nursing home following the hospital 267
stay. If the nursing home receives such notification and 268
all other provisions of this subsection have been satisfied , 269
the nursing home shall provide notice to the participant or 270
the participant's responsible party prior to release of the 271
reserved bed; 272
(20) Prescribed medically necessary durable medical 273
equipment. An electronic web-based prior authorization 274
system using best medical evidence and care and treatment 275
guidelines consistent with national standards shall be used 276
to verify medical need; 277
(21) Hospice care. As used in this subdivision, the 278
term "hospice care" means a coordinated program of ac tive 279 SB 548 35
professional medical attention within a home, outpatient and 280
inpatient care which treats the terminally ill patient and 281
family as a unit, employing a medically directed 282
interdisciplinary team. The program provides relief of 283
severe pain or other physical symptoms and supportive care 284
to meet the special needs arising out of physical, 285
psychological, spiritual, social, and economic stresses 286
which are experienced during the final stages of illness, 287
and during dying and bereavement and meets the Me dicare 288
requirements for participation as a hospice as are provided 289
in 42 CFR Part 418. The rate of reimbursement paid by the 290
MO HealthNet division to the hospice provider for room and 291
board furnished by a nursing home to an eligible hospice 292
patient shall not be less than ninety -five percent of the 293
rate of reimbursement which would have been paid for 294
facility services in that nursing home facility for that 295
patient, in accordance with subsection (c) of Section 6408 296
of P.L. 101-239 (Omnibus Budget Re conciliation Act of 1989); 297
(22) Prescribed medically necessary dental services. 298
Such services shall be subject to appropriations. An 299
electronic web-based prior authorization system using best 300
medical evidence and care and treatment guidelines 301
consistent with national standards shall be used to verify 302
medical need; 303
(23) Prescribed medically necessary optometric 304
services. Such services shall be subject to 305
appropriations. An electronic web-based prior authorization 306
system using best med ical evidence and care and treatment 307
guidelines consistent with national standards shall be used 308
to verify medical need; 309
(24) Blood clotting products -related services. For 310
persons diagnosed with a bleeding disorder, as defined in 311 SB 548 36
section 338.400, reliant on blood clotting products, as 312
defined in section 338.400, such services include: 313
(a) Home delivery of blood clotting products and 314
ancillary infusion equipment and supplies, including the 315
emergency deliveries of the product when medicall y necessary; 316
(b) Medically necessary ancillary infusion equipment 317
and supplies required to administer the blood clotting 318
products; and 319
(c) Assessments conducted in the participant's home by 320
a pharmacist, nurse, or local home health care agen cy 321
trained in bleeding disorders when deemed necessary by the 322
participant's treating physician; 323
(25) Medically necessary cochlear implants and hearing 324
instruments, as defined in section 345.015, that are: 325
(a) Prescribed by an audiologist, as defined in 326
section 345.015; or 327
(b) Dispensed by a hearing instrument specialist, as 328
defined in section 346.010; 329
(26) The MO HealthNet division shall, by January 1, 330
2008, and annually thereafter, report the status of MO 331
HealthNet provider r eimbursement rates as compared to one 332
hundred percent of the Medicare reimbursement rates and 333
compared to the average dental reimbursement rates paid by 334
third-party payors licensed by the state. The MO HealthNet 335
division shall, by July 1, 2008, provid e to the general 336
assembly a four-year plan to achieve parity with Medicare 337
reimbursement rates and for third -party payor average dental 338
reimbursement rates. Such plan shall be subject to 339
appropriation and the division shall include in its annual 340
budget request to the governor the necessary funding needed 341
to complete the four -year plan developed under this 342
subdivision. 343 SB 548 37
2. Additional benefit payments for medical assistance 344
shall be made on behalf of those eligible needy children, 345
pregnant women and blind persons with any payments to be 346
made on the basis of the reasonable cost of the care or 347
reasonable charge for the services as defined and determined 348
by the MO HealthNet division, unless otherwise hereinafter 349
provided, for the following: 350
(1) Dental services; 351
(2) Services of podiatrists as defined in section 352
330.010; 353
(3) Optometric services as described in section 354
336.010; 355
(4) Orthopedic devices or other prosthetics, including 356
eye glasses, dentures, [hearing aids,] and wheelchairs; 357
(5) Hospice care. As used in this subdivision, the 358
term "hospice care" means a coordinated program of active 359
professional medical attention within a home, outpatient and 360
inpatient care which treats the terminally ill patient and 361
family as a unit, employing a medically directed 362
interdisciplinary team. The program provides relief of 363
severe pain or other physical symptoms and supportive care 364
to meet the special needs arising out of physical, 365
psychological, spiritual, social, and economic stresses 366
which are experienced during the final stages of illness, 367
and during dying and bereavement and meets the Medicare 368
requirements for participation as a hospice as are provided 369
in 42 CFR Part 418. The rate of reimbursement paid by the 370
MO HealthNet division to the hospice provider for room and 371
board furnished by a nursing home to an eligible hospice 372
patient shall not be less than ninety -five percent of the 373
rate of reimbursement which would have been paid for 374
facility services in tha t nursing home facility for that 375 SB 548 38
patient, in accordance with subsection (c) of Section 6408 376
of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989); 377
(6) Comprehensive day rehabilitation services 378
beginning early posttrauma as part of a coordina ted system 379
of care for individuals with disabling impairments. 380
Rehabilitation services must be based on an individualized, 381
goal-oriented, comprehensive and coordinated treatment plan 382
developed, implemented, and monitored through an 383
interdisciplinary assessment designed to restore an 384
individual to optimal level of physical, cognitive, and 385
behavioral function. The MO HealthNet division shall 386
establish by administrative rule the definition and criteria 387
for designation of a comprehensive day rehabili tation 388
service facility, benefit limitations and payment 389
mechanism. Any rule or portion of a rule, as that term is 390
defined in section 536.010, that is created under the 391
authority delegated in this subdivision shall become 392
effective only if it complie s with and is subject to all of 393
the provisions of chapter 536 and, if applicable, section 394
536.028. This section and chapter 536 are nonseverable and 395
if any of the powers vested with the general assembly 396
pursuant to chapter 536 to review, to delay the effective 397
date, or to disapprove and annul a rule are subsequently 398
held unconstitutional, then the grant of rulemaking 399
authority and any rule proposed or adopted after August 28, 400
2005, shall be invalid and void. 401
3. The MO HealthNet division may r equire any 402
participant receiving MO HealthNet benefits to pay part of 403
the charge or cost until July 1, 2008, and an additional 404
payment after July 1, 2008, as defined by rule duly 405
promulgated by the MO HealthNet division, for all covered 406
services except for those services covered under 407 SB 548 39
subdivisions (15) and (16) of subsection 1 of this section 408
and sections 208.631 to 208.657 to the extent and in the 409
manner authorized by Title XIX of the federal Social 410
Security Act (42 U.S.C. Section 1396, et seq.) a nd 411
regulations thereunder. When substitution of a generic drug 412
is permitted by the prescriber according to section 338.056, 413
and a generic drug is substituted for a name -brand drug, the 414
MO HealthNet division may not lower or delete the 415
requirement to make a co-payment pursuant to regulations of 416
Title XIX of the federal Social Security Act. A provider of 417
goods or services described under this section must collect 418
from all participants the additional payment that may be 419
required by the MO HealthNet division under authority 420
granted herein, if the division exercises that authority, to 421
remain eligible as a provider. Any payments made by 422
participants under this section shall be in addition to and 423
not in lieu of payments made by the state for goods o r 424
services described herein except the participant portion of 425
the pharmacy professional dispensing fee shall be in 426
addition to and not in lieu of payments to pharmacists. A 427
provider may collect the co -payment at the time a service is 428
provided or at a later date. A provider shall not refuse to 429
provide a service if a participant is unable to pay a 430
required payment. If it is the routine business practice of 431
a provider to terminate future services to an individual 432
with an unclaimed debt, the provide r may include uncollected 433
co-payments under this practice. Providers who elect not to 434
undertake the provision of services based on a history of 435
bad debt shall give participants advance notice and a 436
reasonable opportunity for payment. A provider, 437
representative, employee, independent contractor, or agent 438
of a pharmaceutical manufacturer shall not make co -payment 439 SB 548 40
for a participant. This subsection shall not apply to other 440
qualified children, pregnant women, or blind persons. If 441
the Centers for Medicare and Medicaid Services does not 442
approve the MO HealthNet state plan amendment submitted by 443
the department of social services that would allow a 444
provider to deny future services to an individual with 445
uncollected co-payments, the denial of services shall not be 446
allowed. The department of social services shall inform 447
providers regarding the acceptability of denying services as 448
the result of unpaid co -payments. 449
4. The MO HealthNet division shall have the right to 450
collect medication samples from participants in order to 451
maintain program integrity. 452
5. Reimbursement for obstetrical and pediatric 453
services under subdivision (6) of subsection 1 of this 454
section shall be timely and sufficient to enlist enough 455
health care providers so that care and services are 456
available under the state plan for MO HealthNet benefits at 457
least to the extent that such care and services are 458
available to the general population in the geographic area, 459
as required under subparagraph (a)(30)(A) of 42 U.S.C. 460
Section 1396a and federal regulations promulgated thereunder. 461
6. Beginning July 1, 1990, reimbursement for services 462
rendered in federally funded health centers shall be in 463
accordance with the provisions of subsection 6402(c) and 464
Section 6404 of P.L. 101-239 (Omnibus Budget Reconciliation 465
Act of 1989) and federal regulations promulgated thereunder. 466
7. Beginning July 1, 1990, the department of social 467
services shall provide notification and referral of children 468
below age five, and pregnant, bre ast-feeding, or postpartum 469
women who are determined to be eligible for MO HealthNet 470
benefits under section 208.151 to the special supplemental 471 SB 548 41
food programs for women, infants and children administered 472
by the department of health and senior services. Such 473
notification and referral shall conform to the requirements 474
of Section 6406 of P.L. 101 -239 and regulations promulgated 475
thereunder. 476
8. Providers of long-term care services shall be 477
reimbursed for their costs in accordance with the provisions 478
of Section 1902 (a)(13)(A) of the Social Security Act, 42 479
U.S.C. Section 1396a, as amended, and regulations 480
promulgated thereunder. 481
9. Reimbursement rates to long -term care providers 482
with respect to a total change in ownership, at arm's 483
length, for any facility previously licensed and certified 484
for participation in the MO HealthNet program shall not 485
increase payments in excess of the increase that would 486
result from the application of Section 1902 (a)(13)(C) of 487
the Social Security Act, 42 U.S .C. Section 1396a (a)(13)(C). 488
10. The MO HealthNet division may enroll qualified 489
residential care facilities and assisted living facilities, 490
as defined in chapter 198, as MO HealthNet personal care 491
providers. 492
11. Any income earned by individ uals eligible for 493
certified extended employment at a sheltered workshop under 494
chapter 178 shall not be considered as income for purposes 495
of determining eligibility under this section. 496
12. If the Missouri Medicaid audit and compliance unit 497
changes any interpretation or application of the 498
requirements for reimbursement for MO HealthNet services 499
from the interpretation or application that has been applied 500
previously by the state in any audit of a MO HealthNet 501
provider, the Missouri Medicaid audit and compliance unit 502
shall notify all affected MO HealthNet providers five 503 SB 548 42
business days before such change shall take effect. Failure 504
of the Missouri Medicaid audit and compliance unit to notify 505
a provider of such change shall entitle the provider to 506
continue to receive and retain reimbursement until such 507
notification is provided and shall waive any liability of 508
such provider for recoupment or other loss of any payments 509
previously made prior to the five business days after such 510
notice has been sent. Each provider shall provide the 511
Missouri Medicaid audit and compliance unit a valid email 512
address and shall agree to receive communications 513
electronically. The notification required under this 514
section shall be delivered in writing by the United S tates 515
Postal Service or electronic mail to each provider. 516
13. Nothing in this section shall be construed to 517
abrogate or limit the department's statutory requirement to 518
promulgate rules under chapter 536. 519
14. Beginning July 1, 2016, and subje ct to 520
appropriations, providers of behavioral, social, and 521
psychophysiological services for the prevention, treatment, 522
or management of physical health problems shall be 523
reimbursed utilizing the behavior assessment and 524
intervention reimbursement codes 96150 to 96154 or their 525
successor codes under the Current Procedural Terminology 526
(CPT) coding system. Providers eligible for such 527
reimbursement shall include psychologists. 528
15. There shall be no payments made under this section 529
for gender transition surgeries, cross -sex hormones, or 530
puberty-blocking drugs, as such terms are defined in section 531
191.1720, for the purpose of a gender transition. 532
210.030. 1. Every licensed physician, midwife, 1
registered nurse and all persons w ho may undertake, in a 2
professional way, the obstetrical and gynecological care of 3 SB 548 43
a pregnant woman in the state of Missouri shall, if the 4
woman consents, take or cause to be taken a sample of venous 5
blood of such woman at the time of the first prenata l 6
examination, or not later than twenty days after the first 7
prenatal examination, and another sample at twenty -eight 8
weeks of pregnancy and subject such [sample] samples to an 9
approved and standard serological test for syphilis [, an] 10
and approved serological [test] tests for hepatitis B, 11
hepatitis C, human immunodeficiency virus (HIV), and such 12
other treatable diseases and metabolic disorders as are 13
prescribed by the department of health and senior services. 14
[In any area of the state designated a s a syphilis outbreak 15
area by the department of health and senior services, if the 16
mother consents, a sample of her venous blood shall be taken 17
later in the course of pregnancy and at delivery for 18
additional testing for syphilis as may be prescribed by the 19
department] If a mother tests positive for syphilis, 20
hepatitis B, hepatitis C, or HIV, or any combination of such 21
diseases, the physician or person providing care shall 22
administer treatment in accordance with the most recent 23
accepted medical prac tice. If a mother tests positive for 24
hepatitis B, the physician or person who professionally 25
undertakes the pediatric care of a newborn shall also 26
administer the appropriate doses of hepatitis B vaccine and 27
hepatitis B immune globulin (HBIG) in accord ance with the 28
current recommendations of the Advisory Committee on 29
Immunization Practices (ACIP). If the mother's hepatitis B 30
status is unknown, the appropriate dose of hepatitis B 31
vaccine shall be administered to the newborn in accordance 32
with the current ACIP recommendations. If the mother 33
consents, a sample of her venous blood shall be taken. If 34
she tests positive for hepatitis B, hepatitis B immune 35 SB 548 44
globulin (HBIG) shall be administered to the newborn in 36
accordance with the current ACIP recom mendations. 37
2. The department of health and senior services 38
shall[, in consultation with the Missouri genetic disease 39
advisory committee,] make such rules pertaining to such 40
tests as shall be dictated by accepted medical practice, and 41
tests shall be of the types approved or accepted by the 42
[department of health and senior services. An approved and 43
standard test for syphilis, hepatitis B, and other treatable 44
diseases and metabolic disorders shall mean a test made in a 45
laboratory approved by th e department of health and senior 46
services] United States Food and Drug Administration . No 47
individual shall be denied testing by the department of 48
health and senior services because of inability to pay. 49
332.081. 1. Notwithstanding any other provision of 1
law to the contrary, hospitals licensed under chapter 197 2
shall be authorized to employ any or all of the following 3
oral health providers: 4
(1) A dentist licensed under this chapter for the 5
purpose of treating on hospital pr emises those patients who 6
present with a dental condition and such treatment is 7
necessary to ameliorate the condition for which they 8
presented such as severe pain or tooth abscesses; 9
(2) An oral and maxillofacial surgeon licensed under 10
this chapter for the purpose of treating oral conditions 11
that need to be ameliorated as part of treating the 12
underlying cause of the patient's medical needs including, 13
but not limited to, head and neck cancer, HIV or AIDS, 14
severe trauma resulting in admission to the hospital, organ 15
transplant, diabetes, or seizure disorders. It shall be a 16
condition of treatment that such patients are admitted to 17
the hospital on either an in - or out-patient basis; and 18 SB 548 45
(3) A maxillofacial prosthodontist licensed under thi s 19
chapter for the purpose of treating and supporting patients 20
of a head and neck cancer team or other complex care or 21
surgical team for the fabrication of appliances following 22
ablative surgery, surgery to correct birth anomalies, 23
extensive radiation t reatment of the head or neck, or trauma - 24
related surgery. 25
2. No person or other entity shall practice dentistry 26
in Missouri or provide dental services as defined in section 27
332.071 unless and until the board has issued to the person 28
a certificate certifying that the person has been duly 29
registered as a dentist in Missouri or the board has issued 30
such certificate to an entity that has been duly registered 31
to provide dental services by licensed dentists and dental 32
hygienists and unless and until the board has issued to the 33
person a license, to be renewed each period, as provided in 34
this chapter, to practice dentistry or as a dental 35
hygienist, or has issued to the person or entity a permit, 36
to be renewed each period, to provide dental services in 37
Missouri. Nothing in this chapter shall be so construed as 38
to make it unlawful for: 39
(1) A legally qualified physician or surgeon, who does 40
not practice dentistry as a specialty, from extracting teeth; 41
(2) A dentist licensed in a state ot her than Missouri 42
from making a clinical demonstration before a meeting of 43
dentists in Missouri; 44
(3) Dental students in any accredited dental school to 45
practice dentistry under the personal direction of 46
instructors; 47
(4) Dental hygiene stude nts in any accredited dental 48
hygiene school to practice dental hygiene under the personal 49
direction of instructors; 50 SB 548 46
(5) A duly registered and licensed dental hygienist in 51
Missouri to practice dental hygiene as defined in section 52
332.091; 53
(6) A dental assistant, certified dental assistant, or 54
expanded functions dental assistant to be delegated duties 55
as defined in section 332.093; 56
(7) A duly registered dentist or dental hygienist to 57
teach in an accredited dental or dental hygiene sch ool; 58
(8) A person who has been granted a dental faculty 59
permit under section 332.183 to practice dentistry in the 60
scope of his or her employment at an accredited dental 61
school, college, or program in Missouri; 62
(9) A duly qualified anesthesio logist or nurse 63
anesthetist to administer an anesthetic in connection with 64
dental services or dental surgery; 65
(10) A person to practice dentistry in or for: 66
(a) The United States Armed Forces; 67
(b) The United States Public Health Service ; 68
(c) Migrant, community, or health care for the 69
homeless health centers provided in Section 330 of the 70
Public Health Service Act (42 U.S.C. Section 254b); 71
(d) Federally qualified health centers as defined in 72
Section 1905(l) (42 U.S.C. Secti on 1396d(l)) of the Social 73
Security Act; 74
(e) Governmental entities, including county health 75
departments; or 76
(f) The United States Veterans Bureau; or 77
(11) A dentist licensed in a state other than Missouri 78
to evaluate a patient or rende r an oral, written, or 79
otherwise documented dental opinion when providing testimony 80
or records for the purpose of a civil or criminal action 81 SB 548 47
before any judicial or administrative proceeding of this 82
state or other forum in this state. 83
3. No corporation shall practice dentistry as defined 84
in section 332.071 unless that corporation is organized 85
under the provisions of chapter 355 or 356 provided that a 86
corporation organized under the provisions of chapter 355 87
and qualifying as an organization und er 26 U.S.C. Section 88
501(c)(3) may only employ dentists and dental hygienists 89
licensed in this state to render dental services to Medicaid 90
recipients, low-income individuals who have available income 91
below two hundred percent of the federal poverty lev el, and 92
all participants in the SCHIP program, unless such 93
limitation is contrary to or inconsistent with federal or 94
state law or regulation. This subsection shall not apply to: 95
(1) A hospital licensed under chapter 197 that 96
provides care and tr eatment only to children under the age 97
of eighteen at which a person regulated under this chapter 98
provides dental care within the scope of his or her license 99
or registration; 100
(2) A federally qualified health center as defined in 101
Section 1905(l) of the Social Security Act (42 U.S.C. 102
Section 1396d(l)), or a migrant, community, or health care 103
for the homeless health center provided for in Section 330 104
of the Public Health Services Act (42 U.S.C. Section 254b) 105
at which a person regulated under this chapter provides 106
dental care within the scope of his or her license or 107
registration; 108
(3) A city or county health department organized under 109
chapter 192 or chapter 205 at which a person regulated under 110
this chapter provides dental care within the scope of his or 111
her license or registration; 112 SB 548 48
(4) A social welfare board organized under section 113
205.770, a city health department operating under a city 114
charter, or a city-county health department at which a 115
person regulated under this chapter p rovides dental care 116
within the scope of his or her license or registration; 117
(5) Any entity that has received a permit from the 118
dental board and does not receive compensation from the 119
patient or from any third party on the patient's behalf at 120
which a person regulated under this chapter provides dental 121
care within the scope of his or her license or registration; 122
(6) Any hospital nonprofit corporation exempt from 123
taxation under Section 501(c)(3) of the Internal Revenue 124
Code, as amended, that engages in its operations and 125
provides dental services at facilities owned by a city, 126
county, or other political subdivision of the state , or any 127
entity contracted with the state to provide care in a 128
correctional center, as such term is defined in sec tion 129
217.010, at which a person regulated under this chapter 130
provides dental care within the scope of his or her license 131
or registration. 132
If any of the entities exempted from the requirements of 133
this subsection are unable to provide services to a patie nt 134
due to the lack of a qualified provider and a referral to 135
another entity is made, the exemption shall extend to the 136
person or entity that subsequently provides services to the 137
patient. 138
4. No unincorporated organization shall practice 139
dentistry as defined in section 332.071 unless such 140
organization is exempt from federal taxation under Section 141
501(c)(3) of the Internal Revenue Code of 1986, as amended, 142
and provides dental treatment without compensation from the 143 SB 548 49
patient or any third party on their behalf as a part of a 144
broader program of social services including food 145
distribution. Nothing in this chapter shall prohibit 146
organizations under this subsection from employing any 147
person regulated by this chapter. 148
5. A dentist shall not e nter into a contract that 149
allows a person who is not a dentist to influence or 150
interfere with the exercise of the dentist's independent 151
professional judgment. 152
6. A not-for-profit corporation organized under the 153
provisions of chapter 355 and quali fying as an organization 154
under 26 U.S.C. Section 501(c)(3), an unincorporated 155
organization operating pursuant to subsection 4 of this 156
section, or any other person should not direct or interfere 157
or attempt to direct or interfere with a licensed dentist' s 158
professional judgment and competent practice of dentistry. 159
Nothing in this subsection shall be so construed as to make 160
it unlawful for not-for-profit organizations to enforce 161
employment contracts, corporate policy and procedure 162
manuals, or quality improvement or assurance requirements. 163
7. All entities defined in subsection 3 of this 164
section and those exempted under subsection 4 of this 165
section shall apply for a permit to employ dentists and 166
dental hygienists licensed in this state to render dental 167
services, and the entity shall apply for the permit in 168
writing on forms provided by the Missouri dental board. The 169
board shall not charge a fee of any kind for the issuance or 170
renewal of such permit. The provisions of this subsection 171
shall not apply to a federally qualified health center as 172
defined in Section 1905(l) of the Social Security Act (42 173
U.S.C. Section 1396d(l)). 174 SB 548 50
8. Any entity that obtains a permit to render dental 175
services in this state is subject to discipline pursuant to 176
section 332.321. If the board concludes that the person or 177
entity has committed an act or is engaging in a course of 178
conduct that would be grounds for disciplinary action, the 179
board may file a complaint before the administrative hearing 180
commission. The board may refuse to issue or renew the 181
permit of any entity for one or any combination of causes 182
stated in subsection 2 of section 332.321. The board shall 183
notify the applicant in writing of the reasons for the 184
refusal and shall advise the applic ant of his or her right 185
to file a complaint with the administrative hearing 186
commission as provided by chapter 621. 187
9. A federally qualified health center as defined in 188
Section 1905(l) of the Social Security Act (42 U.S.C. 189
Section 1396d(l)) shall register with the board. The 190
information provided to the board as part of the 191
registration shall include the name of the health center, 192
the nonprofit status of the health center, sites where 193
dental services will be provided, and the names of all 194
persons employed by, or contracting with, the health center 195
who are required to hold a license pursuant to this 196
chapter. The registration shall be renewed every twenty - 197
four months. The board shall not charge a fee of any kind 198
for the issuance or renewal of the registration. The 199
registration of the health center shall not be subject to 200
discipline pursuant to section 332.321. Nothing in this 201
subsection shall prohibit disciplinary action against a 202
licensee of this chapter who is employed by, or contrac ts 203
with, such health center for the actions of the licensee in 204
connection with such employment or contract. 205 SB 548 51
10. The board may promulgate rules and regulations to 206
ensure not-for-profit corporations are rendering care to the 207
patient populations as set forth herein, including 208
requirements for covered not -for-profit corporations to 209
report patient census data to the board. The provisions of 210
this subsection shall not apply to a federally qualified 211
health center as defined in Section 1905(l) of the Social 212
Security Act (42 U.S.C. Section 1396d(l)). 213
11. All not-for-profit corporations organized or 214
operated pursuant to the provisions of chapter 355 and 215
qualifying as an organization under 26 U.S.C. Section 216
501(c)(3), or the requirements relatin g to migrant, 217
community, or health care for the homeless health centers 218
provided in Section 330 of the Public Health Service Act (42 219
U.S.C. Section 254b) and federally qualified health centers 220
as defined in Section 1905(l) (42 U.S.C. Section 1396d(l)) 221
of the Social Security Act, that employ persons who practice 222
dentistry or dental hygiene in this state shall do so in 223
accordance with the relevant laws of this state except to 224
the extent that such laws are contrary to, or inconsistent 225
with, federal statute or regulation. 226
335.081. So long as the person involved does not 1
represent or hold himself or herself out as a nurse licensed 2
to practice in this state, no provision of sections 335.011 3
to 335.096 shall be construed as prohibiti ng: 4
(1) The practice of any profession for which a license 5
is required and issued pursuant to the laws of this state by 6
a person duly licensed to practice that profession; 7
(2) The services rendered by technicians, nurses' 8
aides or their equivalent trained and employed in public or 9
private hospitals and licensed long -term care facilities 10
except the services rendered in licensed long -term care 11 SB 548 52
facilities shall be limited to administering medication, 12
excluding injectable medications other than: 13
(a) Insulin; 14
(b) Subcutaneous injectable medications to treat 15
diabetes as ordered by an individual legally authorized to 16
prescribe such medications; and 17
(c) Epinephrine auto-injectors ordered for stock 18
supply in accordance with se ction 196.990 or prescribed for 19
a resident's individual use by an individual legally 20
authorized to prescribe such epinephrine auto -injectors. 21
Expected epinephrine auto -injector users shall receive 22
training set forth in section 196.990. As used in this 23
paragraph, the term "epinephrine auto -injector" means a 24
single-use device used for the automatic injection of a 25
premeasured dose of epinephrine into the human body or 26
another epinephrine delivery system approved by the United 27
States Food and Drug Ad ministration for public use; 28
(3) The providing of nursing care by friends or 29
members of the family of the person receiving such care; 30
(4) The incidental care of the sick, aged, or infirm 31
by domestic servants or persons primarily employed as 32
housekeepers; 33
(5) The furnishing of nursing assistance in the case 34
of an emergency situation; 35
(6) The practice of nursing under proper supervision: 36
(a) As a part of the course of study by students 37
enrolled in approved schools of profess ional nursing or in 38
schools of practical nursing; 39
(b) By graduates of accredited nursing programs 40
pending the results of the first licensing examination or 41
ninety days after graduation, whichever first occurs; 42 SB 548 53
(c) A graduate nurse who is pre vented from attending 43
the first licensing examination following graduation by 44
reason of active duty in the military may practice as a 45
graduate nurse pending the results of the first licensing 46
examination scheduled by the board following the release of 47
such graduate nurse from active military duty or pending the 48
results of the first licensing examination taken by the 49
graduate nurse while involved in active military service 50
whichever comes first; 51
(7) The practice of nursing in this state by any 52
legally qualified nurse duly licensed to practice in another 53
state whose engagement requires such nurse to accompany and 54
care for a patient temporarily residing in this state for a 55
period not to exceed six months; 56
(8) The practice of any legally qualified nurse who is 57
employed by the government of the United States or any 58
bureau, division or agency thereof, while in the discharge 59
of his or her official duties or to the practice of any 60
legally qualified nurse serving in the Armed Forces of the 61
United States while stationed within this state; 62
(9) Nonmedical nursing care of the sick with or 63
without compensation when done in connection with the 64
practice of the religious tenets of any church by adherents 65
thereof, as long as they do not eng age in the practice of 66
nursing as defined in sections 335.011 to 335.096; 67
(10) The practice of any legally qualified and 68
licensed nurse of another state, territory, or foreign 69
country whose responsibilities include transporting patients 70
into, out of, or through this state while actively engaged 71
in patient transport that does not exceed forty -eight hours 72
in this state. 73
338.010. 1. The "practice of pharmacy" includes: 1 SB 548 54
(1) The interpretation, implementation, and evaluatio n 2
of medical prescription orders, including any legend drugs 3
under 21 U.S.C. Section 353, and the receipt, transmission, 4
or handling of such orders or facilitating the dispensing of 5
such orders; 6
(2) The designing, initiating, implementing, and 7
monitoring of a medication therapeutic plan in accordance 8
with the provisions of this section; 9
(3) The compounding, dispensing, labeling, and 10
administration of drugs and devices pursuant to medical 11
prescription orders; 12
(4) The ordering and administration of vaccines 13
approved or authorized by the U.S. Food and Drug 14
Administration, excluding vaccines for cholera, monkeypox, 15
Japanese encephalitis, typhoid, rabies, yellow fever, tick - 16
borne encephalitis, anthrax, tuberculosis, dengue, Hib, 17
polio, rotavirus, smallpox, chikungunya, and any vaccine 18
approved after January 1, [2023] 2025, to persons at least 19
seven years of age or the age recommended by the Centers for 20
Disease Control and Prevention, whichever is older, pursuant 21
to joint promulgation of rules established by the board of 22
pharmacy and the state board of registration for the healing 23
arts unless rules are established under a state of emergency 24
as described in section 44.100; 25
(5) The participation in drug selection according t o 26
state law and participation in drug utilization reviews; 27
(6) The proper and safe storage of drugs and devices 28
and the maintenance of proper records thereof; 29
(7) Consultation with patients and other health care 30
practitioners, and veterinari ans and their clients about 31
legend drugs, about the safe and effective use of drugs and 32
devices; 33 SB 548 55
(8) The prescribing and dispensing of any nicotine 34
replacement therapy product under section 338.665; 35
(9) The dispensing of HIV postexposure pro phylaxis 36
pursuant to section 338.730; and 37
(10) The offering or performing of those acts, 38
services, operations, or transactions necessary in the 39
conduct, operation, management and control of a pharmacy. 40
2. No person shall engage in the practi ce of pharmacy 41
unless he or she is licensed under the provisions of this 42
chapter. 43
3. This chapter shall not be construed to prohibit the 44
use of auxiliary personnel under the direct supervision of a 45
pharmacist from assisting the pharmacist in any of his or 46
her duties. This assistance in no way is intended to 47
relieve the pharmacist from his or her responsibilities for 48
compliance with this chapter and he or she will be 49
responsible for the actions of the auxiliary personnel 50
acting in his or her assistance. 51
4. This chapter shall not be construed to prohibit or 52
interfere with any legally registered practitioner of 53
medicine, dentistry, or podiatry, or veterinary medicine 54
only for use in animals, or the practice of optometry in 55
accordance with and as provided in sections 195.070 and 56
336.220 in the compounding, administering, prescribing, or 57
dispensing of his or her own prescriptions. 58
5. A pharmacist with a certificate of medication 59
therapeutic plan authority may provide medication t herapy 60
services pursuant to a written protocol from a physician 61
licensed under chapter 334 to patients who have established 62
a physician-patient relationship, as described in 63
subdivision (1) of subsection 1 of section 191.1146, with 64
the protocol physician. The written protocol authorized by 65 SB 548 56
this section shall come only from the physician and shall 66
not come from a nurse engaged in a collaborative practice 67
arrangement under section 334.104, or from a physician 68
assistant engaged in a collaborative pra ctice arrangement 69
under section 334.735. 70
6. Nothing in this section shall be construed as to 71
prevent any person, firm or corporation from owning a 72
pharmacy regulated by sections 338.210 to 338.315, provided 73
that a licensed pharmacist is in charge of such pharmacy. 74
7. Nothing in this section shall be construed to apply 75
to or interfere with the sale of nonprescription drugs and 76
the ordinary household remedies and such drugs or medicines 77
as are normally sold by those engaged in the sale of g eneral 78
merchandise. 79
8. No health carrier as defined in chapter 376 shall 80
require any physician with which they contract to enter into 81
a written protocol with a pharmacist for medication 82
therapeutic services. 83
9. This section shall not be con strued to allow a 84
pharmacist to diagnose or independently prescribe 85
pharmaceuticals. 86
10. The state board of registration for the healing 87
arts, under section 334.125, and the state board of 88
pharmacy, under section 338.140, shall jointly promulgate 89
rules regulating the use of protocols for medication therapy 90
services. Such rules shall require protocols to include 91
provisions allowing for timely communication between the 92
pharmacist and the protocol physician or similar body 93
authorized by this se ction, and any other patient protection 94
provisions deemed appropriate by both boards. In order to 95
take effect, such rules shall be approved by a majority vote 96
of a quorum of each board. Neither board shall separately 97 SB 548 57
promulgate rules regulating the u se of protocols for 98
medication therapy services. Any rule or portion of a rule, 99
as that term is defined in section 536.010, that is created 100
under the authority delegated in this section shall become 101
effective only if it complies with and is subject to all of 102
the provisions of chapter 536 and, if applicable, section 103
536.028. This section and chapter 536 are nonseverable and 104
if any of the powers vested with the general assembly 105
pursuant to chapter 536 to review, to delay the effective 106
date, or to disapprove and annul a rule are subsequently 107
held unconstitutional, then the grant of rulemaking 108
authority and any rule proposed or adopted after August 28, 109
2007, shall be invalid and void. 110
11. The state board of pharmacy may grant a 111
certificate of medication therapeutic plan authority to a 112
licensed pharmacist who submits proof of successful 113
completion of a board -approved course of academic clinical 114
study beyond a bachelor of science in pharmacy, including 115
but not limited to clinical assessment skills, from a 116
nationally accredited college or university, or a 117
certification of equivalence issued by a nationally 118
recognized professional organization and approved by the 119
board of pharmacy. 120
12. Any pharmacist who has received a certificate of 121
medication therapeutic plan authority may engage in the 122
designing, initiating, implementing, and monitoring of a 123
medication therapeutic plan as defined by a written protocol 124
from a physician that may be specific to each patient for 125
care by a pharmacist. 126
13. Nothing in this section shall be construed to 127
allow a pharmacist to make a therapeutic substitution of a 128
pharmaceutical prescribed by a physician unless authorized 129 SB 548 58
by the written protocol or the physician's prescription 130
order. 131
14. "Veterinarian", "doctor of veterinary medicine", 132
"practitioner of veterinary medicine", "DVM", "VMD", "BVSe", 133
"BVMS", "BSe (Vet Science)", "VMB", "MRCVS", or an 134
equivalent title means a person who has received a doctor's 135
degree in veterinary medicine fr om an accredited school of 136
veterinary medicine or holds an Educational Commission for 137
Foreign Veterinary Graduates (EDFVG) certificate issued by 138
the American Veterinary Medical Association (AVMA). 139
15. In addition to other requirements established by 140
the joint promulgation of rules by the board of pharmacy and 141
the state board of registration for the healing arts: 142
(1) A pharmacist shall administer vaccines by protocol 143
in accordance with treatment guidelines established by the 144
Centers for Disease Control and Prevention (CDC); 145
(2) A pharmacist who is administering a vaccine shall 146
request a patient to remain in the pharmacy a safe amount of 147
time after administering the vaccine to observe any adverse 148
reactions. Such pharmacist shall ha ve adopted emergency 149
treatment protocols. 150
16. In addition to other requirements by the board, a 151
pharmacist shall receive additional training as required by 152
the board and evidenced by receiving a certificate from the 153
board upon completion, and sha ll display the certification 154
in his or her pharmacy where vaccines are delivered. 155
17. A pharmacist shall inform the patient that the 156
administration of a vaccine will be entered into the 157
ShowMeVax system, as administered by the department of 158
health and senior services. The patient shall attest to the 159
inclusion of such information in the system by signing a 160
form provided by the pharmacist. If the patient indicates 161 SB 548 59
that he or she does not want such information entered into 162
the ShowMeVax system, the pharmacist shall provide a written 163
report within fourteen days of administration of a vaccine 164
to the patient's health care provider, if provided by the 165
patient, containing: 166
(1) The identity of the patient; 167
(2) The identity of the vaccin e or vaccines 168
administered; 169
(3) The route of administration; 170
(4) The anatomic site of the administration; 171
(5) The dose administered; and 172
(6) The date of administration. 173
18. A pharmacist licensed under this chapter may order 174
and administer vaccines approved or authorized by the U.S. 175
Food and Drug Administration to address a public health 176
need, as lawfully authorized by the state or federal 177
government, or a department or agency thereof, during a 178
state or federally declared public health emergency. 179
579.060. 1. A person commits the offense of unlawful 1
sale, distribution, or purchase of over -the-counter 2
methamphetamine precursor drugs if he or she knowingly: 3
(1) Sells, distributes, dispenses, or oth erwise 4
provides any number of packages of any drug product 5
containing detectable amounts of ephedrine, 6
phenylpropanolamine, or pseudoephedrine, or any of their 7
salts, optical isomers, or salts of optical isomers, in a 8
total amount greater than seven a nd two-tenths grams to the 9
same individual within a thirty -day period, unless the 10
amount is dispensed, sold, or distributed pursuant to a 11
valid prescription; or 12
(2) Purchases, receives, or otherwise acquires within 13
a thirty-day period any number of packages of any drug 14 SB 548 60
product containing any detectable amount of ephedrine, 15
phenylpropanolamine, or pseudoephedrine, or any of their 16
salts or optical isomers, or salts of optical isomers in a 17
total amount greater than seven and two -tenths grams, 18
without regard to the number of transactions, unless the 19
amount is purchased, received, or acquired pursuant to a 20
valid prescription; or 21
(3) Purchases, receives, or otherwise acquires within 22
a twenty-four-hour period any number of packages of any dr ug 23
product containing any detectable amount of ephedrine, 24
phenylpropanolamine, or pseudoephedrine, or any of their 25
salts or optical isomers, or salts of optical isomers in a 26
total amount greater than three and six -tenths grams, 27
without regard to the n umber of transactions, unless the 28
amount is purchased, received, or acquired pursuant to a 29
valid prescription; or 30
(4) Sells, distributes, dispenses, or otherwise 31
provides any number of packages of any drug product 32
containing detectable amounts of ephedrine, 33
phenylpropanolamine, or pseudoephedrine, or any of their 34
salts, optical isomers, or salts of optical isomers, in a 35
total amount greater than [forty-three] sixty-one and two- 36
tenths grams to the same individual within a twelve -month 37
period, unless the amount is dispensed, sold, or distributed 38
pursuant to a valid prescription; or 39
(5) Purchases, receives, or otherwise acquires within 40
a twelve-month period any number of packages of any drug 41
product containing any detectable amount of ep hedrine, 42
phenylpropanolamine, or pseudoephedrine, or any of their 43
salts or optical isomers, or salts of optical isomers in a 44
total amount greater than [forty-three] sixty-one and two- 45
tenths grams, without regard to the number of transactions, 46 SB 548 61
unless the amount is purchased, received, or acquired 47
pursuant to a valid prescription; or 48
(6) Dispenses or offers drug products that are not 49
excluded from Schedule V in subsection 17 or 18 of section 50
195.017 and that contain detectable amounts of ephedri ne, 51
phenylpropanolamine, or pseudoephedrine, or any of their 52
salts, optical isomers, or salts of optical isomers, without 53
ensuring that such products are located behind a pharmacy 54
counter where the public is not permitted and that such 55
products are dispensed by a registered pharmacist or 56
pharmacy technician under subsection 11 of section 195.017; 57
or 58
(7) Holds a retail sales license issued under chapter 59
144 and knowingly sells or dispenses packages that do not 60
conform to the packaging requirem ents of section 195.418. 61
2. A pharmacist, intern pharmacist, or registered 62
pharmacy technician commits the offense of unlawful sale, 63
distribution, or purchase of over -the-counter 64
methamphetamine precursor drugs if he or she knowingly: 65
(1) Sells, distributes, dispenses, or otherwise 66
provides any number of packages of any drug product 67
containing detectable amounts of ephedrine, 68
phenylpropanolamine, or pseudoephedrine, or any of their 69
salts or optical isomers, or salts of optical isomers, in a 70
total amount greater than three and six -tenth grams to the 71
same individual within a twenty -four hour period, unless the 72
amount is dispensed, sold, or distributed pursuant to a 73
valid prescription; or 74
(2) Fails to submit information under subsec tion 13 of 75
section 195.017 and subsection 6 of section 195.417 about 76
the sales of any compound, mixture, or preparation of 77
products containing detectable amounts of ephedrine, 78 SB 548 62
phenylpropanolamine, or pseudoephedrine, or any of their 79
salts, optical isomers, or salts of optical isomers, in 80
accordance with transmission methods and frequency 81
established by the department of health and senior services; 82
or 83
(3) Fails to implement and maintain an electronic log, 84
as required by subsection 12 of sectio n 195.017, of each 85
transaction involving any detectable quantity of 86
pseudoephedrine, its salts, isomers, or salts of optical 87
isomers or ephedrine, its salts, optical isomers, or salts 88
of optical isomers; or 89
(4) Sells, distributes, dispenses or ot herwise 90
provides to an individual under eighteen years of age 91
without a valid prescription any number of packages of any 92
drug product containing any detectable quantity of 93
pseudoephedrine, its salts, isomers, or salts of optical 94
isomers, or ephedrine, its salts or optical isomers, or 95
salts of optical isomers. 96
3. Any person who violates the packaging requirements 97
of section 195.418 and is considered the general owner or 98
operator of the outlet where ephedrine, pseudoephedrine, or 99
phenylpropanolamine products are available for sale shall 100
not be penalized if he or she documents that an employee 101
training program was in place to provide the employee who 102
made the unlawful retail sale with information on the state 103
and federal regulations regarding ephedrine, 104
pseudoephedrine, or phenylpropanolamine. 105
4. The offense of unlawful sale, distribution, or 106
purchase of over-the-counter methamphetamine precursor drugs 107
is a class A misdemeanor. 108
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