FIRSTREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
SENATESUBSTITUTEFOR
SENATEBILLNO.7
103RDGENERALASSEMBLY
0565H.04C JOSEPHENGLER,ChiefClerk
ANACT
Torepealsections96.192,96.196,167.627,167.630,190.053,190.098,190.101,190.109,
190.246,190.800,191.227,191.600,191.603,191.605,191.607,191.611,191.614,
191.615,191.648,191.1145,192.769,195.417,196.990,206.110,208.152,210.030,
292.606,301.142,321.621,332.081,332.211,332.281,335.081,338.010,338.710,
345.050,and579.060,RSMo,andtoenactinlieuthereoffifty-eightnewsections
relatingtohealthcare,withpenaltyprovisions.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections96.192,96.196,167.627,167.630,190.053,190.098,190.101,
2190.109,190.246,190.800,191.227,191.600,191.603,191.605,191.607,191.611,191.614,
3191.615,191.648,191.1145,192.769,195.417,196.990,206.110,208.152,210.030,
4292.606,301.142,321.621,332.081,332.211,332.281,335.081,338.010,338.710,
5345.050,and579.060,RSMo,arerepealedandfifty-eightnewsectionsenactedinlieu
6thereof,tobeknownassections96.192,96.196,167.627,167.630,190.053,190.076,
7190.098,190.101,190.109,190.112,190.166,190.246,190.800,191.227,191.600,191.603,
8191.605,191.607,191.611,191.614,191.615,191.648,191.1145,192.2521,195.417,
9196.990,206.110,206.158,208.152,210.030,210.225,292.606,301.142,321.621,332.081,
10332.211,332.281,332.700,332.705,332.710,332.715,332.720,332.725,332.730,332.735,
11332.740,332.745,332.750,332.755,332.760,335.081,338.010,338.710,345.050,
12376.1240,376.1280,537.038,and579.060,toreadasfollows:
96.192.1.Theboardoftrusteesofanyhospitalauthorizedundersubsection2ofthis
2section,andestablishedandorganizedundertheprovisionsofsections96.150to96.229[,]:
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 3 (1)Mayinvestupto[twenty-five] fiftypercentofthehospital's"availablefunds",
4definedinthissectionasfundsnotrequiredforimmediatedisbursementinobligationsorfor
5theoperationofthehospital[inanyUnitedStatesinvestmentgradefixedincomefundsorany
6diversifiedstockfunds,orboth.],into:
7 (a)Anymutualfundsthatinvestinstocks,bonds,orrealestate,orany
8combinationthereof;
9 (b)Bondsthathave:
10 a.Oneofthefivehighestlong-termratingsorthehighestshort-termrating
11issuedbyanationallyrecognizedratingagency;and
12 b.Afinalmaturityoftenyearsorless;
13 (c)Moneymarketinvestments;or
14 (d)Anycombinationofinvestmentsdescribedinparagraphs(a)to(c)ofthis
15subdivision;and
16 (2)Shallinvesttheremainingpercentageofanyavailablefundsnotinvestedas
17allowedundersubdivision(1)ofthissubsectionintoanyinvestmentinwhichthestate
18treasurerisallowedtoinvest.
19 2.Theprovisionsofthissectionshallonlyapplyifthehospital:
20 (1)Receiveslessthan[one]threepercentofitsannualrevenuesfrommunicipal,
21county,orstatetaxes;and
22 (2)Receiveslessthan[one]threepercentofitsannualrevenuefromappropriated
23fundsfromthemunicipalityinwhichsuchhospitalislocated.
96.196.1.Ahospitalorganizedunderthischaptermaypurchase,operateorlease,as
2lessororlessee,relatedfacilitiesorengageinhealthcareactivities,exceptincountiesofthe
3thirdorfourthclassification(otherthanthecountyinwhichthehospitalislocated)where
4therealreadyexistsahospitalorganizedpursuanttothischapter[andchapter205or206];
5provided,however,thatthisexceptionshallnotprohibitthecontinuationofexistingactivities
6otherwiseallowedbylaw.
7 2.Ifahospitalorganizedpursuanttothischapteracceptsappropriatedfundsfromthe
8cityduringthetwelvemonthsimmediatelyprecedingthedatethatthehospitalpurchases,
9operatesorleasesitsfirstrelatedfacilityoutsidethecityboundariesorengagesinitsfirst
10healthcareactivityoutsidethecityboundaries,thegoverningbodyofthecityshallapprove
11thehospital'splanforsuchpurchase,operationorleasepriortoimplementationoftheplan.
167.627.1.Forpurposesofthissection,thefollowingtermsshallmean:
2 (1)"Epinephrinedeliverydevice",asingle-usedeviceusedforthedeliveryofa
3premeasureddoseofepinephrineintothehumanbody;
HCSSSSB7 2 4 (2)"Medication",anymedicineprescribedororderedbyaphysicianforthetreatment
5ofasthmaoranaphylaxis,includingwithoutlimitationinhaledbronchodilatorsand[auto-
6injectible] epinephrinedeliverydevices;
7 [(2)](3)"Self-administration",apupil'sdiscretionaryuseofmedicationprescribedby
8aphysicianorunderawrittentreatmentplanfromaphysician.
9 2.Eachboardofeducationanditsemployeesandagentsinthisstateshallgrantany
10pupilintheschoolauthorizationforthepossessionandself-administrationofmedicationto
11treatsuchpupil'schronichealthcondition,includingbutnotlimitedtoasthmaoranaphylaxis
12if:
13 (1)Alicensedphysicianprescribedororderedsuchmedicationforusebythepupil
14andinstructedsuchpupilinthecorrectandresponsibleuseofsuchmedication;
15 (2)Thepupilhasdemonstratedtothepupil'slicensedphysicianorthelicensed
16physician'sdesignee,andtheschoolnurse,ifavailable,theskilllevelnecessarytousethe
17medicationandanydevicenecessarytoadministersuchmedicationprescribedorordered;
18 (3)Thepupil'sphysicianhasapprovedandsignedawrittentreatmentplanfor
19managingthepupil'schronichealthcondition,includingasthmaoranaphylaxisepisodesand
20formedicationforusebythepupil.Suchplanshallincludeastatementthatthepupilis
21capableofself-administeringthemedicationunderthetreatmentplan;
22 (4)Thepupil'sparentorguardianhascompletedandsubmittedtotheschoolany
23writtendocumentationrequiredbytheschool,includingthetreatmentplanrequiredunder
24subdivision(3)ofthissubsectionandtheliabilitystatementrequiredundersubdivision(5)of
25thissubsection;and
26 (5)Thepupil'sparentorguardianhassignedastatementacknowledgingthatthe
27schooldistrictanditsemployeesoragentsshallincurnoliabilityasaresultofanyinjury
28arisingfromtheself-administrationofmedicationbythepupilortheadministrationofsuch
29medicationbyschoolstaff.Suchstatementshallnotbeconstruedtoreleasetheschool
30districtanditsemployeesoragentsfromliabilityfornegligence.
31 3.Anauthorizationgrantedundersubsection2ofthissectionshall:
32 (1)Permitsuchpupiltopossessandself-administersuchpupil'smedicationwhilein
33school,ataschool-sponsoredactivity,andintransittoorfromschoolorschool-sponsored
34activity;and
35 (2)Beeffectiveonlyforthesameschoolandschoolyearforwhichitisgranted.
36Suchauthorizationshallberenewedbythepupil'sparentorguardianeachsubsequentschool
37yearinaccordancewiththissection.
38 4.Anycurrentduplicateprescriptionmedication,ifprovidedbyapupil'sparentor
39guardianorbytheschool,shallbekeptatapupil'sschoolinalocationatwhichthepupilor
40schoolstaffhasimmediateaccessintheeventofanasthmaoranaphylaxisemergency.
HCSSSSB7 3 41 5.Theinformationdescribedinsubdivisions(3)and(4)ofsubsection2ofthis
42sectionshallbekeptonfileatthepupil'sschoolinalocationeasilyaccessibleintheeventof
43anemergency.
167.630.1.Asusedinthissection,theterm"epinephrinedeliverydevice"has
2thesamemeaninggiventotheterminsection167.627.
3 2.Eachschoolboardmayauthorizeaschoolnurselicensedunderchapter335whois
4employedbytheschooldistrictandforwhomtheboardisresponsiblefortomaintainan
5adequatesupplyof[prefilledautosyringesof]epinephrine[withfifteen-hundredthsmilligram
6orthree-tenthsmilligram] deliverydevicesattheschool.Thenurseshallrecommendtothe
7schoolboardthenumberof[prefilled] epinephrine[autosyringes] deliverydevicesthatthe
8schoolshouldmaintain.
9 [2.]3.Toobtain[prefilled] epinephrine[autosyringes] deliverydevicesforaschool
10district,aprescriptionwrittenbyalicensedphysician,aphysician'sassistant,ornurse
11practitionerisrequired.Forsuchprescriptions,theschooldistrictshallbedesignatedasthe
12patient,thenurse'snameshallberequired,andtheprescriptionshallbefilledatalicensed
13pharmacy.
14 [3.]4.Aschoolnurse,contractedagenttrainedbyanurse,orotherschoolemployee
15trainedbyandsupervisedbythenurseshallhavethediscretiontouseanepinephrine[auto
16syringe] deliverydeviceonanystudenttheschoolnurse,trainedemployee,ortrained
17contractedagentbelievesishavingalife-threateninganaphylacticreactionbasedonthe
18traininginrecognizinganacuteepisodeofananaphylacticreaction.Theprovisionsof
19section167.624concerningimmunityfromcivilliabilityfortrainedemployeesadministering
20lifesavingmethodsshallapplytotrainedemployeesadministering[aprefilledautosyringe]
21anepinephrinedeliverydeviceunderthissection.Trainedcontractedagentsshallhave
22immunityfromcivilliabilityforadministering[aprefilledautosyringe] anepinephrine
23deliverydeviceunderthissection.
190.053.1.Allmembersoftheboardofdirectorsofanambulancedistrictfirst
2electedonorafterJanuary1,2008,shallattendandcompleteaneducationalseminaror
3conferenceorothersuitabletrainingontheroleanddutiesofaboardmemberofan
4ambulancedistrict.Thetrainingrequiredunderthissectionshallbeofferedbyastatewide
5associationorganizedforthebenefitofambulancedistrictsorbeapprovedbythestate
6advisorycouncilonemergencymedicalservices.Suchtrainingshallinclude,ataminimum:
7 (1)Informationrelatingtotherolesanddutiesofanambulancedistrictdirector;
8 (2)Areviewofallstatestatutesandregulationsrelevanttoambulancedistricts;
9 (3)Stateethicslaws;
10 (4)Statesunshinelaws,chapter610;
11 (5)Financialandfiduciaryresponsibility;
HCSSSSB7 4 12 (6)Statelawsrelatingtothesettingoftaxrates;and
13 (7)Statelawsrelatingtorevenuelimitations.
14 2.[Ifanyambulancedistrictboardmemberfailstoattendatrainingsessionwithin
15twelvemonthsaftertakingoffice,theboardmembershallnotbecompensatedforattendance
16atmeetingsthereafteruntiltheboardmemberhascompletedsuchtrainingsession.Ifany
17ambulancedistrictboardmemberfailstoattendatrainingsessionwithintwelvemonthsof
18takingofficeregardlessofwhethertheboardmemberreceivedanattendancefeefora
19trainingsession,theboardmembershallbeineligibletorunforreelectionforanothertermof
20officeuntiltheboardmembersatisfiesthetrainingrequirementofthissection;however,this
21requirementshallonlyapplytoboardmemberselectedafterAugust28,2022] Allmembers
22oftheboardofdirectorsofanambulancedistrictshallcompletethreehoursof
23continuingeducationforeachtermofoffice.Thecontinuingeducationshallbeoffered
24byastatewideassociationorganizedforthebenefitofambulancedistrictsorbe
25approvedbythestateadvisorycouncilonemergencymedicalservices.
26 3.Anyambulancedistrictboardmemberwhofailstocompletetheinitial
27trainingandcontinuingeducationrequirementsonorbeforetheanniversarydateofthe
28member'selectionorappointmentasrequiredunderthissectionshallimmediatelybe
29disqualifiedfromoffice.Uponsuchdisqualification,themember'spositionshallbe
30deemedvacantwithoutfurtherprocessordeclaration.Thevacancyshallbefilledinthe
31mannerprovidedforinsection190.052.
190.076.Inadditiontotheannualauditrequiredundersection190.075,each
2ambulancedistrictshall,atleastonceeverythreeyears,arrangeforacertifiedpublic
3accountantorafirmofcertifiedpublicaccountantstoaudittherecordsandaccountsof
4thedistrict.Theauditshallbemadefreelyavailabletothepubliconthedistrict's
5websiteorbyotherelectronicmeans.
190.098.1.Asusedinthissection,theterm"communityparamedicservices"
2shallmeanservicesprovidedbyanyentitythatemployslicensedparamedicswhoare
3certifiedbythedepartmentascommunityparamedicsforservicesthatare:
4 (1)Providedinanonemergentsettingthatisindependentofanemergency
5telephoneservice,911system,oremergencysummons;
6 (2)Consistentwiththetrainingandeducationrequirementsdescribedin
7subdivision(2)ofsubsection2ofthissection,thescopeofskillandpracticefor
8communityparamedics,andthesupervisorystandardapprovedbytheentity'smedical
9director;and
10 (3)Reflectedanddocumentedintheentity'spatientcareplansorprotocols
11approvedbythemedicaldirectorinaccordancewiththeprovisionsofsection190.142.
HCSSSSB7 5 12 2.Inorderforapersontobeeligibleforcertificationbythedepartmentasa
13communityparamedic,anindividualshall:
14 (1)Becurrently[certified] licensedasaparamedic;
15 (2)Successfullycompleteorhavesuccessfullycompletedacommunityparamedic
16certificationprogramfromacollege,university,oreducationalinstitutionthathasbeen
17approvedbythedepartmentoraccreditedbyanationalaccreditationorganizationapproved
18bythedepartment;and
19 (3)Completeanapplicationformapprovedbythedepartment.
20 [2.]3.Acommunityparamedicshallpracticeinaccordancewithprotocolsand
21supervisorystandardsestablishedbythemedicaldirector.Acommunityparamedicshall
22provideservicesofahealthcareplaniftheplanhasbeendevelopedbythepatient'sphysician
23orbyanadvancedpracticeregisterednursethroughacollaborativepracticearrangementwith
24aphysicianoraphysicianassistantthroughacollaborativepracticearrangementwitha
25physicianandthereisnoduplicationofservicestothepatientfromanotherprovider.
26 [3.]4.(1)Anyambulanceserviceshallenterintoawrittencontracttoprovide
27communityparamedicservicesinanotherambulanceservicearea,asthattermisdefinedin
28section190.100.Thecontractthatisagreeduponmaybeforanindefiniteperiodoftime,as
29longasitincludesatleastasixty-daycancellationnoticebyeitherambulanceservice.
30 (2)Anyambulanceservicethatseekstoprovidecommunityparamedicservices
31outsideoftheambulanceservice'sservicearea:
32 (a)Shallhaveamemorandumofunderstandingregardingtheprovisionofsuch
33serviceswiththeambulanceserviceinthatserviceareaifthatambulanceserviceis
34alreadyprovidingcommunityparamedicservices;or
35 (b)Shallnotberequiredtohaveamemorandumofunderstandingwiththe
36ambulanceserviceinthatserviceareaifthatambulanceserviceisnotalreadyproviding
37communityparamedicservices,providedthattheambulanceserviceseekingtoprovide
38suchservicesshallprovidenotificationtotheotherambulanceserviceofthecommunity
39paramedicservicestobeprovided.
40 (3)Anyemergencymedicalresponseagencythatseekstoprovidecommunity
41paramedicserviceswithinitsdesignatedresponseserviceareamaydosoiftheground
42ambulanceserviceareawithinwhichtheemergencymedicalresponseagencyoperates
43doesnotalreadyprovidesuchservices.Ifthegroundambulanceservicedoesprovide
44communityparamedicservices,thegroundambulanceservicemayenterintoa
45memorandumofunderstandingwiththeemergencymedicalresponseagencyinorder
46tocoordinateprogramsandavoidserviceduplication.Iftheemergencymedical
47responseagencyprovidescommunityparamedicservicesinthegroundambulance
48service'sserviceareapriortotheprovisionofsuchservicesbythegroundambulance
HCSSSSB7 6 49service,theemergencymedicalresponseagencyandthegroundambulanceserviceshall
50enterintoamemorandumofunderstandingforthecoordinationofservices.
51 (4)Anycommunityparamedicprogramshallnotifytheappropriatelocal
52ambulanceservicewhenprovidingserviceswithintheserviceareaofanambulance
53service.
54 (5)Thedepartmentshallpromulgaterulesandregulationsforthepurposeof
55identifyingthecommunityparamedicservicesentitiesthathavemetthestandards
56necessarytoprovidecommunityparamedicservicesincluding,butnotlimitedto,
57physicianmedicaloversight,training,patientrecordretention,formalrelationships
58withprimarycareservicesasneeded,andqualityimprovementpolicies.Community
59paramedicservicesentitiesshallbecertifiedbythedepartment.Anysuchcertification
60shallallowtheentitytoprovidecommunityparamedicservicesforaperiodoffive
61years.
62 [4.]5.Acommunityparamedicissubjecttotheprovisionsofsections190.001to
63190.245andrulespromulgatedundersections190.001to190.245.
64 [5.]6.Nopersonshallholdhimselforherselfoutasacommunityparamedicor
65providetheservicesofacommunityparamedicunlesssuchpersoniscertifiedbythe
66department.
67 [6.]7.Themedicaldirectorshallapprovetheimplementationofthecommunity
68paramedicprogram.
69 [7.]8.Anyruleorportionofarule,asthattermisdefinedinsection536.010,thatis
70createdundertheauthoritydelegatedinthissectionshallbecomeeffectiveonlyifitcomplies
71withandissubjecttoalloftheprovisionsofchapter536and,ifapplicable,section536.028.
72Thissectionandchapter536arenonseverableandifanyofthepowersvestedwiththe
73generalassemblypursuanttochapter536toreview,todelaytheeffectivedate,orto
74disapproveandannularulearesubsequentlyheldunconstitutional,thenthegrantof
75rulemakingauthorityandanyruleproposedoradoptedafterAugust28,2013,shallbeinvalid
76andvoid.
190.101.1.Thereisherebyestablisheda"StateAdvisoryCouncilonEmergency
2MedicalServices"whichshallconsistof[sixteen] nomorethantwenty-threemembers,one
3ofwhichshallbe[aresident] thechiefparamedicofacitynotwithinacounty.The
4membersofthecouncilshallbeappointed[bythegovernorwiththeadviceandconsentofthe
5senate] inaccordancewithsubsection2ofthissectionandshallservetermsoffouryears.
6The[governorshalldesignateoneofthemembersaschairperson] councilmembersshall
7annuallyselectachairperson,alongwithotherofficersasthecouncildeemsnecessary.
8Thechairpersonmayappointsubcommitteesthatincludenoncouncilmembers.
9 2.Councilmembersshallbeappointedasfollows:
HCSSSSB7 7 10 (1)Thedirectorofthedepartmentofhealthandseniorservicesshallmake
11appointmentstothecouncilfromtherecommendationsprovidedbythefollowing:
12 (a)Thestatewideprofessionalassociationrepresentingambulanceservice
13managers;
14 (b)Thestatewideprofessionalassociationrepresentingemergencymedical
15techniciansandparamedics;
16 (c)Thestatewideprofessionalassociationrepresentingambulancedistricts;
17 (d)Thestatewideprofessionalassociationrepresentingfirechiefs;
18 (e)Thestatewideprofessionalassociationrepresentingfireprotectiondistricts;
19 (f)Thestatewideprofessionalassociationrepresentingfirefighters;
20 (g)Thestatewideprofessionalassociationrepresentingemergencynurses;
21 (h)Thestatewideprofessionalassociationrepresentingtheairambulance
22industry;
23 (i)Thestatewideprofessionalassociationrepresentingemergencymedicine
24physicians;
25 (j)Thestatewideassociationrepresentinghospitals;and
26 (k)Thestatewideassociationrepresentingpediatricemergencyprofessionals;
27 (2)Thedirectorofhealthandseniorservicesshallappointamembertothe
28councilwithabackgroundinmobileintegratedhealthcare-communityparamedicine
29(MIH-CP);
30 (3)EachregionalEMSadvisorycommitteeshallappointonemember;and
31 (4)Thetime-criticaldiagnosisadvisorycommitteeestablishedundersection
32190.257shallappointonemember.
33 3.ThestateEMSmedicaldirectorsadvisorycommitteeandtheregionalEMS
34advisorycommitteeswillberecognizedassubcommitteesofthestateadvisorycouncilon
35emergencymedicalservices.
36 [3.]4.Thecouncilshallhavegeographicalrepresentationandrepresentationfrom
37appropriateareasofexpertiseinemergencymedicalservicesincludingvolunteers,
38professionalorganizationsinvolvedinemergencymedicalservices,EMT's,paramedics,
39nurses,firefighters,physicians,ambulanceserviceadministrators,hospitaladministratorsand
40otherhealthcareprovidersconcernedwithemergencymedicalservices.[TheregionalEMS
41advisorycommitteesshallserveasaresourcefortheidentificationofpotentialmembersof
42thestateadvisorycouncilonemergencymedicalservices.
43 4.]5.ThestateEMSmedicaldirector,asdescribedundersection190.103,shallserve
44asanexofficiomemberofthecouncil.
45 [5.]6.Themembersofthecouncilandsubcommitteesshallservewithout
46compensationexceptthatmembersofthecouncilshall,subjecttoappropriations,be
HCSSSSB7 8 47reimbursedforreasonabletravelexpensesandmeetingexpensesrelatedtothefunctionsof
48thecouncil.
49 [6.]7.Thepurposeofthecouncilistomakerecommendationstothegovernor,the
50generalassembly,andthedepartmentonpolicies,plans,proceduresandproposedregulations
51onhowtoimprovethestatewideemergencymedicalservicessystem.Thecouncilshall
52advisethegovernor,thegeneralassembly,andthedepartmentonallaspectsoftheemergency
53medicalservicessystem.
54 [7.]8.(1)Thereisherebyestablishedastandingsubcommitteeofthecouncilto
55monitortheimplementationoftherecognitionoftheEMSpersonnellicensureinterstate
56compactundersections190.900to190.939,theinterstatecommissionforEMSpersonnel
57practice,andtheinvolvementofthestateofMissouri.Thesubcommitteeshallmeetatleast
58biannuallyandreceivereportsfromtheMissouridelegatetotheinterstatecommissionfor
59EMSpersonnelpractice.Thesubcommitteeshallconsistofatleastsevenmembersappointed
60bythechairofthecouncil,toincludeatleasttwomembersasrecommendedbytheMissouri
61statecounciloffirefightersandonememberasrecommendedbytheMissouriAssociationof
62FireChiefs.Thesubcommitteemaysubmitreportsandrecommendationstothecouncil,the
63departmentofhealthandseniorservices,thegeneralassembly,andthegovernorregarding
64theparticipationofMissouriwiththerecognitionoftheEMSpersonnellicensureinterstate
65compact.
66 (2)Thesubcommitteeshallformallyrequestapublichearingforanyruleproposed
67bytheinterstatecommissionforEMSpersonnelpracticeinaccordancewithsubsection7of
68section190.930.Thehearingrequestshallincludetherequestthatthehearingbepresented
69livethroughtheinternet.TheMissouridelegatetotheinterstatecommissionforEMS
70personnelpracticeshallberesponsibleforensuringthatallhearings,noticesof,andrelated
71rulemakingcommunicationsasrequiredbythecompactbecommunicatedtothecounciland
72emergencymedicalservicespersonnelundertheprovisionsofsubsections4,5,6,and8of
73section190.930.
74 (3)Thedepartmentofhealthandseniorservicesshallnotestablishorincreasefees
75forMissouriemergencymedicalservicespersonnellicensureinaccordancewiththischapter
76forthepurposeofcreatingthefundsnecessaryforpaymentofanannualassessmentunder
77subdivision(3)ofsubsection5ofsection190.924.
78 [8.]9.Thecouncilshallconsultwiththetime-criticaldiagnosisadvisorycommittee,
79asdescribedundersection190.257,regardingtime-criticaldiagnosis.
190.109.1.Thedepartmentshall,withinareasonabletimeafterreceiptofan
2application,causesuchinvestigationasthedepartmentdeemsnecessarytobemadeofthe
3applicantforagroundambulancelicense.
HCSSSSB7 9 4 2.AnypersonthatownedandoperatedalicensedambulanceonDecember31,1997,
5shallreceiveanambulanceservicelicensefromthedepartment,unlesssuspended,revokedor
6terminated,forthatambulanceserviceareawhichwas,onDecember31,1997,describedand
7filedwiththedepartmentastheprimaryserviceareaforitslicensedambulancesonAugust
828,1998,providedthatthepersonmakesapplicationandadherestotherulesandregulations
9promulgatedbythedepartmentpursuanttosections190.001to190.245.
10 3.Thedepartmentshallissueanewgroundambulanceservicelicensetoan
11ambulanceservicethatisnotcurrentlylicensedbythedepartment,oriscurrentlylicensedby
12thedepartmentandisseekingtoexpanditsambulanceservicearea,exceptasprovidedin
13subsection4ofthissection,tobevalidforaperiodoffiveyears,unlesssuspended,revoked
14orterminated,whenthedirectorfindsthattheapplicantmeetstherequirementsofambulance
15servicelicensureestablishedpursuanttosections190.100to190.245andtherulesadoptedby
16thedepartmentpursuanttosections190.001to190.245.Inordertobeconsideredforanew
17ambulanceservicelicense,anambulanceserviceshallsubmittothedepartmentaletterof
18endorsementfromeachambulancedistrictorfireprotectiondistrictthatisauthorizedto
19provideambulanceservice,orfromeachmunicipalitynotwithinanambulancedistrictorfire
20protectiondistrictthatisauthorizedtoprovideambulanceservice,inwhichtheambulance
21serviceproposestooperate.Ifanambulanceserviceproposestooperateinunincorporated
22portionsofacountynotwithinanambulancedistrictorfireprotectiondistrictthatis
23authorizedtoprovideambulanceservice,inordertobeconsideredforanewambulance
24servicelicense,theambulanceserviceshallsubmittothedepartmentaletterofendorsement
25fromthecounty.Anyletterofendorsementrequiredpursuanttothissectionshallverifythat
26thepoliticalsubdivisionhasconductedapublichearingregardingtheendorsementandthat
27thegoverningbodyofthepoliticalsubdivisionhasadoptedaresolutionapprovingthe
28endorsement.Theletterofendorsementshallaffirmativelystatethattheproposedambulance
29service:
30 (1)Willprovideabenefittopublichealththatoutweighstheassociatedcosts;
31 (2)Willmaintainorenhancethepublic'saccesstoambulanceservices;
32 (3)Willmaintainorimprovethepublichealthandpromotethecontinued
33developmentoftheregionalemergencymedicalservicesystem;
34 (4)Hasdemonstratedtheappropriateexpertiseintheoperationofambulance
35services;and
36 (5)Hasdemonstratedthefinancialresourcesnecessaryfortheoperationofthe
37proposedambulanceservice.
38 4.Acontractbetweenapoliticalsubdivisionandalicensedambulanceserviceforthe
39provisionofambulanceservicesforthatpoliticalsubdivisionshallexpand,withoutfurther
40actionbythedepartment,theambulanceserviceareaofthelicensedambulanceserviceto
HCSSSSB7 10 41includethejurisdictionalboundariesofthepoliticalsubdivision.Theterminationofthe
42aforementionedcontractshallresultinareductionofthelicensedambulanceservice's
43ambulanceserviceareabyremovingthegeographicareaofthepoliticalsubdivisionfromits
44ambulanceservicearea,exceptthatlicensedambulanceserviceprovidersmayprovide
45ambulanceservicesasareneededatandaroundthestatefairgroundsforprotectionof
46attendeesatthestatefair.
47 5.Thedepartmentshallrenewagroundambulanceservicelicenseiftheapplicant
48meetstherequirementsestablishedpursuanttosections190.001to190.245,andtherules
49adoptedbythedepartmentpursuanttosections190.001to190.245.
50 6.Thedepartmentshallpromulgaterulesrelatingtotherequirementsforaground
51ambulanceservicelicenseincluding,butnotlimitedto:
52 (1)Vehicledesign,specification,operationandmaintenancestandards;
53 (2)Equipmentrequirements;
54 (3)Staffingrequirements;
55 (4)Five-yearlicenserenewal;
56 (5)Recordsandforms;
57 (6)Medicalcontrolplans;
58 (7)Medicaldirectorqualifications;
59 (8)Standardsformedicalcommunications;
60 (9)Memorandumsofunderstandingwithemergencymedicalresponseagenciesthat
61provideadvancedlifesupport;
62 (10)Qualityimprovementcommittees;[and]
63 (11)Responsetime,patientcareandtransportationstandards;
64 (12)ParticipationwithregionalEMSadvisorycommittees;and
65 (13)Ambulanceserviceadministratorqualifications.
66 7.Applicationforagroundambulanceservicelicenseshallbemadeuponsuchforms
67asprescribedbythedepartmentinrulesadoptedpursuanttosections190.001to190.245.
68Theapplicationformshallcontainsuchinformationasthedepartmentdeemsnecessaryto
69makeadeterminationastowhetherthegroundambulanceservicemeetsalltherequirements
70ofsections190.001to190.245andrulespromulgatedpursuanttosections190.001to
71190.245.
190.112.1.Eachambulanceservicelicensedunderthischaptershallidentifyto
2thedepartmentanindividualastheambulanceserviceadministrator,whoshallbe
3responsiblefortheoperationsandstaffingoftheambulanceservice.
4 2.Anyindividualidentifiedastheambulanceserviceadministratorunder
5subsection1ofthissectionshallberequiredtohaveachievedbasictrainingofatleast
6fortyhoursregardingtheoperationsofanambulanceserviceandtocompletetwohours
HCSSSSB7 11 7ofannualcontinuingeducationtomaintaintheindividual'sstatusastheambulance
8serviceadministrator.
9 3.Thetrainingrequiredunderthissectionshallbeofferedbyastatewide
10associationorganizedforthebenefitofambulancedistrictsorbeapprovedbythestate
11advisorycouncilonemergencymedicalservices.Suchtrainingshallinclude
12informationon:
13 (1)Basicprinciplesofaccountingandeconomics;
14 (2)Stateandfederallawsapplicabletoambulanceservices;
15 (3)Regulatoryrequirementsapplicabletoambulanceservices;
16 (4)Humanresourcesmanagementandlaws;
17 (5)Grantwriting,contracts,andfundraising;
18 (6)Thestatesunshinelawrequirementsunderchapter610andstateethicslaws;
19and
20 (7)Volunteerandcommunityinvolvement.
21 4.AnyindividualservingasanambulanceserviceadministratorasofAugust
2228,2025,shallhaveuntilJanuary1,2027,todemonstratecompliancewiththe
23provisionsofthissection.
190.166.1.Inadditiontotheprovisionsofsection190.165,thedepartmentof
2healthandseniorservicesmayrefusetoissue,denyrenewalof,orsuspendalicense
3requiredundersection190.109,ortakeothercorrectiveactionsasdescribedinthis
4section,basedonthefollowingconsiderations:
5 (1)Thelicenseholderisdeterminedtobefinanciallyinsolvent;
6 (2)Theambulanceservicehasinadequatepersonneltooperatetheambulance
7servicetoprovidebasicemergencyoperations.Theambulanceserviceshallnotbe
8deemedtohavesuchinadequatepersonnelaslongastheambulanceserviceisstaffedto
9meettheneedsofitsemergencycallvolume.Eachambulanceserviceshallhavethe
10abilitytostaffaminimumofoneambulanceunittwenty-fourhourseachday,seven
11dayseachweek,withatleasttwolicensedemergencymedicaltechnicians.Any
12ambulanceserviceoperatingonlyoneambulanceunitshallhaveareasonableplanand
13schedulefortheservicesofasecondambulanceunit;
14 (3)Theambulanceservicerequiresaninordinateamountofmutualaidfrom
15neighboringservices,suchasmorethantenpercentofthetotalrunsintheservicearea
16inanygivenmonthormorethanwouldbeconsideredprudent,andthuscannotprovide
17anappropriatelevelofemergencyresponsefortheserviceareaaswouldbeconsidered
18prudentbythetypicalgroundambulanceservicesoperator;
19 (4)Theprincipalmanager,boardmembers,orotherexecutivesaredetermined
20tobecriminallyliableforactionsrelatedtothelicenseorserviceprovided;
HCSSSSB7 12 21 (5)Thelicenseholderorprincipalmanager,boardmembers,orotherexecutives
22aredeterminedbytheCentersforMedicareandMedicaidServicestobeineligiblefor
23participationinMedicare;
24 (6)Thelicenseholderorprincipalmanager,boardmembers,orotherexecutives
25aredeterminedbytheMOHealthNetdivisiontobeineligibleforparticipationinMO
26HealthNet;
27 (7)Theambulanceserviceadministratorhasfailedtomeettherequired
28qualificationsorfailedtocompletethetrainingrequiredundersection190.112;or
29 (8)Iftheambulanceserviceisanambulancedistrict,threeormoreboard
30membershavefailedtocompleterequiredtrainingundersection190.053.
31 2.Ifthedepartmentmakesadeterminationofinsolvencyorinsufficiencyof
32operationsofalicenseholderundersubsection1ofthissection,thedepartmentmay
33requirethelicenseholdertosubmitacorrectiveplanwithinfifteendaysandrequire
34implementationofthecorrectiveplanwithinthirtydays.
35 3.Thedepartmentshallberequiredtoprovidenoticeofanydeterminationby
36thedepartmentofinsolvencyorinsufficiencyofoperationsofalicenseholdertoother
37licenseholdersoperatinginthelicenseholder'svicinity,membersofthegeneral
38assemblywhorepresentthelicenseholder'sservicearea,thegoverningofficialsofany
39countyormunicipalentityinthelicenseholder'sservicearea,theappropriateregional
40emergencymedicalservicesadvisorycommittee,andthestateadvisorycouncilon
41emergencymedicalservices.
42 4.Thedepartmentshallimmediatelyengagewithotherlicenseholdersinthe
43areatodeterminetheextenttowhichgroundambulanceservicemaybeprovidedtothe
44affectedserviceareaduringthetimeinwhichthelicenseholderisunabletoprovide
45adequateservices,includinganylong-termservicearrangements.Thenatureofthe
46agreementbetweenthelicenseholderandotherlicenseholdersprovidingservicestothe
47affectedareamayincludeanagreementtoprovideservices,ajointpowersagreement,
48formalconsideration,orsomepaymentforservicesrendered.
49 5.Anylicenseholderwhoprovidesassistanceintheserviceareaofanother
50licenseholderwhoselicensehasbeensuspendedunderthissectionshallhavetheright
51toseekreasonablecompensationfromthelicenseholderwhoselicensetooperatehas
52beensuspendedforallcalls,stand-bytime,andresponsestomedicalemergencies
53duringsuchtimeasthelicenseremainssuspended.Thereasonablecompensationshall
54notbelimitedtothoseexpensesincurredinactualresponsesbutmayalsoinclude
55reasonableexpensestomaintainambulanceserviceincluding,butnotlimitedto,the
56dailyoperationcostsofmaintainingtheservice,personnelwagesandbenefits,
57equipmentpurchasesandmaintenance,andothercostsincurredintheoperationofa
HCSSSSB7 13 58groundambulanceservice.Thelicenseholderprovidingassistanceshallbeentitledto
59anawardofcostsandreasonableattorney'sfeesinanyactiontoenforcetheprovisions
60ofthissubsection.
190.246.1.Asusedinthissection,thefollowingtermsshallmean:
2 (1)"Eligibleperson,firm,organizationorotherentity",anambulanceserviceor
3emergencymedicalresponseagency,anemergencymedicalresponder,oranemergency
4medicaltechnicianwhoisemployedby,oranenrolledmember,person,firm,organizationor
5entitydesignatedby,ruleofthedepartmentofhealthandseniorservicesinconsultationwith
6otherappropriateagencies.Allsucheligiblepersons,firms,organizationsorotherentities
7shallbesubjecttotherulespromulgatedbythedirectorofthedepartmentofhealthandsenior
8services;
9 (2)"Emergencyhealthcareprovider":
10 (a)Aphysicianlicensedpursuanttochapter334withknowledgeandexperiencein
11thedeliveryofemergencycare;or
12 (b)Ahospitallicensedpursuanttochapter197thatprovidesemergencycare;
13 (3)"Epinephrinedeliverydevice",asingle-usedeviceusedforthedeliveryofa
14premeasureddoseofepinephrineintothehumanbody.
15 2.Possessionanduseofepinephrine[auto-injector] deliverydevicesshallbelimited
16asfollows:
17 (1)Nopersonshalluseanepinephrine[auto-injector] deliverydeviceunlesssuch
18personhassuccessfullycompletedatrainingcourseintheuseofepinephrine[auto-injector]
19deliverydevicesapprovedbythedirectorofthedepartmentofhealthandseniorservices.
20Nothinginthissectionshallprohibittheuseofanepinephrine[auto-injector] delivery
21device:
22 (a)Byahealthcareprofessionallicensedorcertifiedbythisstatewhoisacting
23withinthescopeofhisorherpractice;or
24 (b)Byapersonactingpursuanttoalawfulprescription;
25 (2)Everyperson,firm,organizationandentityauthorizedtopossessanduse
26epinephrine[auto-injector] deliverydevicespursuanttothissectionshalluse,maintainand
27disposeofsuchdevicesinaccordancewiththerulesofthedepartment;and
28 (3)Everyuseofanepinephrine[auto-injector] deliverydevicepursuanttothis
29sectionshallimmediatelybereportedtotheemergencyhealthcareprovider.
30 3.(1)Useofanepinephrine[auto-injector] deliverydevicepursuanttothissection
31shallbeconsideredfirstaidoremergencytreatmentforthepurposeofanylawrelatingto
32liability.
HCSSSSB7 14 33 (2)Purchase,acquisition,possessionoruseofanepinephrine[auto-injector] delivery
34devicepursuanttothissectionshallnotconstitutetheunlawfulpracticeofmedicineorthe
35unlawfulpracticeofaprofession.
36 (3)Anypersonotherwiseauthorizedtosellorprovideanepinephrine[auto-injector]
37deliverydevicemaysellorprovideittoapersonauthorizedtopossessitpursuanttothis
38section.
39 4.Anyperson,firm,organizationorentitythatviolatestheprovisionsofthissection
40isguiltyofaclassBmisdemeanor.
190.800.1.Eachgroundambulanceservice[, exceptforanyambulanceservice
2ownedandoperatedbyanentityownedandoperatedbythestateofMissouri,includingbut
3notlimitedtoanyhospitalownedoroperatedbytheboardofcurators,asdefinedinchapter
4172,oranydepartmentofthestate,] shall,inadditiontoallotherfeesandtaxesnowrequired
5orpaid,payanambulanceservicereimbursementallowancetaxfortheprivilegeofengaging
6inthebusinessofprovidingambulanceservicesinthisstate.
7 2.Forthepurposeofthissection,thefollowingtermsshallmean:
8 (1)"Ambulance",thesamemeaningassuchtermisdefinedinsection190.100;
9 (2)"Ambulanceservice",thesamemeaningassuchtermisdefinedinsection
10190.100;
11 (3)"Engaginginthebusinessofprovidingambulanceservicesinthisstate",
12acceptingpaymentforsuchservices.
191.227.1.Allphysicians,chiropractors,hospitals,dentists,andotherdulylicensed
2practitionersinthisstate,hereincalled"providers",shall,uponwrittenrequestofapatient,or
3guardianorlegallyauthorizedrepresentativeofapatient,furnishacopyofhisorherrecord
4ofthatpatient'shealthhistoryandtreatmentrenderedtothepersonsubmittingawritten
5request,exceptthatsuchrightshallbelimitedtoaccessconsistentwiththepatient'scondition
6andsoundtherapeutictreatmentasdeterminedbytheprovider.BeginningAugust28,1994,
7suchrecordshallbefurnishedwithinareasonabletimeofthereceiptoftherequesttherefor
8anduponpaymentofafeeasprovidedinthissection.
9 2.Healthcareprovidersmayconditionthefurnishingofthepatient'shealthcare
10recordstothepatient,thepatient'sauthorizedrepresentativeoranyotherpersonorentity
11authorizedbylawtoobtainorreproducesuchrecordsuponpaymentofafeefor:
12 (1)(a)Searchandretrieval,inanamountnotmorethantwenty-fourdollarsand
13eighty-fivecentspluscopyingintheamountoffifty-sevencentsperpageforthecostof
14suppliesandlaborplus,ifthehealthcareproviderhascontractedforoff-siterecordsstorage
15andmanagement,anyadditionallaborcostsofoutsidestorageretrieval,nottoexceedtwenty-
16threedollarsandtwenty-sixcents,asadjustedannuallypursuanttosubsection6ofthis
17section;or
HCSSSSB7 15 18 (b)Therecordsshallbefurnishedelectronicallyuponpaymentofthesearch,
19retrieval,andcopyingfeessetunderthissectionatthetimeoftherequestoronehundred
20eightdollarsandeighty-eightcentstotal,whicheverisless,ifsuchperson:
21 a.Requestshealthrecordstobedeliveredelectronicallyinaformatofthehealthcare
22provider'schoice;
23 b.Thehealthcareproviderstoressuchrecordscompletelyinanelectronichealth
24record;and
25 c.Thehealthcareprovideriscapableofprovidingtherequestedrecordsand
26affidavit,ifrequested,inanelectronicformat;
27 (2)Postage,toincludepackaginganddeliverycost;
28 (3)Notaryfee,nottoexceedtwodollars,ifrequested.
29
30SuchfeeshallbethefeeineffectonFebruary1,2018,increasedordecreasedannuallyunder
31thissection.
32 3.Forpurposesofsubsections1and2ofthissection,"acopyofhisorherrecordof
33thatpatient'shealthhistoryandtreatmentrendered"or"thepatient'shealthcarerecords"
34includesastatementorrecordthatnosuchhealthhistoryortreatmentrecordresponsivetothe
35requestexists.
36 4.Notwithstandingprovisionsofthissectiontothecontrary,providersmaycharge
37forthereasonablecostofallduplicationsofhealthcarerecordmaterialorinformationwhich
38cannotroutinelybecopiedorduplicatedonastandardcommercialphotocopymachine.
39 5.Thetransferofthepatient'srecorddoneingoodfaithshallnotrendertheprovider
40liabletothepatientoranyotherpersonforanyconsequenceswhichresultedormayresult
41fromdisclosureofthepatient'srecordasrequiredbythissection.
42 6.EffectiveFebruaryfirstofeachyear,thefeeslistedinsubsection2ofthissection
43shallbeincreasedordecreasedannuallybasedontheannualpercentagechangeinthe
44unadjusted,U.S.cityaverage,annualaverageinflationrateofthemedicalcarecomponentof
45theConsumerPriceIndexforAllUrbanConsumers(CPI-U).Thecurrentreferencebaseof
46theindex,aspublishedbytheBureauofLaborStatisticsoftheUnitedStatesDepartmentof
47Labor,shallbeusedasthereferencebase.Forpurposesofthissubsection,theannualaverage
48inflationrateshallbebasedonatwelve-monthcalendaryearbeginninginJanuaryandending
49inDecemberofeachprecedingcalendaryear.Thedepartmentofhealthandseniorservices
50shallreporttheannualadjustmentandtheadjustedfeesauthorizedinthissectiononthe
51department'sinternetwebsitebyFebruaryfirstofeachyear.
52 7.Ahealthcareprovidermaydiscloseadeceasedpatient'shealthcarerecordsor
53paymentrecordstotheexecutororadministratorofthedeceasedperson'sestate,orpursuant
54toavalid,unrevokedpowerofattorneyforhealthcarethatspecificallydirectsthatthe
HCSSSSB7 16 55deceasedperson'shealthcarerecordsbereleasedtotheagentafterdeath.Ifanexecutor,
56administrator,oragenthasnotbeenappointed,thedeceasedpriortodeathdidnotspecifically
57objecttodisclosureofhisorherrecordsinwriting,andsuchdisclosureisnotinconsistent
58withanypriorexpressedpreferenceofthedeceasedthatisknowntothehealthcareprovider,
59adeceasedpatient'shealthcarerecordsmaybereleaseduponwrittenrequestofapersonwho
60isdeemedasthepersonalrepresentativeofthedeceasedpersonunderthissubsection.
61Priorityshallbegiventothedeceasedpatient'sspouseandtherecordsshallbereleasedonthe
62affidavitofthesurvivingspousethatheorsheisthesurvivingspouse.Ifthereisnosurviving
63spouse,thehealthcarerecordsmaybereleasedtooneofthefollowingpersons:
64 (1)Theactingtrusteeofatrustcreatedbythedeceasedpatienteitheraloneorwith
65thedeceasedpatient'sspouse;
66 (2)Anadultchildofthedeceasedpatientontheaffidavitoftheadultchildthatheor
67sheistheadultchildofthedeceased;
68 (3)Aparentofthedeceasedpatientontheaffidavitoftheparentthatheorsheisthe
69parentofthedeceased;
70 (4)Anadultbrotherorsisterofthedeceasedpatientontheaffidavitoftheadult
71brotherorsisterthatheorsheistheadultbrotherorsisterofthedeceased;
72 (5)Aguardianorconservatorofthedeceasedpatientatthetimeofthepatient'sdeath
73ontheaffidavitoftheguardianorconservatorthatheorsheistheguardianorconservatorof
74thedeceased;or
75 (6)Aguardianadlitemofthedeceased'sminorchildbasedontheaffidavitofthe
76guardianthatheorsheistheguardianadlitemoftheminorchildofthedeceased.
77 8.(1)Recordscontainingapatient'shealthhistoryandtreatmentcreatedbyan
78emergencycareprovider,asdefinedinsection191.630,oratelecommunicatorfirst
79responder,asdefinedinsection650.320,inthecourseoftheprovider'sorresponder's
80officialdutieswhilerespondingtoaformalrequestforassistanceshallbemade
81available,uponwrittenrequest,toanypersonauthorizedtoobtainthepatient'shealth
82carerecordsundertheprovisionsofthissection.
83 (2)Thefurnishingofhealthcarerecordsunderthissubsectionmaybe
84conditioneduponthepaymentofafeeinanamountequaltothefeeallowedforthe
85furnishingofanyotherhealthcarerecordunderthissection.
86 (3)Nothinginthissubsectionshalllimitthereleaseofinformationregardingthe
87generalnatureoftheeventthatresultedinaformalrequestofassistanceaslongasany
88personalhealthinformationisredacted.
89 (4)Nothinginthissubsectionshalllimitthereleaseofinformationtofacilitate
90thenormaldeliveryofpatientcareortoevaluatethequalityofcareaspartofan
91establishedqualityimprovementprogram.
HCSSSSB7 17 191.600.1.Sections191.600to191.615establishaloanrepaymentprogramfor
2graduatesof[approvedmedicalschools,schoolsofosteopathicmedicine,schoolsofdentistry
3andaccreditedchiropracticcolleges] anaccreditedgraduatetrainingprograminany
4disciplinedesignatedinrulebythedepartmentwhopracticeinareasofdefinedneed[and
5shallbeknownasthe"HealthProfessionalStudentLoanRepaymentProgram".Sections
6191.600to191.615shallapplytograduatesofaccreditedchiropracticcollegeswhenfederal
7guidelinesforchiropracticshortageareasaredeveloped], tobeknownasthe"Missouri
8StateLoanRepaymentProgram(MOSLRP)". Indesignatingdisciplines,the
9departmentshallcomplywithlimitationssetforthintheNationalHealthService
10CorpsLoanRepaymentProgram,42U.S.C.Section254l-1,andanyrelatednoticesof
11fundingopportunity.
12 2.The["HealthProfessionalStudentLoanand]"MissouriStateLoanRepayment
13ProgramFund"isherebycreatedinthestatetreasury.Allfundsrecoveredfromanindividual
14pursuanttosection191.614andallfundsgeneratedbyloanrepaymentsandpenalties
15receivedpursuanttosection191.540shallbecreditedtothefund.Themoneysinthefund
16shallbeusedbythedepartmentofhealthandseniorservicestoprovideloanrepayments
17pursuanttosection191.611inaccordancewithsections191.600to191.614.
191.603.Asusedinsections191.600to191.615,thefollowingtermsshallmean:
2 (1)"Areasofdefinedneed",areasdesignatedbythedepartmentpursuanttosection
3191.605,whenservices[ofaphysician,includingapsychiatrist,chiropractor,ordentist] are
4neededtoimprovethepatient-healthprofessionalratiointhearea,tocontributehealthcare
5professionalservicestoanareaofeconomicimpact,ortocontributehealthcareprofessional
6servicestoanareasufferingfromtheeffectsofanaturaldisaster;
7 (2)["Chiropractor",apersonlicensedandregisteredpursuanttochapter331;
8 (3)]"Department",thedepartmentofhealthandseniorservices[;
9 (4)"Generaldentist",dentistslicensedandregisteredpursuanttochapter332
10engagedingeneraldentistryandwhoareprovidingsuchservicestothegeneralpopulation;
11 (5)"Primarycarephysician",physicianslicensedandregisteredpursuanttochapter
12334engagedingeneralorfamilypractice,internalmedicine,pediatricsorobstetricsand
13gynecologyastheirprimaryspecialties,andwhoareprovidingsuchprimarycareservicesto
14thegeneralpopulation;
15 (6)"Psychiatrist",thesamemeaningasinsection632.005].
191.605.1.Thedepartmentshalldesignatecounties,communities,orsectionsof
2urbanareasasareasofdefinedneedformedical,psychiatric,[chiropractic,] ordentalservices
3whensuchcounty,communityorsectionofanurbanareahasbeendesignatedasaprimary
4carehealthprofessionalshortagearea,amentalhealthcareprofessionalshortagearea,ora
5dentalhealthcareprofessionalshortageareabythefederalDepartmentofHealthandHuman
HCSSSSB7 18 6Services,orhasbeendeterminedbythedirectorofthedepartmentofhealthandsenior
7servicestohaveanextraordinaryneedforhealthcareprofessionalservices,withouta
8correspondingsupplyofsuchprofessionals.
9 2.Annually,atleastthirty-fivepercentoftheappropriatedfundsallocatedfor
10theMissouristateloanrepaymentprogramshallbedesignatedforawardstoprimary
11carephysiciansandgeneraldentists.Anyunusedportionofsuchdesignatedfundsshall
12bemadeavailablewithinthesamefiscalyeartotheothertypesofhealthprofessions
13designatedbythedepartmentundersection191.600.
191.607.Thedepartmentshalladoptandpromulgateregulationsestablishing
2standardsfordeterminingeligiblepersonsforloanrepaymentpursuanttosections191.600to
3191.615.Thesestandardsshallinclude,butarenotlimitedtothefollowing:
4 (1)CitizenshiporpermanentresidencyintheUnitedStates;
5 (2)ResidenceinthestateofMissouri;
6 (3)[Enrollmentasafull-timemedicalstudentinthefinalyearofacourseofstudy
7offeredbyanapprovededucationalinstitutionorlicensedtopracticemedicineorosteopathy
8pursuanttochapter334,includingpsychiatrists;
9 (4)Enrollmentasafull-timedentalstudentinthefinalyearofcoursestudyoffered
10byanapprovededucationalinstitutionorlicensedtopracticegeneraldentistrypursuantto
11chapter332;
12 (5)Enrollmentasafull-timechiropracticstudentinthefinalyearofcoursestudy
13offeredbyanapprovededucationalinstitutionorlicensedtopracticechiropracticmedicine
14pursuanttochapter331]Authorizationtopracticeasanytypeofhealthprofessional
15designatedinsection191.600;
16 [(6)](4)Practiceinanareaofdefinedneed;and
17 (5)Submissionofanapplicationforloanrepayment.
191.611.1.Aloanpaymentprovidedforanindividualunderawrittencontractunder
2the[healthprofessionalstudentloanpayment] Missouristateloanrepaymentprogramshall
3consistofpaymentonbehalfoftheindividualoftheprincipal,interest,andrelatedexpenses
4ongovernmentandcommercialloansreceivedbytheindividualfortuition,fees,books,
5laboratory,andlivingexpensesincurredbytheindividual.
6 2.Foreachyearofobligatedservicesthatanindividualcontractstoserveinanarea
7ofdefinedneed,thedirectormaypayanamountnottoexceedthemaximumamounts
8allowedundertheNationalHealthServiceCorpsLoanRepaymentProgram,42U.S.C.
9Section[2541-1,P.L.106-213] 254l-1, onbehalfoftheindividualforloansdescribedin
10subsection1ofthissection.
11 3.Thedepartmentmayenterintoanagreementwiththeholderoftheloansforwhich
12repaymentsaremadepursuanttothe[healthprofessionalstudentloanpayment] Missouri
HCSSSSB7 19 13stateloanrepaymentprogramtoestablishascheduleforthemakingofsuchpaymentsifthe
14establishmentofsuchaschedulewouldresultinreducingthecoststothestate.
15 4.Anyqualifyingcommunitiesprovidingaportionofaloanrepaymentshallbe
16consideredfirstforplacement.
191.614.1.[Anindividualwhohasenteredintoawrittencontractwiththe
2department;andinthecaseofanindividualwhoisenrolledinthefinalyearofacourseof
3studyandfailstomaintainanacceptablelevelofacademicstandingintheeducational
4institutioninwhichsuchindividualisenrolledorvoluntarilyterminatessuchenrollmentoris
5dismissedfromsucheducationalinstitutionbeforecompletionofsuchcourseofstudyorfails
6tobecomelicensedpursuanttochapter331,332or334withinoneyearshallbeliabletothe
7statefortheamountwhichhasbeenpaidonhisorherbehalfunderthecontract.
8 2.]Ifanindividualbreachesthewrittencontractoftheindividualbyfailingeitherto
9beginsuchindividual'sserviceobligationortocompletesuchserviceobligation,thestate
10shallbeentitledtorecoverfromtheindividualanamountequaltothesumof:
11 (1)Thetotaloftheamountsprepaidbythestateonbehalfoftheindividual;
12 (2)Theinterestontheamountswhichwouldbepayableifatthetimetheamounts
13werepaidtheywereloansbearinginterestatthemaximumprevailingrateasdeterminedby
14theTreasureroftheUnitedStates;
15 (3)Anamountequaltoanydamagesincurredbythedepartmentasaresultofthe
16breach;and
17 (4)Anylegalfeesorassociatedcostsincurredbythedepartmentorthestateof
18Missouriinthecollectionofdamages.
19 [3.]2.Thedepartmentmayactonbehalfofaqualifiedcommunitytorecoverfroman
20individualdescribedin[subsections1and2of]thissectiontheportionofaloanrepayment
21paidbysuchcommunityforsuchindividual.
191.615.1.ThedepartmentshallsubmitagrantapplicationtotheSecretaryofthe
2UnitedStatesDepartmentofHealthandHumanServicesasprescribedbythesecretaryto
3obtainfederalfundstofinancethe[healthprofessionalstudent] Missouristateloan
4repaymentprogram.
5 2.Sections191.600to191.615shallnotbeconstruedtorequirethedepartmentto
6enterintocontractswithindividualswhoqualifyforthe[healthprofessionalstudent]
7Missouristateloanrepaymentprogramwhenfederalandstatefundsarenotavailablefor
8suchpurpose.
191.648.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Designatedsexuallytransmittedinfection",chlamydia,gonorrhea,
3trichomoniasis,oranyothersexuallytransmittedinfectiondesignatedasappropriate
4forexpeditedpartnertherapybythedepartmentofhealthandseniorservicesorfor
HCSSSSB7 20 5whichexpeditedpartnertherapywasrecommendedinthemostrecentCentersfor
6DiseaseControlandPreventionguidelinesforthepreventionortreatmentofsexually
7transmittedinfections;
8 (2)"Expeditedpartnertherapy"[means], thepracticeoftreatingthesexpartnersof
9personswith[chlamydiaorgonorrhea] designatedsexuallytransmittedinfectionswithout
10aninterveningmedicalevaluationorprofessionalpreventioncounseling;
11 (3)"Healthcareprofessional",amemberofanyprofessionregulatedbychapter
12334or335authorizedtoprescribemedications.
13 2.Anylicensed[physician] healthcareprofessionalmay,butshallnotberequired
14to,utilizeexpeditedpartnertherapyforthemanagementofthepartnersofpersonswith
15[chlamydiaorgonorrhea] designatedsexuallytransmittedinfections. Notwithstandingthe
16requirementsof20CSR2150-5.020(5)oranyotherlawtothecontrary,alicensed
17[physician] healthcareprofessionalutilizingexpeditedpartnertherapymayprescribeand
18dispensemedicationsforthetreatmentof[chlamydiaorgonorrhea] adesignatedsexually
19transmittedinfectionforanindividualwhoisthepartnerofapersonwith[chlamydiaor
20gonorrhea] adesignatedsexuallytransmittedinfectionandwhodoesnothavean
21established[physician/patient] healthcareprofessional/patientrelationshipwithsuch
22[physician] healthcareprofessional. [Anyantibioticmedicationsprescribedanddispensed
23forthetreatmentofchlamydiaorgonorrheaunderthissectionshallbeinpillform.]
24 3.Anylicensed[physician] healthcareprofessionalutilizingexpeditedpartner
25therapyforthemanagementofthepartnerswith[chlamydiaorgonorrhea] designated
26sexuallytransmittedinfectionsshallprovideexplanationandguidanceto[a]eachpatient
27[diagnosedwithchlamydiaorgonorrhea] ofthepreventativemeasuresthatcanbetakenby
28thepatienttostopthe[spread] transmissionofsuch[diagnosis] infection.
29 4.Anylicensed[physician] healthcareprofessionalutilizingexpeditedpartner
30therapyforthemanagementofpartnersofpersonswith[chlamydiaorgonorrhea] designated
31sexuallytransmittedinfectionsunderthissectionshallhaveimmunityfromanycivil
32liabilitythatmayotherwiseresultbyreasonofsuchactions,unlesssuch[physician] health
33careprofessionalactsnegligently,recklessly,inbadfaith,orwithmaliciouspurpose.
34 5.Thedepartmentofhealthandseniorservicesandthedivisionofprofessional
35registrationwithinthedepartmentofcommerceandinsuranceshallbyruledevelop
36guidelinesfortheimplementationofsubsection2ofthissection.Anyruleorportionofa
37rule,asthattermisdefinedinsection536.010,thatiscreatedundertheauthoritydelegatedin
38thissectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallofthe
39provisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter536
40arenonseverableandifanyofthepowersvestedwiththegeneralassemblypursuantto
41chapter536toreview,todelaytheeffectivedate,ortodisapproveandannularuleare
HCSSSSB7 21 42subsequentlyheldunconstitutional,thenthegrantofrulemakingauthorityandanyrule
43proposedoradoptedafterAugust28,2010,shallbeinvalidandvoid.
191.1145.1.Asusedinsections191.1145and191.1146,thefollowingtermsshall
2mean:
3 (1)"Asynchronousstore-and-forwardtransfer",thecollectionofapatient'srelevant
4healthinformationandthesubsequenttransmissionofthatinformationfromanoriginating
5sitetoahealthcareprovideratadistantsitewithoutthepatientbeingpresent;
6 (2)"Clinicalstaff",anyhealthcareproviderlicensedinthisstate;
7 (3)"Distantsite",asiteatwhichahealthcareproviderislocatedwhileproviding
8healthcareservicesbymeansoftelemedicine;
9 (4)"Healthcareprovider",asthattermisdefinedinsection376.1350;
10 (5)"Originatingsite",asiteatwhichapatientislocatedatthetimehealthcare
11servicesareprovidedtohimorherbymeansoftelemedicine.Forthepurposesof
12asynchronousstore-and-forwardtransfer,originatingsiteshallalsomeanthelocationat
13whichthehealthcareprovidertransfersinformationtothedistantsite;
14 (6)"Telehealth"or"telemedicine",thedeliveryofhealthcareservicesbymeansof
15informationandcommunicationtechnologies, includingaudiovisualandaudio-only
16technologies,whichfacilitatetheassessment,diagnosis,consultation,treatment,education,
17caremanagement,andself-managementofapatient'shealthcarewhilesuchpatientisatthe
18originatingsiteandthehealthcareproviderisatthedistantsite.Telehealthortelemedicine
19shallalsoincludetheuseofasynchronousstore-and-forwardtechnology.Healthcare
20providersshallnotbelimitedintheirchoiceofelectronicplatformsusedtodeliver
21telehealthortelemedicine,providedthatallservicesdeliveredareinaccordancewith
22theHealthInsurancePortabilityandAccountabilityActof1996.
23 2.Anylicensedhealthcareprovidershallbeauthorizedtoprovidetelehealthservices
24ifsuchservicesarewithinthescopeofpracticeforwhichthehealthcareproviderislicensed
25andareprovidedwiththesamestandardofcareasservicesprovidedinperson.Thissection
26shallnotbeconstruedtoprohibitahealthcarrier,asdefinedinsection376.1350,from
27reimbursingnonclinicalstaffforservicesotherwiseallowedbylaw.
28 3.Inordertotreatpatientsinthisstatethroughtheuseoftelemedicineortelehealth,
29healthcareprovidersshallbefullylicensedtopracticeinthisstateandshallbesubjectto
30regulationbytheirrespectiveprofessionalboards.
31 4.Nothinginsubsection3ofthissectionshallapplyto:
32 (1)Informalconsultationperformedbyahealthcareproviderlicensedinanother
33state,outsideofthecontextofacontractualrelationship,andonanirregularorinfrequent
34basiswithouttheexpectationorexchangeofdirectorindirectcompensation;
HCSSSSB7 22 35 (2)Furnishingofhealthcareservicesbyahealthcareproviderlicensedandlocatedin
36anotherstateincaseofanemergencyordisaster;providedthat,nochargeismadeforthe
37medicalassistance;or
38 (3)Episodicconsultationbyahealthcareproviderlicensedandlocatedinanother
39statewhoprovidessuchconsultationservicesonrequesttoaphysicianinthisstate.
40 5.Nothinginthissectionshallbeconstruedtoalterthescopeofpracticeofany
41healthcareproviderortoauthorizethedeliveryofhealthcareservicesinasettingorina
42mannernototherwiseauthorizedbythelawsofthisstate.
43 6.Nooriginatingsiteforservicesoractivitiesprovidedunderthissectionshallbe
44requiredtomaintainimmediateavailabilityofon-siteclinicalstaffduringthetelehealth
45services,exceptasnecessarytomeetthestandardofcareforthetreatmentofthepatient's
46medicalconditionifsuchconditionisbeingtreatedbyaneligiblehealthcareproviderwhois
47notattheoriginatingsite,hasnotpreviouslyseenthepatientinpersoninaclinicalsetting,
48andisnotprovidingcoverageforahealthcareproviderwhohasanestablishedrelationship
49withthepatient.Healthcareprovidersshallnotbelimitedintheirchoiceofelectronic
50platformsusedtodelivertelehealthortelemedicine.
51 7.Nothinginthissectionshallbeconstruedtoalteranycollaborativepractice
52requirementasprovidedinchapters334and335.
192.2521.Aspecialtyhospitalisexemptfromtheprovisionsofsections192.2520
2and197.135ifsuchhospitalhasapolicyforthetransferofavictimofasexualassaultto
3anappropriatehospitalwithanemergencydepartment.Asusedinthissection,
4"specialtyhospital"meansahospitalthathasbeendesignatedbythedepartmentof
5healthandseniorservicesassomethingotherthanageneralacutecarehospital.
195.417.1.Thelimitsspecifiedinthissectionshallnotapplytoanyquantityofsuch
2product,mixture,orpreparationwhichmustbedispensed,sold,ordistributedinapharmacy
3pursuanttoavalidprescription.
4 2.Withinanythirty-dayperiod,nopersonshallsell,dispense,orotherwiseprovideto
5thesameindividual,andnopersonshallpurchase,receive,orotherwiseacquiremorethanthe
6followingamount:anynumberofpackagesofanydrugproductcontaininganydetectable
7amountofephedrine,phenylpropanolamine,orpseudoephedrine,oranyoftheirsaltsor
8opticalisomers,orsaltsofopticalisomers,eitheras:
9 (1)Thesoleactiveingredient;or
10 (2)Oneoftheactiveingredientsofacombinationdrug;or
11 (3)Acombinationofanyoftheproductsspecifiedinsubdivisions(1)and(2)ofthis
12subsection;
13
HCSSSSB7 23 14inanytotalamountgreaterthansevenandtwo-tenthsgrams,withoutregardtothenumberof
15transactions.
16 3.Withinanytwenty-four-hourperiod,nopharmacist,internpharmacist,or
17registeredpharmacytechnicianshallsell,dispense,orotherwiseprovidetothesame
18individual,andnopersonshallpurchase,receive,orotherwiseacquiremorethanthe
19followingamount:anynumberofpackagesofanydrugproductcontaininganydetectable
20amountofephedrine,phenylpropanolamine,orpseudoephedrine,oranyoftheirsaltsor
21opticalisomers,orsaltsofopticalisomers,eitheras:
22 (1)Thesoleactiveingredient;or
23 (2)Oneoftheactiveingredientsofacombinationdrug;or
24 (3)Acombinationofanyoftheproductsspecifiedinsubdivisions(1)and(2)ofthis
25subsection;
26
27inanytotalamountgreaterthanthreeandsix-tenthsgramswithoutregardtothenumberof
28transactions.
29 4.Withinanytwelve-monthperiod,nopersonshallsell,dispense,orotherwise
30providetothesameindividual,andnopersonshallpurchase,receive,orotherwiseacquire
31morethanthefollowingamount:anynumberofpackagesofanydrugproductcontainingany
32detectableamountofephedrine,phenylpropanolamine,orpseudoephedrine,oranyoftheir
33saltsoropticalisomers,orsaltsofopticalisomers,eitheras:
34 (1)Thesoleactiveingredient;or
35 (2)Oneoftheactiveingredientsofacombinationdrug;or
36 (3)Acombinationofanyoftheproductsspecifiedinsubdivisions(1)and(2)ofthis
37subsection;
38
39inanytotalamountgreaterthan[forty-three] sixty-oneandtwo-tenthsgrams,withoutregard
40tothenumberoftransactions.
41 5.Allpackagesofanycompound,mixture,orpreparationcontaininganydetectable
42quantityofephedrine,phenylpropanolamine,orpseudoephedrine,oranyoftheirsaltsor
43opticalisomers,orsaltsofopticalisomers,exceptthosethatareexcludedfromScheduleVin
44subsection17or18ofsection195.017,shallbeofferedforsaleonlyfrombehindapharmacy
45counterwherethepublicisnotpermitted,andonlybyaregisteredpharmacistorregistered
46pharmacytechnicianundersection195.017.
47 6.Eachpharmacyshallsubmitinformationregardingsalesofanycompound,
48mixture,orpreparationasspecifiedinthissectioninaccordancewithtransmissionmethods
49andfrequencyestablishedbythedepartmentbyregulation.
HCSSSSB7 24 50 7.(1)Asusedinthissubsection,"administratorofthereal-timeelectronic
51pseudoephedrinetrackingsystem"meanstheentityresponsiblefordeveloping,
52implementing,andmaintainingthedatacollectionsystemdescribedin19CSR30-
531.074oranysuccessorregulation.
54 (2)BeginningOctober1,2025,andcontinuingthereafter,anymanufacturerof
55anycompound,mixture,orpreparationspecifiedinthissectionthatissoldinorintothe
56stateshall,onamonthlybasis,payfeestotheadministratorofthereal-timeelectronic
57pseudoephedrinetrackingsystem.
58 (3)Theadministratorofthereal-timeelectronicpseudoephedrinetracking
59systemshallberesponsibleforsettingthefeelevelsrequiredunderthissubsection.
60 (4)Upontherequestofthedepartmentofhealthandseniorservices,any
61manufacturerrequiredtopayfeesunderthissubsectionshallprovidewritten
62documentationdemonstratingthatthemanufacturerhaspaidsuchfees.
63 8.Noprescriptionshallberequiredforthedispensation,sale,ordistributionofany
64drugproductcontaininganydetectableamountofephedrine,phenylpropanolamine,or
65pseudoephedrine,oranyoftheirsaltsoropticalisomers,orsaltsofopticalisomers,inan
66amountwithinthelimitsdescribedinsubsections2,3,and4ofthissection.The
67superintendentoftheMissouristatehighwaypatrolshallreporttotherevisorofstatutesand
68thegeneralassemblybyFebruaryfirstwhenthestatewidenumberofmethamphetamine
69laboratoryseizureincidentsexceedsthreehundredincidentsinthepreviouscalendaryear.
70TheprovisionsofthissubsectionshallexpireonAprilfirstofthecalendaryearinwhichthe
71revisorofstatutesreceivessuchnotification.
72 [8.]9.Thissectionshallsupersedeandpreemptanylocalordinancesorregulations,
73includinganyordinancesorregulationsenactedbyanypoliticalsubdivisionofthestate.This
74sectionshallnotapplytothesaleofanyanimalfeedproductscontainingephedrineorany
75naturallyoccurringorherbalephedraorextractofephedra.
76 [9.]10.Anylocalordinancesorregulationsenactedbyanypoliticalsubdivisionof
77thestatepriortoAugust28,2020,requiringaprescriptionforthedispensation,sale,or
78distributionofanydrugproductcontaininganydetectableamountofephedrine,
79phenylpropanolamine,orpseudoephedrine,oranyoftheirsaltsoropticalisomers,orsalts
80ofopticalisomers,inanamountwithinthelimitsdescribedinsubsections2,3,and4ofthis
81sectionshallbevoidandofnoeffectandnosuchpoliticalsubdivisionshallmaintainor
82enforcesuchordinanceorregulation.
83 [10.]11.Alllogs,records,documents,andelectronicinformationmaintainedforthe
84dispensingoftheseproductsshallbeopenforinspectionandcopyingbymunicipal,county,
85andstateorfederallawenforcementofficerswhosedutyitistoenforcethecontrolled
86substanceslawsofthisstateortheUnitedStates.
HCSSSSB7 25 87 [11.]12.Allpersonswhodispenseorofferforsalepseudoephedrineandephedrine
88products,exceptthosethatareexcludedfromScheduleVinsubsection17or18ofsection
89195.017,shallensurethatallsuchproductsarelocatedonlybehindapharmacycounterwhere
90thepublicisnotpermitted.
91 [12.]13.Thepenaltyforaknowingorrecklessviolationofthissectionisfoundin
92section579.060.
196.990.1.Asusedinthissection,thefollowingtermsshallmean:
2 (1)"Administer",thedirectapplicationofanepinephrine[auto-injector] delivery
3devicetothebodyofanindividual;
4 (2)"Authorizedentity",anyentityororganizationatorinconnectionwithwhich
5allergenscapableofcausinganaphylaxismaybepresentincluding,butnotlimitedto,
6qualifiedfirstresponders,assuchtermisdefinedinsection321.621,facilitieslicensed
7underchapter198,restaurants,recreationcamps,youthsportsleagues,childcarefacilities,
8amusementparks,andsportsarenas."Authorizedentity"shallnotincludeanypublicschool
9orpubliccharterschool;
10 (3)"Epinephrine[auto-injector] deliverydevice", asingle-usedeviceusedforthe
11[automaticinjection] deliveryofapremeasureddoseofepinephrineintothehumanbody;
12 (4)"Physician",aphysicianlicensedinthisstateunderchapter334;
13 (5)"Provide",thesupplyofoneormoreepinephrine[auto-injectors] delivery
14devicestoanindividual;
15 (6)"Self-administration",aperson'sdiscretionaryuseofanepinephrine[auto-
16injector] deliverydevice.
17 2.Aphysicianmayprescribeepinephrine[auto-injectors] deliverydevicesinthe
18nameofanauthorizedentityforuseinaccordancewiththissection,andpharmacists,
19physicians,andotherpersonsauthorizedtodispenseprescriptionmedicationsmaydispense
20epinephrine[auto-injectors] deliverydevicesunderaprescriptionissuedinthenameofan
21authorizedentity.
22 3.Anauthorizedentitymayacquireandstockasupplyofepinephrine[auto-
23injectors] deliverydevicesunderaprescriptionissuedinaccordancewiththissection.Such
24epinephrine[auto-injectors] deliverydevicesshallbestoredinalocationreadilyaccessible
25inanemergencyandinaccordancewiththeepinephrine[auto-injector's] deliverydevice's
26instructionsforuseandanyadditionalrequirementsestablishedbythedepartmentofhealth
27andseniorservicesbyrule.Anauthorizedentityshalldesignateemployeesoragentswho
28havecompletedthetrainingrequiredunderthissectiontoberesponsibleforthestorage,
29maintenance,andgeneraloversightofepinephrine[auto-injectors] deliverydevicesacquired
30bytheauthorizedentity.
HCSSSSB7 26 31 4.Anauthorizedentitythatacquiresasupplyofepinephrine[auto-injectors] delivery
32devicesunderaprescriptionissuedinaccordancewiththissectionshallensurethat:
33 (1)Expectedepinephrine[auto-injector] deliverydeviceusersreceivetrainingin
34recognizingsymptomsofsevereallergicreactionsincludinganaphylaxisandtheuseof
35epinephrine[auto-injectors] deliverydevicesfromanationallyrecognizedorganization
36experiencedintraininglaypersonsinemergencyhealthtreatmentoranotherentityorperson
37approvedbythedepartmentofhealthandseniorservices;
38 (2)Allepinephrine[auto-injectors] deliverydevicesaremaintainedandstored
39accordingtotheepinephrine[auto-injector's] deliverydevice'sinstructionsforuse;
40 (3)Anypersonwhoprovidesoradministersanepinephrine[auto-injector] delivery
41devicetoanindividualwhothepersonbelievesingoodfaithisexperiencinganaphylaxis
42activatestheemergencymedicalservicessystemassoonaspossible;and
43 (4)Aproperreviewofallsituationsinwhichanepinephrine[auto-injector] delivery
44deviceisusedtorenderemergencycareisconducted.
45 5.Anyauthorizedentitythatacquiresasupplyofepinephrine[auto-injectors]
46deliverydevicesunderaprescriptionissuedinaccordancewiththissectionshallnotifythe
47emergencycommunicationsdistrictortheambulancedispatchcenteroftheprimaryprovider
48ofemergencymedicalserviceswheretheepinephrine[auto-injectors] deliverydevicesareto
49belocatedwithintheentity'sfacility.
50 6.Nopersonshallprovideoradministeranepinephrine[auto-injector] delivery
51devicetoanyindividualwhoisundereighteenyearsofagewithouttheverbalconsentofa
52parentorguardianwhoispresentatthetimewhenprovisionoradministrationofthe
53epinephrine[auto-injector] deliverydeviceisneeded.Provided,however,thatapersonmay
54provideoradministeranepinephrine[auto-injector] deliverydevicetosuchanindividual
55withouttheconsentofaparentorguardianiftheparentorguardianisnotphysicallypresent
56andthepersonreasonablybelievestheindividualshallbeinimminentdangerwithoutthe
57provisionoradministrationoftheepinephrine[auto-injector] deliverydevice.
58 7.Thefollowingpersonsandentitiesshallnotbeliableforanyinjuriesorrelated
59damagesthatresultfromtheadministrationorself-administrationofanepinephrine[auto-
60injector] deliverydeviceinaccordancewiththissectionthatmayconstituteordinary
61negligence:
62 (1)Anauthorizedentitythatpossessesandmakesavailableepinephrine[auto-
63injectors] deliverydevicesanditsemployees,agents,andothertrainedpersons;
64 (2)Anypersonwhousesanepinephrine[auto-injector] deliverydevicemade
65availableunderthissection;
66 (3)Aphysicianthatprescribesepinephrine[auto-injectors] deliverydevicestoan
67authorizedentity;or
HCSSSSB7 27 68 (4)Anypersonorentitythatconductsthetrainingdescribedinthissection.
69
70Suchimmunitydoesnotapplytoactsoromissionsconstitutingarecklessdisregardforthe
71safetyofothersorwillfulorwantonconduct.Theadministrationofanepinephrine[auto-
72injector] deliverydeviceinaccordancewiththissectionshallnotbeconsideredthepractice
73ofmedicine.Theimmunityfromliabilityprovidedunderthissubsectionisinadditiontoand
74notinlieuofthatprovidedundersection537.037.Anauthorizedentitylocatedinthisstate
75shallnotbeliableforanyinjuriesorrelateddamagesthatresultfromtheprovisionor
76administrationofanepinephrine[auto-injector] deliverydevicebyitsemployeesoragents
77outsideofthisstateiftheentityoritsemployeeoragentisnotliableforsuchinjuriesor
78relateddamagesunderthelawsofthestateinwhichsuchprovisionoradministration
79occurred.Notrainedpersonwhoisincompliancewiththissectionandwhoingoodfaithand
80exercisingreasonablecarefailstoadministeranepinephrine[auto-injector] deliverydevice
81shallbeliableforsuchfailure.
82 8.Allbasiclifesupportambulancesandstretchervansoperatedinthestateshallbe
83equippedwithepinephrine[auto-injectors] deliverydevicesandbestaffedbyatleastone
84individualtrainedintheuseofepinephrine[auto-injectors] deliverydevices.
85 9.Theprovisionsofthissectionshallapplyinallcountieswithinthestateandany
86citynotwithinacounty.
87 10.Nothinginthissectionshallbeconstruedassupersedingtheprovisionsofsection
88167.630.
206.110.1.Ahospitaldistrict,bothwithinandoutsidesuchdistrict,exceptin
2countiesofthethirdorfourthclassification(otherthanwithinthedistrictboundaries)where
3therealreadyexistsahospitalorganizedpursuantto[chapters96,205or]thischapter;
4provided,however,thatthisexceptionshallnotprohibitthecontinuationorexpansionof
5existingactivitiesotherwiseallowedbylaw,shallhaveandexercisethefollowing
6governmentalpowers,andallotherpowersincidental,necessary,convenientordesirable
7tocarryoutandeffectuatetheexpresspowers:
8 (1)Toestablishandmaintainahospitalorhospitalsandhospitalfacilities,andto
9construct,acquire,develop,expand,extendandimproveanysuchhospitalorhospitalfacility
10includingmedicalofficebuildingstoprovideofficesforrentaltophysiciansanddentistson
11thedistricthospital'smedicalordentalstaff,andtheprovidingofsitestherefor,including
12offstreetparkingspaceformotorvehicles;
13 (2)Toacquirelandinfeesimple,rightsinlandandeasementsupon,overoracross
14landandleaseholdinterestinlandandtangibleandintangiblepersonalpropertyusedor
15usefulforthelocation,establishment,maintenance,development,expansion,extensionor
HCSSSSB7 28 16improvementofanyhospitalorhospitalfacility.Theacquisitionmaybebydedication,
17purchase,gift,agreement,lease,useoradversepossessionorbycondemnation;
18 (3)Tooperate,maintainandmanageahospitalandhospitalfacilities,andtomake
19andenterintocontracts,fortheuse,operationormanagementofahospitalorhospital
20facilities;toengageinhealthcareactivities;andtomakeandenterintoleasesofequipment
21andrealproperty,ahospitalorhospitalfacilities,aslessororlessee,regardlessoftheduration
22ofsuchlease;andtoproviderulesandregulationsfortheoperation,managementoruseofa
23hospitalorhospitalfacilities.Anyagreemententeredintopursuanttothissubsection
24pertainingtotheleaseofthehospitalshallhaveadefiniteterminationdateasnegotiatedby
25theparties,butthisshallnotprecludethetrusteesfromenteringintoarenewalofthe
26agreementwiththesameorotherpartiespertainingtothesameorothersubjectsuponsuch
27termsandconditionsasthepartiesmayagree;
28 (4)Tofix,chargeandcollectreasonablefeesandcompensationfortheuseor
29occupancyofthehospitaloranypartthereof,oranyhospitalfacility,andfornursingcare,
30medicine,attendance,orotherservicesfurnishedbythehospitalorhospitalfacilities,
31accordingtotherulesandregulationsprescribedbytheboardfromtimetotime;
32 (5)Toborrowmoneyandtoissuebonds,notes,certificates,orotherevidencesof
33indebtednessforthepurposeofaccomplishinganyofitscorporatepurposes,subjectto
34compliancewithanyconditionorlimitationsetforthinthischapterorotherwiseprovidedby
35theConstitutionofthestateofMissouri;
36 (6)Toemployorenterintocontractsfortheemploymentofanyperson,firm,or
37corporation,andforprofessionalservices,necessaryordesirablefortheaccomplishmentof
38thecorporateobjectsofthedistrictortheproperadministration,management,protectionor
39controlofitsproperty;
40 (7)Tomaintainthehospitalforthebenefitoftheinhabitantsoftheareacomprising
41thedistrictwhoaresick,injured,ormaimedregardlessofrace,creedorcolor,andtoadopt
42suchreasonablerulesandregulationsasmaybenecessarytorendertheuseofthehospitalof
43thegreatestbenefittothegreatestnumber;toexcludefromtheuseofthehospitalallpersons
44whowillfullydisregardanyoftherulesandregulationssoestablished;toextendthe
45privilegesanduseofthehospitaltopersonsresidingoutsidetheareaofthedistrictuponsuch
46termsandconditionsastheboardofdirectorsprescribesbyitsrulesandregulations;
47 (8)Topoliceitspropertyandtoexercisepolicepowersinrespecttheretoorinrespect
48totheenforcementofanyruleorregulationprovidedbytheordinancesofthedistrictandto
49employandcommissionpoliceofficersandotherqualifiedpersonstoenforcethesame;
50 (9)Toleasetoorallowforanyinstitutionofhighereducationtouseoroccupythe
51hospital,anyrealestateorfacilityownedorleasedbythedistrictoranypartthereofforthe
52purposeofhealthcare-relatedandgeneraleducationortraining.
HCSSSSB7 29 53 2.Theuseofanyhospitalorhospitalfacilityofadistrictshallbesubjecttothe
54reasonableregulationandcontrolofthedistrictanduponsuchreasonabletermsand
55conditionsasshallbeestablishedbyitsboardofdirectors.
56 3.Aregulatoryordinanceofadistrictadoptedunderanyprovisionofthissection
57mayprovideforasuspensionorrevocationofanyrightsorprivilegeswithinthecontrolof
58thedistrictforaviolationofanysuchregulatoryordinance.
59 4.Nothinginthissectionorinotherprovisionsofthischaptershallbeconstruedto
60authorizethedistrictorboardtoestablishorenforceanyregulationorruleinrespectto
61hospitalizationortheoperationormaintenanceofsuchhospitaloranyhospitalfacilities
62withinitsjurisdictionwhichisinconflictwithanyfederalorstatelaworregulation
63applicabletothesamesubjectmatter.
206.158.1.Theboardofdirectorsofanyhospitaldistrictauthorizedunder
2subsection2ofthissection,andestablishedandorganizedundertheprovisionsofthis
3chapter:
4 (1)Mayinvestuptofiftypercentofits"availablefunds",definedinthissection
5asfundsnotrequiredforimmediatedisbursementinobligationsorfortheoperationof
6thehospitaldistrict,into:
7 (a)Anymutualfundsthatinvestinstocks,bonds,orrealestate,orany
8combinationthereof;
9 (b)Bondsthathave:
10 a.Oneofthefivehighestlong-termratingsorthehighestshort-termrating
11issuedbyanationallyrecognizedratingagency;and
12 b.Afinalmaturityoftenyearsorless;
13 (c)Moneymarketinvestments;or
14 (d)Anycombinationofinvestmentsdescribedinparagraphs(a)to(c)ofthis
15subdivision;and
16 (2)Shallinvesttheremainingpercentageofanyavailablefundsnotinvestedas
17allowedundersubdivision(1)ofthissubsectionintoanyinvestmentinwhichthestate
18treasurerisallowedtoinvest.
19 2.Theprovisionsofthissectionshallapplyonlyifthehospitaldistrictreceives
20lessthanthreepercentofitsannualrevenuesfromhospitaldistrictorstatetaxes.
208.152.1.MOHealthNetpaymentsshallbemadeonbehalfofthoseeligibleneedy
2personsasdescribedinsection208.151whoareunabletoprovideforitinwholeorinpart,
3withanypaymentstobemadeonthebasisofthereasonablecostofthecareorreasonable
4chargefortheservicesasdefinedanddeterminedbytheMOHealthNetdivision,unless
5otherwisehereinafterprovided,forthefollowing:
HCSSSSB7 30 6 (1)Inpatienthospitalservices,excepttopersonsinaninstitutionformentaldiseases
7whoareundertheageofsixty-fiveyearsandovertheageoftwenty-oneyears;providedthat
8theMOHealthNetdivisionshallprovidethroughruleandregulationanexceptionprocessfor
9coverageofinpatientcostsinthosecasesrequiringtreatmentbeyondtheseventy-fifth
10percentileprofessionalactivitiesstudy(PAS)ortheMOHealthNetchildren'sdiagnosis
11length-of-stayschedule;andprovidedfurtherthattheMOHealthNetdivisionshalltakeinto
12accountthroughitspaymentsystemforhospitalservicesthesituationofhospitalswhich
13serveadisproportionatenumberoflow-incomepatients;
14 (2)Alloutpatienthospitalservices,paymentstherefortobeinamountswhich
15representnomorethaneightypercentofthelesserofreasonablecostsorcustomarycharges
16forsuchservices,determinedinaccordancewiththeprinciplessetforthinTitleXVIIIAand
17B,PublicLaw89-97,1965amendmentstothefederalSocialSecurityAct(42U.S.C.Section
18301,etseq.),buttheMOHealthNetdivisionmayevaluateoutpatienthospitalservices
19renderedunderthissectionanddenypaymentforserviceswhicharedeterminedbytheMO
20HealthNetdivisionnottobemedicallynecessary,inaccordancewithfederallawand
21regulations;
22 (3)LaboratoryandX-rayservices;
23 (4)Nursinghomeservicesforparticipants,excepttopersonswithmorethanfive
24hundredthousanddollarsequityintheirhomeorexceptforpersonsinaninstitutionfor
25mentaldiseaseswhoareundertheageofsixty-fiveyears,whenresidinginahospitallicensed
26bythedepartmentofhealthandseniorservicesoranursinghomelicensedbythedepartment
27ofhealthandseniorservicesorappropriatelicensingauthorityofotherstatesorgovernment-
28ownedand-operatedinstitutionswhicharedeterminedtoconformtostandardsequivalentto
29licensingrequirementsinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section
30[301,] 1396etseq.),asamended,fornursingfacilities.TheMOHealthNetdivisionmay
31recognizethroughitspaymentmethodologyfornursingfacilitiesthosenursingfacilities
32whichserveahighvolumeofMOHealthNetpatients.TheMOHealthNetdivisionwhen
33determiningtheamountofthebenefitpaymentstobemadeonbehalfofpersonsunderthe
34ageoftwenty-oneinanursingfacilitymayconsidernursingfacilitiesfurnishingcareto
35personsundertheageoftwenty-oneasaclassificationseparatefromothernursingfacilities;
36 (5)Nursinghomecostsforparticipantsreceivingbenefitpaymentsundersubdivision
37(4)ofthissubsectionforthosedays,whichshallnotexceedtwelveperanyperiodofsix
38consecutivemonths,duringwhichtheparticipantisonatemporaryleaveofabsencefromthe
39hospitalornursinghome,providedthatnosuchparticipantshallbeallowedatemporary
40leaveofabsenceunlessitisspecificallyprovidedforinhisorherplanofcare.Asusedin
41thissubdivision,theterm"temporaryleaveofabsence"shallincludeallperiodsoftime
HCSSSSB7 31 42duringwhichaparticipantisawayfromthehospitalornursinghomeovernightbecauseheor
43sheisvisitingafriendorrelative;
44 (6)Physicians'services,whetherfurnishedintheoffice,home,hospital,nursing
45home,orelsewhere,provided,thatnofundsshallbeexpendedtoanyabortionfacility,as
46definedinsection188.015,ortoanyaffiliate,asdefinedinsection188.015,ofsuchabortion
47facility;
48 (7)Subjecttoappropriation,uptotwentyvisitsperyearforserviceslimitedto
49examinations,diagnoses,adjustments,andmanipulationsandtreatmentsofmalpositioned
50articulationsandstructuresofthebodyprovidedbylicensedchiropracticphysicians
51practicingwithintheirscopeofpractice.Nothinginthissubdivisionshallbeinterpretedto
52otherwiseexpandMOHealthNetservices;
53 (8)Drugsandmedicineswhenprescribedbyalicensedphysician,dentist,podiatrist,
54oranadvancedpracticeregisterednurse;exceptthatnopaymentfordrugsandmedicines
55prescribedonandafterJanuary1,2006,byalicensedphysician,dentist,podiatrist,oran
56advancedpracticeregisterednursemaybemadeonbehalfofanypersonwhoqualifiesfor
57prescriptiondrugcoverageundertheprovisionsofP.L.108-173;
58 (9)Emergencyambulanceservicesand,effectiveJanuary1,1990,medically
59necessarytransportationtoscheduled,physician-prescribednonelectivetreatments;
60 (10)Earlyandperiodicscreeninganddiagnosisofindividualswhoareundertheage
61oftwenty-onetoascertaintheirphysicalormentaldefects,andhealthcare,treatment,and
62othermeasurestocorrectoramelioratedefectsandchronicconditionsdiscoveredthereby.
63SuchservicesshallbeprovidedinaccordancewiththeprovisionsofSection6403ofP.L.
64101-239andfederalregulationspromulgatedthereunder;
65 (11)Homehealthcareservices;
66 (12)Familyplanningasdefinedbyfederalrulesandregulations;provided,thatno
67fundsshallbeexpendedtoanyabortionfacility,asdefinedinsection188.015,ortoany
68affiliate,asdefinedinsection188.015,ofsuchabortionfacility;andfurtherprovided,
69however,thatsuchfamilyplanningservicesshallnotincludeabortionsoranyabortifacient
70drugordevicethatisusedforthepurposeofinducinganabortionunlesssuchabortionsare
71certifiedinwritingbyaphysiciantotheMOHealthNetagencythat,inthephysician's
72professionaljudgment,thelifeofthemotherwouldbeendangeredifthefetuswerecarriedto
73term;
74 (13)Inpatientpsychiatrichospitalservicesforindividualsunderagetwenty-oneas
75definedinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396d,etseq.);
76 (14)Outpatientsurgicalprocedures,includingpresurgicaldiagnosticservices
77performedinambulatorysurgicalfacilitieswhicharelicensedbythedepartmentofhealth
78andseniorservicesofthestateofMissouri;except,thatsuchoutpatientsurgicalservicesshall
HCSSSSB7 32 79notincludepersonswhoareeligibleforcoverageunderPartBofTitleXVIII,PublicLaw89-
8097,1965amendmentstothefederalSocialSecurityAct,asamended,ifexclusionofsuch
81personsispermittedunderTitleXIX,PublicLaw89-97,1965amendmentstothefederal
82SocialSecurityAct,asamended;
83 (15)Personalcareserviceswhicharemedicallyorientedtaskshavingtodowitha
84person'sphysicalrequirements,asopposedtohousekeepingrequirements,whichenablea
85persontobetreatedbyhisorherphysicianonanoutpatientratherthanonaninpatientor
86residentialbasisinahospital,intermediatecarefacility,orskillednursingfacility.Personal
87careservicesshallberenderedbyanindividualnotamemberoftheparticipant'sfamilywho
88isqualifiedtoprovidesuchserviceswheretheservicesareprescribedbyaphysicianin
89accordancewithaplanoftreatmentandaresupervisedbyalicensednurse.Personseligible
90toreceivepersonalcareservicesshallbethosepersonswhowouldotherwiserequire
91placementinahospital,intermediatecarefacility,orskillednursingfacility.Benefitspayable
92forpersonalcareservicesshallnotexceedforanyoneparticipantonehundredpercentofthe
93averagestatewidechargeforcareandtreatmentinanintermediatecarefacilityfora
94comparableperiodoftime.Suchservices,whendeliveredinaresidentialcarefacilityor
95assistedlivingfacilitylicensedunderchapter198,shallbeauthorizedonatierlevelbasedon
96theservicestheresidentrequiresandthefrequencyoftheservices.Aresidentofsuchfacility
97whoqualifiesforassistanceundersection208.030shall,ataminimum,ifprescribedbya
98physician,qualifyforthetierlevelwiththefewestservices.Theratepaidtoprovidersfor
99eachtierofserviceshallbesetsubjecttoappropriations.Subjecttoappropriations,each
100residentofsuchfacilitywhoqualifiesforassistanceundersection208.030andmeetsthe
101levelofcarerequiredinthissectionshall,ataminimum,ifprescribedbyaphysician,be
102authorizeduptoonehourofpersonalcareservicesperday.Authorizedunitsofpersonalcare
103servicesshallnotbereducedortierlevelloweredunlessanorderapprovingsuchreductionor
104loweringisobtainedfromtheresident'spersonalphysician.Suchauthorizedunitsofpersonal
105careservicesortierlevelshallbetransferredwithsuchresidentifheorshetransfersto
106anothersuchfacility.Suchprovisionshallterminateuponreceiptofrelevantwaiversfrom
107thefederalDepartmentofHealthandHumanServices.IftheCentersforMedicareand
108MedicaidServicesdeterminesthatsuchprovisiondoesnotcomplywiththestateplan,this
109provisionshallbenullandvoid.TheMOHealthNetdivisionshallnotifytherevisorof
110statutesastowhethertherelevantwaiversareapprovedoradeterminationofnoncompliance
111ismade;
112 (16)Mentalhealthservices.Thestateplanforprovidingmedicalassistanceunder
113TitleXIXoftheSocialSecurityAct,42U.S.C.Section[301]1396etseq.,asamended,shall
114includethefollowingmentalhealthserviceswhensuchservicesareprovidedbycommunity
115mentalhealthfacilitiesoperatedbythedepartmentofmentalhealthordesignatedbythe
HCSSSSB7 33 116departmentofmentalhealthasacommunitymentalhealthfacilityorasanalcoholanddrug
117abusefacilityorasachild-servingagencywithinthecomprehensivechildren'smentalhealth
118servicesystemestablishedinsection630.097.Thedepartmentofmentalhealthshall
119establishbyadministrativerulethedefinitionandcriteriafordesignationasacommunity
120mentalhealthfacilityandfordesignationasanalcoholanddrugabusefacility.Suchmental
121healthservicesshallinclude:
122 (a)Outpatientmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
123rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
124settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
125established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
126apartofclientservicesmanagement;
127 (b)Clinicmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
128rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
129settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
130established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
131apartofclientservicesmanagement;
132 (c)Rehabilitativementalhealthandalcoholanddrugabuseservicesincludinghome
133andcommunity-basedpreventive,diagnostic,therapeutic,rehabilitative,andpalliative
134interventionsrenderedtoindividualsinanindividualorgroupsettingbyamentalhealth
135oralcoholanddrugabuseprofessionalinaccordancewithaplanoftreatmentappropriately
136established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
137apartofclientservicesmanagement.Asusedinthissection,mentalhealthprofessionaland
138alcoholanddrugabuseprofessionalshallbedefinedbythedepartmentofmentalhealth
139pursuanttodulypromulgatedrules.Withrespecttoservicesestablishedbythissubdivision,
140thedepartmentofsocialservices,MOHealthNetdivision,shallenterintoanagreementwith
141thedepartmentofmentalhealth.Matchingfundsforoutpatientmentalhealthservices,clinic
142mentalhealthservices,andrehabilitationservicesformentalhealthandalcoholanddrug
143abuseshallbecertifiedbythedepartmentofmentalhealthtotheMOHealthNetdivision.
144Theagreementshallestablishamechanismforthejointimplementationoftheprovisionsof
145thissubdivision.Inaddition,theagreementshallestablishamechanismbywhichratesfor
146servicesmaybejointlydeveloped;
147 (17)SuchadditionalservicesasdefinedbytheMOHealthNetdivisiontobe
148furnishedunderwaiversoffederalstatutoryrequirementsasprovidedforandauthorizedby
149thefederalSocialSecurityAct(42U.S.C.Section301,etseq.)subjecttoappropriationbythe
150generalassembly;
HCSSSSB7 34 151 (18)Theservicesofanadvancedpracticeregisterednursewithacollaborative
152practiceagreementtotheextentthatsuchservicesareprovidedinaccordancewithchapters
153334and335,andregulationspromulgatedthereunder;
154 (19)Nursinghomecostsforparticipantsreceivingbenefitpaymentsunder
155subdivision(4)ofthissubsectiontoreserveabedfortheparticipantinthenursinghome
156duringthetimethattheparticipantisabsentduetoadmissiontoahospitalforserviceswhich
157cannotbeperformedonanoutpatientbasis,subjecttotheprovisionsofthissubdivision:
158 (a)Theprovisionsofthissubdivisionshallapplyonlyif:
159 a.Theoccupancyrateofthenursinghomeisatoraboveninety-sevenpercentofMO
160HealthNetcertifiedlicensedbeds,accordingtothemostrecentquarterlycensusprovidedto
161thedepartmentofhealthandseniorserviceswhichwastakenpriortowhentheparticipantis
162admittedtothehospital;and
163 b.Thepatientisadmittedtoahospitalforamedicalconditionwithananticipated
164stayofthreedaysorless;
165 (b)Thepaymenttobemadeunderthissubdivisionshallbeprovidedforamaximum
166ofthreedaysperhospitalstay;
167 (c)Foreachdaythatnursinghomecostsarepaidonbehalfofaparticipantunderthis
168subdivisionduringanyperiodofsixconsecutivemonthssuchparticipantshall,duringthe
169sameperiodofsixconsecutivemonths,beineligibleforpaymentofnursinghomecostsof
170twootherwiseavailabletemporaryleaveofabsencedaysprovidedundersubdivision(5)of
171thissubsection;and
172 (d)Theprovisionsofthissubdivisionshallnotapplyunlessthenursinghome
173receivesnoticefromtheparticipantortheparticipant'sresponsiblepartythattheparticipant
174intendstoreturntothenursinghomefollowingthehospitalstay.Ifthenursinghomereceives
175suchnotificationandallotherprovisionsofthissubsectionhavebeensatisfied,thenursing
176homeshallprovidenoticetotheparticipantortheparticipant'sresponsiblepartypriorto
177releaseofthereservedbed;
178 (20)Prescribedmedicallynecessarydurablemedicalequipment.Anelectronicweb-
179basedpriorauthorizationsystemusingbestmedicalevidenceandcareandtreatment
180guidelinesconsistentwithnationalstandardsshallbeusedtoverifymedicalneed;
181 (21)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
182coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
183inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
184medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
185physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
186psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
187stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
HCSSSSB7 35 188participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
189paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
190nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
191rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
192facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
193(OmnibusBudgetReconciliationActof1989);
194 (22)Prescribedmedicallynecessarydentalservices.Suchservicesshallbesubjectto
195appropriations.Anelectronicweb-basedpriorauthorizationsystemusingbestmedical
196evidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshallbeusedto
197verifymedicalneed;
198 (23)Prescribedmedicallynecessaryoptometricservices.Suchservicesshallbe
199subjecttoappropriations.Anelectronicweb-basedpriorauthorizationsystemusingbest
200medicalevidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshall
201beusedtoverifymedicalneed;
202 (24)Bloodclottingproducts-relatedservices.Forpersonsdiagnosedwithableeding
203disorder,asdefinedinsection338.400,reliantonbloodclottingproducts,asdefinedin
204section338.400,suchservicesinclude:
205 (a)Homedeliveryofbloodclottingproductsandancillaryinfusionequipmentand
206supplies,includingtheemergencydeliveriesoftheproductwhenmedicallynecessary;
207 (b)Medicallynecessaryancillaryinfusionequipmentandsuppliesrequiredto
208administerthebloodclottingproducts;and
209 (c)Assessmentsconductedintheparticipant'shomebyapharmacist,nurse,orlocal
210homehealthcareagencytrainedinbleedingdisorderswhendeemednecessarybythe
211participant'streatingphysician;
212 (25)Medicallynecessarycochlearimplantsandhearinginstruments,asdefined
213insection345.015,thatare:
214 (a)Prescribedbyanaudiologist,asdefinedinsection345.015;or
215 (b)Dispensedbyahearinginstrumentspecialist,asdefinedinsection346.010;
216 (26)TheMOHealthNetdivisionshall,byJanuary1,2008,andannuallythereafter,
217reportthestatusofMOHealthNetproviderreimbursementratesascomparedtoonehundred
218percentoftheMedicarereimbursementratesandcomparedtotheaveragedental
219reimbursementratespaidbythird-partypayorslicensedbythestate.TheMOHealthNet
220divisionshall,byJuly1,2008,providetothegeneralassemblyafour-yearplantoachieve
221paritywithMedicarereimbursementratesandforthird-partypayoraveragedental
222reimbursementrates.Suchplanshallbesubjecttoappropriationandthedivisionshall
223includeinitsannualbudgetrequesttothegovernorthenecessaryfundingneededtocomplete
224thefour-yearplandevelopedunderthissubdivision.
HCSSSSB7 36 225 2.Additionalbenefitpaymentsformedicalassistanceshallbemadeonbehalfof
226thoseeligibleneedychildren,pregnantwomenandblindpersonswithanypaymentstobe
227madeonthebasisofthereasonablecostofthecareorreasonablechargefortheservicesas
228definedanddeterminedbytheMOHealthNetdivision,unlessotherwisehereinafterprovided,
229forthefollowing:
230 (1)Dentalservices;
231 (2)Servicesofpodiatristsasdefinedinsection330.010;
232 (3)Optometricservicesasdescribedinsection336.010;
233 (4)Orthopedicdevicesorotherprosthetics,includingeyeglasses,dentures,[hearing
234aids,] andwheelchairs;
235 (5)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
236coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
237inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
238medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
239physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
240psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
241stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
242participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
243paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
244nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
245rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
246facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
247(OmnibusBudgetReconciliationActof1989);
248 (6)Comprehensivedayrehabilitationservicesbeginningearlyposttraumaaspartofa
249coordinatedsystemofcareforindividualswithdisablingimpairments.Rehabilitation
250servicesmustbebasedonanindividualized,goal-oriented,comprehensiveandcoordinated
251treatmentplandeveloped,implemented,andmonitoredthroughaninterdisciplinary
252assessmentdesignedtorestoreanindividualtoanoptimallevelofphysical,cognitive,and
253behavioralfunction.TheMOHealthNetdivisionshallestablishbyadministrativerulethe
254definitionandcriteriafordesignationofacomprehensivedayrehabilitationservicefacility,
255benefitlimitationsandpaymentmechanism.Anyruleorportionofarule,asthattermis
256definedinsection536.010,thatiscreatedundertheauthoritydelegatedinthissubdivision
257shallbecomeeffectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsof
258chapter536and,ifapplicable,section536.028.Thissectionandchapter536are
259nonseverableandifanyofthepowersvestedwiththegeneralassemblypursuanttochapter
260536toreview,todelaytheeffectivedate,ortodisapproveandannularulearesubsequently
HCSSSSB7 37 261heldunconstitutional,thenthegrantofrulemakingauthorityandanyruleproposedor
262adoptedafterAugust28,2005,shallbeinvalidandvoid.
263 3.TheMOHealthNetdivisionmayrequireanyparticipantreceivingMOHealthNet
264benefitstopaypartofthechargeorcostuntilJuly1,2008,andanadditionalpaymentafter
265July1,2008,asdefinedbyruledulypromulgatedbytheMOHealthNetdivision,forall
266coveredservicesexceptforthoseservicescoveredundersubdivisions(15)and(16)of
267subsection1ofthissectionandsections208.631to208.657totheextentandinthemanner
268authorizedbyTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396,etseq.)
269andregulationsthereunder.Whensubstitutionofagenericdrugispermittedbytheprescriber
270accordingtosection338.056,andagenericdrugissubstitutedforaname-branddrug,the
271MOHealthNetdivisionmaynotlowerordeletetherequirementtomakeaco-payment
272pursuanttoregulationsofTitleXIXofthefederalSocialSecurityAct.Aproviderofgoods
273orservicesdescribedunderthissectionmustcollectfromallparticipantstheadditional
274paymentthatmayberequiredbytheMOHealthNetdivisionunderauthoritygrantedherein,
275ifthedivisionexercisesthatauthority,toremaineligibleasaprovider.Anypaymentsmade
276byparticipantsunderthissectionshallbeinadditiontoandnotinlieuofpaymentsmadeby
277thestateforgoodsorservicesdescribedhereinexcepttheparticipantportionofthepharmacy
278professionaldispensingfeeshallbeinadditiontoandnotinlieuofpaymentstopharmacists.
279Aprovidermaycollecttheco-paymentatthetimeaserviceisprovidedoratalaterdate.A
280providershallnotrefusetoprovideaserviceifaparticipantisunabletopayarequired
281payment.Ifitistheroutinebusinesspracticeofaprovidertoterminatefutureservicestoan
282individualwithanunclaimeddebt,theprovidermayincludeuncollectedco-paymentsunder
283thispractice.Providerswhoelectnottoundertaketheprovisionofservicesbasedona
284historyofbaddebtshallgiveparticipantsadvancenoticeandareasonableopportunityfor
285payment.Aprovider,representative,employee,independentcontractor,oragentofa
286pharmaceuticalmanufacturershallnotmakeco-paymentforaparticipant.Thissubsection
287shallnotapplytootherqualifiedchildren,pregnantwomen,orblindpersons.IftheCenters
288forMedicareandMedicaidServicesdoesnotapprovetheMOHealthNetstateplan
289amendmentsubmittedbythedepartmentofsocialservicesthatwouldallowaproviderto
290denyfutureservicestoanindividualwithuncollectedco-payments,thedenialofservices
291shallnotbeallowed.Thedepartmentofsocialservicesshallinformprovidersregardingthe
292acceptabilityofdenyingservicesastheresultofunpaidco-payments.
293 4.TheMOHealthNetdivisionshallhavetherighttocollectmedicationsamplesfrom
294participantsinordertomaintainprogramintegrity.
295 5.Reimbursementforobstetricalandpediatricservicesundersubdivision(6)of
296subsection1ofthissectionshallbetimelyandsufficienttoenlistenoughhealthcare
297providerssothatcareandservicesareavailableunderthestateplanforMOHealthNet
HCSSSSB7 38 298benefitsatleasttotheextentthatsuchcareandservicesareavailabletothegeneral
299populationinthegeographicarea,asrequiredundersubparagraph(a)(30)(A)of42U.S.C.
300Section1396aandfederalregulationspromulgatedthereunder.
301 6.BeginningJuly1,1990,reimbursementforservicesrenderedinfederallyfunded
302healthcentersshallbeinaccordancewiththeprovisionsofsubsection6402(c)andSection
3036404ofP.L.101-239(OmnibusBudgetReconciliationActof1989)andfederalregulations
304promulgatedthereunder.
305 7.BeginningJuly1,1990,thedepartmentofsocialservicesshallprovidenotification
306andreferralofchildrenbelowagefive,andpregnant,breast-feeding,orpostpartumwomen
307whoaredeterminedtobeeligibleforMOHealthNetbenefitsundersection208.151tothe
308specialsupplementalfoodprogramsforwomen,infantsandchildrenadministeredbythe
309departmentofhealthandseniorservices.Suchnotificationandreferralshallconformtothe
310requirementsofSection6406ofP.L.101-239andregulationspromulgatedthereunder.
311 8.Providersoflong-termcareservicesshallbereimbursedfortheircostsin
312accordancewiththeprovisionsofSection1902(a)(13)(A)oftheSocialSecurityAct,42
313U.S.C.Section1396a,asamended,andregulationspromulgatedthereunder.
314 9.Reimbursementratestolong-termcareproviderswithrespecttoatotalchangein
315ownership,atarm'slength,foranyfacilitypreviouslylicensedandcertifiedforparticipation
316intheMOHealthNetprogramshallnotincreasepaymentsinexcessoftheincreasethat
317wouldresultfromtheapplicationofSection1902(a)(13)(C)oftheSocialSecurityAct,42
318U.S.C.Section1396a(a)(13)(C).
319 10.TheMOHealthNetdivisionmayenrollqualifiedresidentialcarefacilitiesand
320assistedlivingfacilities,asdefinedinchapter198,asMOHealthNetpersonalcareproviders.
321 11.Anyincomeearnedbyindividualseligibleforcertifiedextendedemploymentata
322shelteredworkshopunderchapter178shallnotbeconsideredasincomeforpurposesof
323determiningeligibilityunderthissection.
324 12.IftheMissouriMedicaidauditandcomplianceunitchangesanyinterpretationor
325applicationoftherequirementsforreimbursementforMOHealthNetservicesfromthe
326interpretationorapplicationthathasbeenappliedpreviouslybythestateinanyauditofaMO
327HealthNetprovider,theMissouriMedicaidauditandcomplianceunitshallnotifyallaffected
328MOHealthNetprovidersfivebusinessdaysbeforesuchchangeshalltakeeffect.Failureof
329theMissouriMedicaidauditandcomplianceunittonotifyaproviderofsuchchangeshall
330entitletheprovidertocontinuetoreceiveandretainreimbursementuntilsuchnotificationis
331providedandshallwaiveanyliabilityofsuchproviderforrecoupmentorotherlossofany
332paymentspreviouslymadepriortothefivebusinessdaysaftersuchnoticehasbeensent.
333EachprovidershallprovidetheMissouriMedicaidauditandcomplianceunitavalidemail
334addressandshallagreetoreceivecommunicationselectronically.Thenotificationrequired
HCSSSSB7 39 335underthissectionshallbedeliveredinwritingbytheUnitedStatesPostalServiceor
336electronicmailtoeachprovider.
337 13.Nothinginthissectionshallbeconstruedtoabrogateorlimitthedepartment's
338statutoryrequirementtopromulgaterulesunderchapter536.
339 14.BeginningJuly1,2016,andsubjecttoappropriations,providersofbehavioral,
340social,andpsychophysiologicalservicesfortheprevention,treatment,ormanagementof
341physicalhealthproblemsshallbereimbursedutilizingthebehaviorassessmentand
342interventionreimbursementcodes96150to96154ortheirsuccessorcodesunderthe
343CurrentProceduralTerminology(CPT)codingsystem.Providerseligibleforsuch
344reimbursementshallincludepsychologists.
345 15.Thereshallbenopaymentsmadeunderthissectionforgendertransition
346surgeries,cross-sexhormones,orpuberty-blockingdrugs,assuchtermsaredefinedinsection
347191.1720,forthepurposeofagendertransition.
210.030.1.Everylicensedphysician,midwife,registerednurseandallpersonswho
2mayundertake,inaprofessionalway,theobstetricalandgynecologicalcareofapregnant
3womaninthestateofMissourishall,ifthewomanconsents,takeorcausetobetakena
4sampleofvenousbloodofsuchwomanatthetimeofthefirstprenatalexamination,ornot
5laterthantwentydaysafterthefirstprenatalexamination,anothersampleattwenty-eight
6weeksofpregnancy,andanothersampleimmediatelyafterbirthandsubjectsuch
7[sample] samplestoanapprovedandstandardserologicaltestforsyphilis[, an]andapproved
8serological[test]testsforhepatitisB,hepatitisC,humanimmunodeficiencyvirus(HIV),
9andsuchothertreatablediseasesandmetabolicdisordersasareprescribedbythedepartment
10ofhealthandseniorservices.[Inanyareaofthestatedesignatedasasyphilisoutbreakarea
11bythedepartmentofhealthandseniorservices,ifthemotherconsents,asampleofher
12venousbloodshallbetakenlaterinthecourseofpregnancyandatdeliveryforadditional
13testingforsyphilisasmaybeprescribedbythedepartment] Ifamothertestspositivefor
14syphilis,hepatitisB,hepatitisC,orHIV,oranycombinationofsuchdiseases,the
15physicianorpersonprovidingcareshalladministertreatmentinaccordancewiththe
16mostrecentacceptedmedicalpractice. IfamothertestspositiveforhepatitisB,the
17physicianorpersonwhoprofessionallyundertakesthepediatriccareofanewbornshallalso
18administertheappropriatedosesofhepatitisBvaccineandhepatitisBimmuneglobulin
19(HBIG)inaccordancewiththecurrentrecommendationsoftheAdvisoryCommitteeon
20ImmunizationPractices(ACIP).Ifthemother'shepatitisBstatusisunknown,theappropriate
21doseofhepatitisBvaccineshallbeadministeredtothenewborninaccordancewiththe
22currentACIPrecommendations.Ifthemotherconsents,asampleofhervenousbloodshall
23betaken.IfshetestspositiveforhepatitisB,hepatitisBimmuneglobulin(HBIG)shallbe
24administeredtothenewborninaccordancewiththecurrentACIPrecommendations.
HCSSSSB7 40 25 2.Thedepartmentofhealthandseniorservicesshall[, inconsultationwiththe
26Missourigeneticdiseaseadvisorycommittee,] makesuchrulespertainingtosuchtestsas
27shallbedictatedbyacceptedmedicalpractice,andtestsshallbeofthetypesapprovedor
28acceptedbythe[departmentofhealthandseniorservices.Anapprovedandstandardtestfor
29syphilis,hepatitisB,andothertreatablediseasesandmetabolicdisordersshallmeanatest
30madeinalaboratoryapprovedbythedepartmentofhealthandseniorservices] UnitedStates
31FoodandDrugAdministration. Noindividualshallbedeniedtestingbythedepartmentof
32healthandseniorservicesbecauseofinabilitytopay.
33 3.Allpersonsprovidingcareunderthissectionshalldosopursuanttothe
34provisionsofsection431.061.
210.225.1.Thissectionshallbeknownandmaybecitedas"Elijah'sLaw".
2 2.(1)BeforeJuly1,2027,eachlicensedchildcareprovidershalladoptapolicy
3onallergypreventionandresponsewithprioritygiventoaddressingpotentiallydeadly
4food-borneallergies.Suchpolicyshallcontain,butshallnotbelimitedto,thefollowing
5elements:
6 (a)Distinguishingbetweenbuilding-wide,room-level,andindividualapproaches
7toallergypreventionandmanagement;
8 (b)Providinganage-appropriateresponsetobuilding-levelandroom-level
9allergyeducationandprevention;
10 (c)Describingtheroleofchildcarefacilitystaffindetermininghowtomanage
11anallergyproblem,whetherthroughaplanpreparedforachildunderSection504of
12theRehabilitationActof1973,asamended,forachildwithanallergythathasbeen
13determinedtobeadisability,anindividualizedhealthplanforachildwhohasan
14allergythatisnotdisabling,oranotherallergymanagementplan;
15 (d)Describingtheroleofotherchildrenandparentsincooperatingtoprevent
16andmitigateallergies;
17 (e)Addressingconfidentialityissuesinvolvedwithsharingmedicalinformation,
18includingspecifyingwhenparentalpermissionisrequiredtomakemedicalinformation
19available;and
20 (f)Coordinatingwiththedepartmentofelementaryandsecondaryeducation,
21localhealthauthorities,andotherappropriateentitiestoensureefficientpromulgation
22ofaccurateinformationandtoensurethatexistingchildcarefacilitysafetyand
23environmentalpoliciesdonotconflict.
24 (2)Suchpoliciesmaycontaininformationfromorlinkstochildcarefacility
25allergypreventioninformationfurnishedbytheFoodAllergyResearch&Education
26organizationorequivalentorganizationwithamedicaladvisoryboardthathasallergy
27specialists.
HCSSSSB7 41 28 3.Thedepartmentofelementaryandsecondaryeducationshall,incooperation
29withanyappropriateprofessionalassociation,developamodelpolicyorpoliciesbefore
30July1,2026.
292.606.1.FeesshallbecollectedforaperiodofsixyearsfromAugust28,[2018]
22025.
3 2.(1)Anyemployerrequiredtoreportundersubsection1ofsection292.605,except
4localgovernmentsandfamily-ownedfarmoperations,shallsubmitanannualfeetothe
5commissionofonehundreddollarsalongwiththeTierIIform.Ownersoroperatorsof
6petroleumretailfacilitiesshallpayafeeofnomorethanfiftydollarsforeachsuchfacility.
7Anyperson,firmorcorporationselling,deliveringortransportingpetroleumorpetroleum
8productsandwhoseprimarybusinessdealswithpetroleumproductsorwhoiscoveredbythe
9provisionsofchapter323,ifsuchperson,firmorcorporationispayingfeesunderthe
10provisionsofthefederalhazardousmaterialstransportationregistrationandfeeassessment
11program,shalldeductsuchfederalfeesfromthosefeesowedtothestateundertheprovisions
12ofthissubsection.Ifthefederalfeesexceedorareequaltowhatwouldotherwisebeowed
13underthissubsection,suchemployershallnotbeliableforstatefeesunderthissubsection.
14Inrelationtopetroleumproducts"primarybusiness"shallmeanthattheperson,firmor
15corporationshallearnmorethanfiftypercentofhazardouschemicalrevenuesfromthesale,
16deliveryortransportofpetroleumproducts.Forthepurposeofcalculatingfees,allgradesof
17gasolineareconsideredtobeoneproduct,allgradesofheatingoils,dieselfuels,kerosenes,
18naphthas,aviationturbinefuel,andallotherheavydistillateproductsexceptforgradesof
19gasolineareconsideredtobeoneproduct,andallvarietiesofmotorlubricatingoilare
20consideredtobeoneproduct.Forthepurposesofthissection"facility"shallmeanall
21buildings,equipment,structuresandotherstationaryitemsthatarelocatedonasinglesiteor
22oncontiguousoradjacentsitesandwhichareownedoroperatedbythesameperson.Ifmore
23thanthreehazardoussubstancesormixturesarereportedontheTierIIform,theemployer
24shallsubmitanadditionaltwenty-dollarfeeforeachhazardoussubstanceormixture.Fees
25collectedunderthissubdivisionshallbeforeachhazardouschemicalonhandatanyonetime
26inexcessoftenthousandpoundsorforextremelyhazardoussubstancesonhandatanyone
27timeinexcessoffivehundredpoundsorthethresholdplanningquantity,whicheverisless,or
28forexplosivesorblastingagentsonhandatanyonetimeinexcessofonehundredpounds.
29However,noemployershallpaymorethantenthousanddollarsperyearinfees.Moneys
30acquiredthroughlitigationandanyadministrativefeespaidpursuanttosubsection3ofthis
31sectionshallnotbeappliedtowardthiscap.
32 (2)Employersengagedintransportinghazardousmaterialsbypipelineexceptlocal
33gasdistributioncompaniesregulatedbytheMissouripublicservicecommissionshallpayto
34thecommissionafeeoftwohundredfiftydollarsforeachcountyinwhichtheyoperate.
HCSSSSB7 42 35 (3)PaymentoffeesisdueeachyearbyMarchfirst.Alatefeeoftenpercentofthe
36totalowed,plusonepercentpermonthofthetotal,maybeassessedbythecommission.
37 (4)If,onMarchfirstofeachyear,feescollectedunderthissectionandnatural
38resourcesdamagesmadeavailablepursuanttosection640.235exceedonemilliondollars,
39anyexcessoveronemilliondollarsshallbeproportionatelycreditedtofeespayableinthe
40succeedingyearbyeachemployerwhowasrequiredtopayafeeandwhodidpayafeeinthe
41yearinwhichtheexcessoccurred.Thelimitofonemilliondollarscontainedhereinshallbe
42reviewedbythecommissionconcurrentwiththereviewoffeesasrequiredinsubsection1of
43thissection.
44 3.BeginningJanuary1,2013,anyemployerfilingitsTierIIformpursuantto
45subsection1ofsection292.605mayrequestthatthecommissiondistributethatemployer's
46TierIIreporttothelocalemergencyplanningcommitteesandfiredepartmentslistedinits
47TierIIreport.AnyemployeroptingtohavethecommissiondistributeitsTierIIreportshall
48payanadditionalfeeoftendollarsforeachfacilitylistedinthereportatthetimeoffilingto
49recoupthecommission'sdistributioncosts.Feesshallbedepositedinthechemical
50emergencypreparednessfundestablishedundersection292.607.Anemployerwhopaysthe
51additionalfeeandwhoseTierIIreportincludesalllocalemergencyplanningcommitteesand
52firedepartmentsrequiredtobenotifiedundersubsection1ofsection292.605shallsatisfythe
53reportingrequirementsofsubsection1ofsection292.605.Thecommissionshalldevelopa
54mechanismforanemployertoexerciseitsoptiontohavethecommissiondistributeitsTierII
55report.
56 4.Localemergencyplanningcommitteesreceivingfundsundersection292.604shall
57coordinatewiththecommissionandthedepartmentinchemicalemergencyplanning,
58training,preparedness,andresponseactivities.Localemergencyplanningcommittees
59receivingfundsunderthissection,section260.394,sections292.602,292.604,292.605,
60292.615andsection640.235shallprovidetothecommissionanannualreportof
61expendituresandactivities.
62 5.Feescollectedbythedepartmentandallfundsprovidedtolocalemergency
63planningcommitteesshallbeusedforchemicalemergencypreparednesspurposesasoutlined
64insections292.600to292.625andthefederalact,includingcontingencyplanningfor
65chemicalreleases;exercising,evaluating,anddistributingplans,providingtrainingrelatedto
66chemicalemergencypreparednessandpreventionofchemicalaccidents;identifyingfacilities
67requiredtoreport;processingtheinformationsubmittedbyfacilitiesandmakingitavailable
68tothepublic;receivingandhandlingemergencynotificationsofchemicalreleases;operating
69alocalemergencyplanningcommittee;andprovidingpublicnoticeofchemicalpreparedness
70activities.Localemergencyplanningcommitteesreceivingfundsunderthissectionmay
HCSSSSB7 43 71combinesuchfundswithotherlocalemergencyplanningcommitteestofurtherthepurposes
72ofsections292.600to292.625,orthefederalact.
73 6.Thecommissionshallestablishcriteriaandguidanceonhowfundsreceivedby
74localemergencyplanningcommitteesmaybeused.
75 7.Aone-timefeeshallbeassessedinaccordancewithsubsection2ofthissection
76andshallbecalculatedbasedonthefilingdueonMarch1,2025,andshallbepaidby
77November1,2025.
301.142.1.Asusedinsections301.141to301.143,thefollowingtermsmean:
2 (1)"Department",thedepartmentofrevenue;
3 (2)"Director",thedirectorofthedepartmentofrevenue;
4 (3)"Otherauthorizedhealthcarepractitioner"includesadvancedpracticeregistered
5nurseslicensedpursuanttochapter335,physicianassistantslicensedpursuanttochapter334,
6chiropractorslicensedpursuanttochapter331,podiatristslicensedpursuanttochapter330,
7assistantphysicians,physicaltherapistslicensedpursuanttochapter334,occupational
8therapistslicensedpursuanttochapter324,andoptometristslicensedpursuanttochapter
9336;
10 (4)"Physicallydisabled",anaturalpersonwhoisblind,asdefinedinsection8.700,
11oranaturalpersonwithmedicaldisabilitieswhichprohibits,limits,orseverelyimpairsone's
12abilitytoambulateorwalk,asdeterminedbyalicensedphysicianorotherauthorizedhealth
13carepractitionerasfollows:
14 (a)Thepersoncannotambulateorwalkfiftyorlessfeetwithoutstoppingtorestdue
15toasevereanddisablingarthritic,neurological,orthopediccondition,orothersevereand
16disablingcondition;or
17 (b)Thepersoncannotambulateorwalkwithouttheuseof,orassistancefrom,a
18brace,cane,crutch,anotherperson,prostheticdevice,wheelchair,orotherassistivedevice;or
19 (c)Isrestrictedbyarespiratoryorotherdiseasetosuchanextentthattheperson's
20forcedrespiratoryexpiratoryvolumeforonesecond,whenmeasuredbyspirometry,isless
21thanoneliter,orthearterialoxygentensionislessthansixtymm/hgonroomairatrest;or
22 (d)Usesportableoxygen;or
23 (e)Hasacardiacconditiontotheextentthattheperson'sfunctionallimitationsare
24classifiedinseverityasclassIIIorclassIVaccordingtostandardssetbytheAmericanHeart
25Association;or
26 (f)Exceptasotherwiseprovidedinsubdivision(3)ofsubsection16ofthissection,a
27person'sage,inandofitself,shallnotbeafactorindeterminingwhethersuchpersonis
28physicallydisabledorisotherwiseentitledtodisabledlicenseplatesand/ordisabled
29windshieldhangingplacardswithinthemeaningofsections301.141to301.143;
30 (5)"Physician",apersonlicensedtopracticemedicinepursuanttochapter334;
HCSSSSB7 44 31 (6)"Physician'sstatement",astatementpersonallysignedbyadulyauthorizedperson
32whichcertifiesthatapersonisdisabledasdefinedinthissection;
33 (7)"Temporarilydisabledperson",adisabledpersonasdefinedinthissectionwhose
34disabilityorincapacityisexpectedtolastnomorethanonehundredeightydays;
35 (8)"Temporarywindshieldplacard",aplacardtobeissuedtopersonswhoare
36temporarilydisabledpersonsasdefinedinthissection,certificationofwhichshallbe
37indicatedonthephysician'sstatement;
38 (9)"Windshieldplacard",aplacardtobeissuedtopersonswhoarephysically
39disabledasdefinedinthissection,certificationofwhichshallbeindicatedonthephysician's
40statement.
41 2.Otherauthorizedhealthcarepractitionersmayfurnishtoadisabledortemporarily
42disabledpersonaphysician'sstatementforonlythosephysicalhealthcareconditionsfor
43whichsuchhealthcarepractitionerislegallyauthorizedtodiagnoseandtreat.
44 3.Aphysician'sstatementshall:
45 (1)Beonaformprescribedbythedirectorofrevenue;
46 (2)Setforththespecificdiagnosisandmedicalconditionwhichrenderstheperson
47physicallydisabledortemporarilydisabledasdefinedinthissection;
48 (3)Includethephysician'sorotherauthorizedhealthcarepractitioner'slicense
49number;and
50 (4)Bepersonallysignedbytheissuingphysicianorotherauthorizedhealthcare
51practitioner.
52 4.Ifitistheprofessionalopinionofthephysicianorotherauthorizedhealthcare
53practitionerissuingthestatementthatthephysicaldisabilityoftheapplicant,user,ormember
54oftheapplicant'shouseholdispermanent,itshallbenotedonthestatement.Otherwise,the
55physicianorotherauthorizedhealthcarepractitionershallnoteonthestatementthe
56anticipatedlengthofthedisability,whichshalldeterminetheexpirationdateforthe
57temporarywindshieldplacard,andwhichperiodshallnotexceedonehundredeightydays.If
58thephysicianorhealthcarepractitionerfailstorecordanexpirationdateonthephysician's
59statement,thedirectorshallissueatemporarywindshieldplacardforaperiodofthirtydays.
60 5.Aphysicianorotherauthorizedhealthcarepractitionerwhoissuesorsignsa
61physician'sstatementsothatdisabledplatesoradisabledwindshieldplacardmaybeobtained
62shallmaintaininsuchdisabledperson'smedicalchartdocumentationthatsuchacertificate
63hasbeenissued,thedatethestatementwassigned,thediagnosisorconditionwhichexisted
64thatqualifiedthepersonasdisabledpursuanttothissectionandshallcontainsufficient
65documentationsoastoobjectivelyconfirmthatsuchconditionexists.
66 6.Themedicalorotherrecordsofthephysicianorotherauthorizedhealthcare
67practitionerwhoissuedaphysician'sstatementshallbeopentoinspectionandreviewbysuch
HCSSSSB7 45 68practitioner'slicensingboard,inordertoverifycompliancewiththissection.Information
69containedwithinsuchrecordsshallbeconfidentialunlessrequiredforprosecution,
70disciplinarypurposes,orotherwiserequiredtobedisclosedbylaw.
71 7.OwnersofmotorvehicleswhoareresidentsofthestateofMissouri,andwhoare
72physicallydisabled,ownersofmotorvehiclesoperatedatleastfiftypercentofthetimebya
73physicallydisabledperson,orownersofmotorvehiclesusedtoprimarilytransportphysically
74disabledmembersoftheowner'shouseholdmayobtaindisabledpersonlicenseplates.Such
75owners,uponapplicationtothedirectoraccompaniedbythedocumentsandfeesprovidedfor
76inthissection,acurrentphysician'sstatementwhichhasbeenissuedwithinninetydays
77proceedingthedatetheapplicationismade,andproofofcompliancewiththestatemotor
78vehiclelawsrelatingtoregistrationandlicensingofmotorvehicles,shallbeissuedmotor
79vehiclelicenseplatesforvehicles,otherthancommercialvehicleswithagrossweightin
80excessoftwenty-fourthousandpounds,uponwhichshallbeinscribedtheinternational
81wheelchairaccessibilitysymbolandtheword"DISABLED"inadditiontoacombinationof
82lettersandnumbers.Suchlicenseplatesshallbemadewithfullyreflectivematerialwitha
83commoncolorschemeanddesign,shallbeclearlyvisibleatnight,andshallbeaesthetically
84attractive,asprescribedbysection301.130.Ifatanytimeanindividualwhoobtained
85disabledlicenseplatesissuedunderthissubsectionnolongeroccupiesaresidencewitha
86physicallydisabledperson,ornolongerownsavehiclethatisoperatedatleastfiftypercent
87ofthetimebyaphysicallydisabledperson,suchindividualshallsurrenderthedisabled
88licenseplatestothedepartmentwithinthirtydaysofbecomingineligiblefortheiruse.
89 8.Thedirectorshallfurtherissue,uponrequest,tosuchapplicantone,andforgood
90causeshown,asthedirectormaydefinebyruleandregulations,notmorethantwo,
91removabledisabledwindshieldhangingplacardsforusewhenthedisabledpersonis
92occupyingavehicleorwhenavehiclenotbearingthepermanenthandicapplateisbeingused
93topickup,deliver,orcollectthephysicallydisabledpersonissuedthedisabledmotorvehicle
94licenseplateordisabledwindshieldhangingplacard.
95 9.Noadditionalfeeshallbepaidtothedirectorfortheissuanceofthespeciallicense
96platesprovidedinthissection,exceptforspecialpersonalizedlicenseplatesandotherlicense
97platesdescribedinthissubsection.Priorityforanyspecificsetofspeciallicenseplatesshall
98begiventotheapplicantwhoreceivedthenumberintheimmediatelyprecedinglicense
99periodsubjecttotheapplicant'scompliancewiththeprovisionsofthissectionandany
100applicablerulesorregulationsissuedbythedirector.Ifdeterminedfeasiblebytheadvisory
101committeeestablishedinsection301.129,anyspeciallicenseplateissuedpursuanttothis
102sectionmaybeadaptedtoalsoincludetheinternationalwheelchairaccessibilitysymboland
103theword"DISABLED"asprescribedinthissectionandsuchplatemaybeissuedtoany
HCSSSSB7 46 104applicantwhomeetstherequirementsofthissectionandtheotherappropriateprovisionof
105thischapter,subjecttotherequirementsandfeesoftheappropriateprovisionofthischapter.
106 10.Anyphysicallydisabledperson,ortheparentorguardianofanysuchperson,or
107anynot-for-profitgroup,organization,orotherentitywhichtransportsmorethanone
108physicallydisabledperson,mayapplytothedirectorofrevenueforaremovablewindshield
109placard.Theplacardmaybeusedinmotorvehicleswhichdonotbearthepermanent
110handicapsymbolonthelicenseplate.Suchplacardsmustbehungfromthefront,middle
111rearviewmirrorofaparkedmotorvehicleandmaynotbehungfromthemirrorduring
112operation.Theseplacardsmayonlybeusedduringtheperiodoftimewhenthevehicleis
113beingusedbyadisabledperson,orwhenthevehicleisbeingusedtopickup,deliver,or
114collectadisabledperson,andshallbesurrenderedtothedepartment,withinthirtydays,ifa
115group,organization,orentitythatobtainedtheremovablewindshieldplacardduetothe
116transportationofmorethanonephysicallydisabledpersonnolongertransportsmorethanone
117disabledperson.Whenthereisnorearviewmirror,theplacardshallbedisplayedonthe
118dashboardonthedriver'sside.
119 11.Theremovablewindshieldplacardshallconformtothespecifications,inrespect
120tosize,color,andcontent,assetforthinfederalregulationspublishedbytheDepartmentof
121Transportation.Theremovablewindshieldplacardshallberenewedeveryfouryears.The
122directormaystaggertheexpirationdatestoequalizeworkload.Onlyoneremovableplacard
123maybeissuedtoanapplicantwhohasbeenissueddisabledpersonlicenseplates.Upon
124request,oneadditionalwindshieldplacardmaybeissuedtoanapplicantwhohasnotbeen
125issueddisabledpersonlicenseplates.
126 12.Atemporarywindshieldplacardshallbeissuedtoanyphysicallydisabledperson,
127ortheparentorguardianofanysuchpersonwhootherwisequalifiesexceptthatthephysical
128disability,intheopinionofthephysician,isnotexpectedtoexceedaperiodofonehundred
129eightydays.Thetemporarywindshieldplacardshallconformtothespecifications,inrespect
130tosize,color,andcontent,assetforthinfederalregulationspublishedbytheDepartmentof
131Transportation.Thefeeforthetemporarywindshieldplacardshallbetwodollars.Upon
132request,andforgoodcauseshown,oneadditionaltemporarywindshieldplacardmaybe
133issuedtoanapplicant.Temporarywindshieldplacardsshallbeissueduponpresentationof
134thephysician'sstatementprovidedbythissectionandshallbedisplayedinthesamemanner
135asremovablewindshieldplacards.Apersonorentityshallbequalifiedtopossessand
136displayatemporaryremovablewindshieldplacardforsixmonthsandtheplacardmaybe
137renewedonceforanadditionalsixmonthsifaphysician'sstatementpursuanttothissectionis
138suppliedtothedirectorofrevenueatthetimeofrenewal.
139 13.Awindshieldplacardshallberenewableonlybythepersonorentitytowhichthe
140placardwasoriginallyissued.Anyplacardissuedpursuanttothissectionshallonlybeused
HCSSSSB7 47 141whenthephysicallydisabledoccupantforwhomthedisabledplateorplacardwasissuedisin
142themotorvehicleatthetimeofparkingorwhenaphysicallydisabledpersonisbeing
143deliveredorcollected.Adisabledlicenseplateand/oraremovablewindshieldhanging
144placardarenottransferableandmaynotbeusedbyanyotherpersonwhetherdisabledornot.
145 14.Atthetimethedisabledplatesorwindshieldhangingplacardsareissued,the
146directorshallissuearegistrationcertificatewhichshallincludetheapplicant'sname,address,
147andotheridentifyinginformationasprescribedbythedirector,orifissuedtoanagency,such
148agency'snameandaddress.Thiscertificateshallfurthercontainthedisabledlicenseplate
149numberor,forwindshieldhangingplacards,theregistrationoridentifyingnumberstamped
150ontheplacard.Thevalidatedregistrationreceiptgiventotheapplicantshallserveasthe
151registrationcertificate.
152 15.Thedirectorshall,uponissuinganydisabledregistrationcertificateforlicense
153platesand/orwindshieldhangingplacards,provideinformationwhichexplainsthatsuch
154platesorwindshieldhangingplacardsarenontransferable,andtherestrictionsexplainingwho
155andwhenapersonorvehiclewhichbearsorhasthedisabledplatesorwindshieldhanging
156placardsmaybeusedorbeparkedinadisabledreservedparkingspace,andthepenalties
157prescribedforviolationsoftheprovisionsofthisact.
158 16.(1)Exceptasotherwiseprovidedinthissubsection,everyapplicantforissuance
159ofadisabledlicenseplateorplacardshallberequiredtopresentanewphysician'sstatement
160datednomorethanninetydayspriortosuchapplication,andforrenewalapplicationsa
161physician'sstatementdatednomorethanninetydayspriortosuchapplicationshallbe
162requiredeveryeighthyear.
163 (2)Notwithstandinganyprovisionoflawtothecontrary,iftheapplicanthas
164presentedproofofdisabilityintheformofastatementfromtheUnitedStatesDepartmentof
165VeteransAffairsverifyingthatthepersonispermanentlydisabled,theapplicantshallnotbe
166requiredtoprovideaphysician'sstatementforthepurposeofissuanceorrenewalofdisabled
167personlicenseplatesorwindshieldplacards.
168 (3)Notwithstandingtheprovisionsofparagraph(f)ofsubdivision(4)ofsubsection1
169ofthissection,anypersonseventy-fiveyearsofageorolderwhoprovidedaphysician's
170statementwiththeoriginalapplicationshallnotberequiredtoprovideaphysician'sstatement
171forthepurposeofrenewalofdisabledpersonlicenseplatesorwindshieldplacards.
172 17.Thedirectorofrevenueuponreceivingaphysician'sstatementpursuanttothis
173subsectionshallcheckwiththestateboardofregistrationforthehealingartscreatedin
174section334.120,ortheMissouristateboardofnursingestablishedinsection335.021,with
175respecttophysician'sstatementssignedbyadvancedpracticeregisterednurses,orthe
176Missouristateboardofchiropracticexaminersestablishedinsection331.090,withrespectto
177physician'sstatementssignedbylicensedchiropractors,orwiththeboardofoptometry
HCSSSSB7 48 178establishedinsection336.130,withrespecttophysician'sstatementssignedbylicensed
179optometrists,orthestateboardofpodiatricmedicinecreatedinsection330.100,withrespect
180tophysician'sstatementssignedbyphysiciansofthefootorpodiatrists, ortheMissouri
181boardofoccupationaltherapyestablishedinsection324.063,withrespecttophysician's
182statementssignedbylicensedoccupationaltherapists,todeterminewhetherthephysician
183isdulylicensedandregisteredpursuanttolaw.
184 18.Theboardsshallcooperatewiththedirectorandshallsupplyinformation
185requestedpursuanttothissubsection.Thedirectorshall,incooperationwiththeboards
186whichshallassistthedirector,establishalistofallMissouriphysiciansandotherauthorized
187healthcarepractitionersandofanyotherinformationnecessarytoadministerthissection.
188 19.Wheretheowner'sapplicationisbasedonthefactthatthevehicleisusedatleast
189fiftypercentofthetimebyaphysicallydisabledperson,theapplicantshallsubmita
190statementstatingthisfact,inadditiontothephysician'sstatement.Thestatementshallbe
191signedbyboththeownerofthevehicleandthephysicallydisabledperson.Theapplicant
192shallberequiredtosubmitthisstatementwitheachapplicationforlicenseplates.Noperson
193shallwillinglyorknowinglysubmitafalsestatementandanysuchfalsestatementshallbe
194consideredperjuryandmaybepunishablepursuanttosection301.420.
195 20.Thedirectorofrevenueshallretainallphysicians'statementsandallother
196documentsreceivedinconnectionwithaperson'sapplicationfordisabledlicenseplatesand/
197ordisabledwindshieldplacards.
198 21.Thedirectorofrevenueshallenterintoreciprocityagreementswithotherstatesor
199thefederalgovernmentforthepurposeofrecognizingdisabledpersonlicenseplatesor
200windshieldplacardsissuedtophysicallydisabledpersons.
201 22.Whenapersontowhomdisabledpersonlicenseplatesoraremovableor
202temporarywindshieldplacardorbothhavebeenissueddies,thepersonalrepresentativeofthe
203decedentorsuchotherpersonwhomaycomeintoorotherwisetakepossessionofthe
204disabledlicenseplatesordisabledwindshieldplacardshallreturnthesametothedirectorof
205revenueunderpenaltyoflaw.Failuretoreturnsuchplatesorplacardsshallconstituteaclass
206Bmisdemeanor.
207 23.Thedirectorofrevenuemayorderanypersonissueddisabledpersonlicense
208platesorwindshieldplacardstosubmittoanexaminationbyachiropractor,osteopath,or
209physician,ortosuchotherinvestigationaswilldeterminewhethersuchpersonqualifiesfor
210thespecialplatesorplacards.
211 24.Ifsuchpersonrefusestosubmitorisfoundtonolongerqualifyforspecialplates
212orplacardsprovidedforinthissection,thedirectorofrevenueshallcollectthespecialplates
213orplacards,andshallfurnishlicenseplatestoreplacetheonescollectedasprovidedbythis
214chapter.
HCSSSSB7 49 215 25.Intheeventaremovableortemporarywindshieldplacardislost,stolen,or
216mutilated,thelawfulholderthereofshall,withinfivedays,filewiththedirectorofrevenuean
217applicationandanaffidavitstatingsuchfact,inordertopurchaseanewplacard.Thefeefor
218thereplacementwindshieldplacardshallbefourdollars.
219 26.Fraudulentapplication,renewal,issuance,procurementoruseofdisabledperson
220licenseplatesorwindshieldplacardsshallbeaclassAmisdemeanor.ItisaclassB
221misdemeanorforaphysician,chiropractor,podiatristoroptometristtocertifythatan
222individualorfamilymemberisqualifiedforalicenseplateorwindshieldplacardbasedona
223disability,thediagnosisofwhichisoutsidetheirscopeofpracticeorifthereisnobasisfor
224thediagnosis.
321.621.1.Forthepurposesofthissection,thefollowingtermsmean:
2 (1)"Epinephrinedeliverydevice",asingle-usedeviceusedforthedeliveryofa
3premeasureddoseofepinephrineintothehumanbody;
4 (2)"Qualifiedfirstresponder"[shallmean], anystateandlocallawenforcement
5agencystaff,firedepartmentpersonnel,firedistrictpersonnel,orlicensedemergencymedical
6technicianwhoisactingunderthedirectivesandestablishedprotocolsofamedicaldirector
7whocomesincontactwithapersonsufferingfromananaphylacticreactionandwhohas
8receivedtraininginrecognizingandrespondingtoanaphylacticreactionsandthe
9administrationofepinephrine[auto-injector] deliverydevicestoapersonsufferingfrom
10anapparentanaphylacticreaction[.];
11 (3)"Qualifiedfirstresponderagencies"[shallmean], anystateorlocallaw
12enforcementagency,firedepartment,orambulanceservicethatprovidesdocumentedtraining
13toitsstaffrelatedtotheadministrationofepinephrine[auto-injector] deliverydevicesinan
14apparentanaphylacticreaction.
15 2.Thedirectorofthedepartmentofhealthandseniorservices,ifalicensed
16physician,mayissueastatewidestandingorderforepinephrine[auto-injector] delivery
17devicesforadultpatientstofireprotectiondistrictsinnonmetropolitanareasinMissourias
18suchareasaredeterminedaccordingtotheUnitedStatesCensusBureau'sAmerican
19CommunitySurvey,basedonthemostrecentoffive-yearperiodestimatedatainwhichthe
20finalyearoftheestimateendsineitherzeroorfive.Ifthedirectorofthedepartmentofhealth
21andseniorservicesisnotalicensedphysician,thedepartmentofhealthandseniorservices
22mayemployorcontractwithalicensedphysicianwhomayissuesuchastatewideorderwith
23theexpressconsentofthedirector.
24 3.Possessionanduseofepinephrine[auto-injector] deliverydevicesforadult
25patientsshallbelimitedasfollows:
26 (1)Nopersonshalluseanepinephrine[auto-injector] deliverydevicepursuanttothis
27sectionunlesssuchpersonhassuccessfullycompletedatrainingcourseintheuseof
HCSSSSB7 50 28epinephrine[auto-injector] deliverydevicesforadultpatientsapprovedbythedirectorofthe
29departmentofhealthandseniorservices.Nothinginthissectionshallprohibittheuseofan
30epinephrine[auto-injector] deliverydevice:
31 (a)Byahealthcareprofessionallicensedorcertifiedbythisstatewhoisacting
32withinthescopeofhisorherpractice;or
33 (b)Byapersonactingpursuanttoalawfulprescription;
34 (2)Everyperson,firm,organizationandentityauthorizedtopossessanduse
35epinephrine[auto-injector] deliverydevicesforadultpatientspursuanttothissectionshall
36use,maintainanddisposeofsuchdevicesforadultpatientsinaccordancewiththerulesofthe
37department;and
38 (3)Everyuseofanepinephrine[auto-injector] deliverydevicepursuanttothis
39sectionshallimmediatelybereportedtotheemergencyhealthcareproviderasdefinedin
40section190.246.
41 4.(1)Useofanepinephrine[auto-injector] deliverydevicepursuanttothissection
42shallbeconsideredfirstaidoremergencytreatmentforthepurposeofanylawrelatingto
43liability.
44 (2)Purchase,acquisition,possessionoruseofanepinephrine[auto-injector] delivery
45devicepursuanttothissectionshallnotconstitutetheunlawfulpracticeofmedicineorthe
46unlawfulpracticeofaprofession.
47 (3)Anypersonotherwiseauthorizedtosellorprovideanepinephrine[auto-injector]
48deliverydevicemaysellorprovideittoapersonauthorizedtopossessitpursuanttothis
49section.
50 5.(1)Thereisherebycreatedinthestatetreasurythe"Epinephrine[Auto-injector]
51DeliveryDevicesforFirePersonnelFund",whichshallconsistof[moneycollectedunder
52thissection] moneysappropriatedtothefund. Thestatetreasurershallbecustodianofthe
53fund.Inaccordancewithsections30.170and30.180,thestatetreasurermayapprove
54disbursements.Themoneysinthefundassetforthinthissectionshallbesubjectto
55appropriationbythegeneralassemblyfortheparticularpurposeforwhichcollected.The
56fundshallbeadedicatedfundandmoneyinthefundshallbeusedsolelybythedepartment
57ofhealthandseniorservicesforthepurposesofprovidingepinephrine[auto-injector]
58deliverydevicesforadultpatientstoqualifiedfirstresponderagenciesasusedinthissection.
59 (2)Notwithstandingtheprovisionsofsection33.080tothecontrary,anymoneys
60remaininginthefundattheendofthebienniumshallnotreverttothecreditofthegeneral
61revenuefund.
62 (3)Thestatetreasurershallinvestmoneysinthefundinthesamemannerasother
63fundsareinvested.Anyinterestandmoneysearnedonsuchinvestmentsshallbecreditedto
64thefund.
HCSSSSB7 51 332.081.1.Notwithstandinganyotherprovisionoflawtothecontrary,hospitals
2licensedunderchapter197shallbeauthorizedtoemployanyorallofthefollowingoral
3healthproviders:
4 (1)Adentistlicensedunderthischapterforthepurposeoftreatingonhospital
5premisesthosepatientswhopresentwithadentalconditionandsuchtreatmentisnecessaryto
6amelioratetheconditionforwhichtheypresentedsuchasseverepainortoothabscesses;
7 (2)Anoralandmaxillofacialsurgeonlicensedunderthischapterforthepurposeof
8treatingoralconditionsthatneedtobeamelioratedaspartoftreatingtheunderlyingcauseof
9thepatient'smedicalneedsincluding,butnotlimitedto,headandneckcancer,HIVorAIDS,
10severetraumaresultinginadmissiontothehospital,organtransplant,diabetes,orseizure
11disorders.Itshallbeaconditionoftreatmentthatsuchpatientsareadmittedtothehospitalon
12eitheranin-orout-patientbasis;and
13 (3)Amaxillofacialprosthodontistlicensedunderthischapterforthepurposeof
14treatingandsupportingpatientsofaheadandneckcancerteamorothercomplexcareor
15surgicalteamforthefabricationofappliancesfollowingablativesurgery,surgerytocorrect
16birthanomalies,extensiveradiationtreatmentoftheheadorneck,ortrauma-relatedsurgery.
17 2.NopersonorotherentityshallpracticedentistryinMissouriorprovidedental
18servicesas[defined] describedinsection332.071unlessanduntiltheboardhasissuedtothe
19personacertificatecertifyingthatthepersonhasbeendulyregisteredasadentistinMissouri
20ortheboardhasissuedsuchcertificatetoanentitythathasbeendulyregisteredtoprovide
21dentalservicesbylicenseddentistsanddentalhygienistsandunlessanduntiltheboardhas
22issuedtothepersonalicense,toberenewedeachperiod,asprovidedinthischapter,to
23practicedentistryorasadentalhygienist,orhasissuedtothepersonorentityapermit,tobe
24renewedeachperiod,toprovidedentalservicesinMissouri.Nothinginthischaptershallbe
25soconstruedastomakeitunlawfulfor:
26 (1)Alegallyqualifiedphysicianorsurgeon,whodoesnotpracticedentistryasa
27specialty,fromextractingteeth;
28 (2)AdentistlicensedinastateotherthanMissourifrommakingaclinical
29demonstrationbeforeameetingofdentistsinMissouri;
30 (3)Dentalstudentsinanyaccrediteddentalschooltopracticedentistryunderthe
31personaldirectionofinstructors;
32 (4)Dentalhygienestudentsinanyaccrediteddentalhygieneschooltopracticedental
33hygieneunderthepersonaldirectionofinstructors;
34 (5)AdulyregisteredandlicenseddentalhygienistinMissouritopracticedental
35hygieneasdefinedinsection332.091;
36 (6)Adentalassistant,certifieddentalassistant,orexpandedfunctionsdentalassistant
37tobedelegateddutiesasdefinedinsection332.093;
HCSSSSB7 52 38 (7)Adulyregistereddentistordentalhygienisttoteachinanaccrediteddentalor
39dentalhygieneschool;
40 (8)Apersonwhohasbeengrantedadentalfacultypermitundersection332.183to
41practicedentistryinthescopeofhisorheremploymentatanaccrediteddentalschool,
42college,orprograminMissouri;
43 (9)Adulyqualifiedanesthesiologistornurseanesthetisttoadministerananesthetic
44inconnectionwithdentalservicesordentalsurgery;
45 (10)Apersontopracticedentistryinorfor:
46 (a)TheUnitedStatesArmedForces;
47 (b)TheUnitedStatesPublicHealthService;
48 (c)Migrant,community,orhealthcareforthehomelesshealthcentersprovidedin
49Section330ofthePublicHealthServiceAct(42U.S.C.Section254b);
50 (d)FederallyqualifiedhealthcentersasdefinedinSection1905(l)(42U.S.C.Section
511396d(l))oftheSocialSecurityAct;
52 (e)Governmentalentities,includingcountyhealthdepartments;or
53 (f)TheUnitedStatesVeteransBureau;or
54 (11)AdentistlicensedinastateotherthanMissouritoevaluateapatientorrenderan
55oral,written,orotherwisedocumenteddentalopinionwhenprovidingtestimonyorrecords
56forthepurposeofacivilorcriminalactionbeforeanyjudicialoradministrativeproceeding
57ofthisstateorotherforuminthisstate.
58 3.Nocorporationshallpracticedentistryasdefinedinsection332.071unlessthat
59corporationisorganizedundertheprovisionsofchapter355or356providedthata
60corporationorganizedundertheprovisionsofchapter355andqualifyingasanorganization
61under26U.S.C.Section501(c)(3)mayonlyemploydentistsanddentalhygienistslicensedin
62thisstatetorenderdentalservicestoMedicaidrecipients,low-incomeindividualswhohave
63availableincomebelowtwohundredpercentofthefederalpovertylevel,andallparticipants
64intheSCHIPprogram,unlesssuchlimitationiscontrarytoorinconsistentwithfederalor
65statelaworregulation.Thissubsectionshallnotapplyto:
66 (1)Ahospitallicensedunderchapter197thatprovidescareandtreatmentonlyto
67childrenundertheageofeighteenatwhichapersonregulatedunderthischapterprovides
68dentalcarewithinthescopeofhisorherlicenseorregistration;
69 (2)AfederallyqualifiedhealthcenterasdefinedinSection1905(l)oftheSocial
70SecurityAct(42U.S.C.Section1396d(l)),oramigrant,community,orhealthcareforthe
71homelesshealthcenterprovidedforinSection330ofthePublicHealthServicesAct(42
72U.S.C.Section254b)atwhichapersonregulatedunderthischapterprovidesdentalcare
73withinthescopeofhisorherlicenseorregistration;
HCSSSSB7 53 74 (3)Acityorcountyhealthdepartmentorganizedunderchapter192orchapter205at
75whichapersonregulatedunderthischapterprovidesdentalcarewithinthescopeofhisorher
76licenseorregistration;
77 (4)Asocialwelfareboardorganizedundersection205.770,acityhealthdepartment
78operatingunderacitycharter,oracity-countyhealthdepartmentatwhichapersonregulated
79underthischapterprovidesdentalcarewithinthescopeofhisorherlicenseorregistration;
80 (5)Anyentitythathasreceivedapermitfromthedentalboardanddoesnotreceive
81compensationfromthepatientorfromanythirdpartyonthepatient'sbehalfatwhicha
82personregulatedunderthischapterprovidesdentalcarewithinthescopeofhisorherlicense
83orregistration;or
84 (6)AnyhospitalnonprofitcorporationexemptfromtaxationunderSection501(c)(3)
85oftheInternalRevenueCode,asamended,thatengagesinitsoperationsandprovidesdental
86servicesatfacilitiesownedbyacity,county,orotherpoliticalsubdivisionofthestate,orany
87entitycontractedwiththestatetoprovidecareinacorrectionalcenter,assuchtermis
88definedinsection217.010,atwhichapersonregulatedunderthischapterprovidesdental
89carewithinthescopeofhisorherlicenseorregistration.
90
91Ifanyoftheentitiesexemptedfromtherequirementsofthissubsectionareunabletoprovide
92servicestoapatientduetothelackofaqualifiedproviderandareferraltoanotherentityis
93made,theexemptionshallextendtothepersonorentitythatsubsequentlyprovidesservices
94tothepatient.
95 4.Nounincorporatedorganizationshallpracticedentistryasdefinedinsection
96332.071unlesssuchorganizationisexemptfromfederaltaxationunderSection501(c)(3)of
97theInternalRevenueCodeof1986,asamended,andprovidesdentaltreatmentwithout
98compensationfromthepatientoranythirdpartyontheirbehalfasapartofabroader
99programofsocialservicesincludingfooddistribution.Nothinginthischaptershallprohibit
100organizationsunderthissubsectionfromemployinganypersonregulatedbythischapter.
101 5.Adentistshallnotenterintoacontractthatallowsapersonwhoisnotadentistto
102influenceorinterferewiththeexerciseofthedentist'sindependentprofessionaljudgment.
103 6.Anot-for-profitcorporationorganizedundertheprovisionsofchapter355and
104qualifyingasanorganizationunder26U.S.C.Section501(c)(3),anunincorporated
105organizationoperatingpursuanttosubsection4ofthissection,oranyotherpersonshouldnot
106directorinterfereorattempttodirectorinterferewithalicenseddentist'sprofessional
107judgmentandcompetentpracticeofdentistry.Nothinginthissubsectionshallbeso
108construedastomakeitunlawfulfornot-for-profitorganizationstoenforceemployment
109contracts,corporatepolicyandproceduremanuals,orqualityimprovementorassurance
110requirements.
HCSSSSB7 54 111 7.Allentitiesdefinedinsubsection3ofthissectionandthoseexemptedunder
112subsection4ofthissectionshallapplyforapermittoemploydentistsanddentalhygienists
113licensedinthisstatetorenderdentalservices,andtheentityshallapplyforthepermitin
114writingonformsprovidedbytheMissouridentalboard.Theboardshallnotchargeafeeof
115anykindfortheissuanceorrenewalofsuchpermit.Theprovisionsofthissubsectionshall
116notapplytoafederallyqualifiedhealthcenterasdefinedinSection1905(l)oftheSocial
117SecurityAct(42U.S.C.Section1396d(l)).
118 8.Anyentitythatobtainsapermittorenderdentalservicesinthisstateissubjectto
119disciplinepursuanttosection332.321.Iftheboardconcludesthatthepersonorentityhas
120committedanactorisengaginginacourseofconductthatwouldbegroundsfordisciplinary
121action,theboardmayfileacomplaintbeforetheadministrativehearingcommission.The
122boardmayrefusetoissueorrenewthepermitofanyentityforoneoranycombinationof
123causesstatedinsubsection2ofsection332.321.Theboardshallnotifytheapplicantin
124writingofthereasonsfortherefusalandshalladvisetheapplicantofhisorherrighttofilea
125complaintwiththeadministrativehearingcommissionasprovidedbychapter621.
126 9.AfederallyqualifiedhealthcenterasdefinedinSection1905(l)oftheSocial
127SecurityAct(42U.S.C.Section1396d(l))shallregisterwiththeboard.Theinformation
128providedtotheboardaspartoftheregistrationshallincludethenameofthehealthcenter,the
129nonprofitstatusofthehealthcenter,siteswheredentalserviceswillbeprovided,andthe
130namesofallpersonsemployedby,orcontractingwith,thehealthcenterwhoarerequiredto
131holdalicensepursuanttothischapter.Theregistrationshallberenewedeverytwenty-four
132months.Theboardshallnotchargeafeeofanykindfortheissuanceorrenewalofthe
133registration.Theregistrationofthehealthcentershallnotbesubjecttodisciplinepursuantto
134section332.321.Nothinginthissubsectionshallprohibitdisciplinaryactionagainsta
135licenseeofthischapterwhoisemployedby,orcontractswith,suchhealthcenterforthe
136actionsofthelicenseeinconnectionwithsuchemploymentorcontract.
137 10.Theboardmaypromulgaterulesandregulationstoensurenot-for-profit
138corporationsarerenderingcaretothepatientpopulationsassetforthherein,including
139requirementsforcoverednot-for-profitcorporationstoreportpatientcensusdatatotheboard.
140Theprovisionsofthissubsectionshallnotapplytoafederallyqualifiedhealthcenteras
141definedinSection1905(l)oftheSocialSecurityAct(42U.S.C.Section1396d(l)).
142 11.Allnot-for-profitcorporationsorganizedoroperatedpursuanttotheprovisionsof
143chapter355andqualifyingasanorganizationunder26U.S.C.Section501(c)(3),orthe
144requirementsrelatingtomigrant,community,orhealthcareforthehomelesshealthcenters
145providedinSection330ofthePublicHealthServiceAct(42U.S.C.Section254b)and
146federallyqualifiedhealthcentersasdefinedinSection1905(l)(42U.S.C.Section1396d(l))
147oftheSocialSecurityAct,thatemploypersonswhopracticedentistryordentalhygienein
HCSSSSB7 55 148thisstateshalldosoinaccordancewiththerelevantlawsofthisstateexcepttotheextentthat
149suchlawsarecontraryto,orinconsistentwith,federalstatuteorregulation.
332.211.[Theboardshallgrantwithoutexaminationacertificateofregistrationanda
2licensetoadentistwhohasbeenlicensedinanotherstateforatleastfiveconsecutiveyears
3immediatelyprecedinghisapplying,iftheboardissatisfiedbyproofadducedbythe
4applicantthathisqualificationsareatleastequivalenttotherequirementsforinitial
5registrationasadentistinMissouriundertheprovisionsofthischapter,thatheisatleast
6twenty-oneyearsofageandisofgoodmoralcharacterandreputation;providedthatthe
7boardmaybyrulerequireanapplicantunderthissectiontotakeanyexaminationover
8Missourilawsgiventodentistsinitiallyseekinglicensureundersection332.151andtotakea
9practicalexaminationifhislicensureinanystatewaseverdenied,revokedorsuspendedfor
10incompetencyorinabilitytopracticeinasafemanner,orifhehasfailedanypractical
11examinationgivenasaprerequisitetolicensureasadentistinanystate.Anysuchdentist
12applyingtobesoregisteredandlicensedshallaccompanyhisapplicationwithafeenot
13greaterthanthedentalexaminationandlicensefeesandifregisteredandlicensedshallrenew
14hislicenseasprovidedinsection332.181.] 1.Forpurposesofthissection,thefollowing
15termsmean:
16 (1)"License",alicense,certificate,registration,permit,accreditation,or
17militaryoccupationalspecialtythatenablesapersontolegallypracticeanoccupationor
18professioninaparticularjurisdiction;
19 (2)"Military",theArmedForcesoftheUnitedStates,includingtheAirForce,
20Army,CoastGuard,MarineCorps,Navy,SpaceForce,NationalGuard,andanyother
21militarybranchthatisdesignatedbyCongressaspartoftheArmedForcesofthe
22UnitedStates,andallreservecomponentsandauxiliaries.Theterm"military"also
23includesthemilitaryreservesandmilitiaofanyUnitedStatesterritoryorstate;
24 (3)"Nonresidentmilitaryspouse",anonresidentspouseofanactiveduty
25memberoftheArmedForcesoftheUnitedStateswhohasbeentransferredoris
26scheduledtobetransferredtothestateofMissouri,orwhohasbeentransferredoris
27scheduledtobetransferredtoanadjacentstateandisorwillbedomiciledinthestateof
28Missouri,orhasmovedtothestateofMissourionapermanentchange-of-stationbasis;
29 (4)"Oversightbody",anyboard,department,agency,orofficeofajurisdiction
30thatissueslicenses;
31 (5)"Residentmilitaryspouse",aspouseofanactivedutymemberoftheArmed
32ForcesoftheUnitedStateswhohasbeentransferredorisscheduledtobetransferredto
33thestateofMissourioranadjacentstateandwhoisapermanentresidentofthestateof
34Missouri,whoisdomiciledinthestateofMissouri,orwhohasMissouriashisorher
35homeofrecord.
HCSSSSB7 56 36 2.Anypersonwhoholdsavalidcurrentdentistlicenseissuedbyanotherstate,a
37branchorunitofthemilitary,aterritoryoftheUnitedStates,ortheDistrictof
38Columbia,andwhohasbeenlicensedforatleastoneyearinsuchotherjurisdiction,
39maysubmittotheboardanapplicationforadentistlicenseinMissourialongwithproof
40ofcurrentlicensureandproofoflicensureforatleastoneyearintheotherjurisdiction.
41 3.Theboardshall:
42 (1)Withinsixmonthsofreceivinganapplicationdescribedinsubsection2of
43thissection,waiveanyexamination,educational,orexperiencerequirementsfor
44licensureinthisstatefortheapplicantifitdeterminesthattherewereminimum
45educationrequirementsand,ifapplicable,workexperienceandclinicalsupervision
46requirementsineffectandtheotherjurisdictionverifiesthatthepersonmetthose
47requirementsinordertobelicensedorcertifiedinthatjurisdiction.Theboardmay
48requireanapplicanttotakeandpassanexaminationspecifictothelawsofthisstate;or
49 (2)Withinthirtydaysofreceivinganapplicationdescribedinsubsection2of
50thissectionfromanonresidentmilitaryspouseoraresidentmilitaryspouse,waiveany
51examination,educational,orexperiencerequirementsforlicensureinthisstateforthe
52applicantandissuesuchapplicantalicenseunderthissectionifsuchapplicant
53otherwisemeetstherequirementsofthissection.
54 4.(1)Theboardshallnotwaiveanyexamination,educational,orexperience
55requirementsforanyapplicantwhohashadhisorherlicenserevokedbyanoversight
56bodyoutsidethestate;whoiscurrentlyunderinvestigation,whohasacomplaint
57pending,orwhoiscurrentlyunderdisciplinaryaction,exceptasprovidedinsubdivision
58(2)ofthissubsection,withanoversightbodyoutsidethestate;whodoesnotholda
59licenseingoodstandingwithanoversightbodyoutsidethestate;whohasacriminal
60recordthatwoulddisqualifyhimorherforlicensureinMissouri;orwhodoesnothold
61avalidcurrentlicenseintheotherjurisdictiononthedatetheboardreceiveshisorher
62applicationunderthissection.
63 (2)Ifanotherjurisdictionhastakendisciplinaryactionagainstanapplicant,the
64boardshalldetermineifthecausefortheactionwascorrectedandthematterresolved.
65Ifthematterhasnotbeenresolvedbythatjurisdiction,theboardmaydenyalicense
66untilthematterisresolved.
67 5.Nothinginthissectionshallprohibittheboardfromdenyingalicensetoan
68applicantunderthissectionforanyreasondescribedinsection332.321.
69 6.Anypersonwhoislicensedundertheprovisionsofthissectionshallbesubject
70totheboard'sjurisdictionandallrulesandregulationspertainingtothepracticeasa
71dentistinthisstate.
HCSSSSB7 57 72 7.Thissectionshallnotbeconstruedtowaiveanyrequirementforanapplicant
73topayanyfees.
332.281.[Theboardshallgrantwithoutexaminationacertificateofregistrationand
2licensetoadentalhygienistwhohasbeenlicensedinanotherstateforatleasttwo
3consecutiveyearsimmediatelyprecedinghisapplicationtopracticeinMissouriiftheboardis
4satisfiedbyproofadducedbytheapplicantthathisqualificationsareatleastequivalenttothe
5requirementsforinitialregistrationasadentalhygienistinMissouriundertheprovisionsof
6thischapter;providedthattheboardmaybyrulerequireanapplicantunderthissectionto
7takeanyexaminationoverMissourilawsgiventodentalhygienistinitiallyseekinglicensure
8undersection332.251andtotakeapracticalexaminationifhislicensureinanystatewas
9everdenied,revokedorsuspendedforincompetencyorinabilitytopracticeinasafemanner,
10orifhehasfailedanypracticalexaminationgivenasaprerequisitetolicensureasadental
11hygienistinanystate.Anysuchdentalhygienistapplyingtobesoregisteredandlicensed
12shallaccompanyhisapplicationwithafeenotgreaterthanthedentalhygienistexamination
13andlicensefeesandifregisteredandlicensedshallrenewhislicenseasprovidedinsection
14332.261.] 1.Forpurposesofthissection,thefollowingtermsmean:
15 (1)"License",alicense,certificate,registration,permit,accreditation,or
16militaryoccupationalspecialtythatenablesapersontolegallypracticeanoccupationor
17professioninaparticularjurisdiction;
18 (2)"Military",theArmedForcesoftheUnitedStates,includingtheAirForce,
19Army,CoastGuard,MarineCorps,Navy,SpaceForce,NationalGuard,andanyother
20militarybranchthatisdesignatedbyCongressaspartoftheArmedForcesofthe
21UnitedStates,andallreservecomponentsandauxiliaries.Theterm"military"also
22includesthemilitaryreservesandmilitiaofanyUnitedStatesterritoryorstate;
23 (3)"Nonresidentmilitaryspouse",anonresidentspouseofanactiveduty
24memberoftheArmedForcesoftheUnitedStateswhohasbeentransferredoris
25scheduledtobetransferredtothestateofMissouri,orwhohasbeentransferredoris
26scheduledtobetransferredtoanadjacentstateandisorwillbedomiciledinthestateof
27Missouri,orhasmovedtothestateofMissourionapermanentchange-of-stationbasis;
28 (4)"Oversightbody",anyboard,department,agency,orofficeofajurisdiction
29thatissueslicenses;
30 (5)"Residentmilitaryspouse",aspouseofanactivedutymemberoftheArmed
31ForcesoftheUnitedStateswhohasbeentransferredorisscheduledtobetransferredto
32thestateofMissourioranadjacentstateandwhoisapermanentresidentofthestateof
33Missouri,whoisdomiciledinthestateofMissouri,orwhohasMissouriashisorher
34homeofrecord.
HCSSSSB7 58 35 2.Anypersonwhoholdsavalidcurrentdentalhygienistlicenseissuedby
36anotherstate,abranchorunitofthemilitary,aterritoryoftheUnitedStates,orthe
37DistrictofColumbia,andwhohasbeenlicensedforatleastoneyearinsuchother
38jurisdiction,maysubmittotheboardanapplicationforadentalhygienistlicensein
39Missourialongwithproofofcurrentlicensureandproofoflicensureforatleastone
40yearintheotherjurisdiction.
41 3.Theboardshall:
42 (1)Withinsixmonthsofreceivinganapplicationdescribedinsubsection2of
43thissection,waiveanyexamination,educational,orexperiencerequirementsfor
44licensureinthisstatefortheapplicantifitdeterminesthattherewereminimum
45educationrequirementsand,ifapplicable,workexperienceandclinicalsupervision
46requirementsineffectandtheotherjurisdictionverifiesthatthepersonmetthose
47requirementsinordertobelicensedorcertifiedinthatjurisdiction.Theboardmay
48requireanapplicanttotakeandpassanexaminationspecifictothelawsofthisstate;or
49 (2)Withinthirtydaysofreceivinganapplicationdescribedinsubsection2of
50thissectionfromanonresidentmilitaryspouseoraresidentmilitaryspouse,waiveany
51examination,educational,orexperiencerequirementsforlicensureinthisstateforthe
52applicantandissuesuchapplicantalicenseunderthissectionifsuchapplicant
53otherwisemeetstherequirementsofthissection.
54 4.(1)Theboardshallnotwaiveanyexamination,educational,orexperience
55requirementsforanyapplicantwhohashadhisorherlicenserevokedbyanoversight
56bodyoutsidethestate;whoiscurrentlyunderinvestigation,whohasacomplaint
57pending,orwhoiscurrentlyunderdisciplinaryaction,exceptasprovidedinsubdivision
58(2)ofthissubsection,withanoversightbodyoutsidethestate;whodoesnotholda
59licenseingoodstandingwithanoversightbodyoutsidethestate;whohasacriminal
60recordthatwoulddisqualifyhimorherforlicensureinMissouri;orwhodoesnothold
61avalidcurrentlicenseintheotherjurisdictiononthedatetheboardreceiveshisorher
62applicationunderthissection.
63 (2)Ifanotherjurisdictionhastakendisciplinaryactionagainstanapplicant,the
64boardshalldetermineifthecausefortheactionwascorrectedandthematterresolved.
65Ifthematterhasnotbeenresolvedbythatjurisdiction,theboardmaydenyalicense
66untilthematterisresolved.
67 5.Nothinginthissectionshallprohibittheboardfromdenyingalicensetoan
68applicantunderthissectionforanyreasondescribedinsection332.321.
69 6.Anypersonwhoislicensedundertheprovisionsofthissectionshallbesubject
70totheboard'sjurisdictionandallrulesandregulationspertainingtothepracticeasa
71dentalhygienistinthisstate.
HCSSSSB7 59 72 7.Thissectionshallnotbeconstruedtowaiveanyrequirementforanapplicant
73topayanyfees.
332.700.Sections332.700to332.760shallbeknownandcitedastheDentistand
2DentalHygienistCompact.ThepurposesofthisCompactaretofacilitatetheinterstate
3practiceofdentistryanddentalhygieneandimprovepublicaccesstodentistryand
4dentalhygieneservicesbyprovidingDentistsandDentalHygienistslicensedina
5ParticipatingStatetheabilitytopracticeinParticipatingStatesinwhichtheyarenot
6licensed.TheCompactdoesthisbyestablishingapathwayforDentistsandDental
7HygienistslicensedinaParticipatingStatetoobtainaCompactPrivilegethat
8authorizesthemtopracticeinanotherParticipatingStateinwhichtheyarenotlicensed.
9TheCompactenablesParticipatingStatestoprotectthepublichealthandsafetywith
10respecttothepracticeofsuchDentistsandDentalHygienists,throughtheState's
11authoritytoregulatethepracticeofdentistryanddentalhygieneintheState.The
12Compact:
13 (1)EnablesDentistsandDentalHygienistswhoqualifyforaCompactPrivilege
14topracticeinotherParticipatingStateswithoutsatisfyingburdensomeandduplicative
15requirementsassociatedwithsecuringaLicensetopracticeinthoseStates;
16 (2)Promotesmobilityandaddressesworkforceshortagesthrougheach
17ParticipatingState'sacceptanceofaCompactPrivilegetopracticeinthatState;
18 (3)Increasespublicaccesstoqualified,licensedDentistsandDentalHygienists
19bycreatingaresponsible,streamlinedpathwayforLicenseestopracticeinParticipating
20States;
21 (4)EnhancestheabilityofParticipatingStatestoprotectthepublic'shealthand
22safety;
23 (5)DoesnotinterferewithlicensurerequirementsestablishedbyaParticipating
24State;
25 (6)Facilitatesthesharingoflicensureanddisciplinaryinformationamong
26ParticipatingStates;
27 (7)RequiresDentistsandDentalHygienistswhopracticeinaParticipatingState
28pursuanttoaCompactPrivilegetopracticewithintheScopeofPracticeauthorizedin
29thatState;
30 (8)ExtendstheauthorityofaParticipatingStatetoregulatethepracticeof
31dentistryanddentalhygienewithinitsborderstoDentistsandDentalHygienistswho
32practiceintheStatethroughaCompactPrivilege;
33 (9)PromotesthecooperationofParticipatingStatesinregulatingthepracticeof
34dentistryanddentalhygienewithinthoseStates;
HCSSSSB7 60 35 (10)Facilitatestherelocationofmilitarymembersandtheirspouseswhoare
36licensedtopracticedentistryordentalhygiene.
332.705.AsusedinthisCompact,unlessthecontextrequiresotherwise,the
2followingdefinitionsshallapply:
3 (1)"ActiveMilitaryMember"meansanypersonwithfull-timedutystatusin
4thearmedforcesoftheUnitedStates,includingmembersoftheNationalGuardand
5Reserve.
6 (2)"AdverseAction"meansdisciplinaryactionorencumbranceimposedona
7LicenseorCompactPrivilegebyaStateLicensingAuthority.
8 (3)"AlternativeProgram"meansanon-disciplinarymonitoringorpractice
9remediationprocessapplicabletoaDentistorDentalHygienistapprovedbyaState
10LicensingAuthorityofaParticipatingStateinwhichtheDentistorDentalHygienistis
11licensed.Thisincludes,butisnotlimitedto,programstowhichLicenseeswith
12substanceabuseoraddictionissuesarereferredinlieuofAdverseAction.
13 (4)"ClinicalAssessment"meansexaminationorprocess,requiredforlicensure
14asaDentistorDentalHygienistasapplicable,thatprovidesevidenceofclinical
15competenceindentistryordentalhygiene.
16 (5)"Commissioner"meanstheindividualappointedbyaParticipatingStateto
17serveasthememberoftheCommissionforthatParticipatingState.
18 (6)"Compact"meansthisDentistandDentalHygienistCompact.
19 (7)"CompactPrivilege"meanstheauthorizationgrantedbyaRemoteStateto
20allowaLicenseefromaParticipatingStatetopracticeasaDentistorDentalHygienist
21inaRemoteState.
22 (8)"ContinuingProfessionalDevelopment"meansarequirement,asacondition
23ofLicenserenewaltoprovideevidenceofsuccessfulparticipationineducationalor
24professionalactivitiesrelevanttopracticeorareaofwork.
25 (9)"CriminalBackgroundCheck"meansthesubmissionoffingerprintsor
26otherbiometric-basedinformationforaLicenseapplicantforthepurposeofobtaining
27thatapplicant'scriminalhistoryrecordinformation,asdefinedin28C.F.R.§20.3(d)
28fromtheFederalBureauofInvestigationandtheState'scriminalhistoryrecord
29repositoryasdefinedin28C.F.R.§20.3(f).
30 (10)"DataSystem"meanstheCommission'srepositoryofinformationabout
31Licensees,includingbutnotlimitedtoexamination,licensure,investigative,Compact
32Privilege,AdverseAction,andAlternativeProgram.
33 (11)"DentalHygienist"meansanindividualwhoislicensedbyaStateLicensing
34Authoritytopracticedentalhygiene.
HCSSSSB7 61 35 (12)"Dentist"meansanindividualwhoislicensedbyaStateLicensing
36Authoritytopracticedentistry.
37 (13)"DentistandDentalHygienistCompactCommission"or"Commission"
38meansajointgovernmentagencyestablishedbythisCompactcomprisedofeachState
39thathasenactedtheCompactandanationaladministrativebodycomprisedofa
40CommissionerfromeachStatethathasenactedtheCompact.
41 (14)"EncumberedLicense"meansaLicensethataStateLicensingAuthority
42haslimitedinanywayotherthanthroughanAlternativeProgram.
43 (15)"ExecutiveBoard"meanstheChair,ViceChair,SecretaryandTreasurer
44andanyotherCommissionersasmaybedeterminedbyCommissionRuleorbylaw.
45 (16)"JurisprudenceRequirement"meanstheassessmentofanindividual's
46knowledgeofthelawsandRulesgoverningthepracticeofdentistryordentalhygiene,
47asapplicable,inaState.
48 (17)"License"meanscurrentauthorizationbyaState,otherthanauthorization
49pursuanttoaCompactPrivilege,orotherprivilege,foranindividualtopracticeasa
50DentistorDentalHygienistinthatState.
51 (18)"Licensee"meansanindividualwhoholdsanunrestrictedLicensefroma
52ParticipatingStatetopracticeasaDentistorDentalHygienistinthatState.
53 (19)"ModelCompact"meansthemodelfortheDentistandDentalHygienist
54CompactonfilewiththeCouncilofStateGovernmentsorotherentityasdesignatedby
55theCommission.
56 (20)"ParticipatingState"meansaStatethathasenactedtheCompactandbeen
57admittedtotheCommissioninaccordancewiththeprovisionshereinandCommission
58Rules.
59 (21)"QualifyingLicense"meansaLicensethatisnotanEncumberedLicense
60issuedbyaParticipatingStatetopracticedentistryordentalhygiene.
61 (22)"RemoteState"meansaParticipatingStatewhereaLicenseewhoisnot
62licensedasaDentistorDentalHygienistisexercisingorseekingtoexercisetheCompact
63Privilege.
64 (23)"Rule"meansaregulationpromulgatedbyanentitythathastheforceof
65law.
66 (24)"ScopeofPractice"meanstheprocedures,actions,andprocessesaDentist
67orDentalHygienistlicensedinaStateispermittedtoundertakeinthatStateandthe
68circumstancesunderwhichtheLicenseeispermittedtoundertakethoseprocedures,
69actionsandprocesses.Suchprocedures,actionsandprocessesandthecircumstances
70underwhichtheymaybeundertakenmaybeestablishedthroughmeans,including,but
HCSSSSB7 62 71notlimitedto,statute,regulations,caselaw,andotherprocessesavailabletotheState
72LicensingAuthorityorothergovernmentagency.
73 (25)"SignificantInvestigativeInformation"meansinformation,records,and
74documentsreceivedorgeneratedbyaStateLicensingAuthoritypursuanttoan
75investigationforwhichadeterminationhasbeenmadethatthereisprobablecauseto
76believethattheLicenseehasviolatedastatuteorregulationthatisconsideredmore
77thanaminorinfractionforwhichtheStateLicensingAuthoritycouldpursueAdverse
78ActionagainsttheLicensee.
79 (26)"State"meansanystate,commonwealth,district,orterritoryoftheUnited
80StatesofAmericathatregulatesthepracticesofdentistryanddentalhygiene.
81 (27)"StateLicensingAuthority"meansanagencyorotherentityofaStatethat
82isresponsibleforthelicensingandregulationofDentistsorDentalHygienists.
332.710.1.InordertojointheCompactandthereaftercontinueasa
2ParticipatingState,aStatemust:
3 (1)EnactacompactthatisnotmateriallydifferentfromtheModelCompactas
4determinedinaccordancewithCommissionRules;
5 (2)ParticipatefullyintheCommission'sDataSystem;
6 (3)Haveamechanisminplaceforreceivingandinvestigatingcomplaintsabout
7itsLicenseesandLicenseapplicants;
8 (4)NotifytheCommission,incompliancewiththetermsoftheCompactand
9CommissionRules,ofanyAdverseActionortheavailabilityofSignificantInvestigative
10InformationregardingaLicenseeandLicenseapplicant;
11 (5)FullyimplementaCriminalBackgroundCheckrequirement,withinatime
12frameestablishedbyCommissionRule,byreceivingtheresultsofaqualifyingCriminal
13BackgroundCheck;
14 (6)ComplywiththeCommissionRulesapplicabletoaParticipatingState;
15 (7)AccepttheNationalBoardExaminationsoftheJointCommissionon
16NationalDentalExaminationsoranotherexaminationacceptedbyCommissionRuleas
17alicensureexamination;
18 (8)AcceptforlicensurethatapplicantsforaDentistLicensegraduatefroma
19predoctoraldentaleducationprogramaccreditedbytheCommissiononDental
20Accreditation,oranotheraccreditingagencyrecognizedbytheUnitedStates
21DepartmentofEducationfortheaccreditationofdentistryanddentalhygiene
22educationprograms,leadingtotheDoctorofDentalSurgery(D.D.S.)orDoctorof
23DentalMedicine(D.M.D.)degree;
24 (9)AcceptforlicensurethatapplicantsforaDentalHygienistLicensegraduate
25fromadentalhygieneeducationprogramaccreditedbytheCommissiononDental
HCSSSSB7 63 26AccreditationoranotheraccreditingagencyrecognizedbytheUnitedStates
27DepartmentofEducationfortheaccreditationofdentistryanddentalhygiene
28educationprograms;
29 (10)RequireforlicensurethatapplicantssuccessfullycompleteaClinical
30Assessment;
31 (11)HaveContinuingProfessionalDevelopmentrequirementsasaconditionfor
32Licenserenewal;and
33 (12)PayaparticipationfeetotheCommissionasestablishedbyCommission
34Rule.
35 2.Providingalternativepathwaysforanindividualtoobtainanunrestricted
36LicensedoesnotdisqualifyaStatefromparticipatingintheCompact.
37 3.WhenconductingaCriminalBackgroundChecktheStateLicensing
38Authorityshall:
39 (1)Considerthatinformationinmakingalicensuredecision;
40 (2)MaintaindocumentationofcompletionoftheCriminalBackgroundCheck
41andbackgroundcheckinformationtotheextentallowedbyStateandfederallaw;and
42 (3)ReporttotheCommissionwhetherithascompletedtheCriminal
43BackgroundCheckandwhethertheindividualwasgrantedordeniedaLicense.
44 4.ALicenseeofaParticipatingStatewhohasaQualifyingLicenseinthatState
45anddoesnotholdanEncumberedLicenseinanyotherParticipatingState,shallbe
46issuedaCompactPrivilegeinaRemoteStateinaccordancewiththetermsofthe
47CompactandCommissionRules.IfaRemoteStatehasaJurisprudenceRequirementa
48CompactPrivilegewillnotbeissuedtotheLicenseeunlesstheLicenseehassatisfiedthe
49JurisprudenceRequirement.
332.715.1.ToobtainandexercisetheCompactPrivilegeunderthetermsand
2provisionsoftheCompact,theLicenseeshall:
3 (1)HaveaQualifyingLicenseasaDentistorDentalHygienistinaParticipating
4State;
5 (2)BeeligibleforaCompactPrivilegeinanyRemoteStateinaccordancewith
6subsections4,7,and8ofthissection;
7 (3)SubmittoanapplicationprocesswhenevertheLicenseeisseekingaCompact
8Privilege;
9 (4)PayanyapplicableCommissionandRemoteStatefeesforaCompact
10PrivilegeintheRemoteState;
11 (5)MeetanyJurisprudenceRequirementestablishedbyaRemoteStatein
12whichtheLicenseeisseekingaCompactPrivilege;
HCSSSSB7 64 13 (6)HavepassedaNationalBoardExaminationoftheJointCommissionon
14NationalDentalExaminationsoranotherexaminationacceptedbyCommissionRule;
15 (7)ForaDentist,havegraduatedfromapredoctoraldentaleducationprogram
16accreditedbytheCommissiononDentalAccreditation,oranotheraccreditingagency
17recognizedbytheUnitedStatesDepartmentofEducationfortheaccreditationof
18dentistryanddentalhygieneeducationprograms,leadingtotheDoctorofDental
19Surgery(D.D.S.)orDoctorofDentalMedicine(D.M.D.)degree;
20 (8)ForaDentalHygienist,havegraduatedfromadentalhygieneeducation
21programaccreditedbytheCommissiononDentalAccreditationoranotheraccrediting
22agencyrecognizedbytheUnitedStatesDepartmentofEducationfortheaccreditation
23ofdentistryanddentalhygieneeducationprograms;
24 (9)HavesuccessfullycompletedaClinicalAssessmentforlicensure;
25 (10)ReporttotheCommissionAdverseActiontakenbyanynon-Participating
26StatewhenapplyingforaCompactPrivilegeand,otherwise,withinthirty(30)days
27fromthedatetheAdverseActionistaken;
28 (11)ReporttotheCommissionwhenapplyingforaCompactPrivilegethe
29addressoftheLicensee'sprimaryresidenceandthereafterimmediatelyreporttothe
30CommissionanychangeintheaddressoftheLicensee'sprimaryresidence;and
31 (12)ConsenttoacceptserviceofprocessbymailattheLicensee'sprimary
32residenceonrecordwiththeCommissionwithrespecttoanyactionbroughtagainstthe
33LicenseebytheCommissionoraParticipatingState,andconsenttoacceptserviceofa
34subpoenabymailattheLicensee'sprimaryresidenceonrecordwiththeCommission
35withrespecttoanyactionbroughtorinvestigationconductedbytheCommissionora
36ParticipatingState.
37 2.TheLicenseemustcomplywiththerequirementsofsubsection1ofthis
38sectiontomaintaintheCompactPrivilegeintheRemoteState.Ifthoserequirements
39aremet,theCompactPrivilegewillcontinueaslongastheLicenseemaintainsa
40QualifyingLicenseintheStatethroughwhichtheLicenseeappliedfortheCompact
41PrivilegeandpaysanyapplicableCompactPrivilegerenewalfees.
42 3.ALicenseeprovidingdentistryordentalhygieneinaRemoteStateunderthe
43CompactPrivilegeshallfunctionwithintheScopeofPracticeauthorizedbytheRemote
44StateforaDentistorDentalHygienistlicensedinthatState.
45 4.ALicenseeprovidingdentistryordentalhygienepursuanttoaCompact
46PrivilegeinaRemoteStateissubjecttothatState'sregulatoryauthority.ARemote
47Statemay,inaccordancewithdueprocessandthatState'slaws,byAdverseAction
48revokeorremoveaLicensee'sCompactPrivilegeintheRemoteStateforaspecific
49periodoftimeandimposefinesortakeanyothernecessaryactionstoprotectthehealth
HCSSSSB7 65 50andsafetyofitscitizens.IfaRemoteStateimposesanAdverseActionagainsta
51CompactPrivilegethatlimitstheCompactPrivilege,thatAdverseActionappliestoall
52CompactPrivilegesinallRemoteStates.ALicenseewhoseCompactPrivilegeina
53RemoteStateisremovedforaspecifiedperiodoftimeisnoteligibleforaCompact
54PrivilegeinanyotherRemoteStateuntilthespecifictimeforremovaloftheCompact
55Privilegehaspassedandallencumbrancerequirementsaresatisfied.
56 5.IfaLicenseinaParticipatingStateisanEncumberedLicense,theLicensee
57shalllosetheCompactPrivilegeinaRemoteStateandshallnotbeeligiblefora
58CompactPrivilegeinanyRemoteStateuntiltheLicenseisnolongerencumbered.
59 6.OnceanEncumberedLicenseinaParticipatingStateisrestoredtogood
60standing,theLicenseemustmeettherequirementsofsubsection1ofthissectionto
61obtainaCompactPrivilegeinaRemoteState.
62 7.IfaLicensee'sCompactPrivilegeinaRemoteStateisremovedbytheRemote
63State,theindividualshallloseorbeineligiblefortheCompactPrivilegeinanyRemote
64Stateuntilthefollowingoccur:
65 (1)ThespecificperiodoftimeforwhichtheCompactPrivilegewasremovedhas
66ended;and
67 (2)AllconditionsforremovaloftheCompactPrivilegehavebeensatisfied.
68 8.Oncetherequirementsofsubsection7ofthissectionhavebeenmet,the
69Licenseemustmeettherequirementsinsubsection1ofthissectiontoobtainaCompact
70PrivilegeinaRemoteState.
332.720.AnActiveMilitaryMemberandtheirspouseshallnotberequiredto
2paytotheCommissionforaCompactPrivilegethefeeotherwisechargedbythe
3Commission.IfaRemoteStatechoosestochargeafeeforaCompactPrivilege,itmay
4choosetochargeareducedfeeornofeetoanActiveMilitaryMemberandtheirspouse
5foraCompactPrivilege.
332.725.1.AParticipatingStateinwhichaLicenseeislicensedshallhave
2exclusiveauthoritytoimposeAdverseActionagainsttheQualifyingLicenseissuedby
3thatParticipatingState.
4 2.AParticipatingStatemaytakeAdverseActionbasedontheSignificant
5InvestigativeInformationofaRemoteState,solongastheParticipatingStatefollowsits
6ownproceduresforimposingAdverseAction.
7 3.NothinginthisCompactshalloverrideaParticipatingState'sdecisionthat
8participationinanAlternativeProgrammaybeusedinlieuofAdverseActionandthat
9suchparticipationshallremainnon-publicifrequiredbytheParticipatingState'slaws.
10ParticipatingStatesmustrequireLicenseeswhoenteranyAlternativePrograminlieu
11ofdisciplinetoagreenottopracticepursuanttoaCompactPrivilegeinanyother
HCSSSSB7 66 12ParticipatingStateduringthetermoftheAlternativeProgramwithoutprior
13authorizationfromsuchotherParticipatingState.
14 4.AnyParticipatingStateinwhichaLicenseeisapplyingtopracticeoris
15practicingpursuanttoaCompactPrivilegemayinvestigateactualorallegedviolations
16ofthestatutesandregulationsauthorizingthepracticeofdentistryordentalhygienein
17anyotherParticipatingStateinwhichtheDentistorDentalHygienistholdsaLicenseor
18CompactPrivilege.
19 5.ARemoteStateshallhavetheauthorityto:
20 (1)TakeAdverseActionsassetforthinsubsection4ofsection332.715againsta
21Licensee'sCompactPrivilegeintheState;
22 (2)InfurtheranceofitsrightsandresponsibilitiesundertheCompactandthe
23Commission'sRulesissuesubpoenasforbothhearingsandinvestigationsthatrequire
24theattendanceandtestimonyofwitnesses,andtheproductionofevidence.Subpoenas
25issuedbyaStateLicensingAuthorityinaParticipatingStatefortheattendanceand
26testimonyofwitnesses,ortheproductionofevidencefromanotherParticipatingState,
27shallbeenforcedinthelatterStatebyanycourtofcompetentjurisdiction,accordingto
28thepracticeandprocedureofthatcourtapplicabletosubpoenasissuedinproceedings
29pendingbeforeit.Theissuingauthorityshallpayanywitnessfees,travelexpenses,
30mileage,andotherfeesrequiredbytheservicestatutesoftheStatewherethewitnesses
31orevidencearelocated;and
32 (3)IfotherwisepermittedbyStatelaw,recoverfromtheLicenseethecostsof
33investigationsanddispositionofcasesresultingfromanyAdverseActiontakenagainst
34thatLicensee.
35 6.(1)InadditiontotheauthoritygrantedtoaParticipatingStatebyitsDentist
36orDentalHygienistlicensureactorotherapplicableStatelaw,aParticipatingState
37mayjointlyinvestigateLicenseeswithotherParticipatingStates.
38 (2)ParticipatingStatesshallshareanySignificantInvestigativeInformation,
39litigation,orcompliancematerialsinfurtheranceofanyjointorindividualinvestigation
40initiatedundertheCompact.
41 7.(1)AfteraLicensee'sCompactPrivilegeinaRemoteStateisterminated,the
42RemoteStatemaycontinueaninvestigationoftheLicenseethatbeganwhenthe
43LicenseehadaCompactPrivilegeinthatRemoteState.
44 (2)IftheinvestigationyieldswhatwouldbeSignificantInvestigative
45InformationhadtheLicenseecontinuedtohaveaCompactPrivilegeinthatRemote
46State,theRemoteStateshallreportthepresenceofsuchinformationtotheDataSystem
47asrequiredbysubdivision(6)ofsubsection2ofsection332.735asifitwasSignificant
48InvestigativeInformation.
HCSSSSB7 67 332.730.1.TheCompactParticipatingStatesherebycreateandestablishajoint
2governmentagencywhosemembershipconsistsofallParticipatingStatesthathave
3enactedtheCompact.TheCommissionisaninstrumentalityoftheParticipatingStates
4actingjointlyandnotaninstrumentalityofanyoneState.TheCommissionshallcome
5intoexistenceonoraftertheeffectivedateoftheCompactassetforthinsubsection1of
6section332.750.
7 2.(1)EachParticipatingStateshallhaveandbelimitedtoone(1)
8CommissionerselectedbythatParticipatingState'sStateLicensingAuthorityor,if
9theStatehasmorethanoneStateLicensingAuthority,selectedcollectivelybytheState
10LicensingAuthorities.
11 (2)TheCommissionershallbeamemberordesigneeofsuchAuthorityor
12Authorities.
13 (3)TheCommissionmaybyRuleorbylawestablishatermofofficefor
14CommissionersandmaybyRuleorbylawestablishtermlimits.
15 (4)TheCommissionmayrecommendtoaStateLicensingAuthorityor
16Authorities,asapplicable,removalorsuspensionofanindividualastheState's
17Commissioner.
18 (5)AParticipatingState'sStateLicensingAuthority,orAuthorities,as
19applicable,shallfillanyvacancyofitsCommissionerontheCommissionwithinsixty
20(60)daysofthevacancy.
21 (6)EachCommissionershallbeentitledtoonevoteonallmattersthatarevoted
22uponbytheCommission.
23 (7)TheCommissionshallmeetatleastonceduringeachcalendaryear.
24Additionalmeetingsmaybeheldassetforthinthebylaws.TheCommissionmaymeet
25bytelecommunication,videoconferenceorothersimilarelectronicmeans.
26 3.TheCommissionshallhavethefollowingpowers:
27 (1)EstablishthefiscalyearoftheCommission;
28 (2)Establishacodeofconductandconflictofinterestpolicies;
29 (3)AdoptRulesandbylaws;
30 (4)Maintainitsfinancialrecordsinaccordancewiththebylaws;
31 (5)Meetandtakesuchactionsasareconsistentwiththeprovisionsofthis
32Compact,theCommission'sRules,andthebylaws;
33 (6)Initiateandconcludelegalproceedingsoractionsinthenameofthe
34Commission,providedthatthestandingofanyStateLicensingAuthoritytosueorbe
35suedunderapplicablelawshallnotbeaffected;
HCSSSSB7 68 36 (7)MaintainandcertifyrecordsandinformationprovidedtoaParticipating
37StateastheauthenticatedbusinessrecordsoftheCommission,anddesignateaperson
38todosoontheCommission'sbehalf;
39 (8)Purchaseandmaintaininsuranceandbonds;
40 (9)Borrow,accept,orcontractforservicesofpersonnel,including,butnot
41limitedto,employeesofaParticipatingState;
42 (10)Conductanannualfinancialreview;
43 (11)Hireemployees,electorappointofficers,fixcompensation,defineduties,
44grantsuchindividualsappropriateauthoritytocarryoutthepurposesoftheCompact,
45andestablishtheCommission'spersonnelpoliciesandprogramsrelatingtoconflictsof
46interest,qualificationsofpersonnel,andotherrelatedpersonnelmatters;
47 (12)AssetforthintheCommissionRules,chargeafeetoaLicenseeforthe
48grantofaCompactPrivilegeinaRemoteStateandthereafter,asmaybeestablishedby
49CommissionRule,chargetheLicenseeaCompactPrivilegerenewalfeeforeach
50renewalperiodinwhichthatLicenseeexercisesorintendstoexercisetheCompact
51PrivilegeinthatRemoteState.NothinghereinshallbeconstruedtopreventaRemote
52StatefromchargingaLicenseeafeeforaCompactPrivilegeorrenewalsofaCompact
53Privilege,orafeefortheJurisprudenceRequirementiftheRemoteStateimposessuch
54arequirementforthegrantofaCompactPrivilege;
55 (13)Acceptanyandallappropriategifts,donations,grantsofmoney,other
56sourcesofrevenue,equipment,supplies,materials,andservices,andreceive,utilize,and
57disposeofthesame;providedthatatalltimestheCommissionshallavoidany
58appearanceofimproprietyand/orconflictofinterest;
59 (14)Lease,purchase,retain,own,hold,improve,oruseanyproperty,real,
60personal,ormixed,oranyundividedinteresttherein;
61 (15)Sell,convey,mortgage,pledge,lease,exchange,abandon,orotherwise
62disposeofanypropertyreal,personal,ormixed;
63 (16)Establishabudgetandmakeexpenditures;
64 (17)Borrowmoney;
65 (18)Appointcommittees,includingstandingcommittees,whichmaybe
66composedofmembers,Stateregulators,Statelegislatorsortheirrepresentatives,and
67consumerrepresentatives,andsuchotherinterestedpersonsasmaybedesignatedin
68thisCompactandthebylaws;
69 (19)Provideandreceiveinformationfrom,andcooperatewith,lawenforcement
70agencies;
71 (20)ElectaChair,ViceChair,SecretaryandTreasurerandsuchotherofficers
72oftheCommissionasprovidedintheCommission'sbylaws;
HCSSSSB7 69 73 (21)EstablishandelectanExecutiveBoard;
74 (22)AdoptandprovidetotheParticipatingStatesanannualreport;
75 (23)DeterminewhetheraState'senactedcompactismateriallydifferentfrom
76theModelCompactlanguagesuchthattheStatewouldnotqualifyforparticipationin
77theCompact;and
78 (24)Performsuchotherfunctionsasmaybenecessaryorappropriatetoachieve
79thepurposesofthisCompact.
80 4.(1)AllmeetingsoftheCommissionthatarenotclosedpursuanttothis
81subsectionshallbeopentothepublic.Noticeofpublicmeetingsshallbepostedonthe
82Commission'swebsiteatleastthirty(30)dayspriortothepublicmeeting.
83 (2)Notwithstandingsubdivision(1)ofthissubsection,theCommissionmay
84conveneanemergencypublicmeetingbyprovidingatleasttwenty-four(24)hoursprior
85noticeontheCommission'swebsite,andanyothermeansasprovidedinthe
86Commission'sRules,foranyofthereasonsitmaydispensewithnoticeofproposed
87rulemakingundersubsection12ofsection332.740.TheCommission'slegalcounsel
88shallcertifythatoneofthereasonsjustifyinganemergencypublicmeetinghasbeen
89met.
90 (3)NoticeofallCommissionmeetingsshallprovidethetime,date,andlocation
91ofthemeeting,andifthemeetingistobeheldoraccessibleviatelecommunication,
92videoconference,orotherelectronicmeans,thenoticeshallincludethemechanismfor
93accesstothemeetingthroughsuchmeans.
94 (4)TheCommissionmayconveneinaclosed,non-publicmeetingforthe
95Commissiontoreceivelegaladviceortodiscuss:
96 (a)Non-complianceofaParticipatingStatewithitsobligationsunderthe
97Compact;
98 (b)Theemployment,compensation,disciplineorothermatters,practicesor
99proceduresrelatedtospecificemployeesorothermattersrelatedtotheCommission's
100internalpersonnelpracticesandprocedures;
101 (c)CurrentorthreateneddisciplineofaLicenseeorCompactPrivilegeholder
102bytheCommissionorbyaParticipatingState'sLicensingAuthority;
103 (d)Current,threatened,orreasonablyanticipatedlitigation;
104 (e)Negotiationofcontractsforthepurchase,lease,orsaleofgoods,services,or
105realestate;
106 (f)Accusinganypersonofacrimeorformallycensuringanyperson;
107 (g)Tradesecretsorcommercialorfinancialinformationthatisprivilegedor
108confidential;
HCSSSSB7 70 109 (h)Informationofapersonalnaturewheredisclosurewouldconstituteaclearly
110unwarrantedinvasionofpersonalprivacy;
111 (i)Investigativerecordscompiledforlawenforcementpurposes;
112 (j)Informationrelatedtoanyinvestigativereportspreparedbyoronbehalfof
113orforuseoftheCommissionorothercommitteechargedwithresponsibilityof
114investigationordeterminationofcomplianceissuespursuanttotheCompact;
115 (k)Legaladvice;
116 (l)Mattersspecificallyexemptedfromdisclosuretothepublicbyfederalor
117ParticipatingStatelaw;and
118 (m)OthermattersaspromulgatedbytheCommissionbyRule.
119 (5)Ifameeting,orportionofameeting,isclosed,thepresidingofficershallstate
120thatthemeetingwillbeclosedandreferenceeachrelevantexemptingprovision,and
121suchreferenceshallberecordedintheminutes.
122 (6)TheCommissionshallkeepminutesthatfullyandclearlydescribeall
123mattersdiscussedinameetingandshallprovideafullandaccuratesummaryofactions
124taken,andthereasonstherefor,includingadescriptionoftheviewsexpressed.All
125documentsconsideredinconnectionwithanactionshallbeidentifiedinsuchminutes.
126Allminutesanddocumentsofaclosedmeetingshallremainunderseal,subjectto
127releaseonlybyamajorityvoteoftheCommissionororderofacourtofcompetent
128jurisdiction.
129 5.(1)TheCommissionshallpay,orprovideforthepaymentof,thereasonable
130expensesofitsestablishment,organization,andongoingactivities.
131 (2)TheCommissionmayacceptanyandallappropriatesourcesofrevenue,
132donations,andgrantsofmoney,equipment,supplies,materials,andservices.
133 (3)TheCommissionmaylevyonandcollectanannualassessmentfromeach
134ParticipatingStateandimposefeesonLicenseesofParticipatingStateswhena
135CompactPrivilegeisgranted,tocoverthecostoftheoperationsandactivitiesofthe
136Commissionanditsstaff,whichmustbeinatotalamountsufficienttocoveritsannual
137budgetasapprovedeachfiscalyearforwhichsufficientrevenueisnotprovidedby
138othersources.TheaggregateannualassessmentamountforParticipatingStatesshall
139beallocatedbaseduponaformulathattheCommissionshallpromulgatebyRule.
140 (4)TheCommissionshallnotincurobligationsofanykindpriortosecuringthe
141fundsadequatetomeetthesame;norshalltheCommissionpledgethecreditofany
142ParticipatingState,exceptbyandwiththeauthorityoftheParticipatingState.
143 (5)TheCommissionshallkeepaccurateaccountsofallreceiptsand
144disbursements.ThereceiptsanddisbursementsoftheCommissionshallbesubject
145tothefinancialreviewandaccountingproceduresestablishedunderitsbylaws.All
HCSSSSB7 71 146receiptsanddisbursementsoffundshandledbytheCommissionshallbesubjecttoan
147annualfinancialreviewbyacertifiedorlicensedpublicaccountant,andthereportof
148thefinancialreviewshallbeincludedinandbecomepartoftheannualreportofthe
149Commission.
150 6.(1)TheExecutiveBoardshallhavethepowertoactonbehalfofthe
151CommissionaccordingtothetermsofthisCompact.Thepowers,duties,and
152responsibilitiesoftheExecutiveBoardshallinclude:
153 (a)Overseeingtheday-to-dayactivitiesoftheadministrationoftheCompact
154includingcompliancewiththeprovisionsoftheCompact,theCommission'sRulesand
155bylaws;
156 (b)RecommendingtotheCommissionchangestotheRulesorbylaws,changes
157tothisCompactlegislation,feeschargedtoCompactParticipatingStates,feescharged
158toLicensees,andotherfees;
159 (c)EnsuringCompactadministrationservicesareappropriatelyprovided,
160includingbycontract;
161 (d)Preparingandrecommendingthebudget;
162 (e)MaintainingfinancialrecordsonbehalfoftheCommission;
163 (f)MonitoringCompactcomplianceofParticipatingStatesandproviding
164compliancereportstotheCommission;
165 (g)Establishingadditionalcommitteesasnecessary;
166 (h)ExercisingthepowersanddutiesoftheCommissionduringtheinterim
167betweenCommissionmeetings,exceptforadoptingoramendingRules,adoptingor
168amendingbylaws,andexercisinganyotherpowersanddutiesexpresslyreservedtothe
169CommissionbyRuleorbylaw;and
170 (i)OtherdutiesasprovidedintheRulesorbylawsoftheCommission.
171 (2)TheExecutiveBoardshallbecomposedofuptoseven(7)members:
172 (a)TheChair,ViceChair,SecretaryandTreasureroftheCommissionandany
173othermembersoftheCommissionwhoserveontheExecutiveBoardshallbevoting
174membersoftheExecutiveBoard;and
175 (b)OtherthantheChair,ViceChair,Secretary,andTreasurer,theCommission
176mayelectuptothree(3)votingmembersfromthecurrentmembershipofthe
177Commission.
178 (3)TheCommissionmayremoveanymemberoftheExecutiveBoardas
179providedintheCommission'sbylaws.
180 (4)TheExecutiveBoardshallmeetatleastannually.
181 (a)AnExecutiveBoardmeetingatwhichittakesorintendstotakeformal
182actiononamattershallbeopentothepublic,exceptthattheExecutiveBoardmaymeet
HCSSSSB7 72 183inaclosed,non-publicsessionofapublicmeetingwhendealingwithanyofthematters
184coveredundersubdivision(4)ofsubsection4ofthissection.
185 (b)TheExecutiveBoardshallgivefive(5)businessdays'noticeofitspublic
186meetings,postedonitswebsiteandasitmayotherwisedeterminetoprovidenoticeto
187personswithaninterestinthepublicmatterstheExecutiveBoardintendstoaddressat
188thosemeetings.
189 (5)TheExecutiveBoardmayholdanemergencymeetingwhenactingforthe
190Commissionto:
191 (a)Meetanimminentthreattopublichealth,safety,orwelfare;
192 (b)PreventalossofCommissionorParticipatingStatefunds;or
193 (c)Protectpublichealthandsafety.
194 7.(1)Themembers,officers,executivedirector,employeesandrepresentatives
195oftheCommissionshallbeimmunefromsuitandliability,bothpersonallyandintheir
196officialcapacity,foranyclaimfordamagetoorlossofpropertyorpersonalinjuryor
197othercivilliabilitycausedbyorarisingoutofanyactualorallegedact,error,or
198omissionthatoccurred,orthatthepersonagainstwhomtheclaimismadehada
199reasonablebasisforbelievingoccurredwithinthescopeofCommissionemployment,
200dutiesorresponsibilities;providedthatnothinginthissubdivisionshallbeconstruedto
201protectanysuchpersonfromsuitorliabilityforanydamage,loss,injury,orliability
202causedbytheintentionalorwillfulorwantonmisconductofthatperson.The
203procurementofinsuranceofanytypebytheCommissionshallnotinanyway
204compromiseorlimittheimmunitygrantedhereunder.
205 (2)TheCommissionshalldefendanymember,officer,executivedirector,
206employee,andrepresentativeoftheCommissioninanycivilactionseekingtoimpose
207liabilityarisingoutofanyactualorallegedact,error,oromissionthatoccurredwithin
208thescopeofCommissionemployment,duties,orresponsibilities,orasdeterminedby
209theCommissionthatthepersonagainstwhomtheclaimismadehadareasonablebasis
210forbelievingoccurredwithinthescopeofCommissionemployment,duties,or
211responsibilities;providedthatnothinghereinshallbeconstruedtoprohibitthat
212personfromretainingtheirowncounselattheirownexpense;andprovidedfurther,
213thattheactualorallegedact,error,oromissiondidnotresultfromthatperson's
214intentionalorwillfulorwantonmisconduct.
215 (3)Notwithstandingsubdivision(1)ofthissubsection,shouldanymember,
216officer,executivedirector,employee,orrepresentativeoftheCommissionbeheldliable
217fortheamountofanysettlementorjudgmentarisingoutofanyactualorallegedact,
218error,oromissionthatoccurredwithinthescopeofthatindividual'semployment,
219duties,orresponsibilitiesfortheCommission,orthatthepersontowhomthat
HCSSSSB7 73 220individualisliablehadareasonablebasisforbelievingoccurredwithinthescopeofthe
221individual'semployment,duties,orresponsibilitiesfortheCommission,the
222Commissionshallindemnifyandholdharmlesssuchindividual,providedthatthe
223actualorallegedact,error,oromissiondidnotresultfromtheintentionalorwillfulor
224wantonmisconductoftheindividual.
225 (4)Nothinghereinshallbeconstruedasalimitationontheliabilityofany
226Licenseeforprofessionalmalpracticeormisconduct,whichshallbegovernedsolelyby
227anyotherapplicableStatelaws.
228 (5)NothinginthisCompactshallbeinterpretedtowaiveorotherwiseabrogate
229aParticipatingState'sstateactionimmunityorstateactionaffirmativedefensewith
230respecttoantitrustclaimsundertheShermanAct,ClaytonAct,oranyotherStateor
231federalantitrustoranticompetitivelaworregulation.
232 (6)NothinginthisCompactshallbeconstruedtobeawaiverofsovereign
233immunitybytheParticipatingStatesorbytheCommission.
332.735.1.TheCommissionshallprovideforthedevelopment,maintenance,
2operation,andutilizationofacoordinateddatabaseandreportingsystemcontaining
3licensure,AdverseAction,andthepresenceofSignificantInvestigativeInformationon
4allLicenseesandapplicantsforaLicenseinParticipatingStates.
5 2.NotwithstandinganyotherprovisionofStatelawtothecontrary,a
6ParticipatingStateshallsubmitauniformdatasettotheDataSystemonallindividuals
7towhomthisCompactisapplicableasrequiredbytheRulesoftheCommission,
8including:
9 (1)Identifyinginformation;
10 (2)Licensuredata;
11 (3)AdverseActionsagainstaLicensee,LicenseapplicantorCompactPrivilege
12andinformationrelatedthereto;
13 (4)Non-confidentialinformationrelatedtoAlternativeProgramparticipation,
14thebeginningandendingdatesofsuchparticipation,andotherinformationrelatedto
15suchparticipation;
16 (5)Anydenialofanapplicationforlicensure,andthereasonorreasonsforsuch
17denial,(excludingthereportingofanycriminalhistoryrecordinformationwhere
18prohibitedbylaw);
19 (6)ThepresenceofSignificantInvestigativeInformation;and
20 (7)OtherinformationthatmayfacilitatetheadministrationofthisCompactor
21theprotectionofthepublic,asdeterminedbytheRulesoftheCommission.
22 3.TherecordsandinformationprovidedtoaParticipatingStatepursuantto
23thisCompactorthroughtheDataSystem,whencertifiedbytheCommissionoran
HCSSSSB7 74 24agentthereof,shallconstitutetheauthenticatedbusinessrecordsoftheCommission,
25andshallbeentitledtoanyassociatedhearsayexceptioninanyrelevantjudicial,quasi-
26judicialoradministrativeproceedingsinaParticipatingState.
27 4.SignificantInvestigativeInformationpertainingtoaLicenseeinany
28ParticipatingStatewillonlybeavailabletootherParticipatingStates.
29 5.ItistheresponsibilityoftheParticipatingStatestomonitorthedatabaseto
30determinewhetherAdverseActionhasbeentakenagainstaLicenseeorLicense
31applicant.AdverseActioninformationpertainingtoaLicenseeorLicenseapplicantin
32anyParticipatingStatewillbeavailabletoanyotherParticipatingState.
33 6.ParticipatingStatescontributinginformationtotheDataSystemmay
34designateinformationthatmaynotbesharedwiththepublicwithouttheexpress
35permissionofthecontributingState.
36 7.AnyinformationsubmittedtotheDataSystemthatissubsequentlyexpunged
37pursuanttofederallaworthelawsoftheParticipatingStatecontributingthe
38informationshallberemovedfromtheDataSystem.
332.740.1.TheCommissionshallpromulgatereasonableRulesinorderto
2effectivelyandefficientlyimplementandadministerthepurposesandprovisionsofthe
3Compact.ACommissionRuleshallbeinvalidandhavenoforceoreffectonlyifacourt
4ofcompetentjurisdictionholdsthattheRuleisinvalidbecausetheCommission
5exerciseditsrulemakingauthorityinamannerthatisbeyondthescopeandpurposesof
6theCompact,orthepowersgrantedhereunder,orbaseduponanotherapplicable
7standardofreview.
8 2.TheRulesoftheCommissionshallhavetheforceoflawineachParticipating
9State,providedhoweverthatwheretheRulesoftheCommissionconflictwiththelaws
10oftheParticipatingStatethatestablishtheParticipatingState'sScopeofPracticeas
11heldbyacourtofcompetentjurisdiction,theRulesoftheCommissionshallbe
12ineffectiveinthatStatetotheextentoftheconflict.
13 3.TheCommissionshallexerciseitsRulemakingpowerspursuanttothecriteria
14setforthinthissectionandtheRulesadoptedthereunder.Rulesshallbecomebinding
15asofthedatespecifiedbytheCommissionforeachRule.
16 4.IfamajorityofthelegislaturesoftheParticipatingStatesrejectsa
17CommissionRuleorportionofaCommissionRule,byenactmentofastatuteor
18resolutioninthesamemannerusedtoadopttheCompact,withinfour(4)yearsofthe
19dateofadoptionoftheRule,thensuchRuleshallhavenofurtherforceandeffectinany
20ParticipatingStateortoanyStateapplyingtoparticipateintheCompact.
21 5.RulesshallbeadoptedataregularorspecialmeetingoftheCommission.
HCSSSSB7 75 22 6.PriortoadoptionofaproposedRule,theCommissionshallholdapublic
23hearingandallowpersonstoprovideoralandwrittencomments,data,facts,opinions,
24andarguments.
25 7.PriortoadoptionofaproposedRulebytheCommission,andatleastthirty
26(30)daysinadvanceofthemeetingatwhichtheCommissionwillholdapublichearing
27ontheproposedRule,theCommissionshallprovideaNoticeofProposedRulemaking:
28 (1)OnthewebsiteoftheCommissionorotherpubliclyaccessibleplatform;
29 (2)TopersonswhohaverequestednoticeoftheCommission'snoticesof
30proposedrulemaking;and
31 (3)InsuchotherwayorwaysastheCommissionmaybyRulespecify.
32 8.TheNoticeofProposedRulemakingshallinclude:
33 (1)Thetime,date,andlocationofthepublichearingatwhichtheCommission
34willhearpubliccommentsontheproposedRuleand,ifdifferent,thetime,date,and
35locationofthemeetingwheretheCommissionwillconsiderandvoteontheproposed
36Rule;
37 (2)Ifthehearingisheldviatelecommunication,videoconference,orother
38electronicmeans,theCommissionshallincludethemechanismforaccesstothehearing
39intheNoticeofProposedRulemaking;
40 (3)ThetextoftheproposedRuleandthereasontherefor;
41 (4)ArequestforcommentsontheproposedRulefromanyinterestedperson;
42and
43 (5)Themannerinwhichinterestedpersonsmaysubmitwrittencomments.
44 9.Allhearingswillberecorded.Acopyoftherecordingandallwritten
45commentsanddocumentsreceivedbytheCommissioninresponsetotheproposedRule
46shallbeavailabletothepublic.
47 10.Nothinginthissectionshallbeconstruedasrequiringaseparatehearingon
48eachCommissionRule.RulesmaybegroupedfortheconvenienceoftheCommission
49athearingsrequiredbythissection.
50 11.TheCommissionshall,bymajorityvoteofallCommissioners,takefinal
51actionontheproposedRulebasedontherulemakingrecord.
52 (1)TheCommissionmayadoptchangestotheproposedRuleprovidedthe
53changesdonotenlargetheoriginalpurposeoftheproposedRule.
54 (2)TheCommissionshallprovideanexplanationofthereasonsforsubstantive
55changesmadetotheproposedRuleaswellasreasonsforsubstantivechangesnotmade
56thatwererecommendedbycommenters.
57 (3)TheCommissionshalldetermineareasonableeffectivedatefortheRule.
58Exceptforanemergencyasprovidedinsubsection12ofthissection,theeffectivedate
HCSSSSB7 76 59oftheRuleshallbenosoonerthanthirty(30)daysaftertheCommissionissuingthe
60noticethatitadoptedoramendedtheRule.
61 12.Upondeterminationthatanemergencyexists,theCommissionmayconsider
62andadoptanemergencyRulewith24hours'notice,withopportunitytocomment,
63providedthattheusualrulemakingproceduresprovidedintheCompactandinthis
64sectionshallberetroactivelyappliedtotheRuleassoonasreasonablypossible,inno
65eventlaterthanninety(90)daysaftertheeffectivedateoftheRule.Forthepurposesof
66thisprovision,anemergencyRuleisonethatmustbeadoptedimmediatelyinorderto:
67 (1)Meetanimminentthreattopublichealth,safety,orwelfare;
68 (2)PreventalossofCommissionorParticipatingStatefunds;
69 (3)MeetadeadlineforthepromulgationofaRulethatisestablishedbyfederal
70laworrule;or
71 (4)Protectpublichealthandsafety.
72 13.TheCommissionoranauthorizedcommitteeoftheCommissionmaydirect
73revisionstoapreviouslyadoptedRuleforpurposesofcorrectingtypographicalerrors,
74errorsinformat,errorsinconsistency,orgrammaticalerrors.Publicnoticeofany
75revisionsshallbepostedonthewebsiteoftheCommission.Therevisionshallbesubject
76tochallengebyanypersonforaperiodofthirty(30)daysafterposting.Therevision
77maybechallengedonlyongroundsthattherevisionresultsinamaterialchangetoa
78Rule.AchallengeshallbemadeinwritinganddeliveredtotheCommissionpriortothe
79endofthenoticeperiod.Ifnochallengeismade,therevisionwilltakeeffectwithout
80furtheraction.Iftherevisionischallenged,therevisionmaynottakeeffectwithoutthe
81approvaloftheCommission.
82 14.NoParticipatingState'srulemakingrequirementsshallapplyunderthis
83Compact.
332.745.1.(1)TheexecutiveandjudicialbranchesofStategovernmentineach
2ParticipatingStateshallenforcethisCompactandtakeallactionsnecessaryand
3appropriatetoimplementtheCompact.
4 (2)VenueisproperandjudicialproceedingsbyoragainsttheCommissionshall
5bebroughtsolelyandexclusivelyinacourtofcompetentjurisdictionwherethe
6principalofficeoftheCommissionislocated.TheCommissionmaywaivevenueand
7jurisdictionaldefensestotheextentitadoptsorconsentstoparticipateinalternative
8disputeresolutionproceedings.Nothinghereinshallaffectorlimittheselectionor
9proprietyofvenueinanyactionagainstaLicenseeforprofessionalmalpractice,
10misconductoranysuchsimilarmatter.
11 (3)TheCommissionshallbeentitledtoreceiveserviceofprocessinany
12proceedingregardingtheenforcementorinterpretationoftheCompactorCommission
HCSSSSB7 77 13Ruleandshallhavestandingtointerveneinsuchaproceedingforallpurposes.Failure
14toprovidetheCommissionserviceofprocessshallrenderajudgmentorordervoidas
15totheCommission,thisCompact,orpromulgatedRules.
16 2.(1)IftheCommissiondeterminesthataParticipatingStatehasdefaultedin
17theperformanceofitsobligationsorresponsibilitiesunderthisCompactorthe
18promulgatedRules,theCommissionshallprovidewrittennoticetothedefaultingState.
19Thenoticeofdefaultshalldescribethedefault,theproposedmeansofcuringthe
20default,andanyotheractionthattheCommissionmaytake,andshalloffertraining
21andspecifictechnicalassistanceregardingthedefault.
22 (2)TheCommissionshallprovideacopyofthenoticeofdefaulttotheother
23ParticipatingStates.
24 3.IfaStateindefaultfailstocurethedefault,thedefaultingStatemaybe
25terminatedfromtheCompactuponanaffirmativevoteofamajorityofthe
26Commissioners,andallrights,privilegesandbenefitsconferredonthatStatebythis
27Compactmaybeterminatedontheeffectivedateoftermination.Acureofthedefault
28doesnotrelievetheoffendingStateofobligationsorliabilitiesincurredduringthe
29periodofdefault.
30 4.TerminationofparticipationintheCompactshallbeimposedonlyafterall
31othermeansofsecuringcompliancehavebeenexhausted.Noticeofintenttosuspendor
32terminateshallbegivenbytheCommissiontothegovernor,themajorityandminority
33leadersofthedefaultingState'slegislature,thedefaultingState'sStateLicensing
34AuthorityorAuthorities,asapplicable,andeachoftheParticipatingStates'State
35LicensingAuthorityorAuthorities,asapplicable.
36 5.AStatethathasbeenterminatedisresponsibleforallassessments,
37obligations,andliabilitiesincurredthroughtheeffectivedateoftermination,including
38obligationsthatextendbeyondtheeffectivedateoftermination.
39 6.UpontheterminationofaState'sparticipationinthisCompact,thatState
40shallimmediatelyprovidenoticetoallLicenseesoftheState,includingLicenseesof
41otherParticipatingStatesissuedaCompactPrivilegetopracticewithinthatState,of
42suchtermination.TheterminatedStateshallcontinuetorecognizeallCompact
43PrivilegesthenineffectinthatStateforaminimumofonehundredeighty(180)days
44afterthedateofsaidnoticeoftermination.
45 7.TheCommissionshallnotbearanycostsrelatedtoaStatethatisfoundtobe
46indefaultorthathasbeenterminatedfromtheCompact,unlessagreeduponinwriting
47betweentheCommissionandthedefaultingState.
48 8.ThedefaultingStatemayappealtheactionoftheCommissionbypetitioning
49theU.S.DistrictCourtfortheDistrictofColumbiaorthefederaldistrictwherethe
HCSSSSB7 78 50Commissionhasitsprincipaloffices.Theprevailingpartyshallbeawardedallcostsof
51suchlitigation,includingreasonableattorney'sfees.
52 9.(1)UponrequestbyaParticipatingState,theCommissionshallattemptto
53resolvedisputesrelatedtotheCompactthatariseamongParticipatingStatesand
54betweenParticipatingStatesandnon-ParticipatingStates.
55 (2)TheCommissionshallpromulgateaRuleprovidingforbothmediationand
56bindingdisputeresolutionfordisputesasappropriate.
57 10.(1)TheCommission,inthereasonableexerciseofitsdiscretion,shallenforce
58theprovisionsofthisCompactandtheCommission'sRules.
59 (2)Bymajorityvote,theCommissionmayinitiatelegalactionagainsta
60ParticipatingStateindefaultintheUnitedStatesDistrictCourtfortheDistrictof
61ColumbiaorthefederaldistrictwheretheCommissionhasitsprincipalofficesto
62enforcecompliancewiththeprovisionsoftheCompactanditspromulgatedRules.The
63reliefsoughtmayincludebothinjunctivereliefanddamages.Intheeventjudicial
64enforcementisnecessary,theprevailingpartyshallbeawardedallcostsofsuch
65litigation,includingreasonableattorney'sfees.Theremedieshereinshallnotbethe
66exclusiveremediesoftheCommission.TheCommissionmaypursueanyother
67remediesavailableunderfederalorthedefaultingParticipatingState'slaw.
68 (3)AParticipatingStatemayinitiatelegalactionagainsttheCommissioninthe
69U.S.DistrictCourtfortheDistrictofColumbiaorthefederaldistrictwherethe
70Commissionhasitsprincipalofficestoenforcecompliancewiththeprovisionsofthe
71CompactanditspromulgatedRules.Thereliefsoughtmayincludebothinjunctive
72reliefanddamages.Intheeventjudicialenforcementisnecessary,theprevailingparty
73shallbeawardedallcostsofsuchlitigation,includingreasonableattorney'sfees.
74 (4)NoindividualorentityotherthanaParticipatingStatemayenforcethis
75CompactagainsttheCommission.
332.750.1.TheCompactshallcomeintoeffectonthedateonwhichthe
2CompactstatuteisenactedintolawintheseventhParticipatingState.
3 (1)OnoraftertheeffectivedateoftheCompact,theCommissionshallconvene
4andreviewtheenactmentofeachoftheStatesthatenactedtheCompactpriortothe
5Commissionconvening("CharterParticipatingStates")todetermineifthestatute
6enactedbyeachsuchCharterParticipatingStateismateriallydifferentthantheModel
7Compact.
8 (a)ACharterParticipatingStatewhoseenactmentisfoundtobematerially
9differentfromtheModelCompactshallbeentitledtothedefaultprocesssetforthin
10section332.745.
HCSSSSB7 79 11 (b)IfanyParticipatingStateislaterfoundtobeindefault,oristerminatedor
12withdrawsfromtheCompact,theCommissionshallremaininexistenceandthe
13CompactshallremainineffectevenifthenumberofParticipatingStatesshouldbeless
14thanseven(7).
15 (2)ParticipatingStatesenactingtheCompactsubsequenttotheCharter
16ParticipatingStatesshallbesubjecttotheprocesssetforthinsubdivision(23)of
17subsection3ofsection332.730todetermineiftheirenactmentsaremateriallydifferent
18fromtheModelCompactandwhethertheyqualifyforparticipationintheCompact.
19 (3)AllactionstakenforthebenefitoftheCommissionorinfurtheranceofthe
20purposesoftheadministrationoftheCompactpriortotheeffectivedateoftheCompact
21ortheCommissioncomingintoexistenceshallbeconsideredtobeactionsofthe
22CommissionunlessspecificallyrepudiatedbytheCommission.
23 (4)AnyStatethatjoinstheCompactsubsequenttotheCommission'sinitial
24adoptionoftheRulesandbylawsshallbesubjecttotheCommission'sRulesandbylaws
25astheyexistonthedateonwhichtheCompactbecomeslawinthatState.AnyRule
26thathasbeenpreviouslyadoptedbytheCommissionshallhavethefullforceandeffect
27oflawonthedaytheCompactbecomeslawinthatState.
28 2.AnyParticipatingStatemaywithdrawfromthisCompactbyenactinga
29statuterepealingthatState'senactmentoftheCompact.
30 (1)AParticipatingState'swithdrawalshallnottakeeffectuntilonehundred
31eighty(180)daysafterenactmentoftherepealingstatute.
32 (2)Withdrawalshallnotaffectthecontinuingrequirementofthewithdrawing
33State'sLicensingAuthorityorAuthoritiestocomplywiththeinvestigativeandAdverse
34ActionreportingrequirementsofthisCompactpriortotheeffectivedateofwithdrawal.
35 (3)UpontheenactmentofastatutewithdrawingfromthisCompact,theState
36shallimmediatelyprovidenoticeofsuchwithdrawaltoallLicenseeswithinthatState.
37Notwithstandinganysubsequentstatutoryenactmenttothecontrary,suchwithdrawing
38StateshallcontinuetorecognizeallCompactPrivilegestopracticewithinthatState
39grantedpursuanttothisCompactforaminimumofonehundredeighty(180)daysafter
40thedateofsuchnoticeofwithdrawal.
41 3.NothingcontainedinthisCompactshallbeconstruedtoinvalidateorprevent
42anylicensureagreementorothercooperativearrangementbetweenaParticipating
43Stateandanon-ParticipatingStatethatdoesnotconflictwiththeprovisionsofthis
44Compact.
45 4.ThisCompactmaybeamendedbytheParticipatingStates.Noamendmentto
46thisCompactshallbecomeeffectiveandbindinguponanyParticipatingStateuntilitis
47enactedintothelawsofallParticipatingStates.
HCSSSSB7 80 332.755.1.ThisCompactandtheCommission'srulemakingauthorityshallbe
2liberallyconstruedsoastoeffectuatethepurposes,andtheimplementationand
3administrationoftheCompact.ProvisionsoftheCompactexpresslyauthorizingor
4requiringthepromulgationofRulesshallnotbeconstruedtolimittheCommission's
5rulemakingauthoritysolelyforthosepurposes.
6 2.TheprovisionsofthisCompactshallbeseverableandifanyphrase,clause,
7sentenceorprovisionofthisCompactisheldbyacourtofcompetentjurisdictiontobe
8contrarytotheconstitutionofanyParticipatingState,aStateseekingparticipationin
9theCompact,oroftheUnitedStates,ortheapplicabilitythereoftoanygovernment,
10agency,personorcircumstanceisheldtobeunconstitutionalbyacourtofcompetent
11jurisdiction,thevalidityoftheremainderofthisCompactandtheapplicabilitythereof
12toanyothergovernment,agency,personorcircumstanceshallnotbeaffectedthereby.
13 3.Notwithstandingsubsection2ofthissection,theCommissionmaydenya
14State'sparticipationintheCompactor,inaccordancewiththerequirementsof
15subsection2ofsection332.745,terminateaParticipatingState'sparticipationinthe
16Compact,ifitdeterminesthataconstitutionalrequirementofaParticipatingStateisa
17materialdeparturefromtheCompact.Otherwise,ifthisCompactshallbeheldtobe
18contrarytotheconstitutionofanyParticipatingState,theCompactshallremaininfull
19forceandeffectastotheremainingParticipatingStatesandinfullforceandeffectasto
20theParticipatingStateaffectedastoallseverablematters.
332.760.1.Nothinghereinshallpreventorinhibittheenforcementofanyother
2lawofaParticipatingStatethatisnotinconsistentwiththeCompact.
3 2.Anylaws,statutes,regulations,orotherlegalrequirementsinaParticipating
4StateinconflictwiththeCompactaresupersededtotheextentoftheconflict.
5 3.AllpermissibleagreementsbetweentheCommissionandtheParticipating
6Statesarebindinginaccordancewiththeirterms.
335.081.Solongasthepersoninvolveddoesnotrepresentorholdhimselforherself
2outasanurselicensedtopracticeinthisstate,noprovisionofsections335.011to335.096
3shallbeconstruedasprohibiting:
4 (1)Thepracticeofanyprofessionforwhichalicenseisrequiredandissuedpursuant
5tothelawsofthisstatebyapersondulylicensedtopracticethatprofession;
6 (2)Theservicesrenderedbytechnicians,nurses'aidesortheirequivalenttrainedand
7employedinpublicorprivatehospitalsandlicensedlong-termcarefacilitiesexceptthe
8servicesrenderedinlicensedlong-termcarefacilitiesshallbelimitedtoadministering
9medication,excludinginjectablemedicationsotherthan:
10 (a)Insulin;
HCSSSSB7 81 11 (b)Subcutaneousinjectablemedicationstotreatdiabetesasorderedbyan
12individuallegallyauthorizedtoprescribesuchmedications;and
13 (c)Epinephrinedeliverydevicesorderedforstocksupplyinaccordancewith
14section196.990orprescribedforaresident'sindividualusebyanindividuallegally
15authorizedtoprescribesuchepinephrinedeliverydevices.Expectedepinephrine
16deliverydeviceusersshallreceivetrainingsetforthinsection196.990.Asusedinthis
17paragraph,theterm"epinephrinedeliverydevice"meansasingle-usedeviceusedfor
18thedeliveryofapremeasureddoseofepinephrineintothehumanbody;
19 (3)Theprovidingofnursingcarebyfriendsormembersofthefamilyoftheperson
20receivingsuchcare;
21 (4)Theincidentalcareofthesick,aged,orinfirmbydomesticservantsorpersons
22primarilyemployedashousekeepers;
23 (5)Thefurnishingofnursingassistanceinthecaseofanemergencysituation;
24 (6)Thepracticeofnursingunderpropersupervision:
25 (a)Asapartofthecourseofstudybystudentsenrolledinapprovedschoolsof
26professionalnursingorinschoolsofpracticalnursing;
27 (b)Bygraduatesofaccreditednursingprogramspendingtheresultsofthefirst
28licensingexaminationorninetydaysaftergraduation,whicheverfirstoccurs;
29 (c)Agraduatenursewhoispreventedfromattendingthefirstlicensingexamination
30followinggraduationbyreasonofactivedutyinthemilitarymaypracticeasagraduatenurse
31pendingtheresultsofthefirstlicensingexaminationscheduledbytheboardfollowingthe
32releaseofsuchgraduatenursefromactivemilitarydutyorpendingtheresultsofthefirst
33licensingexaminationtakenbythegraduatenursewhileinvolvedinactivemilitaryservice
34whichevercomesfirst;
35 (7)Thepracticeofnursinginthisstatebyanylegallyqualifiednursedulylicensedto
36practiceinanotherstatewhoseengagementrequiressuchnursetoaccompanyandcarefora
37patienttemporarilyresidinginthisstateforaperiodnottoexceedsixmonths;
38 (8)Thepracticeofanylegallyqualifiednursewhoisemployedbythegovernmentof
39theUnitedStatesoranybureau,divisionoragencythereof,whileinthedischargeofhisor
40herofficialdutiesortothepracticeofanylegallyqualifiednurseservingintheArmedForces
41oftheUnitedStateswhilestationedwithinthisstate;
42 (9)Nonmedicalnursingcareofthesickwithorwithoutcompensationwhendonein
43connectionwiththepracticeofthereligioustenetsofanychurchbyadherentsthereof,aslong
44astheydonotengageinthepracticeofnursingasdefinedinsections335.011to335.096;
45 (10)Thepracticeofanylegallyqualifiedandlicensednurseofanotherstate,territory,
46orforeigncountrywhoseresponsibilitiesincludetransportingpatientsinto,outof,orthrough
HCSSSSB7 82 47thisstatewhileactivelyengagedinpatienttransportthatdoesnotexceedforty-eighthoursin
48thisstate.
338.010.1.The"practiceofpharmacy"includes:
2 (1)Theinterpretation,implementation,andevaluationofmedicalprescriptionorders,
3includinganylegenddrugsunder21U.S.C.Section353,andthereceipt,transmission,or
4handlingofsuchordersorfacilitatingthedispensingofsuchorders;
5 (2)Thedesigning,initiating,implementing,andmonitoringofamedication
6therapeuticplaninaccordancewiththeprovisionsofthissection;
7 (3)Thecompounding,dispensing,labeling,andadministrationofdrugsanddevices
8pursuanttomedicalprescriptionorders;
9 (4)TheorderingandadministrationofvaccinesapprovedorauthorizedbytheU.S.
10FoodandDrugAdministration,excludingvaccinesforcholera,monkeypox,Japanese
11encephalitis,typhoid,rabies,yellowfever,tick-borneencephalitis,anthrax,tuberculosis,
12dengue,Hib,polio,rotavirus,smallpox,chikungunya,andanyvaccineapprovedafter
13January1,[2023] 2025, topersonsatleastsevenyearsofageortheagerecommendedbythe
14CentersforDiseaseControlandPrevention,whicheverisolder,pursuanttojoint
15promulgationofrulesestablishedbytheboardofpharmacyandthestateboardof
16registrationforthehealingartsunlessrulesareestablishedunderastateofemergencyas
17describedinsection44.100;
18 (5)Theparticipationindrugselectionaccordingtostatelawandparticipationindrug
19utilizationreviews;
20 (6)Theproperandsafestorageofdrugsanddevicesandthemaintenanceofproper
21recordsthereof;
22 (7)Consultationwithpatientsandotherhealthcarepractitioners,andveterinarians
23andtheirclientsaboutlegenddrugs,aboutthesafeandeffectiveuseofdrugsanddevices;
24 (8)Theprescribinganddispensingofanynicotinereplacementtherapyproductunder
25section338.665;
26 (9)ThedispensingofHIVpostexposureprophylaxispursuanttosection338.730;and
27 (10)Theofferingorperformingofthoseacts,services,operations,ortransactions
28necessaryintheconduct,operation,managementandcontrolofapharmacy.
29 2.Nopersonshallengageinthepracticeofpharmacyunlessheorsheislicensed
30undertheprovisionsofthischapter.
31 3.Thischaptershallnotbeconstruedtoprohibittheuseofauxiliarypersonnelunder
32thedirectsupervisionofapharmacistfromassistingthepharmacistinanyofhisorherduties.
33Thisassistanceinnowayisintendedtorelievethepharmacistfromhisorherresponsibilities
34forcompliancewiththischapterandheorshewillberesponsiblefortheactionsofthe
35auxiliarypersonnelactinginhisorherassistance.
HCSSSSB7 83 36 4.Thischaptershallnotbeconstruedtoprohibitorinterferewithanylegally
37registeredpractitionerofmedicine,dentistry,orpodiatry,orveterinarymedicineonlyforuse
38inanimals,orthepracticeofoptometryinaccordancewithandasprovidedinsections
39195.070and336.220inthecompounding,administering,prescribing,ordispensingofhisor
40herownprescriptions.
41 5.Apharmacistwithacertificateofmedicationtherapeuticplanauthoritymay
42providemedicationtherapyservicespursuanttoawrittenprotocolfromaphysicianlicensed
43underchapter334topatientswhohaveestablishedaphysician-patientrelationship,as
44describedinsubdivision(1)ofsubsection1ofsection191.1146,withtheprotocolphysician.
45Thewrittenprotocolauthorizedbythissectionshallcomeonlyfromthephysicianandshall
46notcomefromanurseengagedinacollaborativepracticearrangementundersection
47334.104,orfromaphysicianassistantengagedinacollaborativepracticearrangementunder
48section334.735.
49 6.Nothinginthissectionshallbeconstruedastopreventanyperson,firmor
50corporationfromowningapharmacyregulatedbysections338.210to338.315,providedthat
51alicensedpharmacistisinchargeofsuchpharmacy.
52 7.Nothinginthissectionshallbeconstruedtoapplytoorinterferewiththesaleof
53nonprescriptiondrugsandtheordinaryhouseholdremediesandsuchdrugsormedicinesas
54arenormallysoldbythoseengagedinthesaleofgeneralmerchandise.
55 8.Nohealthcarrierasdefinedinchapter376shallrequireanyphysicianwithwhich
56theycontracttoenterintoawrittenprotocolwithapharmacistformedicationtherapeutic
57services.
58 9.Thissectionshallnotbeconstruedtoallowapharmacisttodiagnoseor
59independentlyprescribepharmaceuticals.
60 10.Thestateboardofregistrationforthehealingarts,undersection334.125,andthe
61stateboardofpharmacy,undersection338.140,shalljointlypromulgaterulesregulatingthe
62useofprotocolsformedicationtherapyservices.Suchrulesshallrequireprotocolstoinclude
63provisionsallowingfortimelycommunicationbetweenthepharmacistandtheprotocol
64physicianorsimilarbodyauthorizedbythissection,andanyotherpatientprotection
65provisionsdeemedappropriatebybothboards.Inordertotakeeffect,suchrulesshallbe
66approvedbyamajorityvoteofaquorumofeachboard.Neitherboardshallseparately
67promulgaterulesregulatingtheuseofprotocolsformedicationtherapyservices.Anyruleor
68portionofarule,asthattermisdefinedinsection536.010,thatiscreatedundertheauthority
69delegatedinthissectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallof
70theprovisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter
71536arenonseverableandifanyofthepowersvestedwiththegeneralassemblypursuantto
72chapter536toreview,todelaytheeffectivedate,ortodisapproveandannularuleare
HCSSSSB7 84 73subsequentlyheldunconstitutional,thenthegrantofrulemakingauthorityandanyrule
74proposedoradoptedafterAugust28,2007,shallbeinvalidandvoid.
75 11.Thestateboardofpharmacymaygrantacertificateofmedicationtherapeutic
76planauthoritytoalicensedpharmacistwhosubmitsproofofsuccessfulcompletionofa
77board-approvedcourseofacademicclinicalstudybeyondabachelorofscienceinpharmacy,
78includingbutnotlimitedtoclinicalassessmentskills,fromanationallyaccreditedcollegeor
79university,oracertificationofequivalenceissuedbyanationallyrecognizedprofessional
80organizationandapprovedbytheboardofpharmacy.
81 12.Anypharmacistwhohasreceivedacertificateofmedicationtherapeuticplan
82authoritymayengageinthedesigning,initiating,implementing,andmonitoringofa
83medicationtherapeuticplanasdefinedbyawrittenprotocolfromaphysicianthatmaybe
84specifictoeachpatientforcarebyapharmacist.
85 13.Nothinginthissectionshallbeconstruedtoallowapharmacisttomakea
86therapeuticsubstitutionofapharmaceuticalprescribedbyaphysicianunlessauthorizedby
87thewrittenprotocolorthephysician'sprescriptionorder.
88 14."Veterinarian","doctorofveterinarymedicine","practitionerofveterinary
89medicine","DVM","VMD","BVSe","BVMS","BSe(VetScience)","VMB","MRCVS",or
90anequivalenttitlemeansapersonwhohasreceivedadoctor'sdegreeinveterinarymedicine
91fromanaccreditedschoolofveterinarymedicineorholdsanEducationalCommissionfor
92ForeignVeterinaryGraduates(EDFVG)certificateissuedbytheAmericanVeterinary
93MedicalAssociation(AVMA).
94 15.Inadditiontootherrequirementsestablishedbythejointpromulgationofrulesby
95theboardofpharmacyandthestateboardofregistrationforthehealingarts:
96 (1)Apharmacistshalladministervaccinesbyprotocolinaccordancewithtreatment
97guidelinesestablishedbytheCentersforDiseaseControlandPrevention(CDC);
98 (2)Apharmacistwhoisadministeringavaccineshallrequestapatienttoremainin
99thepharmacyasafeamountoftimeafteradministeringthevaccinetoobserveanyadverse
100reactions.Suchpharmacistshallhaveadoptedemergencytreatmentprotocols.
101 16.Inadditiontootherrequirementsbytheboard,apharmacistshallreceive
102additionaltrainingasrequiredbytheboardandevidencedbyreceivingacertificatefromthe
103boarduponcompletion,andshalldisplaythecertificationinhisorherpharmacywhere
104vaccinesaredelivered.
105 17.Apharmacistshallinformthepatientthattheadministrationofavaccinewillbe
106enteredintotheShowMeVaxsystem,asadministeredbythedepartmentofhealthandsenior
107services.Thepatientshallattesttotheinclusionofsuchinformationinthesystembysigning
108aformprovidedbythepharmacist.Ifthepatientindicatesthatheorshedoesnotwantsuch
109informationenteredintotheShowMeVaxsystem,thepharmacistshallprovideawritten
HCSSSSB7 85 110reportwithinfourteendaysofadministrationofavaccinetothepatient'shealthcareprovider,
111ifprovidedbythepatient,containing:
112 (1)Theidentityofthepatient;
113 (2)Theidentityofthevaccineorvaccinesadministered;
114 (3)Therouteofadministration;
115 (4)Theanatomicsiteoftheadministration;
116 (5)Thedoseadministered;and
117 (6)Thedateofadministration.
118 18.Apharmacistlicensedunderthischaptermayorderandadministervaccines
119approvedorauthorizedbytheU.S.FoodandDrugAdministrationtoaddressapublichealth
120need,aslawfullyauthorizedbythestateorfederalgovernment,oradepartmentoragency
121thereof,duringastateorfederallydeclaredpublichealthemergency.
338.710.1.ThereisherebycreatedintheMissouriboardofpharmacythe"RXCares
2forMissouriProgram".Thegoaloftheprogramshallbetopromotemedicationsafetyandto
3preventprescriptiondrugabuse,misuse,anddiversioninMissouri.
4 2.Theboard,inconsultationwiththedepartment,shallbeauthorizedtoexpend,
5allocate,orawardfundsappropriatedtotheboardtoprivateorpublicentitiestodevelopor
6provideprogramsoreducationtopromotemedicationsafetyortosuppressorprevent
7prescriptiondrugabuse,misuse,anddiversioninthestateofMissouri.Innocaseshallthe
8authorizationinclude,northefundsbeexpendedfor,anystateprescriptiondrugmonitoring
9programincluding,butnotlimitedto,suchasaredefinedin38CFR1.515.Fundsdisbursed
10toastateagencyunderthissectionmayenhance,butshallnotsupplant,fundsotherwise
11appropriatedtosuchstateagency.
12 3.Theboardshallbetheadministrativeagencyresponsibleforimplementingthe
13programinconsultationwiththedepartment.Theboardandthedepartmentmayenterinto
14interagencyagreementsbetweenthemselvestoallowthedepartmenttoassistinthe
15managementoroperationoftheprogram.Theboardmayawardfundsdirectlytothe
16departmenttoimplement,manage,develop,orprovideprogramsoreducationpursuanttothe
17program.
18 4.Afterafullyearofprogramoperation,theboardshallprepareandsubmitan
19evaluationreporttothegovernorandthegeneralassemblydescribingtheoperationofthe
20programandthefundsallocated.[Unlessotherwiseauthorizedbythegeneralassembly,the
21programshallexpireonAugust28,2026.]
345.050.Tobeeligibleforlicensurebytheboardbyexamination,eachapplicant
2shallsubmittheapplicationfeeandshallfurnishevidenceofsuchperson'scurrent
3competenceandshall:
HCSSSSB7 86 4 (1)Holdamaster'soradoctoraldegreefromaprogramthatwasawarded
5"accreditationcandidate"statusorisaccreditedbytheCouncilonAcademicAccreditationof
6theAmericanSpeech-Language-HearingAssociationorotheraccreditingagencyapproved
7bytheboardintheareainwhichlicensureissought;
8 (2)Submitofficialtranscriptsfromoneormoreaccreditedcollegesoruniversities
9presentingevidenceofthecompletionofcourseworkandclinicalpracticumrequirements
10equivalenttothatrequiredbytheCouncilonAcademicAccreditationoftheAmerican
11Speech-Language-HearingAssociationorotheraccreditingagencyapprovedbytheboard;
12 (3)Presentwrittenevidenceofcompletionofaclinicalfellowshipfromsupervisors.
13Theexperiencerequiredbythissubdivisionshallfollowthecompletionoftherequirements
14ofsubdivisions(1)and(2)ofthissection.Thisperiodofemploymentshallbeunderthe
15directsupervisionofa[personwhois]licensed[bythestateofMissouriintheprofessionin
16whichtheapplicantseekstobelicensed] speech-languagepathologistingoodstanding.
17Personsapplyingwithanaudiologyclinicaldoctoraldegreeareexemptfromthisprovision;
18and
19 (4)Passanexaminationpromulgatedorapprovedbytheboard.Theboardshall
20determinethesubjectandscopeoftheexaminations.
376.1240.1.Forpurposesofthissection,termsshallhavethesamemeaningsas
2ascribedtotheminsection376.1350,andtheterm"self-administeredhormonal
3contraceptive"shallmeanadrugthatiscomposedofoneormorehormonesandthatis
4approvedbytheFoodandDrugAdministrationtopreventpregnancy,excluding
5emergencycontraception.Nothinginthissectionshallbeconstruedtoapplyto
6medicationsapprovedbytheFoodandDrugAdministrationtoterminateanexisting
7pregnancy.
8 2.Anyhealthbenefitplandelivered,issuedfordelivery,continued,orrenewed
9inthisstateonorafterJanuary1,2026,thatprovidescoverageforself-administered
10hormonalcontraceptivesshallprovidecoveragetoreimburseahealthcareprovideror
11dispensingentityforthedispensingofasupplyofself-administeredhormonal
12contraceptivesintendedtolastuptooneyear.
13 3.Thecoveragerequiredunderthissectionshallnotbesubjecttoanygreater
14deductibleorco-paymentthanothersimilarhealthcareservicesprovidedbythehealth
15benefitplan.
376.1280.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Elevatedriskofopioidmisuse",whenanenrolleemeetsoneormoreofthe
3followingcriteria,asdeterminedbytheprescribinghealthcareprofessional:
4 (a)Currentorprevioushistoryordiagnosisofasubstanceusedisorder;
HCSSSSB7 87 5 (b)Completionofanadvancehealthcaredirectivetolimitpaincontrolto
6nonopioidmeasuresasdescribedinsection459.016;
7 (c)Increasedriskforopioidoverdose,dependency,orserioussideeffectsbased
8onthepatient'sageordiagnosis;or
9 (d)Currentlyprescribedmedicationswithcontraindicationsforopioiduse;
10 (2)"Enrollee",thesamemeaninggiventotheterminsection376.1350;
11 (3)"Healthbenefitplan",thesamemeaninggiventotheterminsection
12376.1350;
13 (4)"Healthcareprofessional",thesamemeaninggiventotheterminsection
14376.1350.
15 2.Notwithstandinganyprovisionoflawtothecontrary,whenalicensedhealth
16careprofessionalactingwithinthescopeofhisorherlicenseprescribesanonopioid
17medicationforthetreatmentofpaintoapatientwithanelevatedriskofopioidmisuse,
18itshallbeunlawfulforahealthbenefitplanto:
19 (1)Denycoverageofthenonopioidprescriptiondruginfavorofanopioid
20prescriptiondrug;
21 (2)Requirethepatienttotryanopioidprescriptiondrugbeforeproviding
22coverageofthenonopioidprescriptiondrug;or
23 (3)Requireahigherlevelofcost-sharingforthenonopioidprescriptiondrug
24thanforanopioidprescriptiondrug.
25 3.Thissectionshallapplytohealthbenefitplansdelivered,issuedfordelivery,
26continued,orrenewedonorafterJanuary1,2026.
537.038.1.Nopersonwho,withoutcompensation,rendersemergencycareat
2thesceneofanaccidentorotheremergencyshallbeheldliableforanycivildamagesfor
3actsoromissionsotherthandamagesoccasionedbygrossnegligenceorbywillfulor
4wantonactsoromissionsbysuchpersoninrenderingsuchemergencycare.
5 2.Anyemergencycareorassistanceprovidedinaccordancewiththeprovisions
6ofsection334.930or537.037shallnotbesubjecttotheprovisionsofthissectionbut
7shallbesubjecttotheprovisionsofsection334.930or537.037.
579.060.1.Apersoncommitstheoffenseofunlawfulsale,distribution,orpurchase
2ofover-the-countermethamphetamineprecursordrugsifheorsheknowingly:
3 (1)Sells,distributes,dispenses,orotherwiseprovidesanynumberofpackagesofany
4drugproductcontainingdetectableamountsofephedrine,phenylpropanolamine,or
5pseudoephedrine,oranyoftheirsalts,opticalisomers,orsaltsofopticalisomers,ina
6totalamountgreaterthansevenandtwo-tenthsgramstothesameindividualwithinathirty-
7dayperiod,unlesstheamountisdispensed,sold,ordistributedpursuanttoavalid
8prescription;or
HCSSSSB7 88 9 (2)Purchases,receives,orotherwiseacquireswithinathirty-dayperiodanynumber
10ofpackagesofanydrugproductcontaininganydetectableamountofephedrine,
11phenylpropanolamine,orpseudoephedrine,oranyoftheirsaltsoropticalisomers,orsalts
12ofopticalisomersinatotalamountgreaterthansevenandtwo-tenthsgrams,withoutregard
13tothenumberoftransactions,unlesstheamountispurchased,received,oracquiredpursuant
14toavalidprescription;or
15 (3)Purchases,receives,orotherwiseacquireswithinatwenty-four-hourperiodany
16numberofpackagesofanydrugproductcontaininganydetectableamountofephedrine,
17phenylpropanolamine,orpseudoephedrine,oranyoftheirsaltsoropticalisomers,orsaltsof
18opticalisomersinatotalamountgreaterthanthreeandsix-tenthsgrams,withoutregardtothe
19numberoftransactions,unlesstheamountispurchased,received,oracquiredpursuanttoa
20validprescription;or
21 (4)Sells,distributes,dispenses,orotherwiseprovidesanynumberofpackagesofany
22drugproductcontainingdetectableamountsofephedrine,phenylpropanolamine,or
23pseudoephedrine,oranyoftheirsalts,opticalisomers,orsaltsofopticalisomers,ina
24totalamountgreaterthan[forty-three] sixty-oneandtwo-tenthsgramstothesameindividual
25withinatwelve-monthperiod,unlesstheamountisdispensed,sold,ordistributedpursuantto
26avalidprescription;or
27 (5)Purchases,receives,orotherwiseacquireswithinatwelve-monthperiodany
28numberofpackagesofanydrugproductcontaininganydetectableamountofephedrine,
29phenylpropanolamine,orpseudoephedrine,oranyoftheirsaltsoropticalisomers,orsaltsof
30opticalisomersinatotalamountgreaterthan[forty-three] sixty-oneandtwo-tenthsgrams,
31withoutregardtothenumberoftransactions,unlesstheamountispurchased,received,or
32acquiredpursuanttoavalidprescription;or
33 (6)DispensesoroffersdrugproductsthatarenotexcludedfromScheduleVin
34subsection17or18ofsection195.017andthatcontaindetectableamountsofephedrine,
35phenylpropanolamine,orpseudoephedrine,oranyoftheirsalts,opticalisomers,orsaltsof
36opticalisomers,withoutensuringthatsuchproductsarelocatedbehindapharmacycounter
37wherethepublicisnotpermittedandthatsuchproductsaredispensedbyaregistered
38pharmacistorpharmacytechnicianundersubsection11ofsection195.017;or
39 (7)Holdsaretailsaleslicenseissuedunderchapter144andknowinglysellsor
40dispensespackagesthatdonotconformtothepackagingrequirementsofsection195.418.
41 2.Apharmacist,internpharmacist,orregisteredpharmacytechniciancommitsthe
42offenseofunlawfulsale,distribution,orpurchaseofover-the-countermethamphetamine
43precursordrugsifheorsheknowingly:
44 (1)Sells,distributes,dispenses,orotherwiseprovidesanynumberofpackagesofany
45drugproductcontainingdetectableamountsofephedrine,phenylpropanolamine,or
HCSSSSB7 89 46pseudoephedrine,oranyoftheirsaltsoropticalisomers,orsaltsofopticalisomers,inatotal
47amountgreaterthanthreeandsix-tenthgramstothesameindividualwithinatwenty-four
48hourperiod,unlesstheamountisdispensed,sold,ordistributedpursuanttoavalid
49prescription;or
50 (2)Failstosubmitinformationundersubsection13ofsection195.017andsubsection
516ofsection195.417aboutthesalesofanycompound,mixture,orpreparationofproducts
52containingdetectableamountsofephedrine,phenylpropanolamine,orpseudoephedrine,or
53anyoftheirsalts,opticalisomers,orsaltsofopticalisomers,inaccordancewithtransmission
54methodsandfrequencyestablishedbythedepartmentofhealthandseniorservices;or
55 (3)Failstoimplementandmaintainanelectroniclog,asrequiredbysubsection12of
56section195.017,ofeachtransactioninvolvinganydetectablequantityofpseudoephedrine,its
57salts,isomers,orsaltsofopticalisomersorephedrine,itssalts,opticalisomers,orsaltsof
58opticalisomers;or
59 (4)Sells,distributes,dispensesorotherwiseprovidestoanindividualundereighteen
60yearsofagewithoutavalidprescriptionanynumberofpackagesofanydrugproduct
61containinganydetectablequantityofpseudoephedrine,itssalts,isomers,orsaltsofoptical
62isomers,orephedrine,itssaltsoropticalisomers,orsaltsofopticalisomers.
63 3.Anypersonwhoviolatesthepackagingrequirementsofsection195.418andis
64consideredthegeneralowneroroperatoroftheoutletwhereephedrine,pseudoephedrine,or
65phenylpropanolamineproductsareavailableforsaleshallnotbepenalizedifheorshe
66documentsthatanemployeetrainingprogramwasinplacetoprovidetheemployeewho
67madetheunlawfulretailsalewithinformationonthestateandfederalregulationsregarding
68ephedrine,pseudoephedrine,orphenylpropanolamine.
69 4.Amanufacturercommitstheoffenseofunlawfulsale,distribution,or
70purchaseofover-the-countermethamphetamineprecursordrugsifheorsheknowingly
71failstopaythefeesrequiredundersubsection7ofsection195.417.
72 5.Theoffenseofunlawfulsale,distribution,orpurchaseofover-the-counter
73methamphetamineprecursordrugsisaclassAmisdemeanor.
[192.769.1.Oncompletionofamammogram,amammography
2 facilitycertifiedbytheUnitedStatesFoodandDrugAdministration(FDA)or
3 byacertificationagencyapprovedbytheFDAshallprovidetothepatientthe
4 followingnotice:
5 "Ifyourmammogramdemonstratesthatyouhavedensebreasttissue,
6 whichcouldhideabnormalities,andyouhaveotherriskfactorsforbreast
7 cancerthathavebeenidentified,youmightbenefitfromsupplemental
8 screeningteststhatmaybesuggestedbyyourorderingphysician.Dense
9 breasttissue,inandofitself,isarelativelycommoncondition.Therefore,this
10 informationisnotprovidedtocauseundueconcern,butrathertoraiseyour
11 awarenessandtopromotediscussionwithyourphysicianregardingthe
HCSSSSB7 90 12 presenceofotherriskfactors,inadditiontodensebreasttissue.Areportof
13 yourmammographyresultswillbesenttoyouandyourphysician.You
14 shouldcontactyourphysicianifyouhaveanyquestionsorconcernsregarding
15 thisreport.".
16 2.Nothinginthissectionshallbeconstruedtocreateadutyofcare
17 beyondthedutytoprovidenoticeassetforthinthissection.
18 3.Theinformationrequiredbythissectionorevidencethataperson
19 violatedthissectionisnotadmissibleinacivil,judicial,oradministrative
20 proceeding.
21 4.Amammographyfacilityisnotrequiredtocomplywiththe
22 requirementsofthissectionuntilJanuary1,2015.]
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HCSSSSB7 91