EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
[PERFECTED]
SENATE SUBSTITUTE NO. 2 FOR
SENATE BILL NO. 79
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR GREGORY (21).
0769S.09P KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 191.648, 191.1145, 192.769, 208.152, 210.030, and 354.465, RSMo, and to
enact in lieu thereof eight new sections relating to health care.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 191.648, 191.1145, 192.769, 208.152, 1
210.030, and 354.465, RSMo, are repealed and eight new sections 2
enacted in lieu thereof, to be known as sections 191.648, 3
191.1145, 192.2521, 208.152, 210.030, 354.465, 376.1240, and 4
376.1850, to read as follows:5
191.648. 1. As used in this section, the following 1
terms mean: 2
(1) "Designated sexually transmitted infection", 3
chlamydia, gonorrhea, trichomoniasis, or any other sexually 4
transmitted infection designated as appropriate for 5
expedited partner therapy by the department of health and 6
senior services or for whi ch expedited partner therapy was 7
recommended in the most recent Centers for Disease Control 8
and Prevention guidelines for the prevention or treatment of 9
sexually transmitted infections; 10
(2) "Expedited partner therapy" [means], the practice 11
of treating the sex partners of persons with [chlamydia or 12
gonorrhea] designated sexually transmitted infections 13 SS#2 SB 79 2
without an intervening medical evaluation or professional 14
prevention counseling ; 15
(3) "Health care professional", a member of any 16
profession regulated by chapter 334 or 335 authorized to 17
prescribe medications . 18
2. Any licensed physician or health care professional 19
may, but shall not be required to, utilize expedited partner 20
therapy for the management of the partners of persons with 21
[chlamydia or gonorrhea ] designated sexually transmitted 22
infections. Notwithstanding the requirements of 20 CSR 2150 - 23
5.020(5) or any other law to the contrary, a licensed 24
physician or health care professional utilizing expedited 25
partner therapy may pres cribe and dispense medications for 26
the treatment of [chlamydia or gonorrhea ] a designated 27
sexually transmitted infection for an individual who is the 28
partner of a person with [chlamydia or gonorrhea ] a 29
designated sexually transmitted infection and who does not 30
have an established physician/patient relationship with such 31
physician or an established health care professional/patient 32
relationship with such health care professional . [Any 33
antibiotic medications prescribed and dispensed for the 34
treatment of chlamydia or gonorrhea under this section shall 35
be in pill form.] 36
3. Any licensed physician or health care professional 37
utilizing expedited partner therapy for the management of 38
the partners with [chlamydia or gonorrhea ] designated 39
sexually transmitted infections shall provide explanation 40
and guidance to [a] each patient [diagnosed with chlamydia 41
or gonorrhea] of the preventative measures that can be taken 42
by the patient to stop the [spread] transmission of such 43
[diagnosis] infection. 44 SS#2 SB 79 3
4. Any licensed physician or health care professional 45
utilizing expedited partner therapy for the management of 46
partners of persons with [chlamydia or gonorrhea ] designated 47
sexually transmitted infections under this section shall 48
have immunity from a ny civil liability that may otherwise 49
result by reason of such actions, unless such physician or 50
health care professional acts negligently, recklessly, in 51
bad faith, or with malicious purpose. 52
5. The department of health and senior services and 53
the division of professional registration within the 54
department of commerce and insurance shall by rule develop 55
guidelines for the implementation of subsection 2 of this 56
section. Any rule or portion of a rule, as that term is 57
defined in section 536.010 , that is created under the 58
authority delegated in this section shall become effective 59
only if it complies with and is subject to all of the 60
provisions of chapter 536 and, if applicable, section 61
536.028. This section and chapter 536 are nonseverable a nd 62
if any of the powers vested with the general assembly 63
pursuant to chapter 536 to review, to delay the effective 64
date, or to disapprove and annul a rule are subsequently 65
held unconstitutional, then the grant of rulemaking 66
authority and any rule prop osed or adopted after August 28, 67
2010, shall be invalid and void. 68
191.1145. 1. As used in sections 191.1145 and 1
191.1146, the following terms shall mean: 2
(1) "Asynchronous store-and-forward transfer", the 3
collection of a patie nt's relevant health information and 4
the subsequent transmission of that information from an 5
originating site to a health care provider at a distant site 6
without the patient being present; 7 SS#2 SB 79 4
(2) "Clinical staff", any health care provider 8
licensed in this state; 9
(3) "Distant site", a site at which a health care 10
provider is located while providing health care services by 11
means of telemedicine; 12
(4) "Health care provider", as that term is defined in 13
section 376.1350; 14
(5) "Originating site", a site at which a patient is 15
located at the time health care services are provided to him 16
or her by means of telemedicine. For the purposes of 17
asynchronous store-and-forward transfer, originating site 18
shall also mean the location at which the health care 19
provider transfers information to the distant site; 20
(6) "Telehealth" or "telemedicine", the delivery of 21
health care services by means of information and 22
communication technologies , including audiovisual and audio - 23
only technologies, which facilitate the assessment, 24
diagnosis, consultation, treatment, education, care 25
management, and self -management of a patient's health care 26
while such patient is at the originating site and the health 27
care provider is at the distant site. Telehealth or 28
telemedicine shall also include the use of asynchronous 29
store-and-forward technology. Health care providers shall 30
not be limited in their choice of electronic platforms used 31
to deliver telehealth or telemedicine, provided that all 32
services delivered are in accordance with the Health 33
Insurance Portability and Accountability Act of 1996. 34
2. Any licensed health care provider shall be 35
authorized to provide telehealth services if such services 36
are within the scope of practice for which the he alth care 37
provider is licensed and are provided with the same standard 38
of care as services provided in person. This section shall 39 SS#2 SB 79 5
not be construed to prohibit a health carrier, as defined in 40
section 376.1350, from reimbursing nonclinical staff for 41
services otherwise allowed by law. 42
3. In order to treat patients in this state through 43
the use of telemedicine or telehealth, health care providers 44
shall be fully licensed to practice in this state and shall 45
be subject to regulation by their respect ive professional 46
boards. 47
4. Nothing in subsection 3 of this section shall apply 48
to: 49
(1) Informal consultation performed by a health care 50
provider licensed in another state, outside of the context 51
of a contractual relationship, and on an irr egular or 52
infrequent basis without the expectation or exchange of 53
direct or indirect compensation; 54
(2) Furnishing of health care services by a health 55
care provider licensed and located in another state in case 56
of an emergency or disaster; provide d that, no charge is 57
made for the medical assistance; or 58
(3) Episodic consultation by a health care provider 59
licensed and located in another state who provides such 60
consultation services on request to a physician in this 61
state. 62
5. Nothing in this section shall be construed to alter 63
the scope of practice of any health care provider or to 64
authorize the delivery of health care services in a setting 65
or in a manner not otherwise authorized by the laws of this 66
state. 67
6. No originating site for services or activities 68
provided under this section shall be required to maintain 69
immediate availability of on -site clinical staff during the 70
telehealth services, except as necessary to meet the 71 SS#2 SB 79 6
standard of care for the treatment of the patient's medical 72
condition if such condition is being treated by an eligible 73
health care provider who is not at the originating site, has 74
not previously seen the patient in person in a clinical 75
setting, and is not providing coverage for a health care 76
provider who has an established relationship with the 77
patient. Health care providers shall not be limited in 78
their choice of electronic platforms used to deliver 79
telehealth or telemedicine. 80
7. Nothing in this section shall be construed to alter 81
any collaborative practice requirement as provided in 82
chapters 334 and 335. 83
192.2521. A specialty hospital is exempt from the 1
provisions of sections 192.2520 and 197.135 if such hospital 2
has a policy for transfer of a victim of a sexual assa ult to 3
an appropriate hospital with an emergency department. As 4
used in this section, "specialty hospital" means a hospital 5
that has been designated by the department of health and 6
senior services as something other than a general acute care 7
hospital. 8
208.152. 1. MO HealthNet payments shall be made on 1
behalf of those eligible needy persons as described in 2
section 208.151 who are unable to provide for it in whole or 3
in part, with any payments to be made on the basis of the 4
reasonable cost of the care or reasonable charge for the 5
services as defined and determined by the MO HealthNet 6
division, unless otherwise hereinafter provided, for the 7
following: 8
(1) Inpatient hospital services, except to persons in 9
an institution for mental diseases who are under the age of 10
sixty-five years and over the age of twenty -one years; 11
provided that the MO HealthNet division shall provide 12 SS#2 SB 79 7
through rule and regulation an exception process for 13
coverage of inpatient costs in those cases req uiring 14
treatment beyond the seventy -fifth percentile professional 15
activities study (PAS) or the MO HealthNet children's 16
diagnosis length-of-stay schedule; and provided further that 17
the MO HealthNet division shall take into account through 18
its payment system for hospital services the situation of 19
hospitals which serve a disproportionate number of low - 20
income patients; 21
(2) All outpatient hospital services, payments 22
therefor to be in amounts which represent no more than 23
eighty percent of the less er of reasonable costs or 24
customary charges for such services, determined in 25
accordance with the principles set forth in Title XVIII A 26
and B, Public Law 89 -97, 1965 amendments to the federal 27
Social Security Act (42 U.S.C. Section 301, et seq.), but 28
the MO HealthNet division may evaluate outpatient hospital 29
services rendered under this section and deny payment for 30
services which are determined by the MO HealthNet division 31
not to be medically necessary, in accordance with federal 32
law and regulations; 33
(3) Laboratory and X-ray services; 34
(4) Nursing home services for participants, except to 35
persons with more than five hundred thousand dollars equity 36
in their home or except for persons in an institution for 37
mental diseases who are under the age of sixty-five years, 38
when residing in a hospital licensed by the department of 39
health and senior services or a nursing home licensed by the 40
department of health and senior services or appropriate 41
licensing authority of other states or government -owned and - 42
operated institutions which are determined to conform to 43
standards equivalent to licensing requirements in Title XIX 44 SS#2 SB 79 8
of the federal Social Security Act (42 U.S.C. Section [301] 45
1396, et seq.), as amended, for nursing facilities. The MO 46
HealthNet division may recognize through its payment 47
methodology for nursing facilities those nursing facilities 48
which serve a high volume of MO HealthNet patients. The MO 49
HealthNet division when determining the amount of the 50
benefit payments to be made o n behalf of persons under the 51
age of twenty-one in a nursing facility may consider nursing 52
facilities furnishing care to persons under the age of 53
twenty-one as a classification separate from other nursing 54
facilities; 55
(5) Nursing home costs for pa rticipants receiving 56
benefit payments under subdivision (4) of this subsection 57
for those days, which shall not exceed twelve per any period 58
of six consecutive months, during which the participant is 59
on a temporary leave of absence from the hospital or nursing 60
home, provided that no such participant shall be allowed a 61
temporary leave of absence unless it is specifically 62
provided for in his plan of care. As used in this 63
subdivision, the term "temporary leave of absence" shall 64
include all periods of time during which a participant is 65
away from the hospital or nursing home overnight because he 66
is visiting a friend or relative; 67
(6) Physicians' services, whether furnished in the 68
office, home, hospital, nursing home, or elsewhere, 69
provided, that no funds shall be expended to any abortion 70
facility, as defined in section 188.015, or to any 71
affiliate, as defined in section 188.015, of such abortion 72
facility; 73
(7) Subject to appropriation, up to twenty visits per 74
year for services limited to examinations, diagnoses, 75
adjustments, and manipulations and treatments of 76 SS#2 SB 79 9
malpositioned articulations and structures of the body 77
provided by licensed chiropractic physicians practicing 78
within their scope of practice. Nothing in this subdivision 79
shall be interpreted to otherwise expand MO HealthNet 80
services; 81
(8) Drugs and medicines when prescribed by a licensed 82
physician, dentist, podiatrist, or an advanced practice 83
registered nurse; except that no payment for drugs and 84
medicines prescribed on and after January 1, 2006, by a 85
licensed physician, dentist, podiatrist, or an advanced 86
practice registered nurse may be made on behalf of any 87
person who qualifies for prescription drug coverage under 88
the provisions of P.L. 108 -173; 89
(9) Emergency ambulance services and, effective 90
January 1, 1990, medically necessary transportation to 91
scheduled, physician -prescribed nonelective treatments; 92
(10) Early and periodic screening and diagnosis of 93
individuals who are under the age of twenty -one to ascertain 94
their physical or mental defects, and health care, 95
treatment, and other measures to correct or ameliorate 96
defects and chronic conditions discovered thereby. Such 97
services shall be provided in accordance with the provisions 98
of Section 6403 of P.L. 101-239 and federal regulations 99
promulgated thereunder; 100
(11) Home health care services; 101
(12) Family planning as defined by federal rules and 102
regulations; provided, that no funds shall be expended to 103
any abortion facility, as defin ed in section 188.015, or to 104
any affiliate, as defined in section 188.015, of such 105
abortion facility; and further provided, however, that such 106
family planning services shall not include abortions or any 107
abortifacient drug or device that is used for the purpose of 108 SS#2 SB 79 10
inducing an abortion unless such abortions are certified in 109
writing by a physician to the MO HealthNet agency that, in 110
the physician's professional judgment, the life of the 111
mother would be endangered if the fetus were carried to term; 112
(13) Inpatient psychiatric hospital services for 113
individuals under age twenty -one as defined in Title XIX of 114
the federal Social Security Act (42 U.S.C. Section 1396d, et 115
seq.); 116
(14) Outpatient surgical procedures, including 117
presurgical diagnost ic services performed in ambulatory 118
surgical facilities which are licensed by the department of 119
health and senior services of the state of Missouri; except, 120
that such outpatient surgical services shall not include 121
persons who are eligible for coverage under Part B of Title 122
XVIII, Public Law 89 -97, 1965 amendments to the federal 123
Social Security Act, as amended, if exclusion of such 124
persons is permitted under Title XIX, Public Law 89 -97, 1965 125
amendments to the federal Social Security Act, as amended; 126
(15) Personal care services which are medically 127
oriented tasks having to do with a person's physical 128
requirements, as opposed to housekeeping requirements, which 129
enable a person to be treated by his or her physician on an 130
outpatient rather than o n an inpatient or residential basis 131
in a hospital, intermediate care facility, or skilled 132
nursing facility. Personal care services shall be rendered 133
by an individual not a member of the participant's family 134
who is qualified to provide such services wh ere the services 135
are prescribed by a physician in accordance with a plan of 136
treatment and are supervised by a licensed nurse. Persons 137
eligible to receive personal care services shall be those 138
persons who would otherwise require placement in a hospital , 139
intermediate care facility, or skilled nursing facility. 140 SS#2 SB 79 11
Benefits payable for personal care services shall not exceed 141
for any one participant one hundred percent of the average 142
statewide charge for care and treatment in an intermediate 143
care facility for a comparable period of time. Such 144
services, when delivered in a residential care facility or 145
assisted living facility licensed under chapter 198 shall be 146
authorized on a tier level based on the services the 147
resident requires and the frequency of the services. A 148
resident of such facility who qualifies for assistance under 149
section 208.030 shall, at a minimum, if prescribed by a 150
physician, qualify for the tier level with the fewest 151
services. The rate paid to providers for each tier of 152
service shall be set subject to appropriations. Subject to 153
appropriations, each resident of such facility who qualifies 154
for assistance under section 208.030 and meets the level of 155
care required in this section shall, at a minimum, if 156
prescribed by a physicia n, be authorized up to one hour of 157
personal care services per day. Authorized units of 158
personal care services shall not be reduced or tier level 159
lowered unless an order approving such reduction or lowering 160
is obtained from the resident's personal phys ician. Such 161
authorized units of personal care services or tier level 162
shall be transferred with such resident if he or she 163
transfers to another such facility. Such provision shall 164
terminate upon receipt of relevant waivers from the federal 165
Department of Health and Human Services. If the Centers for 166
Medicare and Medicaid Services determines that such 167
provision does not comply with the state plan, this 168
provision shall be null and void. The MO HealthNet division 169
shall notify the revisor of statutes as to whether the 170
relevant waivers are approved or a determination of 171
noncompliance is made; 172 SS#2 SB 79 12
(16) Mental health services. The state plan for 173
providing medical assistance under Title XIX of the Social 174
Security Act, 42 U.S.C. Section [301] 1396, et seq., as 175
amended, shall include the following mental health services 176
when such services are provided by community mental health 177
facilities operated by the department of mental health or 178
designated by the department of mental health as a community 179
mental health facility or as an alcohol and drug abuse 180
facility or as a child -serving agency within the 181
comprehensive children's mental health service system 182
established in section 630.097. The department of mental 183
health shall establish by administrat ive rule the definition 184
and criteria for designation as a community mental health 185
facility and for designation as an alcohol and drug abuse 186
facility. Such mental health services shall include: 187
(a) Outpatient mental health services including 188
preventive, diagnostic, therapeutic, rehabilitative, and 189
palliative interventions rendered to individuals in an 190
individual or group setting by a mental health professional 191
in accordance with a plan of treatment appropriately 192
established, implemented, monit ored, and revised under the 193
auspices of a therapeutic team as a part of client services 194
management; 195
(b) Clinic mental health services including 196
preventive, diagnostic, therapeutic, rehabilitative, and 197
palliative interventions rendered to individu als in an 198
individual or group setting by a mental health professional 199
in accordance with a plan of treatment appropriately 200
established, implemented, monitored, and revised under the 201
auspices of a therapeutic team as a part of client services 202
management; 203 SS#2 SB 79 13
(c) Rehabilitative mental health and alcohol and drug 204
abuse services including home and community -based 205
preventive, diagnostic, therapeutic, rehabilitative, and 206
palliative interventions rendered to individuals in an 207
individual or group setting by a mental health or alcohol 208
and drug abuse professional in accordance with a plan of 209
treatment appropriately established, implemented, monitored, 210
and revised under the auspices of a therapeutic team as a 211
part of client services management. As used in this 212
section, mental health professional and alcohol and drug 213
abuse professional shall be defined by the department of 214
mental health pursuant to duly promulgated rules. With 215
respect to services established by this subdivision, the 216
department of social services, MO HealthNet division, shall 217
enter into an agreement with the department of mental 218
health. Matching funds for outpatient mental health 219
services, clinic mental health services, and rehabilitation 220
services for mental health and alcohol an d drug abuse shall 221
be certified by the department of mental health to the MO 222
HealthNet division. The agreement shall establish a 223
mechanism for the joint implementation of the provisions of 224
this subdivision. In addition, the agreement shall 225
establish a mechanism by which rates for services may be 226
jointly developed; 227
(17) Such additional services as defined by the MO 228
HealthNet division to be furnished under waivers of federal 229
statutory requirements as provided for and authorized by the 230
federal Social Security Act (42 U.S.C. Section 301, et seq.) 231
subject to appropriation by the general assembly; 232
(18) The services of an advanced practice registered 233
nurse with a collaborative practice agreement to the extent 234 SS#2 SB 79 14
that such services are provide d in accordance with chapters 235
334 and 335, and regulations promulgated thereunder; 236
(19) Nursing home costs for participants receiving 237
benefit payments under subdivision (4) of this subsection to 238
reserve a bed for the participant in the nursing hom e during 239
the time that the participant is absent due to admission to 240
a hospital for services which cannot be performed on an 241
outpatient basis, subject to the provisions of this 242
subdivision: 243
(a) The provisions of this subdivision shall apply 244
only if: 245
a. The occupancy rate of the nursing home is at or 246
above ninety-seven percent of MO HealthNet certified 247
licensed beds, according to the most recent quarterly census 248
provided to the department of health and senior services 249
which was taken prior to when the participant is admitted to 250
the hospital; and 251
b. The patient is admitted to a hospital for a medical 252
condition with an anticipated stay of three days or less; 253
(b) The payment to be made under this subdivision 254
shall be provided for a maximum of three days per hospital 255
stay; 256
(c) For each day that nursing home costs are paid on 257
behalf of a participant under this subdivision during any 258
period of six consecutive months such participant shall, 259
during the same period of six c onsecutive months, be 260
ineligible for payment of nursing home costs of two 261
otherwise available temporary leave of absence days provided 262
under subdivision (5) of this subsection; and 263
(d) The provisions of this subdivision shall not apply 264
unless the nursing home receives notice from the participant 265
or the participant's responsible party that the participant 266 SS#2 SB 79 15
intends to return to the nursing home following the hospital 267
stay. If the nursing home receives such notification and 268
all other provisions o f this subsection have been satisfied, 269
the nursing home shall provide notice to the participant or 270
the participant's responsible party prior to release of the 271
reserved bed; 272
(20) Prescribed medically necessary durable medical 273
equipment. An electronic web-based prior authorization 274
system using best medical evidence and care and treatment 275
guidelines consistent with national standards shall be used 276
to verify medical need; 277
(21) Hospice care. As used in this subdivision, the 278
term "hospice care" means a coordinated program of active 279
professional medical attention within a home, outpatient and 280
inpatient care which treats the terminally ill patient and 281
family as a unit, employing a medically directed 282
interdisciplinary team. The program provides relief of 283
severe pain or other physical symptoms and supportive care 284
to meet the special needs arising out of physical, 285
psychological, spiritual, social, and economic stresses 286
which are experienced during the final stages of illness, 287
and during dying and bereavement and meets the Medicare 288
requirements for participation as a hospice as are provided 289
in 42 CFR Part 418. The rate of reimbursement paid by the 290
MO HealthNet division to the hospice provider for room and 291
board furnished by a nursing h ome to an eligible hospice 292
patient shall not be less than ninety -five percent of the 293
rate of reimbursement which would have been paid for 294
facility services in that nursing home facility for that 295
patient, in accordance with subsection (c) of Section 640 8 296
of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989); 297 SS#2 SB 79 16
(22) Prescribed medically necessary dental services. 298
Such services shall be subject to appropriations. An 299
electronic web-based prior authorization system using best 300
medical evidence and care and treatment guidelines 301
consistent with national standards shall be used to verify 302
medical need; 303
(23) Prescribed medically necessary optometric 304
services. Such services shall be subject to 305
appropriations. An electronic web-based prior authorization 306
system using best medical evidence and care and treatment 307
guidelines consistent with national standards shall be used 308
to verify medical need; 309
(24) Blood clotting products -related services. For 310
persons diagnosed with a bleeding dis order, as defined in 311
section 338.400, reliant on blood clotting products, as 312
defined in section 338.400, such services include: 313
(a) Home delivery of blood clotting products and 314
ancillary infusion equipment and supplies, including the 315
emergency deliveries of the product when medically necessary; 316
(b) Medically necessary ancillary infusion equipment 317
and supplies required to administer the blood clotting 318
products; and 319
(c) Assessments conducted in the participant's home by 320
a pharmacist, nurse, or local home health care agency 321
trained in bleeding disorders when deemed necessary by the 322
participant's treating physician; 323
(25) Medically necessary cochlear implants and hearing 324
instruments, as defined in section 345.015, that are: 325
(a) Prescribed by an audiologist, as defined in 326
section 345.015; or 327
(b) Dispensed by a hearing instrument specialist, as 328
defined in section 346.010; 329 SS#2 SB 79 17
(26) The MO HealthNet division shall, by January 1, 330
2008, and annually thereafter, report t he status of MO 331
HealthNet provider reimbursement rates as compared to one 332
hundred percent of the Medicare reimbursement rates and 333
compared to the average dental reimbursement rates paid by 334
third-party payors licensed by the state. The MO HealthNet 335
division shall, by July 1, 2008, provide to the general 336
assembly a four-year plan to achieve parity with Medicare 337
reimbursement rates and for third -party payor average dental 338
reimbursement rates. Such plan shall be subject to 339
appropriation and the divis ion shall include in its annual 340
budget request to the governor the necessary funding needed 341
to complete the four -year plan developed under this 342
subdivision. 343
2. Additional benefit payments for medical assistance 344
shall be made on behalf of those el igible needy children, 345
pregnant women and blind persons with any payments to be 346
made on the basis of the reasonable cost of the care or 347
reasonable charge for the services as defined and determined 348
by the MO HealthNet division, unless otherwise hereinaf ter 349
provided, for the following: 350
(1) Dental services; 351
(2) Services of podiatrists as defined in section 352
330.010; 353
(3) Optometric services as described in section 354
336.010; 355
(4) Orthopedic devices or other prosthetics, including 356
eye glasses, dentures, [hearing aids,] and wheelchairs; 357
(5) Hospice care. As used in this subdivision, the 358
term "hospice care" means a coordinated program of active 359
professional medical attention within a home, outpatient and 360
inpatient care which tr eats the terminally ill patient and 361 SS#2 SB 79 18
family as a unit, employing a medically directed 362
interdisciplinary team. The program provides relief of 363
severe pain or other physical symptoms and supportive care 364
to meet the special needs arising out of physical, 365
psychological, spiritual, social, and economic stresses 366
which are experienced during the final stages of illness, 367
and during dying and bereavement and meets the Medicare 368
requirements for participation as a hospice as are provided 369
in 42 CFR Part 418. The rate of reimbursement paid by the 370
MO HealthNet division to the hospice provider for room and 371
board furnished by a nursing home to an eligible hospice 372
patient shall not be less than ninety -five percent of the 373
rate of reimbursement which would have be en paid for 374
facility services in that nursing home facility for that 375
patient, in accordance with subsection (c) of Section 6408 376
of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989); 377
(6) Comprehensive day rehabilitation services 378
beginning early posttrauma as part of a coordinated system 379
of care for individuals with disabling impairments. 380
Rehabilitation services must be based on an individualized, 381
goal-oriented, comprehensive and coordinated treatment plan 382
developed, implemented, and mon itored through an 383
interdisciplinary assessment designed to restore an 384
individual to optimal level of physical, cognitive, and 385
behavioral function. The MO HealthNet division shall 386
establish by administrative rule the definition and criteria 387
for designation of a comprehensive day rehabilitation 388
service facility, benefit limitations and payment 389
mechanism. Any rule or portion of a rule, as that term is 390
defined in section 536.010, that is created under the 391
authority delegated in this subdivision shall become 392
effective only if it complies with and is subject to all of 393 SS#2 SB 79 19
the provisions of chapter 536 and, if applicable, section 394
536.028. This section and chapter 536 are nonseverable and 395
if any of the powers vested with the general assembly 396
pursuant to chapter 536 to review, to delay the effective 397
date, or to disapprove and annul a rule are subsequently 398
held unconstitutional, then the grant of rulemaking 399
authority and any rule proposed or adopted after August 28, 400
2005, shall be invalid and void. 401
3. The MO HealthNet division may require any 402
participant receiving MO HealthNet benefits to pay part of 403
the charge or cost until July 1, 2008, and an additional 404
payment after July 1, 2008, as defined by rule duly 405
promulgated by the MO HealthNet divi sion, for all covered 406
services except for those services covered under 407
subdivisions (15) and (16) of subsection 1 of this section 408
and sections 208.631 to 208.657 to the extent and in the 409
manner authorized by Title XIX of the federal Social 410
Security Act (42 U.S.C. Section 1396, et seq.) and 411
regulations thereunder. When substitution of a generic drug 412
is permitted by the prescriber according to section 338.056, 413
and a generic drug is substituted for a name -brand drug, the 414
MO HealthNet division may not lower or delete the 415
requirement to make a co -payment pursuant to regulations of 416
Title XIX of the federal Social Security Act. A provider of 417
goods or services described under this section must collect 418
from all participants the additional payment that may be 419
required by the MO HealthNet division under authority 420
granted herein, if the division exercises that authority, to 421
remain eligible as a provider. Any payments made by 422
participants under this section shall be in addition to and 423
not in lieu of payments made by the state for goods or 424
services described herein except the participant portion of 425 SS#2 SB 79 20
the pharmacy professional dispensing fee shall be in 426
addition to and not in lieu of payments to pharmacists. A 427
provider may collect the co -payment at the time a service is 428
provided or at a later date. A provider shall not refuse to 429
provide a service if a participant is unable to pay a 430
required payment. If it is the routine business practice of 431
a provider to terminate future services to an individual 432
with an unclaimed debt, the provider may include uncollected 433
co-payments under this practice. Providers who elect not to 434
undertake the provision of services based on a history of 435
bad debt shall give participants advance notice and a 436
reasonable opportunity for payment. A provider, 437
representative, employee, independent contractor, or agent 438
of a pharmaceutical manufacturer shall not make co -payment 439
for a participant. This subsection shall not apply to other 440
qualified children, pregnant women, or b lind persons. If 441
the Centers for Medicare and Medicaid Services does not 442
approve the MO HealthNet state plan amendment submitted by 443
the department of social services that would allow a 444
provider to deny future services to an individual with 445
uncollected co-payments, the denial of services shall not be 446
allowed. The department of social services shall inform 447
providers regarding the acceptability of denying services as 448
the result of unpaid co -payments. 449
4. The MO HealthNet division shall have the right to 450
collect medication samples from participants in order to 451
maintain program integrity. 452
5. Reimbursement for obstetrical and pediatric 453
services under subdivision (6) of subsection 1 of this 454
section shall be timely and sufficient to enlist e nough 455
health care providers so that care and services are 456
available under the state plan for MO HealthNet benefits at 457 SS#2 SB 79 21
least to the extent that such care and services are 458
available to the general population in the geographic area, 459
as required under sub paragraph (a)(30)(A) of 42 U.S.C. 460
Section 1396a and federal regulations promulgated thereunder. 461
6. Beginning July 1, 1990, reimbursement for services 462
rendered in federally funded health centers shall be in 463
accordance with the provisions of subsect ion 6402(c) and 464
Section 6404 of P.L. 101 -239 (Omnibus Budget Reconciliation 465
Act of 1989) and federal regulations promulgated thereunder. 466
7. Beginning July 1, 1990, the department of social 467
services shall provide notification and referral of childr en 468
below age five, and pregnant, breast -feeding, or postpartum 469
women who are determined to be eligible for MO HealthNet 470
benefits under section 208.151 to the special supplemental 471
food programs for women, infants and children administered 472
by the department of health and senior services. Such 473
notification and referral shall conform to the requirements 474
of Section 6406 of P.L. 101 -239 and regulations promulgated 475
thereunder. 476
8. Providers of long-term care services shall be 477
reimbursed for their co sts in accordance with the provisions 478
of Section 1902 (a)(13)(A) of the Social Security Act, 42 479
U.S.C. Section 1396a, as amended, and regulations 480
promulgated thereunder. 481
9. Reimbursement rates to long -term care providers 482
with respect to a total c hange in ownership, at arm's 483
length, for any facility previously licensed and certified 484
for participation in the MO HealthNet program shall not 485
increase payments in excess of the increase that would 486
result from the application of Section 1902 (a)(13)(C ) of 487
the Social Security Act, 42 U.S.C. Section 1396a (a)(13)(C). 488 SS#2 SB 79 22
10. The MO HealthNet division may enroll qualified 489
residential care facilities and assisted living facilities, 490
as defined in chapter 198, as MO HealthNet personal care 491
providers. 492
11. Any income earned by individuals eligible for 493
certified extended employment at a sheltered workshop under 494
chapter 178 shall not be considered as income for purposes 495
of determining eligibility under this section. 496
12. If the Missouri Medica id audit and compliance unit 497
changes any interpretation or application of the 498
requirements for reimbursement for MO HealthNet services 499
from the interpretation or application that has been applied 500
previously by the state in any audit of a MO HealthNet 501
provider, the Missouri Medicaid audit and compliance unit 502
shall notify all affected MO HealthNet providers five 503
business days before such change shall take effect. Failure 504
of the Missouri Medicaid audit and compliance unit to notify 505
a provider of such change shall entitle the provider to 506
continue to receive and retain reimbursement until such 507
notification is provided and shall waive any liability of 508
such provider for recoupment or other loss of any payments 509
previously made prior to the five busines s days after such 510
notice has been sent. Each provider shall provide the 511
Missouri Medicaid audit and compliance unit a valid email 512
address and shall agree to receive communications 513
electronically. The notification required under this 514
section shall be delivered in writing by the United States 515
Postal Service or electronic mail to each provider. 516
13. Nothing in this section shall be construed to 517
abrogate or limit the department's statutory requirement to 518
promulgate rules under chapter 536. 519 SS#2 SB 79 23
14. Beginning July 1, 2016, and subject to 520
appropriations, providers of behavioral, social, and 521
psychophysiological services for the prevention, treatment, 522
or management of physical health problems shall be 523
reimbursed utilizing the behavior assessment and 524
intervention reimbursement codes 96150 to 96154 or their 525
successor codes under the Current Procedural Terminology 526
(CPT) coding system. Providers eligible for such 527
reimbursement shall include psychologists. 528
15. There shall be no payments made under this section 529
for gender transition surgeries, cross -sex hormones, or 530
puberty-blocking drugs, as such terms are defined in section 531
191.1720, for the purpose of a gender transition. 532
210.030. 1. Every licensed physician, midwife , 1
registered nurse and all persons who may undertake, in a 2
professional way, the obstetrical and gynecological care of 3
a pregnant woman in the state of Missouri shall, if the 4
woman consents, take or cause to be taken a sample of venous 5
blood of such woman at the time of the first prenatal 6
examination, or not later than twenty days after the first 7
prenatal examination, another sample at twenty -eight weeks 8
of pregnancy, and another sample immediately after birth and 9
subject such [sample] samples to an approved and standard 10
serological test for syphilis [, an] and approved serological 11
[test] tests for hepatitis B, hepatitis C, human 12
immunodeficiency virus (HIV), and such other treatable 13
diseases and metabolic disorders as are prescribed by the 14
department of health and senior services. [In any area of 15
the state designated as a syphilis outbreak area by the 16
department of health and senior services, if the mother 17
consents, a sample of her venous blood shall be taken later 18
in the course of pregnanc y and at delivery for additional 19 SS#2 SB 79 24
testing for syphilis as may be prescribed by the department ] 20
If a mother tests positive for syphilis, hepatitis B, 21
hepatitis C, or HIV, or any combination of such diseases, 22
the physician or person providing care shall a dminister 23
treatment in accordance with the most recent accepted 24
medical practice. If a mother tests positive for hepatitis 25
B, the physician or person who professionally undertakes the 26
pediatric care of a newborn shall also administer the 27
appropriate doses of hepatitis B vaccine and hepatitis B 28
immune globulin (HBIG) in accordance with the current 29
recommendations of the Advisory Committee on Immunization 30
Practices (ACIP). If the mother's hepatitis B status is 31
unknown, the appropriate dose of hepat itis B vaccine shall 32
be administered to the newborn in accordance with the 33
current ACIP recommendations. If the mother consents, a 34
sample of her venous blood shall be taken. If she tests 35
positive for hepatitis B, hepatitis B immune globulin (HBIG) 36
shall be administered to the newborn in accordance with the 37
current ACIP recommendations. 38
2. The department of health and senior services 39
shall[, in consultation with the Missouri genetic disease 40
advisory committee,] make such rules pertaining to s uch 41
tests as shall be dictated by accepted medical practice, and 42
tests shall be of the types approved or accepted by the 43
[department of health and senior services. An approved and 44
standard test for syphilis, hepatitis B, and other treatable 45
diseases and metabolic disorders shall mean a test made in a 46
laboratory approved by the department of health and senior 47
services] United States Food and Drug Administration . No 48
individual shall be denied testing by the department of 49
health and senior services because of inability to pay. 50 SS#2 SB 79 25
3. All persons providing care under this section shall 51
do so pursuant to the provisions of section 431.061. 52
354.465. 1. The director, or any duly appointed 1
representative, may make an examination of the affairs of 2
any health maintenance organization as often as he deems it 3
necessary for the protection of the interests of the people 4
of this state[, but not less frequently than once every five 5
years]. 6
2. All costs incurred by the state as a r esult of 7
making examinations under this section shall be paid by the 8
organization being examined and remitted as provided in 9
section 374.160. 10
376.1240. 1. For purposes of this section, terms 1
shall have the same meanings as ascribed to them in section 2
376.1350, and the term "self -administered hormonal 3
contraceptive" shall mean a drug that is composed of one or 4
more hormones and that is approved by the Food and Drug 5
Administration to prevent pregnancy, excluding emergency 6
contraception. Nothing in this section shall be construed 7
to apply to medications approved by the Food and Drug 8
Administration to terminate an existing pregnancy. 9
2. Any health benefit plan delivered, issued for 10
delivery, continued, or renewed in this s tate on or after 11
January 1, 2026, that provides coverage for self - 12
administered hormonal contraceptives shall provide coverage 13
to reimburse a health care provider or dispensing entity for 14
the dispensing of a supply of self -administered hormonal 15
contraceptives intended to last up to ninety days, or 16
intended to last up to one hundred eighty days for generic 17
self-administered hormonal contraceptives. 18
3. The coverage required under this section shall not 19
be subject to any greater deductible or co -payment than 20 SS#2 SB 79 26
other similar health care services provided by the health 21
benefit plan. 22
376.1850. 1. As used in this section, the following 1
terms mean: 2
(1) "Contract for health care benefits", a self -funded 3
contractual arrangemen t made in accordance with this section 4
between a qualified membership organization and its members 5
to provide, deliver, arrange for, pay for, or reimburse any 6
of the costs of health care services; 7
(2) "Farm bureau", a nonprofit agricultural member ship 8
organization first incorporated in this state at least one 9
hundred years ago, or an affiliate designated by the 10
nonprofit agricultural membership organization; 11
(3) "Health care service", the same meaning as is 12
ascribed to such term in sectio n 376.1350; 13
(4) "Member of a qualified membership organization", a 14
natural person who pays periodic dues or fees, other than 15
payments for a contract for health care benefits, for 16
membership in a qualified membership organization, and the 17
natural person's spouse or dependent children under the age 18
of twenty-six; 19
(5) "Qualified membership organization", a farm 20
bureau, or an entity with at least one hundred thousand dues 21
paying members, that is governed by a council of its 22
members, that has at least five hundred million dollars in 23
assets, and that exists to serve its members beyond solely 24
offering health coverage. 25
2. The provisions of this chapter relating to health 26
insurance, health maintenance organizations, health benefit 27
plans, group health services, and health carriers shall not 28
apply to contracts for health care benefits provided by a 29
qualified membership organization. A qualified membership 30 SS#2 SB 79 27
organization providing contracts for health care benefits 31
shall not be considered to be engaging in the business of 32
insurance for purposes of any provision of chapters 361 to 33
385. 34
3. It is unlawful to provide a contract for health 35
care benefits under this section unless the qualified 36
membership organization providing the cont ract is registered 37
with the department of commerce and insurance as provided in 38
this subsection. To register as a qualified membership 39
organization, an applicant shall file information with the 40
director demonstrating it meets the requirements of this 41
section and pay an application fee of two hundred and fifty 42
dollars. A registration is valid for five years and may be 43
renewed for additional five year terms if the qualified 44
membership organization continues to meet the requirements 45
of this section and pays a renewal fee of two hundred and 46
fifty dollars. All amounts collected as registration or 47
renewal fees shall be deposited into the insurance dedicated 48
fund established under section 374.150. 49
4. Contracts for health care benefits provided under 50
this section shall be offered only to members of a qualified 51
membership organization who have been members of the 52
organization for at least thirty days; and shall be sold, 53
solicited, or negotiated only by insurance producers 54
licensed under chapt er 375 to produce accident and health or 55
sickness coverage. 56
5. Notwithstanding any provision of law to the 57
contrary, a qualified membership organization providing a 58
contract for health care benefits under this section shall 59
use the services of an administrator permitted to provide 60
services in accordance with sections 376.1075 to 376.1095, 61
and shall agree in the contract with such administrator to 62 SS#2 SB 79 28
utilize processes for benefit determinations and claims 63
payment procedures in accordance with the requirements 64
applicable to health carriers and health benefit plans under 65
sections 376.383, 376.690, and 376.1367. A contract for 66
health care benefits provided under this section shall not 67
be subject to the laws of this state relating to insurance 68
or insurance companies except as specified in this section. 69
6. The risk under contracts provided in accordance 70
with this section may be reinsured in accordance with 71
section 375.246. 72
7. (1) Contracts for health care benefits under this 73
section shall include the following written disclaimer on 74
the front of the contract and all related applications and 75
renewal forms in a bold font no smaller than sixteen point: 76
"NOTICE 77
This contract is not health insurance and is not 78
subject to federal or stat e laws relating to 79
health insurance. This contract offers fewer 80
benefits than an ACA -compliant health plan and 81
may exclude coverage for preexisting 82
conditions. You may qualify for income -based 83
subsidies through the ACA Health Insurance 84
Marketplace. This contract is not covered by 85
the Missouri Insurance Guaranty Association. 86
You may be financially responsible for costs of 87
medical treatment that may not be covered under 88
this contract.". 89
(2) The written disclaimers required by subdivision 90
(1) of this subsection on applications and renewal forms 91
shall be signed by the member entering into or renewing the 92
contract, specifically acknowledging that the coverage is 93 SS#2 SB 79 29
not considered insurance and is not subject to regulation by 94
the department of commerce and insurance. 95
(3) The qualified membership organization providing 96
the contract shall retain a copy of written acknowledgements 97
required under subdivision (2) of this subsection for the 98
duration for which claims may be submitted under t he 99
contract, and shall provide a copy of the acknowledgement to 100
the member upon the member's request. 101
8. Contracts provided under this section shall not be 102
subject to individual post -claim medical underwriting while 103
coverage remains in effect, an d no member covered under a 104
contract provided under this section shall be subject to 105
cancellation, nonrenewal, modification, or increase in 106
premium for reason of a medical event. 107
9. Notwithstanding subsection 2 of this section, the 108
department of commerce and insurance shall receive and 109
review complaints and inquiries from members of a qualified 110
membership organization, pursuant to section 374.085, 111
subject to section 374.071. 112
10. By March thirty-first of each year, each qualified 113
membership organization providing a contract for health care 114
benefits under this section, or its administrator, shall pay 115
to the director a fee equal to one percent of the Missouri 116
claims paid under this section during the immediately 117
preceding year. Funds collected by the director shall be 118
deposited in the insurance dedicated fund established under 119
section 374.150. 120
11. No qualified membership organization, or other 121
entity on behalf of a qualified membership organization, 122
shall refer to a contract fo r health care benefits under 123
this section as insurance or health insurance in any 124
marketing, advertising, or other communication with the 125 SS#2 SB 79 30
public or members of the qualified membership organization. 126
Violation of this subsection shall be an unlawful pra ctice 127
under section 407.020. 128
12. Contracts for health care benefits provided under 129
this section: 130
(1) Shall include coverage for: 131
(a) Ambulatory patient services; 132
(b) Hospitalization; 133
(c) Emergency services, as defined in sec tion 134
376.1350; and 135
(d) Laboratory services; and 136
(2) Shall not be subject to an annual limit of less 137
than two million dollars per year. 138
[192.769. 1. On completion of a 1
mammogram, a mammography facility certified by 2
the United States Food and Drug Administration 3
(FDA) or by a certification agency approved by 4
the FDA shall provide to the patient the 5
following notice: 6
"If your mammogram demonstrates 7
that you have dense breast 8
tissue, which could hide 9
abnormalities, and you have other 10
risk factors for breast cancer 11
that have been identified, you 12
might benefit from supplemental 13
screening tests that may be 14
suggested by your ordering 15
physician. Dense breast tissue, 16
in and of itself, is a relatively 17
common condition. Therefore, 18
this information is not provided 19
to cause undue concern, but 20
rather to raise your awareness 21
and to promote discussion with 22
your physician regarding the 23
presence of other risk factors, 24
in addition to dense breast 25
tissue. A report of your 26 SS#2 SB 79 31
mammography results will be sent 27
to you and your physician. You 28
should contact your physician if 29
you have any questions or 30
concerns regarding this report.". 31
2. Nothing in this section shall be 32
construed to create a duty of care beyond the 33
duty to provide notice as set forth in this 34
section. 35
3. The information required by this 36
section or evidence that a person violated this 37
section is not admissible in a civil, judicial, 38
or administrative proceeding. 39
4. A mammography facilit y is not required 40
to comply with the requirements of this section 41
until January 1, 2015. ] 42
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