FIRSTREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
SENATEBILLNO.94
103RDGENERALASSEMBLY
0749H.03C JOSEPHENGLER,ChiefClerk
ANACT
Torepealsections135.621,167.627,167.630,190.246,191.600,191.603,191.605,191.607,
191.611,191.614,191.615,191.648,191.1145,192.769,196.990,208.152,208.662,
210.030,321.621,332.211,332.281,and338.333,RSMo,andtoenactinlieuthereof
fifty-fournewsectionsrelatingtohealthcare,withpenaltyprovisions.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections135.621,167.627,167.630,190.246,191.600,191.603,191.605,
2191.607,191.611,191.614,191.615,191.648,191.1145,192.769,196.990,208.152,
3208.662,210.030,321.621,332.211,332.281,and338.333,RSMo,arerepealedandfifty-
4fournewsectionsenactedinlieuthereof,tobeknownassections135.621,167.627,167.630,
5190.246,191.600,191.603,191.605,191.607,191.611,191.614,191.615,191.648,191.708,
6191.1145,192.021,192.2521,196.990,197.708,208.149,208.152,208.662,208.1400,
7208.1405,208.1410,208.1415,208.1420,208.1425,210.030,210.225,321.621,332.211,
8332.281,332.700,332.705,332.710,332.715,332.720,332.725,332.730,332.735,332.740,
9332.745,332.750,332.755,332.760,338.333,376.1240,376.1245,376.2100,376.2102,
10376.2104,376.2106,376.2108,and407.324,toreadasfollows:
135.621.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Contribution",adonationofcash,stock,bonds,othermarketablesecurities,or
3realproperty;
4 (2)"Department",thedepartmentofsocialservices;
5 (3)"Diaperbank",anationaldiaperbankoranonprofitentitylocatedinthisstate
6establishedandoperatingprimarilyforthepurposeofcollectingorpurchasingdisposable
7diapersorotherhygieneproductsforinfants,children,orincontinentadultsandthatregularly
8distributessuchdiapersorotherhygieneproductsthroughtwoormoreschools,healthcare
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 9facilities,governmentalagencies,orothernonprofitentitiesforeventualdistributionto
10individualsfreeofcharge;
11 (4)"Nationaldiaperbank",anonprofitentitylocatedinthisstatethatmeetsthe
12followingcriteria:
13 (a)Collects,purchases,warehouses,andmanagesacommunityinventoryof
14disposablediapersorotherhygieneproductsforinfants,children,orincontinentadults;
15 (b)Regularlydistributesaconsistentandreliablesupplyofsuchdiapersor
16otherhygieneproductsthroughtwoormoreschools,healthcarefacilities,
17governmentalagencies,orothernonprofitentitiesforeventualdistributionto
18individualsfreeofcharge,withtheintentionofreducingdiaperneed;and
19 (c)Isamemberofanationalnetworkorganizationservingallfiftystates
20throughwhichcertificationdemonstratesnonprofitbestpractices,data-drivenprogram
21design,andequitabledistributionfocusedonbestservinginfants,children,and
22incontinentadults;
23 (5)"Taxcredit",acreditagainstthetaxotherwisedueunderchapter143,excluding
24withholdingtaximposedundersections143.191to143.265,orotherwisedueunderchapter
25148or153;
26 [(5)](6)"Taxpayer",aperson,firm,partnerinafirm,corporation,orshareholderin
27anScorporationdoingbusinessinthestateofMissouriandsubjecttothestateincometax
28imposedunderchapter143;aninsurancecompanypayinganannualtaxonitsgrosspremium
29receiptsinthisstate;anyotherfinancialinstitutionpayingtaxestothestateofMissourior
30anypoliticalsubdivisionofthisstateunderchapter148;anexpresscompanythatpaysan
31annualtaxonitsgrossreceiptsinthisstateunderchapter153;anindividualsubjecttothe
32stateincometaxunderchapter143;oranycharitableorganizationthatisexemptfromfederal
33incometaxandwhoseMissouriunrelatedbusinesstaxableincome,ifany,wouldbesubjectto
34thestateincometaximposedunderchapter143.
35 2.ForallfiscalyearsbeginningonorafterJuly1,2019,ataxpayershallbeallowed
36toclaimataxcreditagainstthetaxpayer'sstatetaxliabilityinanamountequaltofiftypercent
37oftheamountofsuchtaxpayer'scontributionstoadiaperbank.
38 3.Theamountofthetaxcreditclaimedshallnotexceedtheamountofthetaxpayer's
39statetaxliabilityforthetaxyearforwhichthecreditisclaimed,andsuchtaxpayershallnot
40beallowedtoclaimataxcreditinexcessoffiftythousanddollarspertaxyear.However,any
41taxcreditthatcannotbeclaimedinthetaxyearthecontributionwasmademaybecarried
42overonlytothenextsubsequenttaxyear.Notaxcreditissuedunderthissectionshallbe
43assigned,transferred,orsold.
44 4.Exceptforanyexcesscreditthatiscarriedoverundersubsection3ofthissection,
45notaxpayershallbeallowedtoclaimataxcreditunlessthetaxpayercontributesatleastone
HCSSB94 2 46hundreddollarstooneormorediaperbanksduringthetaxyearforwhichthecreditis
47claimed.
48 5.Thedepartmentshalldetermine,atleastannually,whichentitiesinthisstate
49qualifyasdiaperbanks.Thedepartmentmayrequireofanentityseekingtobeclassifiedasa
50diaperbankanyinformationwhichisreasonablynecessarytomakesuchadetermination.
51Thedepartmentshallclassifyanentityasadiaperbankifsuchentitysatisfiesthedefinition
52undersubsection1ofthissection.
53 6.Thedepartmentshallestablishaprocedurebywhichataxpayercandetermineifan
54entityhasbeenclassifiedasadiaperbank.
55 7.Diaperbanksmaydeclineacontributionfromataxpayer.
56 8.Thecumulativeamountoftaxcreditsthatmaybeclaimedbyallthetaxpayers
57contributingtodiaperbanksinanyonefiscalyearshallnotexceedfivehundredthousand
58dollars.Taxcreditsshallbeissuedintheordercontributionsarereceived.Iftheamountof
59taxcreditsredeemedinataxyearislessthanfivehundredthousanddollars,thedifference
60shallbeaddedtothecumulativelimitcreatedunderthissubsectionforthenextfiscalyear
61andcarriedovertosubsequentfiscalyearsuntilclaimed.
62 9.Thedepartmentshallestablishaprocedurebywhich,fromthebeginningofthe
63fiscalyearuntilsomepointintimelaterinthefiscalyeartobedeterminedbythedepartment,
64thecumulativeamountoftaxcreditsareequallyapportionedamongallentitiesclassifiedas
65diaperbanks.Ifadiaperbankfailstouseall,orsomepercentagetobedeterminedbythe
66department,ofitsapportionedtaxcreditsduringthispredeterminedperiodoftime,the
67departmentmayreapportionsuchunusedtaxcreditstodiaperbanksthathaveusedall,or
68somepercentagetobedeterminedbythedepartment,oftheirapportionedtaxcreditsduring
69thispredeterminedperiodoftime.Thedepartmentmayestablishmultipleperiodseachfiscal
70yearandreapportionaccordingly.Tothemaximumextentpossible,thedepartmentshall
71establishtheproceduredescribedunderthissubsectioninsuchamannerastoensurethat
72taxpayerscanclaimasmanyofthetaxcreditsaspossible,uptothecumulativelimitcreated
73undersubsection8ofthissection.
74 10.Eachdiaperbankshallprovideinformationtothedepartmentconcerningthe
75identityofeachtaxpayermakingacontributionandtheamountofthecontribution.The
76departmentshallprovidetheinformationtothedepartmentofrevenue.Thedepartmentshall
77besubjecttotheconfidentialityandpenaltyprovisionsofsection32.057relatingtothe
78disclosureoftaxinformation.
79 11.Undersection23.253oftheMissourisunsetact:
80 (1)Theprovisionsoftheprogramauthorizedunderthissectionshallautomatically
81sunsetonDecemberthirty-firstsixyearsafterAugust28,[2018] 2025,unlessreauthorizedby
82anactofthegeneralassembly;
HCSSB94 3 83 (2)Ifsuchprogramisreauthorized,theprogramauthorizedunderthissectionshall
84automaticallysunsetonDecemberthirty-firstsixyearsaftertheeffectivedateofthe
85reauthorizationofthissection;
86 (3)ThissectionshallterminateonSeptemberfirstofthecalendaryearimmediately
87followingthecalendaryearinwhichtheprogramauthorizedunderthissectionissunset;and
88 (4)Theprovisionsofthissubsectionshallnotbeconstruedtolimitorinanyway
89impairthedepartment'sabilitytoissuetaxcreditsauthorizedonorbeforethedatethe
90programauthorizedunderthissectionexpiresorataxpayer'sabilitytoredeemsuchtax
91credits.
167.627.1.Forpurposesofthissection,thefollowingtermsshallmean:
2 (1)"Epinephrinedeliverydevice",asingle-usedeviceapprovedbytheUnited
3StatesFoodandDrugAdministrationthatisusedforthedeliveryofapremeasured
4doseofepinephrineintothehumanbody;
5 (2)"Medication",anymedicineprescribedororderedbyaphysicianforthetreatment
6ofasthmaoranaphylaxis,includingwithoutlimitationinhaledbronchodilatorsand[auto-
7injectible] epinephrinedeliverydevices;
8 [(2)](3)"Self-administration",apupil'sdiscretionaryuseofmedicationprescribedby
9aphysicianorunderawrittentreatmentplanfromaphysician.
10 2.Eachboardofeducationanditsemployeesandagentsinthisstateshallgrantany
11pupilintheschoolauthorizationforthepossessionandself-administrationofmedicationto
12treatsuchpupil'schronichealthcondition,includingbutnotlimitedtoasthmaoranaphylaxis
13if:
14 (1)Alicensedphysicianprescribedororderedsuchmedicationforusebythepupil
15andinstructedsuchpupilinthecorrectandresponsibleuseofsuchmedication;
16 (2)Thepupilhasdemonstratedtothepupil'slicensedphysicianorthelicensed
17physician'sdesignee,andtheschoolnurse,ifavailable,theskilllevelnecessarytousethe
18medicationandanydevicenecessarytoadministersuchmedicationprescribedorordered;
19 (3)Thepupil'sphysicianhasapprovedandsignedawrittentreatmentplanfor
20managingthepupil'schronichealthcondition,includingasthmaoranaphylaxisepisodesand
21formedicationforusebythepupil.Suchplanshallincludeastatementthatthepupilis
22capableofself-administeringthemedicationunderthetreatmentplan;
23 (4)Thepupil'sparentorguardianhascompletedandsubmittedtotheschoolany
24writtendocumentationrequiredbytheschool,includingthetreatmentplanrequiredunder
25subdivision(3)ofthissubsectionandtheliabilitystatementrequiredundersubdivision(5)of
26thissubsection;and
27 (5)Thepupil'sparentorguardianhassignedastatementacknowledgingthatthe
28schooldistrictanditsemployeesoragentsshallincurnoliabilityasaresultofanyinjury
HCSSB94 4 29arisingfromtheself-administrationofmedicationbythepupilortheadministrationofsuch
30medicationbyschoolstaff.Suchstatementshallnotbeconstruedtoreleasetheschool
31districtanditsemployeesoragentsfromliabilityfornegligence.
32 3.Anauthorizationgrantedundersubsection2ofthissectionshall:
33 (1)Permitsuchpupiltopossessandself-administersuchpupil'smedicationwhilein
34school,ataschool-sponsoredactivity,andintransittoorfromschoolorschool-sponsored
35activity;and
36 (2)Beeffectiveonlyforthesameschoolandschoolyearforwhichitisgranted.
37Suchauthorizationshallberenewedbythepupil'sparentorguardianeachsubsequentschool
38yearinaccordancewiththissection.
39 4.Anycurrentduplicateprescriptionmedication,ifprovidedbyapupil'sparentor
40guardianorbytheschool,shallbekeptatapupil'sschoolinalocationatwhichthepupilor
41schoolstaffhasimmediateaccessintheeventofanasthmaoranaphylaxisemergency.
42 5.Theinformationdescribedinsubdivisions(3)and(4)ofsubsection2ofthis
43sectionshallbekeptonfileatthepupil'sschoolinalocationeasilyaccessibleintheeventof
44anemergency.
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
HCSSB94 5 22immunityfromcivilliabilityforadministering[aprefilledautosyringe] anepinephrine
23deliverydeviceunderthissection.
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-usedeviceapprovedbytheUnited
14StatesFoodandDrugAdministrationthatisusedforthedeliveryofapremeasured
15doseofepinephrineintothehumanbody.
16 2.Possessionanduseofepinephrine[auto-injector] deliverydevicesshallbelimited
17asfollows:
18 (1)Nopersonshalluseanepinephrine[auto-injector] deliverydeviceunlesssuch
19personhassuccessfullycompletedatrainingcourseintheuseofepinephrine[auto-injector]
20deliverydevicesapprovedbythedirectorofthedepartmentofhealthandseniorservices.
21Nothinginthissectionshallprohibittheuseofanepinephrine[auto-injector] delivery
22device:
23 (a)Byahealthcareprofessionallicensedorcertifiedbythisstatewhoisacting
24withinthescopeofhisorherpractice;or
25 (b)Byapersonactingpursuanttoalawfulprescription;
26 (2)Everyperson,firm,organizationandentityauthorizedtopossessanduse
27epinephrine[auto-injector] deliverydevicespursuanttothissectionshalluse,maintainand
28disposeofsuchdevicesinaccordancewiththerulesofthedepartment;and
29 (3)Everyuseofanepinephrine[auto-injector] deliverydevicepursuanttothis
30sectionshallimmediatelybereportedtotheemergencyhealthcareprovider.
31 3.(1)Useofanepinephrine[auto-injector] deliverydevicepursuanttothissection
32shallbeconsideredfirstaidoremergencytreatmentforthepurposeofanylawrelatingto
33liability.
HCSSB94 6 34 (2)Purchase,acquisition,possessionoruseofanepinephrine[auto-injector] delivery
35devicepursuanttothissectionshallnotconstitutetheunlawfulpracticeofmedicineorthe
36unlawfulpracticeofaprofession.
37 (3)Anypersonotherwiseauthorizedtosellorprovideanepinephrine[auto-injector]
38deliverydevicemaysellorprovideittoapersonauthorizedtopossessitpursuanttothis
39section.
40 4.Anyperson,firm,organizationorentitythatviolatestheprovisionsofthissection
41isguiltyofaclassBmisdemeanor.
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
HCSSB94 7 13gynecologyastheirprimaryspecialties,andwhoareprovidingsuchprimarycareservicesto
14thegeneralpopulation;
15 (6)"Psychiatrist",thesamemeaningasinsection632.005].
191.605.1.Thedepartmentshalldesignatecounties,communities,orsectionsof
2urbanareasasareasofdefinedneedformedical,psychiatric,[chiropractic,] ordentalservices
3whensuchcounty,communityorsectionofanurbanareahasbeendesignatedasaprimary
4carehealthprofessionalshortagearea,amentalhealthcareprofessionalshortagearea,ora
5dentalhealthcareprofessionalshortageareabythefederalDepartmentofHealthandHuman
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
HCSSB94 8 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
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
HCSSB94 9 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
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
HCSSB94 10 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
42subsequentlyheldunconstitutional,thenthegrantofrulemakingauthorityandanyrule
43proposedoradoptedafterAugust28,2010,shallbeinvalidandvoid.
191.708.1.Thechiefmedicalofficerorchiefmedicaldirectorofthedepartment
2ofhealthandseniorservices,thedepartmentofmentalhealth,ortheMOHealthNet
3divisionofthedepartmentofsocialservices,oranylicensedphysicianactingwiththe
4expresswrittenconsentofthedirectorofanysuchdepartmentordivision,may,within
5hisorherscopeofpractice,issue:
6 (1)Nonspecificrecommendationsfordoulaservices;
7 (2)Amedicalstandingorderforprenatalvitamins;or
8 (3)Amedicalstandingorderforanyotherpurpose,otherthanforcontrolled
9substances,thatispromulgatedbyruleincompliancewithchapter536.
10 2.Anystandingorderissuedunderthissectionshall:
11 (1)Bemadeavailableontherelevantdepartment'swebsitewhileineffect;
12 (2)Terminateuponremovaloftheissuingmedicalprofessional'sauthority
13underthissectionbyvacancyofhisorherpositionorotherwise;and
14 (3)Ifnotterminatedsoonerundersubdivision(2)ofthissubsection,expire
15withinoneyearofissuanceunlessrenewed.
16 3.Thechiefmedicalofficer,chiefmedicaldirector,orotherauthorizedand
17licensedphysiciandescribedinsubsection1ofthissectionshallbeimmunefrom
18criminalprosecution,disciplinaryactionfromhisorherprofessionallicensingboard,
19andcivilliabilityforissuingamedicalstandingorderorrecommendationinaccordance
20withthissection,includingforanyoutcomerelatedtothestandingorderor
21recommendation.
191.1145.1.Asusedinsections191.1145and191.1146,thefollowingtermsshall
2mean:
HCSSB94 11 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;
35 (2)Furnishingofhealthcareservicesbyahealthcareproviderlicensedandlocatedin
36anotherstateincaseofanemergencyordisaster;providedthat,nochargeismadeforthe
37medicalassistance;or
38 (3)Episodicconsultationbyahealthcareproviderlicensedandlocatedinanother
39statewhoprovidessuchconsultationservicesonrequesttoaphysicianinthisstate.
HCSSB94 12 40 5.Nothinginthissectionshallbeconstruedtoalterthescopeofpracticeofany
41healthcareproviderortoauthorizethedeliveryofhealthcareservicesinasettingorina
42mannernototherwiseauthorizedbythelawsofthisstate.
43 6.Nooriginatingsiteforservicesoractivitiesprovidedunderthissectionshallbe
44requiredtomaintainimmediateavailabilityofon-siteclinicalstaffduringthetelehealth
45services,exceptasnecessarytomeetthestandardofcareforthetreatmentofthepatient's
46medicalconditionifsuchconditionisbeingtreatedbyaneligiblehealthcareproviderwhois
47notattheoriginatingsite,hasnotpreviouslyseenthepatientinpersoninaclinicalsetting,
48andisnotprovidingcoverageforahealthcareproviderwhohasanestablishedrelationship
49withthepatient.Healthcareprovidersshallnotbelimitedintheirchoiceofelectronic
50platformsusedtodelivertelehealthortelemedicine.
51 7.Nothinginthissectionshallbeconstruedtoalteranycollaborativepractice
52requirementasprovidedinchapters334and335.
192.021.1.Thedepartmentofhealthandseniorservicesshallbeauthorizedto
2contractdirectlywithadesignatedMissouriaffiliateoftheNationalNetworkofPublic
3HealthInstitutes,orasimilarorsuccessorentity,inordertoassistincarryingoutits
4dutiestopromotethehealthandwellbeingoftheresidentsofthisstate.Suchcontracts
5mayinclude,butnotbelimitedto,effortstoassistinthedeliveryofhealthservicesto
6residentsthroughoutthestateandtheadministrationofgrantfundsandrelated
7programs.
8 2.Withinsixtydaysaftertheendofeachfiscalyear,thedepartmentandthe
9designatedaffiliateshallprovidethegeneralassemblywithanannualreportand
10accountingofanyappropriationsandgrantfundsreceivedandexpendedbythe
11designatedaffiliatepursuanttothissectionduringtheimmediatepriorfiscalyearand
12mayproviderecommendationsandsuggestionsforimprovementinservicesprovided.
192.2521.Aspecialtyhospitalisexemptfromtheprovisionsofsections192.2520
2and197.135ifsuchhospitalhasapolicyfortransferofavictimofasexualassaulttoan
3appropriatehospitalwithanemergencydepartment.Asusedinthissection,"specialty
4hospital"meansahospitalthathasbeendesignatedbythedepartmentofhealthand
5seniorservicesassomethingotherthanageneralacutecarehospital.
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,
HCSSB94 13 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.
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.
HCSSB94 14 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
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.
HCSSB94 15 82 8.Allbasiclifesupportambulancesandstretchervansoperatedinthestateshallbe
83equippedwithepinephrine[auto-injectors] deliverydevicesandbestaffedbyatleastone
84individualtrainedintheuseofepinephrine[auto-injectors] deliverydevices.
85 9.Theprovisionsofthissectionshallapplyinallcountieswithinthestateandany
86citynotwithinacounty.
87 10.Nothinginthissectionshallbeconstruedassupersedingtheprovisionsofsection
88167.630.
197.708.Eachhospitalshalldisplayinaprominentplacewithinthewaiting
2roomsoftheemergencydepartmentandthelaboranddeliverydepartmentaprinted
3signwiththefollowingtextinallcapitalletters:"WARNING:ASSAULTINGA
4HEALTHCAREPROFESSIONAL WHOISENGAGEDINTHEPERFORMANCE
5OFHISORHEROFFICIALDUTIES,INCLUDINGSTRIKINGAHEALTHCARE
6PROFESSIONAL WITHANYBODILYFLUID,ISASERIOUSCRIMEANDWILL
7BEPROSECUTED TOTHEFULLESTEXTENTOFTHELAW.".
208.149.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Clinicalpathologyservices",professionalmedicalservicesprovidedbya
3pathologistfortheexamination,diagnosis,andinterpretationoflaboratorytests
4performedonpatientspecimenstoaidinthediagnosisandtreatmentofdisease.
5Clinicalpathologyservicesinclude,butarenotlimitedto,hematology,microbiology,
6immunology,clinicalchemistry,molecularpathology,andotherlaboratory-based
7diagnosticprocedures;
8 (2)"Hospital-basedpathologist",alicensedphysicianspecializinginpathology
9whoprovidesclinicalpathologyserviceswithinahospitalsetting;
10 (3)"Professionalcomponentofclinicalpathologyservices",theportionof
11clinicalpathologyservicesthatinvolvesthepathologist'sprofessionalexpertisein
12interpretingandsupervisinglaboratorytests,excludingthetechnicalcomponentof
13performingthelaboratorytests.
14 2.Thefeefortheprofessionalcomponentofclinicalpathologyservicesshallbe
15paidbyMOHealthNetforprofessionalservicesprovidedbyahospital-based
16pathologistforinpatientclinicalpathologyservicesrenderedtopatientscoveredby
17theMOHealthNetprogram.
18 3.Thereimbursementamountfortheprofessionalcomponentofclinical
19pathologyservicesshallbesetatthirtypercentoftheapprovedoutpatientsimplifiedfee
20schedulebasedonMedicare'sclinicallaboratoryfeescheduleforthecorresponding
21clinicalpathologyservicespayablebyMOHealthNet.
22 4.(1)Ifthefeefortheprofessionalcomponentofclinicalpathologyservicesis
23paidforprofessionalservicesprovidedbyapathologistemployedbythehospitalwhere
HCSSB94 16 24theclinicalpathologyservicesarerenderedtocoveredMOHealthNetpatients,the
25professionalfeeshallbepaiddirectlytothehospital.
26 (2)Ifthefeefortheprofessionalcomponentofclinicalpathologyservicesispaid
27forprofessionalservicesprovidedbyapathologistwhoisnotemployedbythehospital
28whereclinicalpathologyservicesarerenderedtocoveredMOHealthNetpatients,the
29professionalfeeshallbepaiddirectlytothethirdpartyprovidingtheservices.
30 5.Thedepartmentofsocialservicesshallpromulgateallnecessaryrulesand
31regulationsfortheadministrationofthissection.Anyruleorportionofarule,asthat
32termisdefinedinsection536.010,thatiscreatedundertheauthoritydelegatedinthis
33sectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallofthe
34provisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter
35536arenonseverableandifanyofthepowersvestedwiththegeneralassembly
36pursuanttochapter536toreview,todelaytheeffectivedate,ortodisapproveandannul
37arulearesubsequentlyheldunconstitutional,thenthegrantofrulemakingauthority
38andanyruleproposedoradoptedafterAugust28,2025,shallbeinvalidandvoid.
208.152.1.MOHealthNetpaymentsshallbemadeonbehalfofthoseeligibleneedy
2personsasdescribedinsection208.151whoareunabletoprovideforitinwholeorinpart,
3withanypaymentstobemadeonthebasisofthereasonablecostofthecareorreasonable
4chargefortheservicesasdefinedanddeterminedbytheMOHealthNetdivision,unless
5otherwisehereinafterprovided,forthefollowing:
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;
HCSSB94 17 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
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;
HCSSB94 18 60 (10)Earlyandperiodicscreeninganddiagnosisofindividualswhoareundertheage
61oftwenty-onetoascertaintheirphysicalormentaldefects,andhealthcare,treatment,and
62othermeasurestocorrectoramelioratedefectsandchronicconditionsdiscoveredthereby.
63SuchservicesshallbeprovidedinaccordancewiththeprovisionsofSection6403of[P.L.]
64Pub.L.101-239(42U.S.C.Sections1396aand1396d),asamended,andfederal
65regulationspromulgatedthereunder;
66 (11)Homehealthcareservices;
67 (12)Familyplanningasdefinedbyfederalrulesandregulations;provided,thatno
68fundsshallbeexpendedtoanyabortionfacility,asdefinedinsection188.015,ortoany
69affiliate,asdefinedinsection188.015,ofsuchabortionfacility;andfurtherprovided,
70however,thatsuchfamilyplanningservicesshallnotincludeabortionsoranyabortifacient
71drugordevicethatisusedforthepurposeofinducinganabortionunlesssuchabortionsare
72certifiedinwritingbyaphysiciantotheMOHealthNetagencythat,inthephysician's
73professionaljudgment,thelifeofthemotherwouldbeendangeredifthefetuswerecarriedto
74term;
75 (13)Inpatientpsychiatrichospitalservicesforindividualsunderagetwenty-oneas
76definedinTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396d,etseq.);
77 (14)Outpatientsurgicalprocedures,includingpresurgicaldiagnosticservices
78performedinambulatorysurgicalfacilitieswhicharelicensedbythedepartmentofhealth
79andseniorservicesofthestateofMissouri;except,thatsuchoutpatientsurgicalservicesshall
80notincludepersonswhoareeligibleforcoverageunderPartBofTitleXVIII,PublicLaw89-
8197,1965amendmentstothefederalSocialSecurityAct,asamended,ifexclusionofsuch
82personsispermittedunderTitleXIX,PublicLaw89-97,1965amendmentstothefederal
83SocialSecurityAct,asamended;
84 (15)Personalcareserviceswhicharemedicallyorientedtaskshavingtodowitha
85person'sphysicalrequirements,asopposedtohousekeepingrequirements,whichenablea
86persontobetreatedbyhisorherphysicianonanoutpatientratherthanonaninpatientor
87residentialbasisinahospital,intermediatecarefacility,orskillednursingfacility.Personal
88careservicesshallberenderedbyanindividualnotamemberoftheparticipant'sfamilywho
89isqualifiedtoprovidesuchserviceswheretheservicesareprescribedbyaphysicianin
90accordancewithaplanoftreatmentandaresupervisedbyalicensednurse.Personseligible
91toreceivepersonalcareservicesshallbethosepersonswhowouldotherwiserequire
92placementinahospital,intermediatecarefacility,orskillednursingfacility.Benefitspayable
93forpersonalcareservicesshallnotexceedforanyoneparticipantonehundredpercentofthe
94averagestatewidechargeforcareandtreatmentinanintermediatecarefacilityfora
95comparableperiodoftime.Suchservices,whendeliveredinaresidentialcarefacilityor
96assistedlivingfacilitylicensedunderchapter198,shallbeauthorizedonatierlevelbasedon
HCSSB94 19 97theservicestheresidentrequiresandthefrequencyoftheservices.Aresidentofsuchfacility
98whoqualifiesforassistanceundersection208.030shall,ataminimum,ifprescribedbya
99physician,qualifyforthetierlevelwiththefewestservices.Theratepaidtoprovidersfor
100eachtierofserviceshallbesetsubjecttoappropriations.Subjecttoappropriations,each
101residentofsuchfacilitywhoqualifiesforassistanceundersection208.030andmeetsthe
102levelofcarerequiredinthissectionshall,ataminimum,ifprescribedbyaphysician,be
103authorizeduptoonehourofpersonalcareservicesperday.Authorizedunitsofpersonalcare
104servicesshallnotbereducedortierlevelloweredunlessanorderapprovingsuchreductionor
105loweringisobtainedfromtheresident'spersonalphysician.Suchauthorizedunitsofpersonal
106careservicesortierlevelshallbetransferredwithsuchresidentifheorshetransfersto
107anothersuchfacility.Suchprovisionshallterminateuponreceiptofrelevantwaiversfrom
108thefederalDepartmentofHealthandHumanServices.IftheCentersforMedicareand
109MedicaidServicesdeterminesthatsuchprovisiondoesnotcomplywiththestateplan,this
110provisionshallbenullandvoid.TheMOHealthNetdivisionshallnotifytherevisorof
111statutesastowhethertherelevantwaiversareapprovedoradeterminationofnoncompliance
112ismade;
113 (16)Mentalhealthservices.Thestateplanforprovidingmedicalassistanceunder
114TitleXIXoftheSocialSecurityAct,42U.S.C.Section[301]1396etseq.,asamended,shall
115includethefollowingmentalhealthserviceswhensuchservicesareprovidedbycommunity
116mentalhealthfacilitiesoperatedbythedepartmentofmentalhealthordesignatedbythe
117departmentofmentalhealthasacommunitymentalhealthfacilityorasanalcoholanddrug
118abusefacilityorasachild-servingagencywithinthecomprehensivechildren'smentalhealth
119servicesystemestablishedinsection630.097.Thedepartmentofmentalhealthshall
120establishbyadministrativerulethedefinitionandcriteriafordesignationasacommunity
121mentalhealthfacilityandfordesignationasanalcoholanddrugabusefacility.Suchmental
122healthservicesshallinclude:
123 (a)Outpatientmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
124rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
125settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
126established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
127apartofclientservicesmanagement;
128 (b)Clinicmentalhealthservicesincludingpreventive,diagnostic,therapeutic,
129rehabilitative,andpalliativeinterventionsrenderedtoindividualsinanindividualorgroup
130settingbyamentalhealthprofessionalinaccordancewithaplanoftreatmentappropriately
131established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
132apartofclientservicesmanagement;
HCSSB94 20 133 (c)Rehabilitativementalhealthandalcoholanddrugabuseservicesincludinghome
134andcommunity-basedpreventive,diagnostic,therapeutic,rehabilitative,andpalliative
135interventionsrenderedtoindividualsinanindividualorgroupsettingbyamentalhealth
136oralcoholanddrugabuseprofessionalinaccordancewithaplanoftreatmentappropriately
137established,implemented,monitored,andrevisedundertheauspicesofatherapeuticteamas
138apartofclientservicesmanagement.Asusedinthissection,mentalhealthprofessionaland
139alcoholanddrugabuseprofessionalshallbedefinedbythedepartmentofmentalhealth
140pursuanttodulypromulgatedrules.Withrespecttoservicesestablishedbythissubdivision,
141thedepartmentofsocialservices,MOHealthNetdivision,shallenterintoanagreementwith
142thedepartmentofmentalhealth.Matchingfundsforoutpatientmentalhealthservices,clinic
143mentalhealthservices,andrehabilitationservicesformentalhealthandalcoholanddrug
144abuseshallbecertifiedbythedepartmentofmentalhealthtotheMOHealthNetdivision.
145Theagreementshallestablishamechanismforthejointimplementationoftheprovisionsof
146thissubdivision.Inaddition,theagreementshallestablishamechanismbywhichratesfor
147servicesmaybejointlydeveloped;
148 (17)SuchadditionalservicesasdefinedbytheMOHealthNetdivisiontobe
149furnishedunderwaiversoffederalstatutoryrequirementsasprovidedforandauthorizedby
150thefederalSocialSecurityAct(42U.S.C.Section301,etseq.)subjecttoappropriationbythe
151generalassembly;
152 (18)Theservicesofanadvancedpracticeregisterednursewithacollaborative
153practiceagreementtotheextentthatsuchservicesareprovidedinaccordancewithchapters
154334and335,andregulationspromulgatedthereunder;
155 (19)Nursinghomecostsforparticipantsreceivingbenefitpaymentsunder
156subdivision(4)ofthissubsectiontoreserveabedfortheparticipantinthenursinghome
157duringthetimethattheparticipantisabsentduetoadmissiontoahospitalforserviceswhich
158cannotbeperformedonanoutpatientbasis,subjecttotheprovisionsofthissubdivision:
159 (a)Theprovisionsofthissubdivisionshallapplyonlyif:
160 a.Theoccupancyrateofthenursinghomeisatoraboveninety-sevenpercentofMO
161HealthNetcertifiedlicensedbeds,accordingtothemostrecentquarterlycensusprovidedto
162thedepartmentofhealthandseniorserviceswhichwastakenpriortowhentheparticipantis
163admittedtothehospital;and
164 b.Thepatientisadmittedtoahospitalforamedicalconditionwithananticipated
165stayofthreedaysorless;
166 (b)Thepaymenttobemadeunderthissubdivisionshallbeprovidedforamaximum
167ofthreedaysperhospitalstay;
168 (c)Foreachdaythatnursinghomecostsarepaidonbehalfofaparticipantunderthis
169subdivisionduringanyperiodofsixconsecutivemonthssuchparticipantshall,duringthe
HCSSB94 21 170sameperiodofsixconsecutivemonths,beineligibleforpaymentofnursinghomecostsof
171twootherwiseavailabletemporaryleaveofabsencedaysprovidedundersubdivision(5)of
172thissubsection;and
173 (d)Theprovisionsofthissubdivisionshallnotapplyunlessthenursinghome
174receivesnoticefromtheparticipantortheparticipant'sresponsiblepartythattheparticipant
175intendstoreturntothenursinghomefollowingthehospitalstay.Ifthenursinghomereceives
176suchnotificationandallotherprovisionsofthissubsectionhavebeensatisfied,thenursing
177homeshallprovidenoticetotheparticipantortheparticipant'sresponsiblepartypriorto
178releaseofthereservedbed;
179 (20)Prescribedmedicallynecessarydurablemedicalequipment.Anelectronicweb-
180basedpriorauthorizationsystemusingbestmedicalevidenceandcareandtreatment
181guidelinesconsistentwithnationalstandardsshallbeusedtoverifymedicalneed;
182 (21)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
183coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
184inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
185medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
186physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
187psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
188stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
189participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
190paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
191nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
192rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
193facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
194(OmnibusBudgetReconciliationActof1989);
195 (22)Prescribedmedicallynecessarydentalservices.Suchservicesshallbesubjectto
196appropriations.Anelectronicweb-basedpriorauthorizationsystemusingbestmedical
197evidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshallbeusedto
198verifymedicalneed;
199 (23)Prescribedmedicallynecessaryoptometricservices.Suchservicesshallbe
200subjecttoappropriations.Anelectronicweb-basedpriorauthorizationsystemusingbest
201medicalevidenceandcareandtreatmentguidelinesconsistentwithnationalstandardsshall
202beusedtoverifymedicalneed;
203 (24)Bloodclottingproducts-relatedservices.Forpersonsdiagnosedwithableeding
204disorder,asdefinedinsection338.400,reliantonbloodclottingproducts,asdefinedin
205section338.400,suchservicesinclude:
HCSSB94 22 206 (a)Homedeliveryofbloodclottingproductsandancillaryinfusionequipmentand
207supplies,includingtheemergencydeliveriesoftheproductwhenmedicallynecessary;
208 (b)Medicallynecessaryancillaryinfusionequipmentandsuppliesrequiredto
209administerthebloodclottingproducts;and
210 (c)Assessmentsconductedintheparticipant'shomebyapharmacist,nurse,orlocal
211homehealthcareagencytrainedinbleedingdisorderswhendeemednecessarybythe
212participant'streatingphysician;
213 (25)Doulaservicesinaccordancewithsections208.1400to208.1425;
214 (26)Childbirtheducationclassesforpregnantwomenandasupportperson;
215 (27)TheMOHealthNetdivisionshall,byJanuary1,2008,andannuallythereafter,
216reportthestatusofMOHealthNetproviderreimbursementratesascomparedtoonehundred
217percentoftheMedicarereimbursementratesandcomparedtotheaveragedental
218reimbursementratespaidbythird-partypayorslicensedbythestate.TheMOHealthNet
219divisionshall,byJuly1,2008,providetothegeneralassemblyafour-yearplantoachieve
220paritywithMedicarereimbursementratesandforthird-partypayoraveragedental
221reimbursementrates.Suchplanshallbesubjecttoappropriationandthedivisionshall
222includeinitsannualbudgetrequesttothegovernorthenecessaryfundingneededtocomplete
223thefour-yearplandevelopedunderthissubdivision.
224 2.Additionalbenefitpaymentsformedicalassistanceshallbemadeonbehalfof
225thoseeligibleneedychildren,pregnantwomenandblindpersonswithanypaymentstobe
226madeonthebasisofthereasonablecostofthecareorreasonablechargefortheservicesas
227definedanddeterminedbytheMOHealthNetdivision,unlessotherwisehereinafterprovided,
228forthefollowing:
229 (1)Dentalservices;
230 (2)Servicesofpodiatristsasdefinedinsection330.010;
231 (3)Optometricservicesasdescribedinsection336.010;
232 (4)Orthopedicdevicesorotherprosthetics,includingeyeglasses,dentures,hearing
233aids,andwheelchairs;
234 (5)Hospicecare.Asusedinthissubdivision,theterm"hospicecare"meansa
235coordinatedprogramofactiveprofessionalmedicalattentionwithinahome,outpatientand
236inpatientcarewhichtreatstheterminallyillpatientandfamilyasaunit,employinga
237medicallydirectedinterdisciplinaryteam.Theprogramprovidesreliefofseverepainorother
238physicalsymptomsandsupportivecaretomeetthespecialneedsarisingoutofphysical,
239psychological,spiritual,social,andeconomicstresseswhichareexperiencedduringthefinal
240stagesofillness,andduringdyingandbereavementandmeetstheMedicarerequirementsfor
241participationasahospiceasareprovidedin42CFRPart418.Therateofreimbursement
242paidbytheMOHealthNetdivisiontothehospiceproviderforroomandboardfurnishedbya
HCSSB94 23 243nursinghometoaneligiblehospicepatientshallnotbelessthanninety-fivepercentofthe
244rateofreimbursementwhichwouldhavebeenpaidforfacilityservicesinthatnursinghome
245facilityforthatpatient,inaccordancewithsubsection(c)ofSection6408ofP.L.101-239
246(OmnibusBudgetReconciliationActof1989);
247 (6)Comprehensivedayrehabilitationservicesbeginningearlyposttraumaaspartofa
248coordinatedsystemofcareforindividualswithdisablingimpairments.Rehabilitation
249servicesmustbebasedonanindividualized,goal-oriented,comprehensiveandcoordinated
250treatmentplandeveloped,implemented,andmonitoredthroughaninterdisciplinary
251assessmentdesignedtorestoreanindividualtoanoptimallevelofphysical,cognitive,and
252behavioralfunction.TheMOHealthNetdivisionshallestablishbyadministrativerulethe
253definitionandcriteriafordesignationofacomprehensivedayrehabilitationservicefacility,
254benefitlimitationsandpaymentmechanism.Anyruleorportionofarule,asthattermis
255definedinsection536.010,thatiscreatedundertheauthoritydelegatedinthissubdivision
256shallbecomeeffectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsof
257chapter536and,ifapplicable,section536.028.Thissectionandchapter536are
258nonseverableandifanyofthepowersvestedwiththegeneralassemblypursuanttochapter
259536toreview,todelaytheeffectivedate,ortodisapproveandannularulearesubsequently
260heldunconstitutional,thenthegrantofrulemakingauthorityandanyruleproposedor
261adoptedafterAugust28,2005,shallbeinvalidandvoid.
262 3.TheMOHealthNetdivisionmayrequireanyparticipantreceivingMOHealthNet
263benefitstopaypartofthechargeorcostuntilJuly1,2008,andanadditionalpaymentafter
264July1,2008,asdefinedbyruledulypromulgatedbytheMOHealthNetdivision,forall
265coveredservicesexceptforthoseservicescoveredundersubdivisions(15)and(16)of
266subsection1ofthissectionandsections208.631to208.657totheextentandinthemanner
267authorizedbyTitleXIXofthefederalSocialSecurityAct(42U.S.C.Section1396,etseq.)
268andregulationsthereunder.Whensubstitutionofagenericdrugispermittedbytheprescriber
269accordingtosection338.056,andagenericdrugissubstitutedforaname-branddrug,the
270MOHealthNetdivisionmaynotlowerordeletetherequirementtomakeaco-payment
271pursuanttoregulationsofTitleXIXofthefederalSocialSecurityAct.Aproviderofgoods
272orservicesdescribedunderthissectionmustcollectfromallparticipantstheadditional
273paymentthatmayberequiredbytheMOHealthNetdivisionunderauthoritygrantedherein,
274ifthedivisionexercisesthatauthority,toremaineligibleasaprovider.Anypaymentsmade
275byparticipantsunderthissectionshallbeinadditiontoandnotinlieuofpaymentsmadeby
276thestateforgoodsorservicesdescribedhereinexcepttheparticipantportionofthepharmacy
277professionaldispensingfeeshallbeinadditiontoandnotinlieuofpaymentstopharmacists.
278Aprovidermaycollecttheco-paymentatthetimeaserviceisprovidedoratalaterdate.A
279providershallnotrefusetoprovideaserviceifaparticipantisunabletopayarequired
HCSSB94 24 280payment.Ifitistheroutinebusinesspracticeofaprovidertoterminatefutureservicestoan
281individualwithanunclaimeddebt,theprovidermayincludeuncollectedco-paymentsunder
282thispractice.Providerswhoelectnottoundertaketheprovisionofservicesbasedona
283historyofbaddebtshallgiveparticipantsadvancenoticeandareasonableopportunityfor
284payment.Aprovider,representative,employee,independentcontractor,oragentofa
285pharmaceuticalmanufacturershallnotmakeco-paymentforaparticipant.Thissubsection
286shallnotapplytootherqualifiedchildren,pregnantwomen,orblindpersons.IftheCenters
287forMedicareandMedicaidServicesdoesnotapprovetheMOHealthNetstateplan
288amendmentsubmittedbythedepartmentofsocialservicesthatwouldallowaproviderto
289denyfutureservicestoanindividualwithuncollectedco-payments,thedenialofservices
290shallnotbeallowed.Thedepartmentofsocialservicesshallinformprovidersregardingthe
291acceptabilityofdenyingservicesastheresultofunpaidco-payments.
292 4.TheMOHealthNetdivisionshallhavetherighttocollectmedicationsamplesfrom
293participantsinordertomaintainprogramintegrity.
294 5.Reimbursementforobstetricalandpediatricservicesundersubdivision(6)of
295subsection1ofthissectionshallbetimelyandsufficienttoenlistenoughhealthcare
296providerssothatcareandservicesareavailableunderthestateplanforMOHealthNet
297benefitsatleasttotheextentthatsuchcareandservicesareavailabletothegeneral
298populationinthegeographicarea,asrequiredundersubparagraph(a)(30)(A)of42U.S.C.
299Section1396aandfederalregulationspromulgatedthereunder.
300 6.BeginningJuly1,1990,reimbursementforservicesrenderedinfederallyfunded
301healthcentersshallbeinaccordancewiththeprovisionsofsubsection6402(c)andSection
3026404ofP.L.101-239(OmnibusBudgetReconciliationActof1989)andfederalregulations
303promulgatedthereunder.
304 7.BeginningJuly1,1990,thedepartmentofsocialservicesshallprovidenotification
305andreferralofchildrenbelowagefive,andpregnant,breast-feeding,orpostpartumwomen
306whoaredeterminedtobeeligibleforMOHealthNetbenefitsundersection208.151tothe
307specialsupplementalfoodprogramsforwomen,infantsandchildrenadministeredbythe
308departmentofhealthandseniorservices.Suchnotificationandreferralshallconformtothe
309requirementsofSection6406ofP.L.101-239andregulationspromulgatedthereunder.
310 8.Providersoflong-termcareservicesshallbereimbursedfortheircostsin
311accordancewiththeprovisionsofSection1902(a)(13)(A)oftheSocialSecurityAct,42
312U.S.C.Section1396a,asamended,andregulationspromulgatedthereunder.
313 9.Reimbursementratestolong-termcareproviderswithrespecttoatotalchangein
314ownership,atarm'slength,foranyfacilitypreviouslylicensedandcertifiedforparticipation
315intheMOHealthNetprogramshallnotincreasepaymentsinexcessoftheincreasethat
HCSSB94 25 316wouldresultfromtheapplicationofSection1902(a)(13)(C)oftheSocialSecurityAct,42
317U.S.C.Section1396a(a)(13)(C).
318 10.TheMOHealthNetdivisionmayenrollqualifiedresidentialcarefacilitiesand
319assistedlivingfacilities,asdefinedinchapter198,asMOHealthNetpersonalcareproviders.
320 11.Anyincomeearnedbyindividualseligibleforcertifiedextendedemploymentata
321shelteredworkshopunderchapter178shallnotbeconsideredasincomeforpurposesof
322determiningeligibilityunderthissection.
323 12.IftheMissouriMedicaidauditandcomplianceunitchangesanyinterpretationor
324applicationoftherequirementsforreimbursementforMOHealthNetservicesfromthe
325interpretationorapplicationthathasbeenappliedpreviouslybythestateinanyauditofaMO
326HealthNetprovider,theMissouriMedicaidauditandcomplianceunitshallnotifyallaffected
327MOHealthNetprovidersfivebusinessdaysbeforesuchchangeshalltakeeffect.Failureof
328theMissouriMedicaidauditandcomplianceunittonotifyaproviderofsuchchangeshall
329entitletheprovidertocontinuetoreceiveandretainreimbursementuntilsuchnotificationis
330providedandshallwaiveanyliabilityofsuchproviderforrecoupmentorotherlossofany
331paymentspreviouslymadepriortothefivebusinessdaysaftersuchnoticehasbeensent.
332EachprovidershallprovidetheMissouriMedicaidauditandcomplianceunitavalidemail
333addressandshallagreetoreceivecommunicationselectronically.Thenotificationrequired
334underthissectionshallbedeliveredinwritingbytheUnitedStatesPostalServiceor
335electronicmailtoeachprovider.
336 13.Nothinginthissectionshallbeconstruedtoabrogateorlimitthedepartment's
337statutoryrequirementtopromulgaterulesunderchapter536.
338 14.BeginningJuly1,2016,andsubjecttoappropriations,providersofbehavioral,
339social,andpsychophysiologicalservicesfortheprevention,treatment,ormanagementof
340physicalhealthproblemsshallbereimbursedutilizingthebehaviorassessmentand
341interventionreimbursementcodes96150to96154ortheirsuccessorcodesunderthe
342CurrentProceduralTerminology(CPT)codingsystem.Providerseligibleforsuch
343reimbursementshallincludepsychologists.
344 15.Thereshallbenopaymentsmadeunderthissectionforgendertransition
345surgeries,cross-sexhormones,orpuberty-blockingdrugs,assuchtermsaredefinedinsection
346191.1720,forthepurposeofagendertransition.
347 16.Thedepartmentofsocialservicesshallstudytheimpactthatthechildbirth
348educationclassesprovidedundersubdivision(26)ofsubsection1ofthissectionhaveon
349infantandmaternalmortalityamongpregnantwomen.Thedepartmentofsocial
350servicesshallsubmitareporttothegeneralassemblywiththeresultsofthestudybefore
351January1,2028.
HCSSB94 26 208.662.1.Thereisherebyestablishedwithinthedepartmentofsocialservicesthe
2"Show-MeHealthyBabiesProgram"asaseparatechildren'shealthinsuranceprogram
3(CHIP)foranylow-incomeunbornchild.Theprogramshallbeestablishedunderthe
4authorityofTitleXXIofthefederalSocialSecurityAct,theStateChildren'sHealth
5InsuranceProgram,asamended,and42CFR457.1.
6 2.Foranunbornchildtobeenrolledintheshow-mehealthybabiesprogram,hisor
7hermothershallnotbeeligibleforcoverageunderTitleXIXofthefederalSocialSecurity
8Act,theMedicaidprogram,asitisadministeredbythestate,andshallnothaveaccessto
9affordableemployer-subsidizedhealthcareinsuranceorotheraffordablehealthcarecoverage
10thatincludescoveragefortheunbornchild.Inaddition,theunbornchildshallbeinafamily
11withincomeeligibilityofnomorethanthreehundredpercentofthefederalpovertylevel,or
12theequivalentmodifiedadjustedgrossincome,unlesstheincomeeligibilityissetlowerby
13thegeneralassemblythroughappropriations.Incalculatingfamilysizeasitrelatestoincome
14eligibility,thefamilyshallinclude,inadditiontootherfamilymembers,theunbornchild,or
15inthecaseofamotherwithamultiplepregnancy,allunbornchildren.
16 3.Coverageforanunbornchildenrolledintheshow-mehealthybabiesprogram
17shallincludeallprenatalcareandpregnancy-relatedservicesthatbenefitthehealthofthe
18unbornchildandthatpromotehealthylabor,delivery,andbirth, includingchildbirth
19educationclasses. Coverageneednotincludeservicesthataresolelyforthebenefitofthe
20pregnantmother,thatareunrelatedtomaintainingorpromotingahealthypregnancy,andthat
21providenobenefittotheunbornchild.However,thedepartmentmayincludepregnancy-
22relatedassistanceasdefinedin42U.S.C.Section1397ll.
23 4.Thereshallbenowaitingperiodbeforeanunbornchildmaybeenrolledinthe
24show-mehealthybabiesprogram.Inaccordancewiththedefinitionofchildin42CFR
25457.10,coverageshallincludetheperiodfromconceptiontobirth.Thedepartmentshall
26developapresumptiveeligibilityprocedureforenrollinganunbornchild.Thereshallbe
27verificationofthepregnancy.
28 5.Coverageforthechildshallcontinueforuptooneyearafterbirth,unlessotherwise
29prohibitedbylaworunlessotherwiselimitedbythegeneralassemblythroughappropriations.
30 6.(1)Pregnancy-relatedandpostpartumcoverageforthemothershallbeginonthe
31daythepregnancyendsandextendthroughthelastdayofthemonththatincludesthesixtieth
32dayafterthepregnancyends,unlessotherwiseprohibitedbylaworunlessotherwiselimited
33bythegeneralassemblythroughappropriations.Thedepartmentmayincludepregnancy-
34relatedassistanceasdefinedin42U.S.C.Section1397ll.
35 (2)(a)Subjecttoapprovalofanynecessarystateplanamendmentsorwaivers,
36beginningonJuly6,2023,motherseligibletoreceivecoverageunderthissectionshall
37receivemedicalassistancebenefitsduringthepregnancyandduringthetwelve-monthperiod
HCSSB94 27 38thatbeginsonthelastdayofthewoman'spregnancyandendsonthelastdayofthemonthin
39whichsuchtwelve-monthperiodends,consistentwiththeprovisionsof42U.S.C.Section
401397gg(e)(1)(J).Thedepartmentshallseekanynecessarystateplanamendmentsorwaivers
41toimplementtheprovisionsofthissubdivisionwhenthenumberofineligibleMOHealthNet
42participantsremovedfromtheprogramin2023pursuanttosection208.239exceedsthe
43projectednumberofbeneficiarieslikelytoenrollinbenefitsin2023underthissubdivision
44andsubdivision(28)ofsubsection1ofsection208.151,asdeterminedbythedepartment,by
45atleastonehundredindividuals.
46 (b)Theprovisionsofthissubdivisionshallremainineffectforanyperiodoftime
47duringwhichthefederalauthorityunder42U.S.C.Section1397gg(e)(1)(J),asamended,or
48anysuccessorstatutesorimplementingregulations,isineffect.
49 7.Thedepartmentshallprovidecoverageforanunbornchildenrolledintheshow-
50mehealthybabiesprograminthesamemannerinwhichthedepartmentprovidescoverage
51forthechildren'shealthinsuranceprogram(CHIP)inthecountyoftheprimaryresidenceof
52themother.
53 8.Thedepartmentshallprovideinformationabouttheshow-mehealthybabies
54programtomaternityhomesasdefinedinsection135.600,pregnancyresourcecentersas
55definedinsection135.630,andothersimilaragenciesandprogramsinthestatethatassist
56unbornchildrenandtheirmothers.Thedepartmentshallconsiderallowingsuchagenciesand
57programstoassistintheenrollmentofunbornchildrenintheprogram,andinmaking
58determinationsaboutpresumptiveeligibilityandverificationofthepregnancy.
59 9.WithinsixtydaysafterAugust28,2014,thedepartmentshallsubmitastateplan
60amendmentorseekanynecessarywaiversfromthefederalDepartmentofHealthandHuman
61Servicesrequestingapprovalfortheshow-mehealthybabiesprogram.
62 10.Atleastannually,thedepartmentshallprepareandsubmitareporttothe
63governor,thespeakerofthehouseofrepresentatives,andthepresidentprotemporeofthe
64senateanalyzingandprojectingthecostsavingsandbenefits,ifany,tothestate,counties,
65localcommunities,schooldistricts,lawenforcementagencies,correctionalcenters,health
66careproviders,employers,otherpublicandprivateentities,andpersonsbyenrollingunborn
67childrenintheshow-mehealthybabiesprogram.Theanalysisandprojectionofcostsavings
68andbenefits,ifany,mayincludebutneednotbelimitedto:
69 (1)Thehigherfederalmatchingrateforhavinganunbornchildenrolledintheshow-
70mehealthybabiesprogramversusthelowerfederalmatchingrateforapregnantwoman
71beingenrolledinMOHealthNetorotherfederalprograms;
72 (2)Theefficacyinprovidingservicestounbornchildrenthroughmanagedcare
73organizations,grouporindividualhealthinsuranceprovidersorpremiumassistance,or
74throughothernontraditionalarrangementsofprovidinghealthcare;
HCSSB94 28 75 (3)Thechangeintheproportionofunbornchildrenwhoreceivecareinthefirst
76trimesterofpregnancyduetoalackofwaitingperiods,byallowingpresumptiveeligibility,
77orbyremovalofotherbarriers,andanyresultingorprojecteddecreaseinhealthproblems
78andotherproblemsforunbornchildrenandwomenthroughoutpregnancy;atlabor,delivery,
79andbirth;andduringinfancyandchildhood;
80 (4)Thechangeinhealthybehaviorsbypregnantwomen,suchasthecessationofthe
81useoftobacco,alcohol,illicitdrugs,orotherharmfulpractices,andanyresultingorprojected
82short-termandlong-termdecreaseinbirthdefects;poormotorskills;vision,speech,and
83hearingproblems;breathingandrespiratoryproblems;feedinganddigestiveproblems;and
84otherphysical,mental,educational,andbehavioralproblems;and
85 (5)Thechangeininfantandmaternalmortality,pretermbirthsandlowbirthweight
86babiesandanyresultingorprojecteddecreaseinshort-termandlong-termmedicalandother
87interventions.
88 11.Theshow-mehealthybabiesprogramshallnotbedeemedanentitlement
89program,butinsteadshallbesubjecttoafederalallotmentorotherfederalappropriationsand
90matchingstateappropriations.
91 12.Nothinginthissectionshallbeconstruedasobligatingthestatetocontinuethe
92show-mehealthybabiesprogramiftheallotmentorpaymentsfromthefederalgovernment
93endorarenotsufficientfortheprogramtooperate,orifthegeneralassemblydoesnot
94appropriatefundsfortheprogram.
95 13.NothinginthissectionshallbeconstruedasexpandingMOHealthNetor
96fulfillingamandateimposedbythefederalgovernmentonthestate.
208.1400.Sections208.1400to208.1425shallbeknownandmaybecitedasthe
2"MissouriDoulaReimbursementAct".
208.1405.Forpurposesofsections208.1400to208.1425,thefollowingterms
2mean:
3 (1)"Community-basednetwork",anetworkthatisrepresentativeofa
4communityorsignificantsegmentsofacommunityandengagedinmeetingthat
5community'sneedsintheareaofsocial,human,orhealthservices;
6 (2)"Communitynavigationservices",servicesthatconnectpregnant
7individualsandtheirfamilieswithavailableresourcesusingacommunity-based
8approachincluding,butnotlimitedto,anapproachthatunderstandstheservicesand
9supportsavailabletopregnantandpostpartumindividualsreceivingMOHealthNet
10benefitsandfacilitatesaccesstothoseresourcesbaseduponanassessmentofsocial
11serviceneeds;
12 (3)"Doula",atrainedprofessionalprovidingcontinuousphysical,emotional,
13andinformationalsupporttoapregnantindividual,fromtheprenatal,theintrapartum,
HCSSB94 29 14anduptothefirsttwelvemonthsofthepostpartumperiods.Doulasalsoprovide
15assistancebyreferringpregnantindividualstocommunity-basednetworksandcertified
16andlicensedperinatalprofessionalsinmultipledisciplines;
17 (4)"Doulaservices",servicesprovidedbyadoula;
18 (5)"Fee-for-service",apaymentmodelwhereservicesareunbundledandpaid
19forseparately;
20 (6)"Intrapartum",theperiodofpregnancyduringlaboranddeliveryor
21childbirth.Servicesprovidedduringthisperiodarerenderedtothepregnant
22individual;
23 (7)"Managedcare",thedeliveryofMedicaidhealthbenefitsandadditional
24servicesthroughcontractedarrangementsbetweenstateMedicaidagenciesand
25managedcareorganizationsthatacceptasetpermemberpermonth(capitation)
26paymentfortheseservices;
27 (8)"Postpartum",theone-yearperiodafterapregnancyends;
28 (9)"Prenatal",theperiodofpregnancybeforelabororchildbirth.Services
29providedduringthisperiodarerenderedtothepregnantindividual.
208.1410.ThefollowingdoulaservicesshallbecoveredbytheMOHealthNet
2program:
3 (1)Acombinedtotalofsixprenatalandpostpartumsupportsessions;
4 (2)Onebirthattendance;
5 (3)Uptotwovisitsforgeneralconsultationonlactationatanytimeduringthe
6prenatalandpostpartumperiods;and
7 (4)Communitynavigationservices,exceptthatanycommunitynavigation
8servicesprovidedoutsideanyvisitorsessionbilledundersubdivisions(1)to(3)ofthis
9sectionshallbebilledonlyuptotentimestotaloverthecourseofthepregnancyand
10postpartumperiod.
208.1415.Adoulashallbeeligibleforparticipationasaproviderofdoula
2servicescoveredbytheMOHealthNetprogramonlyifthedoula:
3 (1)IsenrolledasaMOHealthNetprovider;
4 (2)Iseighteenyearsofageorolder;
5 (3)Holdsliabilityinsuranceasanindividualorthroughasupervising
6organization;and
7 (4)Either:
8 (a)PossessesacurrentcertificateissuedbyanationalorMissouri-baseddoula
9trainingorganizationwhosecurriculummeetsguidelinesestablishedbytheMO
10HealthNetdivisionbyrule;or
HCSSB94 30 11 (b)Receivedtrainingfromasourcenotdescribedinparagraph(a)ofthis
12subdivision,orfrommultiplesources,whosecurriculummeetstheguidelines
13establishedunderparagraph(a)ofthissubdivisionasverifiedbyapublicroster
14maintainedbyastatewideorganizationcomposedofdoulatrainersfromthreeormore
15independent,well-establisheddoulatrainingorganizationslocatedinMissouriwhose
16purposeincludesthevalidationofcorecompetenciesoftraining.
208.1420.1.OnceenrolledasaMOHealthNetprovider,adoulashallbeeligible
2toenrollasaproviderwithfee-for-serviceandmanagedcarepayersaffiliatedwiththe
3MOHealthNetprogram.
4 2.Doulaservicesshallbereimbursedonafee-for-serviceschedule.
208.1425.TheMOHealthNetdivisionshallpromulgateallnecessaryrulesand
2regulationsfortheadministrationofsections208.1400to208.1425.Anyruleorportion
3ofarule,asthattermisdefinedinsection536.010,thatiscreatedundertheauthority
4delegatedinthissectionshallbecomeeffectiveonlyifitcomplieswithandissubjectto
5alloftheprovisionsofchapter536and,ifapplicable,section536.028.Thissectionand
6chapter536arenonseverableandifanyofthepowersvestedwiththegeneralassembly
7pursuanttochapter536toreview,todelaytheeffectivedate,ortodisapproveandannul
8arulearesubsequentlyheldunconstitutional,thenthegrantofrulemakingauthority
9andanyruleproposedoradoptedafterAugust28,2025,shallbeinvalidandvoid.
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
HCSSB94 31 19(HBIG)inaccordancewiththecurrentrecommendationsoftheAdvisoryCommitteeon
20ImmunizationPractices(ACIP).Ifthemother'shepatitisBstatusisunknown,theappropriate
21doseofhepatitisBvaccineshallbeadministeredtothenewborninaccordancewiththe
22currentACIPrecommendations.Ifthemotherconsents,asampleofhervenousbloodshall
23betaken.IfshetestspositiveforhepatitisB,hepatitisBimmuneglobulin(HBIG)shallbe
24administeredtothenewborninaccordancewiththecurrentACIPrecommendations.
25 2.Thedepartmentofhealthandseniorservicesshall[, inconsultationwiththe
26Missourigeneticdiseaseadvisorycommittee,] makesuchrulespertainingtosuchtestsas
27shallbedictatedbyacceptedmedicalpractice,andtestsshallbeofthetypesapprovedor
28acceptedbythe[departmentofhealthandseniorservices.Anapprovedandstandardtestfor
29syphilis,hepatitisB,andothertreatablediseasesandmetabolicdisordersshallmeanatest
30madeinalaboratoryapprovedbythedepartmentofhealthandseniorservices] UnitedStates
31FoodandDrugAdministration. Noindividualshallbedeniedtestingbythedepartmentof
32healthandseniorservicesbecauseofinabilitytopay.
33 3.Healthcareprovidersshallreceiveinformedconsentpriortoadministering
34anytreatmentorprocedure.
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
HCSSB94 32 22ofaccurateinformationandtoensurethatexistingchildcarefacilitysafetyand
23environmentalpoliciesdonotconflict.
24 (2)Suchpoliciesmaycontaininformationfromorlinkstochildcarefacility
25allergypreventioninformationfurnishedbytheFoodAllergyResearch&Education
26organizationorequivalentorganizationwithamedicaladvisoryboardthathasallergy
27specialists.
28 3.Thedepartmentofelementaryandsecondaryeducationshall,incooperation
29withanyappropriateprofessionalassociation,developamodelpolicyorpoliciesbefore
30July1,2026.
321.621.1.Forthepurposesofthissection,thefollowingtermsmean:
2 (1)"Epinephrinedeliverydevice",asingle-usedeviceapprovedbytheUnited
3StatesFoodandDrugAdministrationthatisusedforthedeliveryofapremeasured
4doseofepinephrineintothehumanbody;
5 (2)"Qualifiedfirstresponder"[shallmean], anystateandlocallawenforcement
6agencystaff,firedepartmentpersonnel,firedistrictpersonnel,orlicensedemergencymedical
7technicianwhoisactingunderthedirectivesandestablishedprotocolsofamedicaldirector
8whocomesincontactwithapersonsufferingfromananaphylacticreactionandwhohas
9receivedtraininginrecognizingandrespondingtoanaphylacticreactionsandthe
10administrationofepinephrine[auto-injector] deliverydevicestoapersonsufferingfrom
11anapparentanaphylacticreaction[.];
12 (3)"Qualifiedfirstresponderagencies"[shallmean], anystateorlocallaw
13enforcementagency,firedepartment,orambulanceservicethatprovidesdocumentedtraining
14toitsstaffrelatedtotheadministrationofepinephrine[auto-injector] deliverydevicesinan
15apparentanaphylacticreaction.
16 2.Thedirectorofthedepartmentofhealthandseniorservices,ifalicensed
17physician,mayissueastatewidestandingorderforepinephrine[auto-injector] delivery
18devicesforadultpatientstofireprotectiondistrictsinnonmetropolitanareasinMissourias
19suchareasaredeterminedaccordingtotheUnitedStatesCensusBureau'sAmerican
20CommunitySurvey,basedonthemostrecentoffive-yearperiodestimatedatainwhichthe
21finalyearoftheestimateendsineitherzeroorfive.Ifthedirectorofthedepartmentofhealth
22andseniorservicesisnotalicensedphysician,thedepartmentofhealthandseniorservices
23mayemployorcontractwithalicensedphysicianwhomayissuesuchastatewideorderwith
24theexpressconsentofthedirector.
25 3.Possessionanduseofepinephrine[auto-injector] deliverydevicesforadult
26patientsshallbelimitedasfollows:
27 (1)Nopersonshalluseanepinephrine[auto-injector] deliverydevicepursuanttothis
28sectionunlesssuchpersonhassuccessfullycompletedatrainingcourseintheuseof
HCSSB94 33 29epinephrine[auto-injector] deliverydevicesforadultpatientsapprovedbythedirectorofthe
30departmentofhealthandseniorservices.Nothinginthissectionshallprohibittheuseofan
31epinephrine[auto-injector] deliverydevice:
32 (a)Byahealthcareprofessionallicensedorcertifiedbythisstatewhoisacting
33withinthescopeofhisorherpractice;or
34 (b)Byapersonactingpursuanttoalawfulprescription;
35 (2)Everyperson,firm,organizationandentityauthorizedtopossessanduse
36epinephrine[auto-injector] deliverydevicesforadultpatientspursuanttothissectionshall
37use,maintainanddisposeofsuchdevicesforadultpatientsinaccordancewiththerulesofthe
38department;and
39 (3)Everyuseofanepinephrine[auto-injector] deliverydevicepursuanttothis
40sectionshallimmediatelybereportedtotheemergencyhealthcareproviderasdefinedin
41section190.246.
42 4.(1)Useofanepinephrine[auto-injector] deliverydevicepursuanttothissection
43shallbeconsideredfirstaidoremergencytreatmentforthepurposeofanylawrelatingto
44liability.
45 (2)Purchase,acquisition,possessionoruseofanepinephrine[auto-injector] delivery
46devicepursuanttothissectionshallnotconstitutetheunlawfulpracticeofmedicineorthe
47unlawfulpracticeofaprofession.
48 (3)Anypersonotherwiseauthorizedtosellorprovideanepinephrine[auto-injector]
49deliverydevicemaysellorprovideittoapersonauthorizedtopossessitpursuanttothis
50section.
51 5.(1)Thereisherebycreatedinthestatetreasurythe"Epinephrine[Auto-injector]
52DeliveryDevicesforFirePersonnelFund",whichshallconsistof[moneycollectedunder
53thissection] moneysappropriatedtothefund. Thestatetreasurershallbecustodianofthe
54fund.Inaccordancewithsections30.170and30.180,thestatetreasurermayapprove
55disbursements.Themoneysinthefundassetforthinthissectionshallbesubjectto
56appropriationbythegeneralassemblyfortheparticularpurposeforwhichcollected.The
57fundshallbeadedicatedfundandmoneyinthefundshallbeusedsolelybythedepartment
58ofhealthandseniorservicesforthepurposesofprovidingepinephrine[auto-injector]
59deliverydevicesforadultpatientstoqualifiedfirstresponderagenciesasusedinthissection.
60 (2)Notwithstandingtheprovisionsofsection33.080tothecontrary,anymoneys
61remaininginthefundattheendofthebienniumshallnotreverttothecreditofthegeneral
62revenuefund.
63 (3)Thestatetreasurershallinvestmoneysinthefundinthesamemannerasother
64fundsareinvested.Anyinterestandmoneysearnedonsuchinvestmentsshallbecreditedto
65thefund.
HCSSB94 34 332.211.[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.
36 2.Anypersonwhoholdsavalidcurrentdentistlicenseissuedbyanotherstate,a
37branchorunitofthemilitary,aterritoryoftheUnitedStates,ortheDistrictof
HCSSB94 35 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.
72 7.Thissectionshallnotbeconstruedtowaiveanyrequirementforanapplicant
73topayanyfees.
HCSSB94 36 332.281.[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.
35 2.Anypersonwhoholdsavalidcurrentdentalhygienistlicenseissuedby
36anotherstate,abranchorunitofthemilitary,aterritoryoftheUnitedStates,orthe
37DistrictofColumbia,andwhohasbeenlicensedforatleastoneyearinsuchother
HCSSB94 37 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.
72 7.Thissectionshallnotbeconstruedtowaiveanyrequirementforanapplicant
73topayanyfees.
HCSSB94 38 332.700.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;
35 (10)Facilitatestherelocationofmilitarymembersandtheirspouseswhoare
36licensedtopracticedentistryordentalhygiene.
HCSSB94 39 332.705.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.
35 (12)"Dentist"meansanindividualwhoislicensedbyaStateLicensing
36Authoritytopracticedentistry.
HCSSB94 40 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
71notlimitedto,statute,regulations,caselaw,andotherprocessesavailabletotheState
72LicensingAuthorityorothergovernmentagency.
HCSSB94 41 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
26AccreditationoranotheraccreditingagencyrecognizedbytheUnitedStates
HCSSB94 42 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;
13 (6)HavepassedaNationalBoardExaminationoftheJointCommissionon
14NationalDentalExaminationsoranotherexaminationacceptedbyCommissionRule;
HCSSB94 43 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
50andsafetyofitscitizens.IfaRemoteStateimposesanAdverseActionagainsta
51CompactPrivilegethatlimitstheCompactPrivilege,thatAdverseActionappliestoall
HCSSB94 44 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
12ParticipatingStateduringthetermoftheAlternativeProgramwithoutprior
13authorizationfromsuchotherParticipatingState.
HCSSB94 45 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.
332.730.1.TheCompactParticipatingStatesherebycreateandestablishajoint
2governmentagencywhosemembershipconsistsofallParticipatingStatesthathave
HCSSB94 46 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;
36 (7)MaintainandcertifyrecordsandinformationprovidedtoaParticipating
37StateastheauthenticatedbusinessrecordsoftheCommission,anddesignateaperson
38todosoontheCommission'sbehalf;
39 (8)Purchaseandmaintaininsuranceandbonds;
HCSSB94 47 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;
73 (21)EstablishandelectanExecutiveBoard;
74 (22)AdoptandprovidetotheParticipatingStatesanannualreport;
HCSSB94 48 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;
109 (h)Informationofapersonalnaturewheredisclosurewouldconstituteaclearly
110unwarrantedinvasionofpersonalprivacy;
111 (i)Investigativerecordscompiledforlawenforcementpurposes;
HCSSB94 49 112 (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
146receiptsanddisbursementsoffundshandledbytheCommissionshallbesubjecttoan
147annualfinancialreviewbyacertifiedorlicensedpublicaccountant,andthereportof
HCSSB94 50 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
183inaclosed,non-publicsessionofapublicmeetingwhendealingwithanyofthematters
184coveredundersubdivision(4)ofsubsection4ofthissection.
HCSSB94 51 185 (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
220individualisliablehadareasonablebasisforbelievingoccurredwithinthescopeofthe
221individual'semployment,duties,orresponsibilitiesfortheCommission,the
HCSSB94 52 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
24agentthereof,shallconstitutetheauthenticatedbusinessrecordsoftheCommission,
HCSSB94 53 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.
HCSSB94 54 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
HCSSB94 55 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
HCSSB94 56 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
HCSSB94 57 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.
HCSSB94 58 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.
HCSSB94 59 332.755.1.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.
338.333.1.Exceptasotherwiseprovidedbytheboardofpharmacybyruleinthe
2eventofanemergencyortoalleviateasupplyshortage,nopersonordistributionoutletshall
3actasawholesaledrugdistributor,pharmacydistributor,drugoutsourcer,orthird-party
4logisticsproviderwithoutfirstobtaininglicensetodosofromtheMissouriboardof
5pharmacyandpayingtherequiredfee.Theboardmaygranttemporarylicenseswhenthe
6wholesaledrugdistributor,pharmacydistributor,drugoutsourcer,orthird-partylogistics
7providerfirstappliesforalicensetooperatewithinthestate.Temporarylicensesshall
8remainvaliduntilsuchtimeastheboardshallfindthattheapplicantmeetsorfailstomeetthe
9requirementsforregularlicensure.Nolicenseshallbeissuedorrenewedforawholesale
10drugdistributor,pharmacydistributor,drugoutsourcer,orthird-partylogisticsproviderto
11operateunlessthesameshallbeoperatedinamannerprescribedbylawandaccordingtothe
HCSSB94 60 12rulesandregulationspromulgatedbytheboardofpharmacywithrespectthereto.Separate
13licensesshallberequiredforeachdistributionsiteownedoroperatedbyawholesaledrug
14distributor,pharmacydistributor,drugoutsourcer,orthird-partylogisticsprovider,unless
15suchdrugdistributor,pharmacydistributor,drugoutsourcer,orthird-partylogisticsprovider
16meetstherequirementsofsection338.335.
17 2.Anagentoremployeeofanylicensedorregisteredwholesaledrugdistributor,
18pharmacydistributor,drugoutsourcer,orthird-partylogisticsproviderneednotseek
19licensureunderthissectionandmaylawfullypossesspharmaceuticaldrugs,iftheagentor
20employeeisactingintheusualcourseofhisorherbusinessoremployment.
21 3.Theboardmaypermitout-of-statewholesaledrugdistributors,drugoutsourcers,
22third-partylogistics[provider] providers, orout-of-statepharmacydistributorstobelicensed
23asrequiredbysections338.210to338.370onthebasisofreciprocitytotheextentthatthe
24entityboth:
25 (1)Possessesavalidlicensegrantedbyanotherstatepursuanttolegalstandards
26comparabletothosewhichmustbemetbyawholesaledrugdistributor,pharmacydistributor,
27drug[outsourcers] outsourcer, orthird-partylogisticsproviderofthisstateasprerequisites
28forobtainingalicenseunderthelawsofthisstate. Ifastatelicenseisnotissuedbytheir
29residentstate,out-of-statewholesaledrugdistributorsandthird-partylogistics
30providerswithacurrentandvaliddrugdistributoraccreditationfromtheNational
31AssociationofBoardsofPharmacyoritssuccessormaybeeligibleforlicensureas
32providedbytheboardbyrule;and
33 (2)DistributesintoMissourifromastatewhichwouldextendreciprocaltreatment
34underitsownlawstoawholesaledrugdistributor,pharmacydistributor,drugoutsourcers,or
35third-partylogisticsproviderofthisstate.
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.
HCSSB94 61 13 3.Thecoveragerequiredunderthissectionshallnotbesubjecttoanygreater
14deductibleorco-paymentthanothersimilarhealthcareservicesprovidedbythehealth
15benefitplan.
376.1245.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Anesthesiatime",theperiodduringwhichananesthesiapractitioneris
3presentwiththepatient,startingwhentheanesthesiapractitionerbeginstopreparethe
4patientforanesthesiaservicesintheoperatingroomoranequivalentareaandending
5whentheanesthesiapractitionerisnolongerfurnishinganesthesiaservicestothe
6patientbecausethepatientmaybeplacedsafelyunderpostoperativeorpostanesthesia
7care.Theterm"anesthesiatime"includes,ifcountedbytheanesthesiapractitioner,
8blocksoftimearoundaninterruptioninanesthesiatimeprovidedtheanesthesia
9practitionerisfurnishingcontinuousanesthesiacarewithinthetimeperiodsaroundthe
10interruption;
11 (2)"Anesthesiatimeunits",timeunitsrecognizedwithappropriatetime
12intervalsthatdonotexceedfifteenminutesinlengthforeachintervalandthat,taken
13together,representthetotalanesthesiatimeforaparticularanesthesiaservice;
14 (3)"Exceptedbenefitplan",thesamemeaninggiventotheterminsection
15376.998;
16 (4)"Healthbenefitplan",thesamemeaninggiventotheterminsection
17376.1350.Theterm"healthbenefitplan"shallalsoincludetheMissouriconsolidated
18healthcareplanestablishedunderchapter103;
19 (5)"Healthcarrier",thesamemeaninggiventotheterminsection376.1350;
20 (6)"Paymentofanesthesiaservices",anamountpaidforanesthesiaservices:
21 (a)Determinedbyusingprevailingmedicalcodingandbillingstandardsinthe
22professionalmedicalbillingcommunity,suchastheCurrentProceduralTerminology
23codebookpublishedbytheAmericanMedicalAssociation,theMedicareClaims
24ProcessingManual,orguidancefromnationallyrecognizedanesthesiaorganizations;
25and
26 (b)Calculatedastheproductobtainedbymultiplyingthefollowingtogether:
27 a.Thesumofthebaseunitsfortheappropriatemedicalcodeplusanesthesia
28timeunitsandmodifyingunits;and
29 b.Ananesthesiaconversionfactorthatisdefinedintheindividualcontract
30betweenthehealthcarrierorhealthbenefitplanandtheanesthesiapractitioneror
31group.
32 2.Nohealthcarrierorhealthbenefitplanshallestablish,implement,orenforce
33anypolicy,practice,orprocedurethatimposesatimelimitforthepaymentof
34anesthesiaservicesprovidedduringamedicalorsurgicalprocedure.
HCSSB94 62 35 3.Nohealthcarrierorhealthbenefitplanshallestablish,implement,orenforce
36anypolicy,practice,orprocedurethatrestrictsorexcludesallanesthesiatimein
37calculatingthepaymentofanesthesiaservices.
38 4.Exceptedbenefitplansshallbesubjecttotherequirementsofthissection.
39 5.Theprovisionsofthissectionshallapplytohealthcarriersthatofferorissue
40healthbenefitplansthataredelivered,issuedfordelivery,continued,orrenewedinthis
41stateonoraftertheeffectivedateofthissection.
376.2100.1.Exceptasotherwiseprovidedinsubsection1ofsection376.2108,as
2usedinsections376.2100to376.2108,termsshallhavethesamemeaningsasare
3ascribedtothemundersection376.1350.
4 2.Asusedinsections376.2100to376.2108,thefollowingtermsmean:
5 (1)"Evaluationperiod",anyconsecutivetwelvemonths;
6 (2)"Value-basedcareagreement",acontractualagreementbetweenahealth
7careprovider,eitherdirectlyorindirectlythroughahealthcareprovidergroupor
8organization,andahealthcarrierthat:
9 (a)Incentivizesorrewardsprovidersbasedononeormoreofthefollowing:
10 a.Qualityofcare;
11 b.Safety;
12 c.Patientoutcomes;
13 d.Efficiency;
14 e.Costreduction;or
15 f.Otherfactors;and
16 (b)May,butisnotrequiredto,includesharedfinancialriskandrewardsbased
17onperformancemetrics.
376.2102.1.Exceptasotherwiseprovidedinthissection,beginningJanuary1,
22026,ahealthcarrierorutilizationreviewentityshallnotrequireahealthcareprovider
3toobtainpriorauthorizationforahealthcareserviceunlessthehealthcarrieror
4utilizationreviewentitymakesadeterminationthatinthemostrecentevaluationperiod
5thehealthcarrierorutilizationreviewentityhasapprovedorwouldhaveapprovedless
6thanninetypercentofthepriorauthorizationrequestssubmittedbythatproviderfor
7thathealthcareservice.
8 2.BeginningJanuary1,2026,ahealthcarrierorutilizationreviewentityshall
9notrequireahealthcareprovidertoobtainpriorauthorizationforanyhealthcare
10servicesunlessthehealthcarrierorutilizationreviewentitymakesadeterminationthat
11inthemostrecentevaluationperiodthehealthcarrierorutilizationreviewentityhas
12approvedorwouldhaveapprovedlessthanninetypercentofallpriorauthorization
13requestssubmittedbythatproviderforhealthcareservices.
HCSSB94 63 14 3.(1)BeginningJanuary1,2026,ahealthcarrierorutilizationreviewentity
15mayelecttohaveahospital,asthattermisdefinedinsection197.020,determinewhich
16ofthefollowingconditionsthatsuchhospitalwillcomplywithtoobtainanexemption
17frompriorauthorizationrequirementsundersubsections1and2ofthissection:
18 (a)Thehospitalenteringinto,eitherdirectlyorindirectlythroughahealthcare
19providergroupororganizationavalue-basedcareagreementwiththehealthcarrier;
20 (b)Thehospital'sscoreofthreeorhigherontheCenterforMedicareand
21MedicaidServicesFive-StarQualityRatingSystem,42CFR§412.190,oritssuccessor
22ratingsystem;or
23 (c)Atleastninety-onepercentofthehospital'spriorauthorizationrequests
24submittedforpurposesofeligibilityforsubsections1or2ofthissectionwereapproved
25orwouldhavebeenapprovedbythehealthcarrierorutilizationreviewentity.
26 (2)CriticalaccesshospitalsandhospitalsthatdonotparticipateintheCenter
27forMedicareandMedicaidServicesFive-StarQualityRatingSystem,oritssuccessor
28ratingsystem,shallbeexemptfromtheprovisionsofthissubsection.
29 4.Theexemptionfrompriorauthorizationrequirementsdescribedin
30subsections1,2,and3ofthissectionshallnotinclude:
31 (1)Pharmacyservices,nottoexceedtheamountofonehundredthousand
32dollars;
33 (2)Imagingservices,nottoexceedtheamountofonehundredthousanddollars;
34 (3)Cosmeticproceduresthatarenotmedicallynecessary;or
35 (4)Investigativeorexperimentaltreatments.
36 5.Theamountofthelimitationsdescribedinsubdivisions(1)and(2)of
37subsection4ofthissectionshallbeincreasedeveryyear,roundedtothenearest
38thousanddollars,beginningJanuary1,2027,basedontheConsumerPriceIndexforAll
39UrbanConsumersfortheUnitedStates(CPI-U),oritssuccessorindex,assuchindexis
40definedandofficiallyreportedbytheUnitedStatesDepartmentofLabor,orits
41successoragency.
42 6.Inmakingadeterminationunderthissection,thehealthcarrierorutilization
43reviewentityshallnotcount:
44 (1)Anypriorauthorizationrequestsdeniedbyahealthcarrierorutilization
45reviewentityandbeingappealedbythehealthcareprovider;or
46 (2)Anyrequestmadebyahealthcareproviderforaservicethatisnotincluded
47inthehealthcarrier'sbenefitplan
48
49butshallcountasapprovedanypriorauthorizationrequestthatwasdeniedbyahealth
50carrierorutilizationreviewentitybutthatwassubsequentlyauthorized.
HCSSB94 64 51 7.Inmakingadeterminationunderthissection,thehealthcarrierorutilization
52reviewentityshalluseeithertheprovider'snationalprovideridentifierorataxpayer
53identificationnumber.Suchdesignationshallremainunlessrequestedtobechangedby
54theprovider.
55 8.Theexemptionfrompriorauthorizationrequirementsdescribedin
56subsections1,2,and3ofthissectionmaybesubjecttointernalauditingofthemost
57recentconsecutivesixmonths,uptoamaximumoftwotimesperyear,bythehealth
58carrierorutilizationreviewentityandmayberescindedif:
59 (1)Suchcarrierorutilizationreviewentitydeterminesthatthecarrieror
60utilizationreviewentitywouldhaveapprovedlessthanninetypercentofprior
61authorizationrequestsforahealthcareservicethattheproviderwasexemptfromthe
62priorauthorizationrequirementundersubsection1ofthissection;
63 (2)Suchcarrierorutilizationreviewentitydeterminesthatthecarrieror
64utilizationreviewentitywouldhaveapprovedlessthanninetypercentofallprior
65authorizationrequestsiftheproviderwasexemptfromthepriorauthorization
66requirementundersubsection2ofthissection;or
67 (3)Therehasbeenanincreaseintheprovisionofexemptproceduresbyahealth
68careproviderofmorethanfiftypercentormorethantwentyprocedures,whichever
69amountisgreater.
70 9.Theexemptiondescribedinsubsections1,2,and3ofthissectionshallbenull
71andvoiduponadeterminationthatthehealthcareproviderhasbeenfoundbyacourt
72oflawtohavecivillyorcriminallyengagedinanyfraudorabuseaftertheexemptionis
73grantedbyahealthcarrierorutilizationreviewentity.
74 10.Ahealthcarrierorutilizationreviewentitymayrequirehealthcare
75providersinthehealthcarrier'sorutilizationreviewentity'snetworktouseanonline
76portaltosubmitrequestsforpriorauthorization.
77 11.Noadversedeterminationshallbefinalizedundersubsections1,2,3,or8
78unlessreviewedbyaclinicalpeer.
79 12.Anypatientwhohasreceivedpriorauthorizationforthecoverageofa
80ninety-daysupplyofmedicationwhosehealthcoverageplanchangesfollowingsuch
81authorizationshallbepermittedaninety-daygraceperiodfromthedateofsuchchange
82inordertodeterminewhethersuchpatient'snewplancoversthepreviouslyauthorized
83medicationorwhetherpriorauthorizationisrequired.
376.2104.1.Thehealthcarrierorutilizationreviewentityshallnotifythehealth
2careprovidernolaterthantwenty-fivedaysafteranydeterminationmadeunder
3section376.2102.Thenotificationshallincludethestatistics,data,andanysupporting
4documentationformakingthedeterminationfortherelevantevaluationperiod.
HCSSB94 65 5 2.Thehealthcarrierorutilizationreviewentityshallestablishaprocessfor
6healthcareproviderstoappealanydeterminationsmadeundersection376.2102.
7 3.Thehealthcarrierorutilizationreviewentityshallmaintainanonlineportal
8toallowhealthcareproviderstoaccessallpriorauthorizationdecisions,including
9determinationsmadeundersection376.2102.Forhealthcareproviderssubjecttoprior
10authorizations,theportalshallincludethestatusofeachpriorauthorizationrequest,all
11notificationstothehealthcareprovider,thedatesthehealthcareproviderreceivedsuch
12notifications,andanyotherinformationrelevanttothedetermination.
376.2106.Nohealthcarrierorutilizationreviewentityshalldenyorreduce
2paymenttoahealthcareproviderforahealthcareserviceforwhichtheproviderhasa
3priorauthorizationunlesstheprovider:
4 (1)Knowinglyandmateriallymisrepresentedthehealthcareserviceinarequest
5forpaymentsubmittedtothehealthcarrierorutilizationreviewentitywiththespecific
6intenttodeceiveandobtainanunlawfulpaymentfromthecarrierorentity;or
7 (2)Failedtosubstantiallyperformthehealthcareservice.
376.2108.1.Theprovisionsofsections376.2100to376.2108shallnotapplyto
2MOHealthNet,exceptthataMedicaidmanagedcareorganizationasdefinedinsection
3208.431shallbeconsideredahealthcarrierforpurposesofsections376.2100to
4376.2108.
5 2.Theprovisionsofsections376.2100to376.2108shallnotapplytohealthcare
6providerswhohavenotparticipatedinahealthbenefitplanofferedbythehealth
7carrierforatleastonefullevaluationperiod.
8 3.Nothinginsections376.2100to376.2108shallbeconstruedto:
9 (1)Authorizeahealthcareprovidertoprovideahealthcareserviceoutsidethe
10scopeofhisorherapplicablelicense;or
11 (2)Requireahealthcarrierorutilizationreviewentitytopayforahealthcare
12servicedescribedinsubdivision(1)ofthissubsection.
407.324.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Airambulancemembershipagreement",anagreementinexchangefor
3considerationtopayfor,indemnify,orprovideanamounttoapersonforthecostofair
4ambulanceservices.Theterm"airambulancemembershipagreement"shallnot
5includeahealthinsuranceplanorpolicyregulatedunderchapter376;
6 (2)"Airambulancemembershiporganization",anindividualorentitythat
7providesanairambulancemembershipagreement.
8 2.(1)Anairambulancemembershiporganizationshallnotknowinglysell,offer
9forsale,orrenewanairambulancemembershipagreementtoanindividualwhois
10enrolledinMOHealthNet.
HCSSB94 66 11 (2)Ifanindividualwhohaspurchasedanairambulancemembership
12agreementsubsequentlyenrollsinMOHealthNetduringthedurationofthe
13membershipagreement,theenrolleemaynotifytheairambulancemembership
14organizationofsuchenrollmentwithinthirtydaysfollowingtheeffectivedateofthe
15enrollment.Iftheenrolleetimelynotifiestheairambulancemembershiporganization
16ofsuchenrollment,theenrolleemayrequest,anduponsuchrequesttheairambulance
17membershiporganizationshallprovide,eitheraproratedrefundofanyconsideration
18paidfortheperiodfromtheeffectivedateoftheMOHealthNetenrollmentthroughthe
19expirationdateoftheairambulancemembershipagreementoratransferofthe
20membershiptoanotherindividualintheenrollee'shousehold.Iftheenrolleedoesnot
21timelynotifytheairambulancemembershiporganizationofsuchenrollment,the
22enrolleeisnotentitledtoaproratedrefund,buttheairambulancemembership
23organizationshallstilldisenrolltheenrolleewithinthirtydaysofreceiptofthenoticeof
24theenrollee'senrollmentinMOHealthNetunlesstheenrollee'smembershipis
25transferredtoanotherindividualintheenrollee'shousehold.
26 3.Allairambulancemembershipagreementwebsites,brochures,andmarketing
27materialshallincludethefollowingdisclosuresinaclearandconspicuousplace:
28 (1)Theairambulancemembershipagreementisamembershipplanandisnot
29insurancecoverage;
30 (2)Medicaidenrolleesarenoteligibletopurchasethismembership;and
31 (3)SomestatelawsprohibitMedicaidbeneficiariesfrombeingofferedair
32ambulancemembershipsorbeingacceptedintoairambulancemembershipprograms.
33 4.Anairambulancemembershipagreementapplicationshallincludethe
34followingdisclosuresinaclearandconspicuousplace:
35 (1)Theairambulancemembershipagreementisamembershipplanandisnot
36insurancecoverage;
37 (2)Medicaidenrolleesarenoteligibletopurchasethismembership;and
38 (3)SomestatelawsprohibitMedicaidbeneficiariesfrombeingofferedair
39ambulancemembershipsorbeingacceptedintoairambulancemembershipprograms.
40 5.Ifanenrolleebelievesthatanindividualorentityhasviolatedtheprovisions
41ofthissection,theenrolleemayfileacomplaintwiththeofficeofthestateattorney
42general.Theattorneygeneralshallhaveallpowers,rights,anddutiesregarding
43violationsofthissectionasareprovidedinsections407.010to407.145.
[192.769.1.Oncompletionofamammogram,amammography
2 facilitycertifiedbytheUnitedStatesFoodandDrugAdministration(FDA)or
3 byacertificationagencyapprovedbytheFDAshallprovidetothepatientthe
4 followingnotice:
HCSSB94 67 5 "Ifyourmammogramdemonstratesthatyouhavedensebreasttissue,
6 whichcouldhideabnormalities,andyouhaveotherriskfactorsforbreast
7 cancerthathavebeenidentified,youmightbenefitfromsupplemental
8 screeningteststhatmaybesuggestedbyyourorderingphysician.Dense
9 breasttissue,inandofitself,isarelativelycommoncondition.Therefore,this
10 informationisnotprovidedtocauseundueconcern,butrathertoraiseyour
11 awarenessandtopromotediscussionwithyourphysicianregardingthe
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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HCSSB94 68