2017 Legislative Session Bills to Watch

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1 Bill Sponsor Summary and Impact MAOPS Position Priority SB 340/SB 231/HB 90 Schupp Establishes the Narcotics Control Act. This is identical to Rep. Rehder's PDMP bill from last year. Basically the same language as It would be funded from appropriations from the legislature or any grant. The dispenser of the meds (phamacists) are required to electronically submit information to program. Failure to do so will result in a $1000 fine for each occurence. All information must be submitted within 24 hours. But it doesn't say how quickly it will be uploaded or how long the information will be stored. SB 323 Brown Specifies when persons operating or riding a motorcycle or motortricycle must wear protective headgear unless they have a health insurance policy of $1 million or more. This would allow for long term birth control measurers that were precribed for a Mo HealthNet participant but never picked up from the physicians office. If more than 12 weeks and it never left the doctors office it may be allowed to be transferred to another Mo HealthNet particiapant. Oppose 2 HB 774 McCreery HB 762 Barnes Allows hospitals to employ dentists and other oral health care providers in order to curb those who might come to the ER in search of narcotics. HB 761 Barnes HB 737 HB 736 HB 720 Stevens Stevens White Establishes requirements for authorized entities to stock epinephrine auto-injectors for use in emergencies. Instructions shall be posted near the injectors. Additionally, an injection cannot happen on someone under 18 without parental consent unless the persons life may be compromised. Changes the laws regarding MO HealthNet services by increasing the participants who are allowed to enroll. Due to the leadership nationally and the state bills like this would have very little chance of being considered. Establishes the "911 Good Samaritan Act" which gives a person immunity from criminal liability for a person who seeks medical assistance for a person experiencing a drug-related overdose or alcohol overdose Modifies the law regarding health insurance adverse determination appeals in that if an independent review reverses a health carriers decision then all fees charged by the reviewer is paid to the department.

2 HB 716 HB 711 HB 710 HB 691 HB 690 Barnes Wood Walker Korman White 2017 Legislative Session Establishes a Prescription Abuse Registry. The registry will be administered by DHSS and will contain the name of anyone who has been found guilty of possessing or selling drugs. Also an individual may submit the name of an individual to be on the list. The person whos name was submitted will be notified and they will have a set time to contest. Allows parents of children receiving habilitative services for occupational medicine, speech therapy, through an individualized education program to choose the provider Allows a participant in drug court to receive medication assisted treatment if under the care of a physician licensed in this state to practice medicine Requires the Department of Social Services to request a waiver to require certain MO HealthNet participants to be Missouri residents for 6 months before receiving benefits Prohibits non-missouri medical schools from entering into exclusive contracts with Missouri health care providers for the placement of medical students Support 3 SB 317 Modifies provisions relating to physician referral to physical therapists SB 314 Schatz Establishes the Narcotics Control Act SB 312/ HB 657 Wasson/ Rhodes Changes the laws regarding dispensations of maintenance medications whereas a pharmacist previously could have prescribed for 90 days if the patient already had recevied a previous prescription from a physician. This bill would extend it for 180 days and not require a previous prescription. HB 684 HB 646 Neely Fitzwater, Paul Changes the laws regarding managed care under the MO HealthNet program in a number of ways. Capitated Health Plans being offered as a provider for Mo HealthNet shall have protocols in place for standarized protocol reviews, grievance procedures. Data collection for utilization review and processes must be collected and submitted to the department. Establishes the "Youth Sports Brain Injury Prevention Act. Besides information and concussion protocols distributed to all coaches and sports bodies. Additionally, training would be required for all coaches, referees and others associated with youth sports

3 HB 636 HB 609/HB 272 HB 601 Merideth Haahr Higdon Provides for the expansion of MO HealthNet services beginning January 1, 2018 by increasing the opportunity of those under age 19 and older than 64 to receive Mo HealthNet benefits that would otherwise not be covered. Due to the legislative makeup in Missouri it is completely unlikely these bills will receive attention. Establishes guidelines for the regulation of occupations and professions not regulated by the Division of Professional Registration. The provisions do not serve to restrict an individuals pursuit of their profession or add undue burden however the wellbeing of the citizens of the state shall be protected. Establishes the Missouri Patient Safety in Radiologic Imaging and Radiation Therapy Act. Futher research needs to be received in order to determine if this would be a burden for independent, rural physicians operating their own X-Ray machine, HB 588 Kelley Prohibits law enforcement from stopping a motorcycle for failing to wear protective headgear Oppose 2 SB 274 HB 576 HB 569 HB 549 HB 544 Wieland McCaherty Barnes Allows enrollment in a health benefit plan by a pregnant person regardless if enrollment period is passed. The plan may require physician documentation that applicant is expecting. Exempts motorcyclists 21 years of age or older from wearing a helmet when operating a motorcycle or motortricycle if they have the appropriate health insurance coverage in the amount of $100,000 or more. Establishes the Show-Me Compassionate Medical Education Act that requires med schools to make applicants aware of increased risk of suicide of med students. Also creates Aug 28 as Med School suicide awareness day. Creates standards for predetermination of health care benefits requests and responses from the health insurer. This bill will allow the insured to request information on what the insurer will cover and what the insured will be required to pay for a procedure. The response is not binding. Specifies that primary care providers who provide services to MO HealthNet participants after normal business hours are eligible for additional reimbursement. The exact amount they would be eligible for are subject to rules being promulgated by the department. Support 3 Oppose 2 Support 2

4 HB 535 Roden Specifies that only motorcycle riders under the age of eighteen operating with a motorcycle training permit shall wear a helmet and requires all other riders who wish to ride without a helmet to show proof of health insurance Oppose 2 HB 529 Provides that no provision of law shall be construed to require maintenance of licensure or the state to require any form of specialty medical board certification to practice medicine Establishes the Death with Dignity Act to allow patients with terminal illnesses to end their life in a humane and dignified manner Changes the laws regarding MO HealthNet services to expand coverage for those over 19 and under 65 who may not currently qualify. Due to the current climate nationally with and statewide it would appear any chance of expanding medicaid would be very unlikely. Prohibits covenants not to compete between two professinoal entities. It would allow physicians more options on employment and to perhaps stay in a community if wanted to leave the employment of a healthcare system. Allows structured family caregiving as a covered service under MO HealthNet, subject to the approval of federal waivers. This bill would add substantial cost to the Mo HealthNet system and could be used for marriage counseling as well. HB 524 Ellington HB 489 Dunn HB 479 HB 455 Bahr HB 452/SB237 Austin/Rowden Modifies definitions of employee and physician employee in actions against health care providers for personal injury or death. This bill would allow for a broader range of liability by terming employees who are working and directed under a physician and where the physician would be eligible. SB 245 Requires health carriers and health care providers to establish and participate in shared savings incentive programs. This bill is identical as Rep. s bill, HB 123, in the House. This bill provides that health care providers are required to disclose, to the best of their ability, the allowed amount or the charge for a non-emergency admission, procedure, or service within 2 days of a prospective patient's request Support 2

5 HB 440 HB 413/ HB 272 HB 437 HB 429/ HB 157 Kidd White Neely Cornejo/ Establishes "Simon's Law", which changes the laws regarding life-sustaining or nonbeneficial treatment policies of health care facilities. For anoyone under 18 years of age at least one parent must have agreed with the witholding of life sustaining measures. If both parents cannot agree then a could date will be set as soon as possible. Establishes guidelines for the regulation of occupations and professions not regulated by the Division of Professional Registration. The provisions do not serve to restrict an individuals pursuit of their profession or add undue burden however the wellbeing of the citizens of the state shall be protected. Allows the use of medical marijuana for certain medical conditions such as epilepsy, cancer, rheumotoid arthritis Allows a physician to have ownership in physical therpay. HB 405 Hubrecht This bill specifies that the county coroner or medical examiner need not be notified and no investigation is necessary for a death that occurs under hospice care HB 395 Adams This bill would create the universal healthcare fund for Missouri. The purpose of this bill would be to create access to all healthcare needs of those who qualify for Medicaid. Wellness, prechecks, medical treatment and diagnosis, etc.these type of expansion bills will not see much activity due to the current political climate. HB 388 HB 381 Messenger Evans Requires health insurance plans to submit their charges for common issues and the department to post them on a public website. Allows that a designated exectuor of the estate or power of attorney may receive medical information from a healthcare provider. HB 373 Neuman This bill allows pharmacist to prescribe birth control medicatons with no prescription from a physician. SB 237 Rowden This bill will to increase the definition of who could be sued in the event of catostrophic events. Any employee who is working for a healthcare provider and is drawing a salary from them would make the primary healthcare provider liable.

6 SB 231/ HB 90 Schatz/ Rehder Establishes the Narcotics Control Act. This is identical to Rep. Rehder's PDMP bill from last year. Basically the same language as It would be funded from appropriations from the legislature or any grant. The dispenser of the meds (phamacists) are required to electronically submit information to program. Failure to do so will result in a $1000 fine for each occurence. All information must be submitted within 24 hours. But it doesn't say how quickly it will be uploaded or how long the information will be stored. SB 212 Provides that inspections of certain x-ray systems shall not be required more frequently than every six years. In the past bills have been filed that would make inspections yearly which takes docs away from their patients. This bill will safe guard that issue. HB 332 HB 330 Morris Morris Changes the laws regarding vaccines and disorder monitoring. Namely, the shingles and chicken pox vaccinne cannot contain any foreign DNA This bill says that someone can apply for the Assistant Physician licensure if they have met all the requirements. HB 297 Lichtenegger Expands the scope of practice for dental hygienists HB 294 Lynch This bill provides certain immunities for persons who seek medical assistance for a drug overdose or an alcohol illness. In other words, they cannot be charged with an offense if they seek medical care for these issues. SB 200 Libla Modifies provisions relating to expert witnesses HB 244 Rowland Modifies laws relating to advanced practice registered nurses in collaborative practice agreements. This bill will eliminate the current mileage restriction, the first 30 day work with, reduces the chart review requirement, etc... HB 235 Roden Specifies that only motorcycle riders under the age of eighteen operating with a motorcycle training permit shall wear a helmet and requires all other riders who wish to ride without a helmet to show proof of health insurance which must total over $50,000 for medical expenses Oppose 2 HB 233 Dogen Changes the laws regarding the dispensing of oral hormonal contraceptives by allowing a pharmacist to prescribe without having to have a prescription or having seen a physician. This bill is similar to HB 373 but requires physician follow up. Oppose 1-Jan

7 HB 227 Hubrecht Establishes the Psychology Interjurisdictional Compact by allowing a physchologist to travel across state line to see a patient if first they treated them via telehealth. HB 226 Hubrecht The bill gives a number of medical clearances to EMS medical directors and changes the laws regarding the powers and duties of Regional EMS Medical Directors. By providing online telecommunications medical direction, off line direction for treatment, triage, transport protocols, etc... HB 211 HB 195 SB 194 HB 165 Redmon Kelley Wallingford Hubrecht This bill changes provisions relating to the scope of practice for physical therapists by giving them permission to treat and diagnose newly discovered conditions. Authorizes any hospital district to repeal a dedicated property tax in favor of a sales tax Provides that a managed care plan's network is adequate if the health carrier is accredited by the Accreditation Association for Ambulatory Health Care. It appears that Missouri is the only state that does not have this accredidation as mandatory for health insurance plans. Changes provisions relating to advanced practice registered nurses. Opens the door to independent practice by erasing mileage, chart review, signing of collaboration, etc Neutral 3 Neutral 1 HB 157 Allows physicians to have ownership in physical therapy clinics by modifing provisions relating to physician referrals to physical therapists SB 168 SB 155 Schaaf Schaaf Modifies provisions relating to health insurance discrimination. This bill was filed last year. It just says an insurer can't reject someone on the basis they don't participate in a wellness program or other things. Modifies provisions relating to prescription drug copayments by saying that a person does not have to pay over the retail price for a drug if the copay is greater than the retail amount. SB 153/ HB 437 Schaaf/ Neely Permits the use of medical marijuana for the treatment of certain impairments such as cancer, epilepsy, aids, rheumotoid arthritis, etc... SB 139 This act creates the Rx Cares for Missouri Program to be administered by the Board of Pharmacy in consultation with the Department of Health and Senior Services. The goals of the program are to promote medication safety and prevent prescription drug abuse. The Board may expend funds appropriated to the Board to private and public entities for the development of programs and education in order to meet these goals.

8 SB 138 SB 125 Wasson More transperancy bills. Creates standards for predetermination of health care benefits requests and responses to a healthcare insurer. A patient or healthcare provider may request: the amount a patient may be required to pay, the amount a healthcare provider may be paid, the amount an institution may be paid This act provides the acceptable ways in which a professional licensee may submit payment, application, requests for educational time extensions, or notify his or her licensing board for changes to items required as part of licensure to the Division of Professional Registration or its component boards, committees, offices, and commissions. SB 120 Schaaf Allows those licensed by the Department of Agriculture to grow and handle industrial hemp. There are a number of bills that do the same thing in order to cultivate the oils from the hemp. Requires hospitals to adopt and implement evidencebased sepsis protocols Establishes a Prescription Drug Monitoring Act. Requires pain med docs and dispencers to put info in. Would be funded by legislature. It has a number of requires for the database for safety aspects. Only keeps the precribing information for 180 days and then it must be expunged. Only pain med docs are required to submit. Other physicians may submit. SB 97 SB 74 Schaaf SB 72 Schaaf Provides that certain health care providers may have their professional licenses disciplined for failure to follow the CDC Guideline for Prescribing Opioids SB 70 Schupp Provides for the expansion of MO HealthNet services beginning January 1, 2018 by including those who are at 133% of the threshold. This bill has been filed for a number of years. Due to political climate, will most likely not receive any attention. SB 56 Holsman Allows marijuana to be produced, distributed, and consumed for medicinal purposes. Lists all the chronic diseases that it can be applicable for such as cancer,epilepsy and glacuma. Additionly directs the oversight of the facilities producing the product and levy's a 4% sales tax on the sale.

9 SB 50 Walsh This act requires the Department of Health and Senior Services to contract with a third party for the establishment of a health care directives registry for the purpose of providing a place to securely store an advance health care directive online and to give authorized health care providers immediate access to the directive. The third party contractor shall be solely responsible for the administration and maintenance of the registry. All data and information contained in the registry shall remain confidential and shall be exempt from the Sunshine law. An "advance health care directive" is defined as either a power of attorney for health care or a declaration signed by an adult declarant containing the person's direction concerning a health care decision SB 42 Wallingford Enacts provisions relating to advanced practice registered nurses by repealing the collabortive practice. Mileage, chart review, etc all gone. This bill modifies provisions relating to the collateral source rule and provides that parties may introduce evidence of the actual cost, rather than the value, of the medical care rendered. Would be a benefit to our physicians who would face a legal suit. This bill passed last year and was veto'd. SB 31 Emery HB 125 HB 124 HB 123 Establishes the "Right to Shop Act" to allow state employees to obtain cost estimates for health care services. Such as: Physical and occupational therapy, radiology and imaging services, lab services, infusion therapy, in patient and outpatient procedures. The bill also requires carriers (insurance plans) to provide an 800 number for patients wishing to have a cost estimate on their procedure. This must be received within 2 business days. This also requires the health plans to have a 'shoppable' component to their offerings. Establishes the "Patients First Medicaid Reform Act." This bill will create a health savings account for those who qualify under the Mo Healthnet Program (medicaid). An amount will be deposited into the recipients account that is equal to the amount they are saving. Deemed the "Missouri Right to Shop Act." This bill, which gives more transperancy to pricing for patients, hopes to give people more control over their options. This bill modifies provisions regarding physicians providing sports medicine services by allowing team doctors from out of state to be able to treat their own players. HB 122

10 HB 121 Adds psychiatrists to the list of individuals eligible for the Health Professional Student Loan Repayment Program Suport 1 HB 103 HB 95 Swan McGaugh Establishes the Controlled Substance Abuse Prevention Fund which would collect registrations to manufacture, dispense controlled substances. Also says the BNDD must hire 1 investigator for every 2500 controlled substance registrants. This bill would make the BNDD fee funded as language states that all moneys authorized to be charged shall be directed to the department. Modifies provisions relating to the collateral source rule and provides that parties may introduce evidence of the actual cost, rather than the value, of the medical care rendered HB 90/ SB 231 HB 88 HB 68 HB 58 Establishes the Narcotics Control Act. This is Rep. Rehder's PDMP bill from last year. Basically the same language as It would be funded from appropriations from the legislature or any grant. The dispenser of the meds (phamacists) are required to electronically submit information to program. Failure Rehder/ Wallingford to do so will result in a $1000 fine for each occurence. All information must be submitted within 24 hours. But it doesn't say how quickly it will be uploaded or how long the information will be stored. Last year, I believe it was 2 years. It does state that rules will be promulgated. Rehder Wessels Haefner Exempts health care entities registered with the Department of Health and Senior Services that distribute hypodermic needles or syringes from the crime of unlawful delivery of drug paraphernalia. This has gotten a lot of press by being named the "Needle Exchange" Establishes the Narcotics Control Act. Funding will again be through appropriations and can include grants. Reimbursements will be made to the pharmacists who submit the information. Will hold the data for a total of 5 years. If information is leaked about an individual they may bring a civil suit. Additionally, anyone with access who leaks information will also be charged with a class E felony which is different from some of the other PDMP's as the punishment arm will be determined by promugating rules. Requires the Department of Health and Senior Services to establish criteria for levels of maternal and neonatal care designations