HB 2372 — Modifies provisions relating to health care

(3)Each "Rarevoter pediatricshall disease",vote afor life-threateningone ordirector chronicallyfrom debilitatingthe diseaseambulance thatelection affectsdistrict fewer than two hundred thousand individuals under eighteen years of age in which the Unitedvoter States.resides.

The directors elected from districts one and four shall serve for a term of one year, the directors elected from districts two and five shall serve for a term of two years, and the directors from districts three and six shall serve for a term of three years;

thereafter, the terms of all directors shall be three years.

All directors shall serve the term to which they were elected or appointed, and until their successors are elected and qualified, except in cases of resignation or disqualification.

The county commission shall reapportion the ambulance districts within sixty days after the population of the county is reported to the governor for each decennial census of the United States.

Notwithstanding any other provision of law, if the number of candidates for the office of director is no greater than the number of directors to be elected, no election shall be held, HCS HB 2372 6 and the candidates shall assume the responsibilities of their offices at the same time and in the same manner as if they have been elected.

[2.

In all counties of the second class having more than one hundred five thousand inhabitants located adjacent to a county of the first class having a charter form of government which has a population of over nine hundred thousand inhabitants, ] (2) If the county commission provides for an at large board of directors, it shall order an election be held on the next regularly scheduled election date and the voters shall vote for six directors elected at large from within the district for a term of three years.

[Those directors holding office in any district in such a county on August 13, 1976, shall continue to hold office until the expiration of their terms, and their successors shall be elected from the district at large for a term of three years.

In any district formed in such counties after August 13, 1976, the governing body of the county shall cause an election to be held in that district within ninety days after the order establishing the ambulance district to elect ambulance district directors.] Each voter shall vote for six directors.

The two candidates receiving the highest number of votes at such election shall be elected for a term of three years, the two candidates receiving the third and fourth highest number of votes shall be elected for a term of two years, the two candidates receiving the fifth and sixth highest number of votes shall be elected for a term of one year;

thereafter, the term of all directors shall be three years.

A director holding office as of August 28, 2026, shall continue as an at-large director for the remainder of such director's existing term.

[3.] 2.

A candidate for director of the ambulance district shall, at the time of filing, be a citizen of the United States, [a qualified voter of the election district as provided in subsection 1 of this section,] a resident of the district for two years next preceding the election, and shall be at least twenty-four years of age.

In an established district which is located within the jurisdiction of more than one election authority, the candidate shall file his or her declaration of candidacy with the secretary of the board.

In all other districts, a candidate shall file a declaration of candidacy with the county clerk of the county in which he or she resides.

A candidate shall file a statement under oath that he or she possesses the required qualifications.

No candidate's name shall be printed on any official ballot unless the candidate has filed a written declaration of candidacy pursuant to subsection 5 of section 115.127.

If the time between the county commission's call for a special election and the date of the election is not sufficient to allow compliance with subsection 5 of section 115.127, the county commission shall, at the time it calls the special election, set the closing date for filing declarations of candidacy.

3.

An ambulance district may, following a public hearing subject to the provisions of chapter 610, by an ordinance adopted by an affirmative vote of two-thirds of the members of the board of directors, abolish the boundaries of any existing election HCS HB 2372 7 subdistricts if the board is unable to find a qualified candidate to fill the director position of each such subdistrict.

Such ordinance may eliminate the subdistricts entirely and provide for the election of directors at large.

A copy of the ordinance shall be filed with the county clerk.

Upon the abolition of such election subdistricts, all current directors shall serve as directors at large for the remainder of their existing terms.

4.

Any ambulance district may, by an ordinance adopted by an affirmative vote of two thirds of the members of the board of directors, establish election subdistricts.

Each election subdistrict shall consist of contiguous territory and shall be as compact and nearly equal in population as practicable.

The boundaries of such subdistricts shall be established by the county commission.

Each board member shall be a resident of the election subdistrict that he or she represents at the time of election and shall remain a resident of such subdistrict for the duration of the member's term.

5.

Notwithstanding any other provision of law to the contrary, if the number of candidates for the office of director is less than the number of directors to be elected, no election shall be held, and the candidates shall assume the responsibilities of their offices at the same time and in the same manner as if they were elected.

190.051.

1.

Notwithstanding the provisions of sections 190.050 and 190.052 to the contrary, upon a [motion] resolution adopted by the board of directors in districts where there are six-member boards, and upon approval by the voters in the district, the number of directors may be increased to seven [with one board member running district wide,] or decreased to five or three board members.

The resolution shall state the names of the existing directors who will fill the positions on the board if such measure is approved by the voters, as well as any vacancies to be filled by subsequent election, and shall state the dates on which those terms shall conclude.

ThereThe isballot herebyto establishedbe withinused for the departmentapproval of higherthe educationvoters andto workforceincrease developmentor decrease the "Pediatricnumber Diseaseof Taskmembers Force".on the board of directors of the ambulance district shall be substantially in the following form:

Shallthe number of members of the board of directors of the ______ (Insert name of district) Ambulance District be (increased to seven members/decreased to five members/decreased to three members)? YES NO [2.] 3.

If a majority of the voters voting on a proposition to increase the number of board members [to seven] vote in favor of the proposition, then at the next election of board members after the voters vote to increase the number of directors, the voters shall select [one person to serve in addition to the existing six directors as the member who shall run district wide] additional persons to fill any such vacancies.

HCS HB 2372 8 [3.] 4.

If a majority of the voters voting on a proposition to decrease the number of board members vote in favor of the proposition, then the county clerk shall redraw the district into the resulting number of subdistricts with equal population bases and hold elections by subdistricts pursuant to section 190.050.

Thereafter, members of the board shall be elected to serve terms of three years and until their successors are duly elected and qualified.

[4.

Members of the board of directors in office on the date of an election pursuant to this section to increase or decrease the number of members of the board of directors shall serve the term to which they were elected or appointed and until their successors are elected and qualified.] 190.052.

Any member of the board of directors who moves residency from the district [from which the member was elected] shall be disqualified as a member of the board.

If one or two vacancies occur in the membership of the board as a result of death, resignation, or disqualification, the remaining members shall appoint one or two qualified persons, as provided in section 190.050, to fill the vacancies until the end of the unexpired term.

Such appointment shall be made with the consent of a majority of the remaining members of the board.

If the board is unable to agree in filling a vacancy [within sixty days or if there are more than two vacancies at any one time], the county commission, upon [notice from the board of failure to agree in filling the vacancies] the written request of a majority of the remaining board members or the ambulance service administrator, as described in section 190.112, shall within [ten] thirty calendar days fill them by appointment of qualified persons, as provided in section 190.050, and shall notify the persons in writing of their appointment.

The persons appointed shall serve for the unexpired term.

190.070.

1.

A petition for annexation of land to an ambulance district shall be signed by not less than ten percent or fifty voters, whichever is fewer, residing within the territory therein described proposed for annexation and shall be filed with the county clerk of the county in which the district or the greater portion thereof is situated, and shall be addressed to the commissioners of the county commission.

A hearing shall be held thereon [as nearly as possible as in the case of a formation petition] within thirty days of the filing of such petition.

If upon the hearing the commissioners of the county commission find that the petition is in compliance with the provisions of sections 190.005 to 190.085, they shall order the question to be submitted to the voters within the territory and within the district.

2.

The question shall be submitted in substantially the following form to all of the voters in the existing ambulance district and the area proposed to be annexed:

Shall ______ (description of territory) be annexed to the ______ ambulance district, and a tax imposed within such annexed area equal to the existing rate of the _____ ambulance district? HCS HB 2372 9 3.

If a majority of the votes cast on the question [in the district and in the territory described in the petition, respectively,] are in favor of the annexation, the commissioners of the county commission shall, within thirty days of the certification of the election results, by order declare the territory annexed and shall describe the altered boundaries of the district.

A copy of the same shall be filed with the county clerk.

190.089.

Upon voter approval of an ambulance district consolidation at an election, the department shall prioritize and expedite any activities necessary to facilitate the consolidation.

190.090.

1.

Two or more organized ambulance districts may consolidate into one ambulance district by following the procedures set forth in this section.

2.

If the consolidation of existing ambulance districts is desired, a number of voters residing in an existing ambulance district equal to ten percent of the vote cast for governor in the existing district in the next preceding gubernatorial election may file with the county clerk in which the territory or greater part of the proposed consolidated district is situated a petition requesting the consolidation of two or more existing ambulance districts.

The taskpetition force shall consistbe ofin the following members:form:

(1)We, Thethe directorundersigned voters of the department______ ofambulance higherdistrict educationdo andhereby workforcepetition developmentthat or______ hisexisting orambulance herdistricts designee;be consolidated into one consolidated ambulance district to be known as the _____ Ambulance District, subject to the attached consolidation plan.

(2) The director of the department of health and senior services or his or her designee;

(3) Four members shall be from the general assembly composed of the following:

SS SCS HCS HB 2372 7 (a) The president pro tempore of the senate shall appoint two members of the senate of whom not more than one shall be of the same party;

and (b) The speaker of the house of representatives shall appoint two members of the house of representatives of whom not more than one shall be of the same party;

and (c) The legislative members shall serve on the task force until such time as they resign, are no longer members of the general assembly, or are replaced by new appointments;

and (4) Eight members to be appointed by the governor with the advice and consent of the senate, composed of the following:

(a) Two members who represent public universities and who have expertise in pediatric diseases, with at least one member who represents the University of Missouri;

(b) Two members who represent the private health care research industry and who have expertise in pediatric diseases;

(c) Two members who represent the private research industry and who have expertise in pediatric diseases;

(d) One member representing a collaborating nonprofit or industry partner;

and (e) One member representing a patient advocacy group.

BeginningAn Januaryalternative 1,procedure 2027,of consolidation may be followed, if the taskboard forceof shalldirectors meetof atthe leastexisting quarterly.ambulance districts pass a resolution in the following form:

TheBe departmentit resolved by the board of higherdirectors educationof andthe workforceambulance developmentdistrict shallthat providethe necessary______ clericalambulance supportdistricts andbe assistanceconsolidated ininto orderone consolidated ambulance district to facilitatebe meetingsknown ofas the task_____ force.Ambulance District, subject to the attached consolidation plan.

TheEvery taskpetition forceor resolution shall submitbe anaccompanied annualby publica reportconsolidation toplan outlining the governorprocess andfor the generalproposed assemblyconsolidation. no later than December thirty-first of each year detailing:

(1)At Researcha initiativesminimum, focusedthe onconsolidation geneticplan orshall pediatricinclude diseases,the includingfollowing: rare pediatric diseases, led by institutions located in this state;

(2)(1) KeyThe outcomesname achievedof the proposed consolidated district, a legal description of the boundaries of such consolidated district, and the proposed tax levy to be imposed by the researchconsolidated initiatives;district.

(3)In Fundsthe expendedevent andthat leveragedthe byproposed plan is for the researchconsolidation initiatives;into an existing district, the consolidation plan shall clearly state that the existing district shall continue as the legal entity into which the other districts are consolidated;

(2) The names of the districts to be consolidated, accompanied by a list of all real property owned and (4)financial Anyassets legislativecurrently recommendations.held by the district, all outstanding bonds HCS HB 2372 10 or debts of each of said districts, and the current tax levies imposed by each of said districts;

(3) The name of the district which shall be responsible for maintaining ambulance service during the consolidation, including continuing operations, administration, and governance of the consolidated district, provided that there shall be a presumption that the district with the largest operating budget in the preceding fiscal year shall assume such responsibility;

(4) The proposed number of board members and specific individuals who will serve as the initial directors, provided that such directors shall be chosen from among the existing board members of the districts to be consolidated such that there is at least one director from each of the districts to be consolidated;

and (5) A proposed time line for consolidation, which shall not exceed one hundred eighty days, provided that such time line shall be subject to modification by the board of the consolidated district for good cause.

ThisUpon sectionthe filing of a petition, or a resolution, and a consolidation plan with the county clerk from each of the ambulance districts proposed to be consolidated, the county clerk shall expirepresent onthe Decemberpetition 31,or 2030.resolution and consolidation plan to the commissioners of the county commission [having jurisdiction who shall thereupon order the submission of the question to the voters of the districts.

The filing of each of the petitions in the ambulance districts shall have occurred within a continuous twelve-month period.

6.

The notice shall set forth the names of the existing ambulance districts to be included in the consolidated district.

7.

The question shall be submitted in substantially the following form:

Shall the existing ______ ambulance districts be consolidated into one ambulance district? 8.

If the county commission having jurisdiction finds that the question to consolidate the districts received a majority of the votes cast, the commission shall make and enter its order declaring that the proposition passed.

9.

Within thirty days after the district has been declared consolidated, the county commission shall divide the district into six election districts and shall order an election to be held and conducted as provided in section 190.050 for the election of directors.

10.

Within thirty days after the election of the initial board of directors of the district, the directors shall meet and the time and place of the first meeting of the board shall be designated by the county commission.

At the first meeting the newly elected board of directors shall choose a name for the consolidated district and shall notify the clerk of the county commission of each county within which the consolidated district is located of the name of the consolidated district.

HCS HB 2372 11 11.

On the thirtieth day following the election of the board of directors, the existing ambulance districts shall cease to exist and the consolidated district shall assume all of the powers and duties exercised by those districts.

All assets and obligations of the existing ambulance districts shall become assets and obligations of the consolidated district], who shall record such documents in the records of the county.

A petition or resolution for a proposed consolidation shall be received from all ambulance districts within the same calendar year or shall be considered null and void.

7.

Each of the ambulance districts seeking to consolidate shall post the notice of the intent to consolidate in the same manner as district public meetings are posted.

In addition, publication of such notice of intent shall be made in a newspaper of general circulation in every county in which the proposed consolidated ambulance district shall be located, with publication to be made once per week for two consecutive weeks.

A public hearing shall be held jointly by all ambulance districts seeking to consolidate at a location within the boundaries of the proposed consolidated ambulance district, provided that such hearing shall be no more than thirty days after the date of the second publication.

The notice of intent shall be in substantially the following form:

NOTICE OF THE FILING OF A PETITION/RESOLUTION FOR CONSOLIDATION OF THE ______ AMBULANCE DISTRICTS To all voters, residents, and interested persons within the boundaries of the above described ambulance districts:

You are hereby notified that a petition/resolution has been filed for the consolidation of the above named ambulance districts into one consolidated ambulance district to be known as _____ Ambulance District.

A proposed consolidation plan is available for inspection at the office of the County Clerk of _____ County.

A public hearing will be held on ______ (date) at ________ (time) at the following location:

________.

The purpose of this public hearing shall be to explain the reasons for the consolidation and answer questions from the public.

Objections to this consolidation may be filed with the County Clerk of _____ County, provided such objections are filed in writing not less than thirty days after the public hearing.

Any such objection must be signed by a number of voters residing in the proposed consolidated district that is not less than five percent of the votes cast for governor in the district in the most recent gubernatorial election.

HCS HB 2372 12 8.

If no objections are filed with the county clerk within thirty days after the public hearing, then within forty-five days following the date of the public hearing, the county commission shall order the districts consolidated pursuant to the terms of the consolidation plan and shall further appoint as directors those individuals identified in the consolidation plan.

The county commission shall further set a date, time, and location for the first meeting of the directors of the newly consolidated district.

9.

Upon receipt of any objections filed, the county clerk shall verify that such objections are signed by the necessary number of voters of the district.

If said objections are signed by an appropriate number of voters, the county commission of each county in which the proposed consolidated district is to be located shall thereupon order the submission of the question to the voters of the districts.

The question shall be submitted in substantially the following form:

Shall the existing ______ ambulance districts be consolidated into one ambulance district to be known as the _________ Ambulance District, with such consolidated district authorized to levy a property tax not to exceed the annual rate of ______ cents on the hundred dollars assessed valuation or a sales tax in an amount not to exceed _ _____ percent, or a combination of both? If the county commission having jurisdiction finds that the question to consolidate the districts received a majority of the votes cast, the commission shall make and enter its order declaring that the proposition passed.

The county commission shall further order the districts consolidated pursuant to the terms of the consolidation plan and shall further appoint as directors those individuals identified in the consolidation plan.

The county commission shall further set a date, time, and location for the first meeting of the directors of the newly consolidated district.

10.

Notwithstanding any other provision of law to the contrary, the consolidated district may impose an initial tax levy up to the highest tax levy of the consolidating districts, provided such tax levy is specifically set forth in the ballot language submitted to and approved by the voters of the consolidating district.

11.

Without a vote of the residents of the consolidated district as provided in this section, no consolidated ambulance district shall be permitted to impose a property tax greater than the lowest of any existing property tax rate of the districts to be consolidated, nor shall the consolidated ambulance district be permitted to impose any sales tax greater than the lowest of any existing sales tax rate of the districts to be consolidated.

HCS HB 2372 13 12.

Upon written certification by the board of directors of the consolidated district to the prior district that the consolidated district has obtained the necessary licenses and permits to operate an ambulance service and all directors of such consolidated district have completed the training required by section 190.053, the existing ambulance districts shall cease to exist and the consolidated district shall assume all of the powers and duties exercised by those districts.

All assets and obligations of the existing ambulance districts shall become assets and obligations of the consolidated district.

SS SCS HCS HB 2372 8 (3) Consistent with the training and education, as well as within the scope of skill and practice, of the personnel and with the supervisory standard approved by the medical director;

HCS HB 2372 14 [3.] 4.

(1) Any ambulance service shall[shall enter into a written contract with another ambulance service provider to provide community paramedic services in [another]another their ambulance service area, as that term is defined in section 190.100.

The contract that is agreed upon may be for an indefinite period of time, as long as it includes at least a sixty-day cancellation notice by either ambulance service.service] that seeks to provide community paramedic services outside of its ambulance service area, as described in section 190.105 and administered by the department, and in the service area of another ambulance service that currently provides community paramedic services shall be required to have a memorandum of understanding with that ambulance service regarding the provision of such community paramedic services.

(2)An Theambulance departmentservice shallthat establishprovides regulationscommunity forparamedic theservices purposemay ofprovide recognizing community paramedic serviceservices entitieswithout thata havememorandum metof understanding in the standardsambulance necessaryservice toarea provideof an ambulance service that is not providing community paramedic services, includingbut physicianthe medicalambulance oversight,service training,providing patientcommunity recordkeeping,paramedic formalservices relationshipsshall provide notification to the ambulance service with primaryemergency careservice servicesresponsibilities wherein necessary,the andservice qualityarea improvementof policies.the general community paramedic activities being performed.

The(2) departmentAny shallemergency issuemedical anresponse endorsementagency seeking to anyprovide community paramedic services within its designated response service entityarea thatmay meetsdo suchso standardsif thatthe allowsground ambulance service covering the entityarea towithin providewhich communitythe paramedicemergency servicesmedical forresponse aagency periodis oflocated fivedoes years.not provide community paramedic services.

[4.]If 5.such ground ambulance service does provide community paramedic services, the ground ambulance service may establish, at its sole discretion, a memorandum of understanding with the emergency medical response agency planning to offer community paramedic services in order to coordinate programs and avoid service duplication.

If an emergency medical response agency is providing community paramedic services in a service area before the ground ambulance service in that service area begins offering community paramedic services, the emergency medical response agency and the ground ambulance service shall establish a memorandum of understanding for the coordination of services.

(3) A community paramedic program shall notify the appropriate local ambulance service when providing services within the service area of an ambulance service.

(4) The department shall establish regulations for the purpose of recognizing community paramedic service entities that have met the standards necessary to provide community paramedic services, including physician medical oversight, training, patient recordkeeping, formal relationships with primary care services where necessary, and quality improvement policies.

The department shall issue an endorsement to any HCS HB 2372 15 community paramedic service entity that meets such standards that allows the entity to provide community paramedic services for a period of five years.

[4.]5.

[5.][5.]6. 6.

SS SCS HCS HB 2372 9 [6.] 7.

190.142.

1.

(1) For applications submitted before the recognition of EMS personnel licensure interstate compact under sections 190.900 to 190.939 takes effect, the department shall, within a reasonable time after receipt of an application, cause such investigation as it deems necessary to be made of the applicant for an emergency medical technician's license.

(2) For applications submitted after the recognition of EMS personnel licensure interstate compact under sections 190.900 to 190.939 takes effect, an applicant for initial licensure as an emergency medical technician in this state shall submit to a background check by the Missouri state highway patrol and the Federal Bureau of Investigation through a process approved by the department of health and senior services.

Such processes may include the use of vendors or systems administered by the Missouri state highway patrol.

The department may share the results of such a criminal background check with any emergency services licensing agency in any member state, as that term is defined under section 190.900, in recognition of the EMS personnel licensure interstate compact.

The department shall not issue a license until the department receives the results of an applicant's criminal background check from the Missouri state highway patrol and the Federal Bureau of Investigation, but, notwithstanding this subsection, the department may issue a temporary license as provided under section 190.143.

Any fees due for a criminal background check shall be paid by the applicant.

(3) The director may authorize investigations into criminal records in other states for any applicant.

2.

The department shall issue a license to all levels of emergency medical technicians, for a period of five years, if the applicant meets the requirements established pursuant to sections 190.001 to 190.245 and the rules adopted by the department pursuant to sections 190.001 to 190.245.

The department may promulgate rules relating to the requirements for an emergency medical technician including but not limited to:

(1) Age requirements;

SS SCS HCS HB 2372 10 (2) Emergency medical technician and paramedic education and training requirements based on respective National Emergency Medical Services Education Standards and any modification to such curricula specified by the department through rules adopted pursuant to sections 190.001 to 190.245;

(3) Paramedic accreditation requirements.

Paramedic training programs shall be accredited as required by the National Registry of Emergency Medical Technicians;

(4) Initial licensure testing requirements.

Initial paramedic licensure testing shall be through the national registry of EMTs;

(5) Continuing education and relicensure requirements;

and (6) Ability to speak, read and write the English language.

3.

Application for all levels of emergency medical technician license shall be made upon such forms as prescribed by the department in rules adopted pursuant to sections 190.001 to 190.245.

The application form shall contain such information as the department deems necessary to make a determination as to whether the emergency medical technician meets all the requirements of sections 190.001 to 190.245 and rules promulgated pursuant to sections 190.001 to 190.245.

4.

All levels of emergency medical technicians may perform only that patient care which is:

(1) Consistent with the training, education and experience of the particular emergency medical technician;

[and] (2) Consistent with the current National EMS Scope of Practice Model.

The state EMS medical director's advisory committee, under section 190.103, may add to this scope of practice for advanced emergency medical technicians and the local medical director may add to this scope of practice for paramedics at the agency or individual clinician level;

and (3) Ordered by a physician or set forth in protocols approved by the medical director.

5.

No person shall hold themselves out as an emergency medical technician or provide the services of an emergency medical technician unless such person is licensed by the department.

6.

Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028.

This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2002, shall be invalid and void.

SS SCS HCS HB 2372 11 190.165.

1.

The department may refuse to issue or deny renewal of any endorsement, certificate, permit or license required pursuant to sections [190.100] 190.098 to 190.245 for failure to comply with the provisions of sections [190.100] 190.098 to 190.245 or any lawful regulations promulgated by the department to implement its provisions as described in subsection 2 of this section.

The department shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of his or her right to file a complaint with the administrative hearing commission as provided by chapter 621.

2.

The department may cause a complaint to be filed with the administrative hearing commission as provided by chapter 621 against any holder of any endorsement, certificate, permit or license required by sections [190.100] 190.098 to 190.245 or any person who has failed to renew or has surrendered his or her certificate, permit or license for failure to comply with the provisions of sections [190.100] 190.098 to 190.245 or any lawful regulations promulgated by the department to implement such sections.

Those regulations shall be limited to the following:

(1) Use or unlawful possession of any controlled substance, as defined in chapter 195, or alcoholic beverage to an extent that such use impairs a person's ability to perform the work of any activity licensed or regulated by sections [190.100] 190.098 to 190.245;

(2) Being finally adjudicated and found guilty, or having entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any activity licensed or regulated pursuant to sections [190.100] 190.098 to 190.245, for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

(3) Use of fraud, deception, misrepresentation or bribery in securing any endorsement, certificate, permit or license issued pursuant to sections [190.100] 190.098 to 190.245 or in obtaining permission to take any examination given or required pursuant to sections [190.100] 190.098 to 190.245;

(4) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud, deception or misrepresentation;

(5) Incompetency, misconduct, gross negligence, fraud, misrepresentation or dishonesty in the performance of the functions or duties of any activity licensed or regulated by sections [190.100] 190.098 to 190.245;

(6) Violation of, or assisting or enabling any person to violate, any provision of sections [190.100] 190.098 to 190.245, or of any lawful rule or regulation adopted by the department pursuant to sections [190.100] 190.098 to 190.245;

SS SCS HCS HB 2372 12 (7) Impersonation of any person holding [a] an endorsement, certificate, permit or license or allowing any person to use his or her endorsement, certificate, permit, license or diploma from any school;

(8) Disciplinary action against the holder of a license or other right to practice any activity regulated by sections [190.100] 190.098 to 190.245 granted by another state, territory, federal agency or country upon grounds for which revocation or suspension is authorized in this state;

(9) For an individual being finally adjudged insane or incompetent by a court of competent jurisdiction;

(10) Assisting or enabling any person to practice or offer to practice any activity licensed or regulated by sections [190.100] 190.098 to 190.245 who is not licensed and currently eligible to practice pursuant to sections [190.100] 190.098 to 190.245;

(11) Issuance of [a] an endorsement, certificate, permit or license based upon a material mistake of fact;

(12) Violation of any professional trust, confidence, or legally protected privacy rights of a patient by means of an unauthorized or unlawful disclosure;

(13) Use of any advertisement or solicitation which is false, misleading or deceptive to the general public or persons to whom the advertisement or solicitation is primarily directed;

(14) Violation of the drug laws or rules and regulations of this state, any other state or the federal government;

(15) Refusal of any applicant or licensee to respond to reasonable department of health and senior services' requests for necessary information to process an application or to determine license status or license eligibility;

(16) Any conduct or practice which is or might be harmful or dangerous to the mental or physical health or safety of a patient or the public;

(17) Repeated acts of negligence or recklessness in the performance of the functions or duties of any activity licensed or regulated by sections [190.100] 190.098 to 190.245.

3.

If the department conducts investigations, the department, prior to interviewing a licensee who is the subject of the investigation, shall explain to the licensee that he or she has the right to:

(1) Consult legal counsel or have legal counsel present;

(2) Have anyone present whom he or she deems to be necessary or desirable;

and (3) Refuse to answer any question or refuse to provide or sign any written statement.

The assertion of any right listed in this subsection shall not be deemed by the department to be a failure to cooperate with any department investigation.

SS SCS HCS HB 2372 13 4.

After the filing of such complaint, the proceedings shall be conducted in accordance with the provisions of chapter 621.

Upon a finding by the administrative hearing commission that the grounds, provided in subsection 2 of this section, for disciplinary action are met, the department may, singly or in combination, censure or place the person named in the complaint on probation on such terms and conditions as the department deems appropriate for a period not to exceed five years, or may suspend, for a period not to exceed three years, or revoke the license, endorsement, certificate, or permit.

Notwithstanding any provision of law to the contrary, the department shall be authorized to impose a suspension or revocation as a disciplinary action only if it first files the requisite complaint with the administrative hearing commission.

The administrative hearing commission shall hear all relevant evidence on remediation activities of the licensee and shall make a recommendation to the department of health and senior services as to licensure disposition based on such evidence.

5.

An individual whose license has been revoked shall wait one year from the date of revocation to apply for relicensure.

Relicensure shall be at the discretion of the department after compliance with all the requirements of sections [190.100] 190.098 to 190.245 relative to the licensing of an applicant for the first time.

Any individual whose license has been revoked twice within a ten-year period shall not be eligible for relicensure.

6.

The department may notify the proper licensing authority of any other state in which the person whose license was suspended or revoked was also licensed of the suspension or revocation.

7.

Any person, organization, association or corporation who reports or provides information to the department pursuant to the provisions of sections [190.100] 190.098 to 190.245 and who does so in good faith shall not be subject to an action for civil damages as a result thereof.

8.

The department of health and senior services may suspend any certificate, permit or license required pursuant to sections [190.100] 190.098 to 190.245 simultaneously with the filing of the complaint with the administrative hearing commission as set forth in subsection 2 of this section, if the department finds that there is an imminent threat to the public health.

The notice of suspension shall include the basis of the suspension and notice of the right to appeal such suspension.

The licensee may appeal the decision to suspend the license, endorsement, certificate, or permit to the department.

The appeal shall be filed within ten days from the date of the filing of the complaint.

A hearing shall be conducted by the department within ten days from the date the appeal is filed.

The suspension shall continue in effect until the conclusion of the proceedings, including review thereof, unless sooner withdrawn by the department, dissolved by a court of competent jurisdiction or stayed by the administrative hearing commission.

SS SCS HCS HB 2372 14 (1) "Eligible person, firm, organization or other entity", an ambulance service or emergency medical response agency, an emergency medical responder, or an emergency medical technician who is employed by, or an enrolled member, person, firm, organization or entity designated by, rule of the department of health and senior services in consultation with other appropriate agencies.

(1) No person shall use an epinephrine [auto-injector device] delivery system unless such person has successfully completed a training course in the use of epinephrine [auto- injector devices] delivery systems approved by the director of the department of health and HCS HB 2372 16 senior services.

SS SCS HCS HB 2372 15 (3) Any person otherwise authorized to sell or provide an epinephrine [auto-injector device] delivery system may sell or provide it to a person authorized to possess it pursuant to this section.

191.117.191.455.

ThisSections section191.455 to 191.467 shall be known and may be cited as the "Lori"Hope Zenafor BakerMissouri Patients Act".

ThereAs isused hereby established in thesections department191.455 ofto health191.467, andunless seniorthe servicescontext aotherwise "Sicklerequires, Cell Standing Committee" as a subcommittee of the Missourifollowing geneticterms advisorymean: committee.

The(1) committee"Eligible shallfacility", consistan ofinstitution that is operating under a Federalwide Assurance (FWA) for the followingProtection members:of Human Subjects under 42 U.S.C.

(1)Section One289(a) memberand who45 isCFR aPart licensed46 physicianand withthat experienceis insubject to the diagnosisFWA andlaws, treatmentregulations, ofpolicies, sickle cell disease and whoguidelines, shallincluding serverenewals asor chairupdates; of the committee;

(2) One"Eligible memberpatient", whoan hasindividual sicklewho cellmeets diseasethe orfollowing isconditions: a family member of a person with sickle cell disease;

(3)(a) OneHas memberconsidered withall expertiseother intreatment sickleoptions cellcurrently diseaseapproved research;by the United States Food and Drug Administration;

(4)(b) OneHas memberreceived a recommendation from ahis leadingor sickleher cellphysician diseasefor organization;an individualized investigational treatment based on analysis of the patient's genomic sequence;

(5)human Onechromosomes; member with expertise in minority health;

anddeoxyribonucleic (6)acid; One member from each of the hemoglobinopathy center that contracts with the department.

ribonucleic acid;

genes;

gene products, such as enzymes and other types of proteins;

or metabolites;

HCS HB 2372 17 (c) Has a life-threatening or severely debilitating illness, or a serious disease or condition associated with morbidity that has a substantial impact on day-to-day functioning, as attested to by the patient's treating physician;

(d) Has given written, informed consent for the use of the individualized investigational drug, biological product, or device;

and (e) Has documentation from his or her physician that he or she meets the requirements of paragraphs (a) to (d) of this subdivision;

(3) "Individualized investigational drug, biological product, or device", any drug, biological product, or device that is unique to and produced exclusively for use for an individual patient based on the patient's own genetic profile.

The term "individualized investigational drug, biological product, or device":

(a) Shall include, but not be limited to, individualized gene therapy antisense oligonucleotides and individualized neoantigen vaccines;

and (b) Shall not include any drug, biological product, or device derived from human primary or secondary embryonic stem cells or cell lines, or tissues or cells derived from abortion, but shall include any drug, biological product, or device derived from human perinatal tissues, cells, and secreted factors not obtained from an abortion;

(4) "Individualized investigational treatment", treatment with an individualized investigational drug, biological product, or device;

(5) "Life-threatening or severely debilitating illness", any disease or condition that is life-threatening or severely debilitating, as such terms are defined in 21 CFR 312.81 or any successor law or regulation, as applicable;

(6) "Written, informed consent", a written document that:

(a) Is signed by the patient or, if the patient is a minor, signed by any person authorized to consent under section 431.061;

(b) Is attested to by the patient's physician and a witness;

and (c) At a minimum, includes all of the following:

a.

An explanation of the currently approved products and treatments for the illness, disease, or condition from which the patient suffers;

b.

An attestation that the patient concurs with his or her physician in believing that all currently approved and conventionally recognized treatments are unlikely to prolong the patient's life;

c.

Clear identification of the specific proposed individualized investigational drug, biological product, or device that the patient is seeking to use;

d.

A description of the potentially best and worst outcomes of using the individualized investigational drug, biological product, or device and a realistic description of the most likely outcome.

The description shall include the possibility HCS HB 2372 18 that new, unanticipated, different, or worse symptoms might result and that death could be hastened by the proposed treatment.

The description shall be based on the physician's knowledge of the proposed treatment in conjunction with an awareness of the patient's condition;

e.

A statement that the patient's health plan or third-party administrator and provider are not obligated to pay for any care or treatments consequent to the use of the individualized investigational drug, biological product, or device unless they are specifically required to do so by law or contract;

f.

A statement that the patient's eligibility for hospice care may be withdrawn if the patient begins curative treatment with the individualized investigational drug, biological product, or device and that care may be reinstated if this treatment ends and the patient meets hospice eligibility requirements;

and g.

A statement that the patient understands that he or she is liable for all expenses consequent to the use of the individualized investigational drug, biological product, or device and that this liability extends to the patient's estate unless a contract between the patient and the manufacturer of the individualized investigational drug, biological product, or device states otherwise.

191.457.

1.

A manufacturer operating within an eligible facility and in accordance with all applicable Federalwide Assurance laws and regulations may make available an individualized investigational drug, biological product, or device and an eligible patient may request an individualized investigational drug, biological product, or device from an eligible facility or manufacturer operating within an eligible facility under sections 191.455 to 191.467.

Sections 191.455 to 191.467 shall not require that a manufacturer make available an individualized investigational drug, biological product, or device to an eligible patient.

2.

An eligible facility or manufacturer operating within an eligible facility may do all of the following:

(1) Provide an individualized investigational drug, biological product, or device to an eligible patient without receiving compensation;

and (2) Require an eligible patient to pay the costs of, or the costs associated with, the manufacture of the individualized investigational drug, biological product, or device.

191.459.

1.

Sections 191.455 to 191.467 shall not expand the coverage required of an insurer under chapter 376.

2.

A health plan, third-party administrator, or governmental agency may, but is not required to, provide coverage for the cost of an individualized investigational drug, biological product, or device or the cost of services related to the use of an individualized HCS HB 2372 19 investigational drug, biological product, or device in accordance with sections 191.455 to 191.467.

TheSections members191.455 ofto the191.467 committee shall benot appointedrequire byany governmental agency to pay costs associated with the directoruse of theor departmentcare or treatment of healtha andpatient seniorwith services.an individualized investigational drug, biological product, or device.

Members shall serve on the committee without compensation or reimbursement for expenses incurred.

TheSections committee191.455 shall:to 191.467 shall not require a hospital or facility licensed by the department of health and senior services to provide new or additional services unless approved by the hospital or facility.

(1)191.461. Assess the impact of sickle cell disease on urban communities in the state of Missouri;

(2)If Examinea thepatient's existingdeath servicesis andproximately resourcescaused addressingby treatment with an individualized investigational drug, biological product, or device, the needspatient's ofestate, personsheirs, withor sickledevisees cellshall disease;not be liable for any debt remaining after payment by insurance for charges directly incurred for such treatment.

andHowever, (3)this Developsection recommendationsshall tonot provide educationalan servicesexemption to schoolsliability onfor charges for nonexperimental treatments provided to the traitspatient, ofincluding sicklenonexperimental celltreatments diseaserendered andto itsthe effects.patient due to complications or consequences of the experimental treatment.

5.191.463.

The1. committee shall include an examination of the following in its assessment and recommendations required under subsection 4 of this section:

(1)A Trendslicensing inboard stateor sickledisciplinary cellsubcommittee diseaseshall populationsnot andrevoke, theirfail needs,to including,renew, butsuspend, notor limitedtake to,any action against a health care provider's license based solely on the state'shealth rolecare inprovider's providingrecommendations assistance;to an eligible patient regarding access to or treatment with an individualized investigational drug, biological product, or device.

(2)2. Existing services and resources;

andAn (3)entity Neededresponsible statefor policiesMedicare orcertification responses,shall including, but not limitedtake to,action directionsagainst fora thehealth provisioncare ofprovider's clearMedicare andcertification coordinatedbased servicessolely andon supportsthe tohealth personscare livingprovider's withrecommendation sicklethat cella diseasepatient andhave strategiesaccess to addressan anyindividualized identifiedinvestigational gapsdrug, inbiological services.product, or device.

SS191.465. SCS HCS HB 2372 16 6.

The1. committee shall hold a minimum of one meeting at three urban regions in the state to seek public input.

7.An official, employee, or agent of this state shall not block or attempt to block an eligible patient's access to an individualized investigational drug, biological product, or device.

The2. committee shall submit a report of its findings and any recommendations to the general assembly and the governor no later than December 31, 2027.

8.Counseling, advice, or a recommendation consistent with medical standards of care from a licensed health care provider shall not be a violation of this section.

After191.467. December 31, 2027, the committee shall continue to meet at the request of the chair and at a minimum of one time annually for the purpose of continuing the study of sickle cell disease in this state, the impact of the committee recommendations, and to provide an annual supplemental report on the findings to the governor and the general assembly.

1.

Sections 191.455 to 191.467 shall not create a private cause of action against a manufacturer of an individualized investigational drug, biological product, or device or against any other person or entity involved in the care of an eligible patient using the individualized investigational drug, biological product, or device for any harm done to the eligible patient resulting from the individualized investigational drug, biological product, or device if the manufacturer or other person or entity has complied in good faith with the terms of sections 191.455 to 191.467 and has exercised reasonable care.

HCS HB 2372 20 2.

Sections 191.455 to 191.467 shall not affect any health care coverage required under section 376.429 for costs incurred due to participation in clinical trials.

SS SCS HCS HB 2372 17 (2) Consultation with another physician, or that physician's delegate, who has an established relationship with the patient and an agreement with the physician to participate in the patient's care;

HCS HB 2372 21 (1) The technology utilized shall be sufficient to establish an informed diagnosis as though the medical [interview] evaluation and, if required to meet the standard of care, the physical examination has been performed in person;

A health care provider,provider utilizingthat uses a medical evaluation questionnaire completed by the patient by way of the internet or telephone,telephone shall provide a written report within fourteen days of evaluation to the patient's primary health care providerprovider, within fourteen days of evaluation, if provided by the patient, that contains:

It shall have power SS SCS HCS HB 2372 18 and authority, with approval of the director of the department, to make such orders, findings, rules and regulations as will prevent the entrance of infectious, contagious and communicable diseases into the state.

The department of health and senior services shall include in its list of communicable[communicable or infectiousinfectious] diseases which must be reported to the department methicillin- resistant staphylococcus aureus (MRSA), carbapenem-resistant enterobacteriaceae (CRE) as HCS HB 2372 22 specified by the department, [and] vancomycin-resistant enterococcus (VRE), and alpha-gal syndrome.

(1) AAny laboratory blood test result for alpha-gal immunoglobulinsyndrome E that yields a level consistent with sensitization to alpha-gal by laboratory standards, as established by the current national case definition,report shall be reportedsubmitted to the department within seven days.days of receiving a positive laboratory confirmation.

The laboratory that generatesfinalizes the positive test resultsresult shall be responsible for submitting the report.

The(2) testA resultsreport of alpha-gal syndrome shall be submittedrequired usingfor an electronicalpha-gal laboratoryimmunoglobulin reportingE systemlevel of greater than or equal to beone-tenth developedof byone theinternational department.unit per milliliter or greater than or equal to one-tenth of one kilounit per liter.

(2)A Subjectlaboratory tothat appropriation,finalizes thesuch departmenta maytest followresult upshall onreport reportedthe casestest ofresult alpha-galas immunoglobulina Ecase bloodof testalpha-gal resultssyndrome byusing applying an appropriateelectronic randomlaboratory samplingreporting methodsystem to ascertainbe casedeveloped status,by using the currentdepartment. national case definition of alpha-gal syndrome.

Reporting(3) underSubject thisto subdivisionappropriations, shallthe commencedepartment noof laterhealth thanand sixsenior monthsservices aftermay Augustfollow 28,up 2026.on reported cases of alpha-gal syndrome by applying an appropriate random sampling method for confirmation that the cases meet the most current Centers for Disease Control and Prevention surveillance case definition of alpha-gal syndrome.

(3)Reporting Theunder departmentthis subdivision shall submitcommence anno annuallater reportthan tosix themonths Centersafter for Disease Control and Prevention summarizing its findings related to the reportingeffective anddate incidence of alpha-galthis syndrome.section.

(4) The laboratory and the department shallof nothealth discloseand thesenior identifiableservices testshall resultsubmit oran otherannual protectedreport health information relating to anythe individualCenters for whichDisease aControl bloodand testPrevention issummarizing obtainedits tofindings anyonerelated otherto than the individualreporting for which the blood test result is obtained and theincidence healthof carealpha-gal providersyndrome. ordering the laboratory blood test.

192.026.192.021.

SectionsThe 103.190department andof 192.026health toand 192.029senior services shall be knownauthorized andto maycontract bedirectly citedwith asa Missouri affiliate of a national public health association or public health institute, or a similar or successor entity, in order to assist in carrying out its duties to promote the "Missourihealth Lymeand Diseasewellbeing Eradicationof Act".the residents of this state.

Such contracts may include, but not be limited to, efforts to assist in the delivery of health services to residents throughout the state and the administration of grant funds and related programs.

AsWithin usedsixty indays sectionsafter 103.190the end of each fiscal year, the department and 192.026the designated affiliate shall provide the general assembly with an annual report and accounting of any appropriations and grant funds received and expended by the designated affiliate pursuant to 192.029,this section during the followingimmediate termsprior shallfiscal mean:year and may provide recommendations and suggestions for improvement in services provided.

(1) "Department", the department of health and senior services;

(2) "Lyme disease", a condition caused by an infection of the bacterium Borrelia burgdorferi, Borrelia mayonii, Borrelia afzelii, Borrelia garinii, Borrelia valaisiana, Borrelia lusitaniae, Bartonella, Babesia, Ehrlichia, or related species, transmitted to humans through the bite of infected blacklegged ticks (Ixodes scapularis) or other ticks, as diagnosed by the two-tier serologic testing recommended by the federal Centers for SS SCS HCS HB 2372 19 Disease Control and Prevention (CDC) or by a similar blood test ordered by a treating health care provider or by clinical evaluation;

(3) "Medically necessary", health care services or products that a treating health care provider exercising prudent clinical judgment would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, disease, or symptoms of such, and that are:

(a) Clinically appropriate in terms of type, frequency, extent, site, and duration for the specific circumstances;

and (b) Not primarily for the mere convenience of the patient, health care provider, or as determined by the provider based on the patient's specific circumstances;

(4) "Posttreatment Lyme disease syndrome", a condition characterized by persistent symptoms, including, but not limited to, fatigue, pain, respiratory impairment, neurological impairment, or other cognitive impairment following standard antibiotic or other treatment for Lyme disease.

3.

Health care providers, laboratories, and local health departments shall report to the department all confirmed or suspected cases of Lyme disease within seven days of diagnosis using standardized surveillance case definitions developed by the CDC.

Any patient who receives a positive or suspected diagnosis of Lyme disease shall be given the option to opt in to having their identifiable information shared with the department, local public health officials, or the CDC.

4.

The department shall compile an annual report on the incidence and prevalence of Lyme disease in Missouri, including, but not limited to, demographic data, geographic distribution, treatment outcomes, and barriers to care.

The department shall submit the report to the CDC and the general assembly and make such report available to the public on the department's website by no later than December thirty- first of each year.

5.

The department shall collaborate with the University of Missouri or any public four-year institution of higher education to integrate Lyme disease surveillance data into existing tick-borne disease monitoring programs.

6.

Any information collected or reported under this section shall be done in a manner that protects individually identifiable or potentially identifiable information and that is consistent with state and federal privacy laws.

7.

The department may promulgate any rules and regulations necessary to implement the provisions of sections 192.026 to 192.028.

Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028.

This section and chapter SS SCS HCS HB 2372 20 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2026, shall be invalid and void.

192.027.

1.

There is hereby created in the state treasury the "Lyme Research and Eradication Fund", which shall consist of moneys appropriated to it by the general assembly, as well as any grants, bequests, gifts, or donations.

The state treasurer shall be custodian of the fund.

In accordance with sections 30.170 and 30.180, the state treasurer may approve disbursements.

The fund shall be a dedicated fund and money in the fund shall be used solely by the department for the purposes of implementing the provisions of this section.

Notwithstanding the provisions of section 33.080 to the contrary, any moneys remaining in the fund at the end of the biennium shall not revert to the credit of the general revenue fund.

The state treasurer shall invest moneys in the fund in the same manner as other funds are invested.

Any interest and moneys earned on such investments shall be credited to the fund.

2.

The department shall use the moneys in the fund to distribute grants to public four-year institutions of higher education, research institutions, and nonprofit organizations for Lyme disease research, including, but not limited to, the following:

(1) Development of improved diagnostics, therapies, and treatments;

(2) Studies on novel therapies, such as those inspired by natural host immunity;

and (3) Eradication strategies, including, but not limited to, tick population control through acaricides, deer management programs, and environmental interventions.

3.

No less than twenty percent of the funds shall be utilized to support eradication efforts in rural counties.

4.

The department shall submit a report to the general assembly no later than March first of each year detailing fund expenditures, research outcomes, and progress toward Lyme disease eradication in the state.

192.028.

1.

There shall be established within the department the "Lyme Disease Task Force" to advise the department on disease prevention and surveillance, as well as education relating to the disease for health care providers and the public.

The task force shall consist of the following members:

(1) The director of the department, or his or her designee, who shall serve as the chairman;

and (2) As appointed by the director of the department:

(a) Two physicians licensed to practice in this state who are members of a statewide organization representing physicians, one of whom represents a medical SS SCS HCS HB 2372 21 school faculty and one of whom has experience treating Lyme disease or posttreatment Lyme disease syndrome;

(b) Two advanced practice registered nurses licensed to practice in this state who are selected from the recommendations of one or more professional nursing associations and who have experience treating Lyme disease or posttreatment Lyme disease syndrome;

(c) One local public health administrator;

and (d) One veterinarian who is licensed to practice in this state;

and (3) Two residents of this state appointed by the governor, with the advice and consent of the senate, who have or have had a diagnosis of Lyme disease.

2.

The terms of office for each member aside from the director, or his or her designee, shall be three years.

Members may continue to serve after the expiration of a term until a new member is appointed.

Each member appointed to fill a vacancy occurring prior to the expiration of the term for which his or her predecessor was appointed shall be appointed for the remainder of such term.

The task force shall meet as frequently as the chairman deems necessary, but not less than two times each year.

Members of the task force shall receive no compensation for their service, but shall, subject to appropriation, be reimbursed for their actual and necessary expenses incurred in the performance of their duties.

3.

The task force shall have the following duties and responsibilities:

(1) Monitor the implementation of the "Missouri Lyme Disease Eradication Act", established under sections 103.190 and 192.026 to 192.029, and provide feedback and input to the department for necessary additions or modifications;

(2) Review relevant literature and guidelines pertaining to accurate diagnoses of Lyme disease and posttreatment Lyme disease syndrome with the purpose of creating cohesive and consistent guidelines for the diagnosis of Lyme disease and posttreatment Lyme disease syndrome across all counties in this state and with the intent of providing accurate and relevant data to the Centers for Disease Control and Prevention;

(3) Provide recommendations on professional continuing education materials and opportunities that emphasize Lyme disease prevention, protection, and treatment;

and (4) Assist the department in establishing policies, procedures, techniques, and criteria for the collection, maintenance, exchange, and sharing of medical information pertaining to Lyme disease and posttreatment Lyme disease syndrome and identifying persons or entities with expertise in Lyme disease to collaborate with the department in the diagnosis, prevention, and treatment of Lyme disease and posttreatment Lyme disease syndrome.

SS SCS HCS HB 2372 22 192.029.

Notwithstanding any provision of law to the contrary, a health care provider shall not be subject to any discipline, suspension or revocation of a license, or denial of a license renewal solely for, within such provider's scope of practice, prescribing, administering, or dispensing treatments or therapies for Lyme disease or posttreatment Lyme disease syndrome, including, but not limited to, extended antibiotic therapy or similar treatment deemed medically necessary.

192.990.

1.

There is hereby established within the department of health and senior services the "Pregnancy-Associated Mortality Review Board" to improve data collection and reporting with respect to maternal deaths.

The department may collaborate with localities and with other states to meet the goals of the initiative.

2.

For purposes of this section, the following terms shall mean:

(1) "Department", the Missouri department of health and senior services;

(2) "Maternal death", the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy, regardless of the cause of death and regardless of whether a delivery, miscarriage, or death occurs inside or outside of a hospital;

(3) "Maternity care deserts", counties in which access to maternity care services is limited or absent, either through a lack of services or through barriers to a woman's ability to access care within a county.

A "maternity care desert" shall include, but not be limited to, any county without a hospital or birth center offering obstetric care and without any obstetric clinicians.

3.

The board shall be composed of no more than [eighteen] twenty-two members, with a chair elected from among its membership.

The board shall meet at least twice per year and shall approve the strategic priorities, funding allocations, work processes, and products of the board.

Members of the board shall be appointed by the director of the department.

Members shall serve four-year terms, except that the initial terms shall be staggered so that approximately one-third serve three-, four-, and five-year terms.

4.

The board shall have a multidisciplinary and diverse membership that represents a variety of medical and nursing specialties, including, but not limited to, obstetrics and maternal-fetal care, as well as state or local public health officials, epidemiologists, statisticians, community organizations, geographic regions, and other individuals or organizations that are most affected by maternal deaths and lack of access to maternal health care services.

At least one member from each congressional district shall be selected to serve on the board and membership shall be demographically diverse and shall include representation from both rural and urban populations.

5.

The duties of the board shall include, but not be limited to:

(1) Conducting ongoing comprehensive, multidisciplinary reviews of all maternal deaths;

SS SCS HCS HB 2372 23 (2) Identifying factors associated with maternal deaths;

(3) Identifying maternity care deserts throughout the state;

(4) Reviewing medical records and other relevant data, which shall include, to the extent available:

(a)A description of the maternal deaths determined by matching each death record of a maternal death to a birth certificate of an infant or fetal death record, as applicable, and an indication of whether the delivery, miscarriage, or death occurred inside or outside of a hospital;

(b) Data collected from medical examiner and coroner reports, as appropriate;

[and] (c) The level and timing of prenatal and postnatal medical care;

and (d) Using other appropriate methods or information to identify maternal deaths, including deaths from pregnancy outcomes not identified under paragraph (a) of this subdivision;

[(4)] (5) Consulting with relevant experts, as needed;

[(5)](6) Analyzing cases to produce recommendations for reducing maternal mortality;

[(6)]7) Disseminating recommendations to policy makers, health care providers and facilities, and the general public;

[(7)] (8) Recommending and promoting preventative strategies and making recommendations for systems changes;

[(8)] (9) Protecting the confidentiality of the hospitals and individuals involved in any maternal deaths;

[(9)] (10) Examining racial and social disparities in maternal deaths;

(11) Investigatingand developing recommendations regarding approaches taken in other states or other organizations to reduce or eliminate racial inequities in maternal deaths, including community-driven strategies, health care accessibility, insurance availability, and other barriers to access and delivery of prenatal and postpartum care;

[(10)](12) Subject to appropriation, providing for voluntary and confidential case reporting of maternal deaths to the appropriate state health agency by family members of the deceased, and other appropriate individuals, for purposes of review by the board;

[(11)](13) Making publicly available the contact information of the board for use in such reporting;

[(12)] (14) Conducting outreach to local professional organizations, community organizations, and social services agencies regarding the availability of the review board;

[and] SS SCS HCS HB 2372 24 (15) Examining and developing recommendations on the adequacy of data collected under this section and if additional categories of data would be informative in the study of maternal deaths in Missouri;

and [(13)] (16) Ensuring that data collected under this section is made available, as appropriate and practicable, for research purposes, in a manner that protects individually identifiable or potentially identifiable information and that is consistent with state and federal privacy laws.

6.

The board may contract with other entities consistent with the duties of the board.

7.

(1) Before June 30, 2020, and annually thereafter, the board shall submit to the Director of the Centers for Disease Control and Prevention, the director of the department, the governor, and the general assembly a report on maternal mortality in the state based on data collected through ongoing comprehensive, multidisciplinary reviews of all maternal deaths, and any other projects or efforts funded by the board.

The data shall be collected using best practices to reliably determine and include all maternal deaths, regardless of the outcome of the pregnancy and shall include data, findings, and recommendations of the committee, and, as applicable, information on the implementation during such year of any recommendations submitted by the board in a previous year.

Data reported by the board shall be disaggregated by race, ethnicity, language, nationality, age, zip code, the presence or absence of maternity care deserts, and level and timing of prenatal and postnatal care in a manner that protects individually identifiable or potentially identifiable information and that is consistent with state and federal privacy laws.

(2) The report shall be made available to the public on the department's website and the director shall disseminate the report to all health care providers and facilities that provide women's health services in the state.

8.

The director of the department, or his or her designee, shall provide the board with the copy of the death certificate and any linked birth or fetal death certificate for any maternal death occurring within the state.

9.

Upon request by the department, health care providers, health care facilities, clinics, laboratories, medical examiners, coroners, law enforcement agencies, driver's license bureaus, other state agencies, and facilities licensed by the department shall provide to the department data related to maternal deaths from sources such as medical records, autopsy reports, medical examiner's reports, coroner's reports, law enforcement reports, motor vehicle records, social services records, and other sources as appropriate.

Such data requests shall be limited to maternal deaths which have occurred within the previous twenty-four months.

No entity shall be held liable for civil damages or be subject to any criminal or disciplinary action when complying in good faith with a request from the department for information under the provisions of this subsection.

SS SCS HCS HB 2372 25 10.

(1) The board shall protect the privacy and confidentiality of all patients, decedents, providers, hospitals, or any other participants involved in any maternal deaths.

In no case shall any individually identifiable health information be provided to the public or submitted to an information clearinghouse.

(2) Nothing in this subsection shall prohibit the board or department from publishing statistical compilations and research reports that:

(a) Are based on confidential information relating to mortality reviews under this section;

and (b) Do not contain identifying information or any other information that could be used to ultimately identify the individuals concerned.

(3) Information, records, reports, statements, notes, memoranda, or other data collected under this section shall not be admissible as evidence in any action of any kind in any court or before any other tribunal, board, agency, or person.

Such information, records, reports, notes, memoranda, data obtained by the department or any other person, statements, notes, memoranda, or other data shall not be exhibited nor their contents disclosed in any way, in whole or in part, by any officer or representative of the department or any other person.

No person participating in such review shall disclose, in any manner, the information so obtained except in strict conformity with such review project.

Such information shall not be subject to disclosure under chapter 610.

(4) All information, records of interviews, written reports, statements, notes, memoranda, or other data obtained by the department, the board, and other persons, agencies, or organizations so authorized by the department under this section shall be confidential.

(5) All proceedings and activities of the board, opinions of members of such board formed as a result of such proceedings and activities, and records obtained, created, or maintained under this section, including records of interviews, written reports, statements, notes, memoranda, or other data obtained by the department or any other person, agency, or organization acting jointly or under contract with the department in connection with the requirements of this section, shall be confidential and shall not be subject to subpoena, discovery, or introduction into evidence in any civil or criminal proceeding;

provided, however, that nothing in this section shall be construed to limit or restrict the right to discover or use in any civil or criminal proceeding anything that is available from another source and entirely independent of the board's proceedings.

(6) Members of the board shall not be questioned in any civil or criminal proceeding regarding the information presented in or opinions formed as a result of a meeting or communication of the board;