and b.

A final maturity of ten years or less;

(c) Money market investments;

or (d) Any combination of investments described in paragraphs (a) to (c) of this subdivision;

and (2) Shall invest the remaining percentage of any available funds not invested as allowed under subdivision (1) of this subsection into any investment in which the state treasurer is allowed to invest.

2.

The provisions of this section shall only apply if the hospital:

(1) Receives less than [one] three percent of its annual revenues from municipal, county, or state taxes;

and SS SCS HCS HB 2372 4 (2) Receives less than [one] three percent of its annual revenue from appropriated funds from the municipality in which such hospital is located.

96.196.

1.

A hospital organized under this chapter may purchase, operate or lease, as lessor or lessee, related facilities or engage in health care activities, except in counties of the third or fourth classification (other than the county in which the hospital is located) where there already exists a hospital organized pursuant to this chapter [and chapter 205 or 206];

provided, however, that this exception shall not prohibit the continuation of existing activities otherwise allowed by law.

2.

If a hospital organized pursuant to this chapter accepts appropriated funds from the city during the twelve months immediately preceding the date that the hospital purchases, operates or leases its first related facility outside the city boundaries or engages in its first health care activity outside the city boundaries, the governing body of the city shall approve the hospital's plan for such purchase, operation or lease prior to implementation of the plan.

103.190.

1.

As used in this section, the terms "Lyme disease" and "posttreatment Lyme disease syndrome" shall have the same meaning as given to the terms under section 192.026.

2.

The Missouri consolidated health care plan shall, at a minimum, provide coverage for diagnostic testing, treatment, and management of Lyme disease and posttreatment Lyme disease syndrome for participants who receive a diagnosis from a licensed health care provider, acting within the scope of his or her practice, after making a thorough evaluation of the participant's symptoms, diagnostic test results, or response to treatment, including, but not limited to, necessary office visits and ongoing testing.

An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for an indication by the U.S.

Food and Drug Administration.

A drug, including, but not limited to, an experimental drug, shall be covered for an off-label use in the treatment of a tick-borne disease if the drug has been approved by the U.S.

Food and Drug Administration.

167.627.

1.

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

(1) "Epinephrine delivery system", a single-use device or system used for the delivery of a premeasured dose of epinephrine into the human body;

(2) "Medication", any medicine prescribed or ordered by a physician for the treatment of asthma or anaphylaxis, including without limitation inhaled bronchodilators and [auto- injectible] epinephrine delivery systems;

[(2)] (3) "Self-administration", a pupil's discretionary use of medication prescribed by a physician or under a written treatment plan from a physician.

2.

Each board of education and its employees and agents in this state shall grant any pupil in the school authorization for the possession and self-administration of medication to SS SCS HCS HB 2372 5 treat such pupil's chronic health condition, including but not limited to asthma or anaphylaxis if:

(1) A licensed physician prescribed or ordered such medication for use by the pupil and instructed such pupil in the correct and responsible use of such medication;

(2) The pupil has demonstrated to the pupil's licensed physician or the licensed physician's designee, and the school nurse, if available, the skill level necessary to use the medication and any device or system necessary to administer such medication prescribed or ordered;

(3) The pupil's physician has approved and signed a written treatment plan for managing the pupil's chronic health condition, including asthma or anaphylaxis episodes and for medication for use by the pupil.

Such plan shall include a statement that the pupil is capable of self-administering the medication under the treatment plan;

(4) The pupil's parent or guardian has completed and submitted to the school any written documentation required by the school, including the treatment plan required under subdivision (3) of this subsection and the liability statement required under subdivision (5) of this subsection;

and (5) The pupil's parent or guardian has signed a statement acknowledging that the school district and its employees or agents shall incur no liability as a result of any injury arising from the self-administration of medication by the pupil or the administration of such medication by school staff.

Such statement shall not be construed to release the school district and its employees or agents from liability for negligence.

3.

An authorization granted under subsection 2 of this section shall:

(1) Permit such pupil to possess and self-administer such pupil's medication while in school, at a school-sponsored activity, and in transit to or from school or school-sponsored activity;

and (2) Be effective only for the same school and school year for which it is granted.

Such authorization shall be renewed by the pupil's parent or guardian each subsequent school year in accordance with this section.

4.

Any current duplicate prescription medication, if provided by a pupil's parent or guardian or by the school, shall be kept at a pupil's school in a location at which the pupil or school staff has immediate access in the event of an asthma or anaphylaxis emergency.

5.

The information described in subdivisions (3) and (4) of subsection 2 of this section shall be kept on file at the pupil's school in a location easily accessible in the event of an emergency.

167.630.

1.

As used in this section, the term "epinephrine delivery system" has the same meaning given to the term in section 167.627.

SS SCS HCS HB 2372 6 2.

Each school board may authorize a school nurse licensed under chapter 335 who is employed by the school district and for whom the board is responsible for to maintain an adequate supply of [prefilled auto syringes of] epinephrine [with fifteen-hundredths milligram or three-tenths milligram] delivery systems at the school.

The nurse shall recommend to the school board the number of [prefilled] epinephrine [auto syringes] delivery systems that the school should maintain.

[2.] 3.

To obtain [prefilled] epinephrine [auto syringes] delivery systems for a school district, a prescription written by a licensed physician, a physician's assistant, or nurse practitioner is required.

For such prescriptions, the school district shall be designated as the patient, the nurse's name shall be required, and the prescription shall be filled at a licensed pharmacy.

[3.] 4.

A school nurse, contracted agent trained by a nurse, or other school employee trained by and supervised by the nurse shall have the discretion to use an epinephrine [auto syringe] delivery system on any student the school nurse, trained employee, or trained contracted agent believes is having a life-threatening anaphylactic reaction based on the training in recognizing an acute episode of an anaphylactic reaction.

The provisions of section 167.624 concerning immunity from civil liability for trained employees administering lifesaving methods shall apply to trained employees administering [a prefilled auto syringe] an epinephrine delivery system under this section.

Trained contracted agents shall have immunity from civil liability for administering [a prefilled auto syringe] an epinephrine delivery system under this section.

173.690.

1.

As used in this section, the following terms mean:

(1) "Genetic disease", any disease, disorder, or condition caused in whole or in part by genetic variation, mutation, or inherited genetic traits;

(2) "Pediatric disease", any disease, disorder, or condition that primarily affects individuals under eighteen years of age;

(3) "Rare pediatric disease", a life-threatening or chronically debilitating disease that affects fewer than two hundred thousand individuals under eighteen years of age in the United States.

2.

There is hereby established within the department of higher education and workforce development the "Pediatric Disease Task Force".

3.

The task force shall consist of the following members:

(1) The director of the department of higher education and workforce development or his or her designee;

(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.

4.

Beginning January 1, 2027, the task force shall meet at least quarterly.

The department of higher education and workforce development shall provide necessary clerical support and assistance in order to facilitate meetings of the task force.

5.

The task force shall submit an annual public report to the governor and the general assembly no later than December thirty-first of each year detailing:

(1) Research initiatives focused on genetic or pediatric diseases, including rare pediatric diseases, led by institutions located in this state;

(2) Key outcomes achieved by the research initiatives;

(3) Funds expended and leveraged by the research initiatives;

and (4) Any legislative recommendations.

6.

This section shall expire on December 31, 2030.

190.098.

1.

As used in this section, the term "community paramedic services" means services that are:

(1) Provided by any entity that:

(a) Employs licensed paramedics who are certified as community paramedics by the department;

and (b) Has received an endorsement by the department as a community paramedic service entity;

(2) Provided in a nonemergent setting, independent of a 911 system or emergency summons;

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;

and (4) Reflected and documented in the entity's patient care plans or protocols approved by the medical director in accordance with section 190.142.

2.

In order for a person to be eligible for certification by the department as a community paramedic, an individual shall:

(1) Be currently [certified] licensed as a paramedic;

(2) Successfully complete or have successfully completed a community paramedic certification program from a college, university, or educational institution that has been approved by the department or accredited by a national accreditation organization approved by the department;

and (3) Complete an application form approved by the department.

[2.] 3.

A community paramedic shall practice in accordance with protocols and supervisory standards established by the medical director.

A community paramedic shall provide services of a health care plan if the plan has been developed by the patient's physician or by an advanced practice registered nurse through a collaborative practice arrangement with a physician or a physician assistant through a collaborative practice arrangement with a physician and there is no duplication of services to the patient from another provider.

[3.] 4.

(1) Any ambulance service shall enter into a written contract with another ambulance service provider to provide community paramedic services in [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.

(2) 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 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.

A community paramedic is subject to the provisions of sections 190.001 to 190.245 and rules promulgated under sections 190.001 to 190.245.

[5.] 6.

No person shall hold himself or herself out as a community paramedic or provide the services of a community paramedic unless such person is certified by the department.

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

The medical director shall approve the implementation of the community paramedic program.

[7.]8.

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, 2013, shall be invalid and void.

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.

190.246.

1.

As used in this section, the following terms shall mean:

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.

All such eligible persons, firms, organizations or other entities shall be subject to the rules promulgated by the director of the department of health and senior services;

(2) "Emergency health care provider":

(a) A physician licensed pursuant to chapter 334 with knowledge and experience in the delivery of emergency care;

or (b) A hospital licensed pursuant to chapter 197 that provides emergency care;

(3) "Epinephrine delivery system", a single-use device or system used for the delivery of a premeasured dose of epinephrine into the human body.

2.

Possession and use of epinephrine [auto-injector devices] delivery systems shall be limited as follows:

(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 senior services.

Nothing in this section shall prohibit the use of an epinephrine [auto-injector device] delivery system:

(a) By a health care professional licensed or certified by this state who is acting within the scope of his or her practice;

or (b) By a person acting pursuant to a lawful prescription;

(2) Every person, firm, organization and entity authorized to possess and use epinephrine [auto-injector devices] delivery systems pursuant to this section shall use, maintain and dispose of such [devices] systems in accordance with the rules of the department;

and (3) Every use of an epinephrine [auto-injector device] delivery system pursuant to this section shall immediately be reported to the emergency health care provider.

3.

(1) Use of an epinephrine [auto-injector device] delivery system pursuant to this section shall be considered first aid or emergency treatment for the purpose of any law relating to liability.

(2) Purchase, acquisition, possession or use of an epinephrine [auto-injector device] delivery system pursuant to this section shall not constitute the unlawful practice of medicine or the unlawful practice of a profession.

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.

4.

Any person, firm, organization or entity that violates the provisions of this section is guilty of a class B misdemeanor.

191.117.

1.

This section shall be known and may be cited as the "Lori Zena Baker Act".

2.

There is hereby established in the department of health and senior services a "Sickle Cell Standing Committee" as a subcommittee of the Missouri genetic advisory committee.

The committee shall consist of the following members:

(1) One member who is a licensed physician with experience in the diagnosis and treatment of sickle cell disease and who shall serve as chair of the committee;

(2) One member who has sickle cell disease or is a family member of a person with sickle cell disease;

(3) One member with expertise in sickle cell disease research;

(4) One member from a leading sickle cell disease organization;

(5) One member with expertise in minority health;

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

3.

The members of the committee shall be appointed by the director of the department of health and senior services.

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

4.

The committee shall:

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

(2) Examine the existing services and resources addressing the needs of persons with sickle cell disease;

and (3) Develop recommendations to provide educational services to schools on the traits of sickle cell disease and its effects.

5.

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

(1) Trends in state sickle cell disease populations and their needs, including, but not limited to, the state's role in providing assistance;

(2) Existing services and resources;

and (3) Needed state policies or responses, including, but not limited to, directions for the provision of clear and coordinated services and supports to persons living with sickle cell disease and strategies to address any identified gaps in services.

SS SCS HCS HB 2372 16 6.

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

7.

The 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.

After 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.

191.708.

1.

The chief medical officer or chief medical director of the department of health and senior services or the MO HealthNet division of the department of social services, or any licensed physician acting with the express written consent of the director of any such department or division, may, within his or her scope of practice, issue:

(1) Nonspecific recommendations for doula services;

(2) A medical standing order for prenatal vitamins;

or (3) A medical standing order for any other purpose, other than for nonemergency pregnancy termination or for controlled substances, that is promulgated by rule in compliance with chapter 536.

2.

Any standing order issued under this section shall:

(1) Be made available on the relevant department's website while in effect;

(2) Terminate upon removal of the issuing medical professional's authority under this section by vacancy of his or her position or otherwise;

and (3) If not terminated sooner under subdivision (2) of this subsection, expire within one year of issuance unless renewed.

3.

The chief medical officer, chief medical director, or other authorized and licensed physician described in subsection 1 of this section shall be immune from criminal prosecution, disciplinary action from his or her professional licensing board, and civil liability for issuing a medical standing order or recommendation in accordance with this section, including for any outcome related to the standing order or recommendation.

191.1146.

1.

Physicians licensed under chapter 334 who use telemedicine shall ensure that a properly established physician-patient relationship exists with the person who receives the telemedicine services.

The physician-patient relationship may be established by:

(1) An in-person encounter through a medical [interview] evaluation and physical examination;

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;

or (3) A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

2.

In order to establish a physician-patient relationship through telemedicine:

(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;

[and] (2) Prior to providing treatment, including issuing prescriptions or physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall [interview] evaluate the patient, collect or review the patient's relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient.

[A] Any questionnaire completed by the patient, whether via the internet or telephone, shall be reviewed by the treating health care professional, as defined in section 376.1350, and shall include such information sufficient to provide the information as though the medical evaluation has been performed in person, otherwise such questionnaire does not constitute an acceptable medical [interview] evaluation and examination for the provision of treatment by telehealth;

and (3) Any provider that uses a questionnaire to establish a physician-patient relationship through telemedicine shall be employed or contracted with a business entity that is licensed to provide health care in this state.

3.

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

(1) The identity of the patient;

(2) The date of the evaluation;

(3) The diagnosis and treatment provided, if any;

and (4) Any further instructions provided to the patient.

192.020.

1.

It shall be the general duty and responsibility of the department of health and senior services to safeguard the health of the people in the state and all its subdivisions.

It shall make a study of the causes and prevention of diseases.

It shall designate those diseases which are infectious, contagious, communicable or dangerous in their nature and shall make and enforce adequate orders, findings, rules and regulations to prevent the spread of such diseases and to determine the prevalence of such diseases within the state.

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.

2.

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

3.

(1) A laboratory blood test result for alpha-gal immunoglobulin E that yields a level consistent with sensitization to alpha-gal by laboratory standards, as established by the current national case definition, shall be reported to the department within seven days.

The laboratory that generates the test results shall be responsible for submitting the report.

The test results shall be submitted using an electronic laboratory reporting system to be developed by the department.

(2) Subject to appropriation, the department may follow up on reported cases of alpha-gal immunoglobulin E blood test results by applying an appropriate random sampling method to ascertain case status, using the current national case definition of alpha-gal syndrome.

Reporting under this subdivision shall commence no later than six months after August 28, 2026.

(3) The department shall submit an annual report to the Centers for Disease Control and Prevention summarizing its findings related to the reporting and incidence of alpha-gal syndrome.

(4) The laboratory and the department shall not disclose the identifiable test result or other protected health information relating to any individual for which a blood test is obtained to anyone other than the individual for which the blood test result is obtained and the health care provider ordering the laboratory blood test.

192.026.

1.

Sections 103.190 and 192.026 to 192.029 shall be known and may be cited as the "Missouri Lyme Disease Eradication Act".

2.

As used in sections 103.190 and 192.026 to 192.029, the following terms shall mean:

(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;

provided, however, that nothing in this section shall be construed to prevent a member of the board from testifying to information obtained independently of the board or which is public information.

SS SCS HCS HB 2372 26 11.

The department may use grant program funds to support the efforts of the board and may apply for additional federal government and private foundation grants as needed.

The department may also accept private, foundation, city, county, or federal moneys to implement the provisions of this section.

192.2155.

1.

The division of senior and disability services within the department of health and senior services shall establish a dementia services coordinator as a full- time position.

2.

The dementia services coordinator shall:

(1) Evaluate the coordination of dementia services within this state;

(2)Coordinate information resources affecting Missourians living with dementia and their caregivers.

Such coordination shall include, but not be limited to:

(a) Using data to improve dementia service delivery for persons with Alzheimer's disease or related dementia;

(b) Establishing and maintaining relationships with other agencies, providers, and organizations within the state in order to meet the needs of affected populations and prevent the duplication of services;