Legislative Corner

Hospice Death

HB1435 PERFECTED – Rep. Dan Houx – The bill specified that, when a death occurs under the care of a hospice, no investigation shall be required if the death is certified by the treating physician of the deceased or the medical director of the hospice as a natural death due to disease or diagnosed illness. The hospice must give written notice to the coroner or medical examiner within 24 hours of the death (Sections 58.451 and 58.720)

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HB1435 changes the statutes regarding the procedures to follow upon the death of a hospice patient. This bill specifies that, when a death occurs under the care of a hospice, no investigation shall be required if the death is certified by the treating physician of the deceased or the medical director of the hospice as a natural death due to disease or diagnosed illness. The hospice must give written notice to the coroner or medical examiner within 24 hours of the death.

This Bill is moving through the legislative process and has a very high probability to pass during the 2020 Legislative Session and this year hopefully signed by the Governor. This bill was first introduced and passed during last year’s (2019) Legislative Session (2019) as HB 447. However, at the last minute prior to its passage an amendment was added allowing for outdoor cremation. The House Bill, with the amendment did pass however, due to the outdoor cremation language that was added at the last-minute, the Governor vetoed the entire bill.

Hospice Death

SB554 – Sen. Jeanie Riddle – Modifies provisions relating to coroners. When a death occurs under the care of a hospice, no investigation shall be required, under this act, if the death is certified by the treating physician of the deceased or the medical director of the hospice as a named death due to disease or diagnosed illness. The hospice must give written notice to the coroner or medical examiner within twenty-four hours of the death.

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End of Life Care Homes

HB1773 – Rep. Lane Roberts – Adds provisions relating to end-of-life care homes. – This bill defines an “End-of-Life Care Home” as a residence operated by a nonprofit organization that provides a home-like dwelling place for terminally ill residents with a life expectancy of six months or less who are enrolled in a hospice program. The bill requires the Department of Health and Senior Services to establish reasonable standards and regulations for these homes and create a process for registration which will cost no more than $100 per home. Staff and volunteers of the homes must be trained to recognize abuse, neglect, and exploitation. They must also have a system for grievances and allow inspection by the department at any time. Homes caring for no more than two persons, or only persons related to the provider are exempt from registration requirements. Any person in violation of any provision of Section 198.190, RSMo, or making false statements on a registration is guilty of a class A misdemeanor. A person violating this section wherein abuse or neglect of a resident has occurred is guilty of a class E felony.

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Nurses

HB1441 – Rep. Nick Schroer – Modifies provisions relating to Advanced Practice Registered Nurses

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Nursing Home Administrators

HB1445 – Rep. Steve Helms – Modifies licensing requirements for nursing home administrators – This bill only allows a person to be a nursing home administrator if the applicant has an associate degree or higher from an accredited academic institution or if the person has met criteria established by the Board of Nursing Home Administrators. Currently, the board may issue a temporary emergency nursing home administrator license for up to 90 days to a person 21 years or older, of good moral character, and a high school graduate or equivalent. This bill allows the board to issue a temporary emergency license for up to 120 days to a person who has met the criteria established by the board.

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Nursing Home Administrators

SB949 – Sen. Jeanie Riddle – Under current law, an applicant for a nursing home administrator license must have a minimum of three years of experience or two years of postsecondary education in health care administration or have satisfactorily completed a course of instruction prescribed by the Missouri Board of Nursing Home Administrators, and passed the examination administered by the Board.

Under this act, such applicant may meet this requirement if he or she has an associate degree or higher from an accredited academic institution.

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Small Business

HB1441 – Rep. Dan Shaul – Changes the laws regarding the Small Business Regulatory Fairness Board – This bill provides that all state agencies shall involve affected small businesses in the development of rules.

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DHSS – Prescribing opioids for Chronic Pain

HB1472 – Rep. LaDonna Appelbaum – Requires the Department of Health and Senior Services to promulgate regulations consistent with CDC guidelines for prescribing opioids for chronic pain.

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Prescribing Opioids for Chronic Pain

HB1580 – Rep. Keri Ingle – Requires the Department of Health and Senior Services to promulgate regulations consistent with CDC guidelines for prescribing opioids for chronic pain. Same as HB1472 above

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Prescription Abuse Registry

SB706 – Sen. Andrew Koenig – Establishes a “Prescription Abuse Registry” and modifies provisions relating to ephedrine, phenylpropanolamine, and pseudoephedrine

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Long Term Care Facilities

HB1387 – Rep. Andrew McDaniel – Establishes the “Authorized Electronic Monitoring in Long-Term Care Facilities Act”

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Veterans Residential Care

HB1485 – Rep. Holly Rehder -Authorizes the issuance of residential care vouchers to certain veterans

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Donations to Charities

HB1505 – Rep. Mark Ellebracht – Requires charities that accept donations to make their tax returns public.

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Narcotics Control Act

HB1693 – Rep. Holly Rehder – Establishes the “Narcotics Control Act” – This Bill would requires that the Department of Health and Senior Servicesl establish a program for monitoring the prescribing and dispensing of all Schedule II, III, and IV controlled substances, subject to appropriations. The department may apply for grants and accept donations.

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Narcotics Control Act

SB677 – Sen. Tony Luetkemeyer – Establishes the Narcotics Control Act and provides for the incineration of certain controlled substances. Under this act, certain controlled substances which have come into the custody of a peace officer or an officer or agent of the Department of Health and Senior Services may be disposed of through incineration, as described in the act, to the extent permissible under federal law.

This act also establishes the “Narcotics Control Act”. The Department of Health and Senior Services shall be required to establish and maintain a program to monitor the prescribing and dispensing of all Schedule II, III, and IV controlled substances by all licensed professionals who prescribe or dispense these substances in Missouri. The provisions of this act shall be subject to appropriations and may also be funded with federal or private moneys.

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Controlled Substances

SB928 – Sen. Justin Brown – Modifies provisions relating to the administration of certain controlled substances. Under current law, a health care practitioner shall not accept any portion of a controlled substance unused by a patient if the practitioner did not originally dispense the drug, unless as part of an authorized drug disposal program. This act permits a non-dispensing practitioner to accept the unused controlled substance when the controlled substance is prescribed to the patient and delivered to the practitioner to administer to the patient. Practitioners shall maintain records and secure the medication.

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Controlled Substances

SB523 SCS SB523 – Sen David Sater – Modifies provisions relating to the schedules of controlled substances. This act modifies several provisions relating to controlled substances, including: (1) the schedules of controlled substances; (2) medical marijuana; and (3) drug trafficking.

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Long Term Care Facilities

HB1743 – Rep. Chrissy Sommer – Establishes the “Authorized Electronic Monitoring in Long-Term Care Facilities Act”

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Long Term Care Facilities

HB1766 – Rep. Kathryn Swan – Modifies provisions relating to the Office of State Ombudsman for Long-Term Care Facility Residents within the Department of Health and Senior Services

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Health Care Professionals in Rural Areas

HB1986 – Rep. Peter Merideth – Beginning January 1, 2021, this bill creates a tax credit for health care professionals servicing a rural area. Beginning January 1, 2021, this bill creates a tax credit for health care professionals servicing a rural area. To qualify for the tax credit, at least 20% of a health care professional’s practice must consist of Medicare participating patients and 15% Missouri HealthNet participants.

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Advanced Practice Registered Nurses

HB2226 – Rep. Mike Stephens – Modifies provisions relating to advanced practice registered nurses

The bill removes all current requirements for a collaborative practice arrangement between an APRN and a collaborating physician, except for the requirements that the arrangement have the name, address, phone number, and license numbers of the APRN and collaborating physician and a description of the APRN’s controlled substance prescriptive authority.

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Advanced Practice Registered Nurses

SB714 – Sen. Eric Burlison – Modifies provisions relating to advanced practice registered nurses. his act modifies the definition of an advanced practice registered nurse to mean a person who is licensed to engage in the practice of advanced practice nursing as a certified clinical nurse specialist, certified nurse midwife, certified nurse practitioner, or certified registered nurse anesthetist.

Under this act, any applicant for licensure to practice as an advanced practice registered nurse (APRN) is required to submit a written application and fee established by the State Board of Nursing. Such application shall contain certain elements set forth in the act, and such fee shall be uniform for all applicants.

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Advanced Practice Registered Nurses

SB965 – Sen. Cindy O’Laughlin – Permits the Missouri State Board of Nursing to establish rules setting forth the licensure, renewal procedures, required fees, and discipline of advanced practice registered nurses.

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Professional Licensing with 8th Grade Education

SB877 – Sen. Eric Burlison – Beginning on January 1,2021, each state licensing authority shall grant a license to any applicant who has successfully completed the eighth grade, completed an apprenticeship approved by the Missouri Division of Professional Registration or the U.S. Department of Labor, and has passed an examination, if one is deemed to be necessary by the appropriate licensing authority. This Bill will affect all disciplines licensed by the Division of Professional Registration.

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Physician Assistants

HB2252 – Rep. Jim Neely – Modifies provisions relating to assistant physicians

Under current law, an assistant physician must have completed Step 2 of the United States Medical Licensing Examination (USMLE) or its equivalent. This bill requires an assistant physician to have completed either Step 2 or Step 3 of the USMLE or its equivalent.

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Cancer Patients/ Dental Treatments Insurance Coverage

HB2255 – Rep. Jim Neely – Requires insurance companies, including MO HealthNet, to cover medically necessary dental procedures that are a result of cancer treatments.

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Physicians

HB2256 – Rep. Derek Grier – Establishes Missouri as a member of the Interstate Medical Licensure Compact

The compact allows a physician who meets the eligibility requirements to receive an expedited license. The state must perform a criminal background check on an applicant and the state cannot require any additional verification beyond primary-source verification of medical education or results of medical or licensing examinations. A physician may renew his or her expedited license as a member of the compact. The compact establishes a confidential database of all physicians who have been granted an expedited license or who have applied for an expedited license, for the purpose of allowing member states to report disciplinary or investigatory information. Member states may participate in joint investigations of physicians with other member states, and any disciplinary action taken by one-member state may subject the physician to discipline with other member states. If a physician’s license is revoked, surrendered, or relinquished in one state, it shall automatically be placed on the same status in the other member states.

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Cancer Awareness License Plate

HB2271 – Establishes a special license plate for cancer awareness

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Health Care Professionals

HB 2326 – Rep. Steve Helms – This Bill makes prohibits an employer from requiring a health care professional employee to sign a noncompete agreement.

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Physicians, Advanced Practice Registered Nurses and Nonprofit Hospitals and Health Systems

SB932 – Sen. Bob Onder -Any contract or agreement that creates or establishes the terms of a partnership, employment, or any other form of professional relationship between a nonprofit hospital or health system and a physician or an advanced practice registered nurse that includes any restriction of the right of the physician or advanced practice registered nurse to practice medicine or nursing in any geographic area for any period of time after the termination of such partnership, employment, or professional relationship shall be void and unenforceable with respect to said restriction.

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Physicians and Health Care Facilities Licensed by Missouri

SB933 – Sen. Bob Onder -Under this act, hospitals, health care facilities, and institutions owned, operated, or licensed by the state are prohibited from conditioning employment or the granting of medical staff privileges of a physician based on his or her maintenance of certification or maintenance of licensure. This act also prohibits health carriers from conditioning physician reimbursement or participation in the carrier’s health plans on a physician’s maintenance of certification or maintenance of licensure.

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Medicaid Payments

SB934 – Sen. Bob Onder – Prohibits Medicaid payments to health care providers for services for non-Missouri residents. The state shall not provide any payments, add-ons, or reimbursements to health care providers through MO HealthNet for medical assistance services to persons who are not considered Missouri residents under federal regulations.

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Credentialing of Health Care Practitioners

SB938 – Sen Bob Onder – This act modifies provisions relating to the credentialing of health care practitioners by health carriers.

This act provides that if a health carrier receives a credentialing application, the carrier shall have ten days from sending notice of the application’s receipt to request additional information from the practitioner. The application shall be deemed complete upon receipt of the additional information. Within 2 working days of receipt of the additional information, the carrier shall send notice to the practitioner that the practitioner has submitted a completed application. If the carrier does not request additional information, the application shall be deemed completed as of the date the notice of receipt was sent by the carrier.

The act specifies that the carrier’s credentialing decision shall be made within 60 days of receipt of the “completed credentialing application”, rather than 60 “business” days of receiving the practitioner’s “credentialing information”.

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Credentialing of Health Care Practitioners

SB957 – Sen. David Sater – Enacts provisions relating to the credentialing of health care practitioners by health carriers. This act provides that once a health care practitioner has been credentialed or re-credentialed by a health carrier, the carrier shall provide retroactive payments for any covered services performed by the practitioner since the carrier received the practitioner’s completed credentialing application.

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Advertising of Healthcare Providers

SB942 – Sen. Jeanie Riddle -Under this act, any advertisement for the services of a health care practitioner shall use certain titles set forth in the act. Any such advertisement shall also include the practitioner’s full name and title and shall not include any fraudulent misrepresentation.

Under this act, any person who holds a license or recognition to practice advanced practice nursing in this state may only use the title “advanced practice registered nurse”, and the abbreviation “APRN, and any title designations set forth in the act, including certified advanced practice registered nurse, advance practice nurse, nurse anesthetist, certified registered nurse anesthetist, nurse midwife, certified nurse midwife, nurse practitioner, certified nurse practitioner, certified nurse specialist, doctor of nursing practice, or certified clinical nurse specialist.

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Latest News

Notice to Submit Comments for State of Missouri Hospice Rule

  Anyone may file a statement in support of or in opposition to this proposed amendment with Lisa Coots, Administrator, Bureau of Home Care and Rehabilitative Standards, Department of Health and Senior Services, Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102 or at Lisa.Coots@health.mo.gov. To be considered, comments must be received within thirty (30) days after publication of this notice in the Missouri Register. No public hearing is scheduled. To read the Missouri Register click here.  

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Coroner Bill

Governor Signs Coroner Bill Into Law COLUMBIA — On Monday, July 6, 2020 Governor Mike Parson signed HB 2046. Inside the omnibus bill was coroner training reform Jay Minor’s been working toward for years. Minor has been fighting for justice for his son, Jayke, who died in 2011. A 2018 KOMU Target 8 Investigation detailed a flawed autopsy from the Howard County Coroner, who ruled his cause of death to be a drug overdose solely due to Jayke’s history. The new law will update training requirements. Click here to read the full story.

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AGG Hospice CMS Quarterly Report

CMS Announces Hospice Flexibilities to Fight COVID-19 CMS has announced a series of temporary regulatory waivers and new rules to provide hospice providers with flexibility to respond to the COVID-19 pandemic. The goals of these actions are to expand the healthcare system workforce; ensure adequate capacity in hospitals and health systems; increase access to telehealth in Medicare; expand in-place testing; and put patients before paperwork. These exibilities include the following: Medicare Telehealth and Telecommunications Technology. Hospice providers can provide services to a Medicare patient through telecommunications technology (e.g., remote patient monitoring; telephone calls (audio only and TTY); and two-way audio-video…

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COVID-19

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Missouri Hospice & Palliative Care Association Incorporated is now a charity on AmazonSmile

What is AmazonSmile?AmazonSmile is a simple and automatic way for you to support your favorite charitable organization every time you shop, at no cost to you. When you shop at smile.amazon.com, you’ll find the exact same low prices, vast selection and convenient shopping experience as Amazon.com, with the added bonus that Amazon will donate a portion of the purchase price to your favorite charitable organization. You can choose from over one million organizations to support. How do I shop at AmazonSmile?To shop at AmazonSmile simply go to smile.amazon.com from the web browser on your computer or mobile device. You may also want…

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