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Size of health omnibus bill swells in session’s final days

by Joe Gamm | May 8, 2022 at 4:00 a.m.

The Missouri House is scrambling to get bills passed as the end of the state's legislative session looms.

However, rancor in the Senate chamber has prevented most legislation from crossing the finish line. Representatives said Wednesday, should the Senate suddenly set its differences aside, it still wouldn't have enough time to hear all the bills the House has passed in committees.

So the lower chamber Wednesday attached 21 amendments to Senate Bill 710, which started out as "Will's Law," requiring public and charter school nurses to develop individualized health care plans for students who have epilepsy or seizure disorders. The plan protects school employees from being held liable for any good faith act or omission while performing their duties. The bill included an emergency clause.

Most lawmakers saw the bill as something they could get onboard with. However, they hoped to bring other bills on board as well, to give them a chance this unusual session.

Representatives in committee added more than a dozen new health laws to it. On Wednesday, when it reached the lower chamber's floor, representatives added another 21 amendments to the bill. They added seven amendments to their amendments.

Initial round of amendments

The House Rules's Administrative Oversight Subcommittee added wording creating Sickle Cell Awareness Week the third full week in September. Under this law, MO HealthNet, the Missouri Medicaid plan, is required to review issues relating to sickle cell disease (including medications and treatments). The review may lead to development of a report.

The subcommittee added the medical preceptorship tax credit, which would authorize a physician acting as a mentor for up to three medical students to receive a $1,000 tax credit for each student.

The committee added administration of epinephrine auto syringes on a student by any agents trained by a nurse. The trained administrator shall be immune from civil liability.

It modified schedules for the Alzheimer's State Plan Task Force, such as when it should submit a report.

It added psychiatry, dental surgery, dental medicine or dental hygiene students to the list of those eligible to be considered for the Medical Student Loan program. It also increases the loan amount from up to $7,500 annually to up to $25,000 annually. The change also modifies amounts for the Nursing Student Loan program, increasing assistance available from $5,000 annually to $10,000.

The subcommittee added a segment intended to prevent someone from knowingly neglecting a person receiving health care. This portion also makes it a felony to abuse an elderly person, a person with a disability or a vulnerable person.

Several subcommittee additions target hospital, hospice or long-term care facility visitation policies.

The "Compassionate Care Visitation Act" would require facilities to a compassionate care visitor during visiting hours. That person may be a friend, family member, clergy member or lay person offering religious or spiritual support, hairdresser or barber, or other person requested by the patient or resident. Health care facilities are required to permit at least two compassionate care visitors simultaneously. Visiting hours shall include evenings, weekends or holidays.

The Essential Caregiver Program Act" would -- during a governor- declared state of emergency -- require hospitals, long-term care facilities, or facilities operated by the Missouri Department of Mental Health to allow residents of facilities (or their guardians) to designate an essential caregiver for in-person contact with the resident, establish in-person contact hours, and set procedures enabling physical contact between the caregiver and resident.

A facility may request a suspension of in-person contact for a period not to exceed seven days. The suspension may be extended, but not for more than 14 consecutive days in a 12-month period.

An amendment to the bill transfers authority for implementation of the federal Older Americans Act from the Department of Social Services to the Department of Health and Senior Services (DHSS).

An amendment increases DHSS oversight for some facilities. It updates the frequency of inspections for adult day care facilities and licensed hospitals.

DHSS conducts at least two inspections per year for licensed adult day care programs (at least one of which is unannounced). The bill reduces the requirement to only an unannounced inspection, according to the bill summary. The bill would also required dated receipts for delivery of statements of deficiency for long-term care facilities.

An amendment incorporates many features of Rep. Dave Griffith's, R- Jefferson City, House Bill 2680, concerning organ donors. It allows money in the Organ Donor Program Fund to be used for educational initiatives donor family recognition efforts, training and other initiatives.

The amendment prohibits hospitals, physicians, procurement organizations, or other persons from considering COVID-19 vaccination status of a potential organ transplant recipient or donor during any part of the transplant process.

An amendment excludes fentanyl testing strips from the definition of drug paraphernalia.

One amendment requires anyone who operates an agency that provides or procures employment for health care personnel in assisting living facilities, intermediate care facilities, residential care facilities or skilled nursing facilities (known as supplemental health care services agencies) must register annually with the DHSS.

Vendors participating in the MO HealthNet consumer-directed services program are directed to pay all payroll, employment and other taxes under penalty of fines.

An amendment repeals requirements for physicians or health care providers to report high-risk pregnancies to the DHSS for referral for services.

All these amendments came before SB 710 hit the House floor. Once on the floor (Wednesday), the bill became a catch-all for health-related legislation.

More amendments added on the floor

The first amendment attached on the floor would create the Kratom Consumer Protection Act. Kratom has opioid properties, according to the National Institute on Drug Abuse. People have reported using it for management of drug withdrawal symptoms and cravings. The act would require purchasers to be 18 or older. The act prevents kratom dealers from contaminating products with dangerous non-kratom substances.

The second amendment attached on the floor changes wording to allow juveniles younger than 12 to be allowed as compassionate care visitors in health care facilities.

"The health care facility shall have the burden of proof to establish that it is entitled to limit access under the provisions of this section," additional wording says. "Any individual aggrieved by a violation of this section may bring a civil action for injunctive relief, damages or both."

Provisions of the section, it states, shall not apply to any inpatient facility operated by DMH.

The third amendment from the floor requires DMH to oversee a project to assess incidence and implications of continued hospitalization of foster children and DMH clients because appropriate post-discharge placement options are not available. It should assess hospitalizations that occur without medical justifications. It should develop recommendations to assure patients received the most cost-effective treatments.

DMH must solicit and consider data from hospital social workers, health insurers, psychiatrists, hospitals, skilled nursing facilities, vendors and others. It should create interim reports before Dec. 31, 2022, and before July 1, 2023. A final report should be delivered by Dec. 1, 2023.

Next came an amendment making June "Myasthenia Gravis Awareness Month" in Missouri. Myasthenia Gravis is an autoimmune disorder in which antibodies destroy communication between nerves and muscles. The amendment also sets aside Sept. 15 each year as "Caregiver Appreciation Day."

The fifth amendment limited a previous amendment concerning transplants.

The sixth amendment allows anyone in a clinical fellowship (supervised professional employment period) shall hold provisional license to practice speech-language pathology or audiology. It sets the limit for a provisional license -- which will expire in a year.

The seventh amendment, which would be called the "Tricia Leann Tharp Act," recommends all licensed pharmacists obtain two hours of continuing education in suicide awareness and prevention. The Board of Pharmacy shall develop guidelines for materials that may be used by accredited schools of pharmacy and other organizations.

The next amendment sets rules for certain health care workers who wish to claim tax credits for work done in rural communities.

The ninth amendment allows nurse practitioners, clinical nurse specialists or physician assistants to create written treatment plans for people receiving certain home health services.

The 10th amendment includes "practitioners," pharmacists, dentists, chiropractors, optometrists, podiatrists, psychologists or advanced practical nurses as professionals who may be considered "health carriers" within a network.

Next came legislation requiring health care providers to get patients' permission before allowing students or trainees to conduct prostate, anal or pelvic examinations on them.

Rep. Shamed Dogan, R-Ballwin, who sponsored the amendment, testified on the floor that some medical schools allow students to conduct the intrusive examinations on patients when they are under anesthesia, without the patients' knowledge.

"If you're going to do something like this, you should have somebody's consent. You should write it up," Dogan said. "Most places, most ethical doctors, most of our teaching hospitals do this already, but there are some who are not doing it."

Amendment 11 changes state policy to align with state policy concerning who may purchase and use tobacco products. The minimum age to purchase the products is 18, while the federal age is 21.

If the entire state does not raise the age to 21, it will be fined under the Substance Abuse and Mental Health Services Administration's grant program, sponsors said.

The 13th amendment limits civil penalties federal agencies may assess against health care facilities to $100,000. It further states that if damages are caused by the negligence, actions or failures of the facility, liability will be determined by a "percentage of fault" and shall be the responsibility of the party against whom the determination is made. Determinations shall be made by a neutral arbiter.

The next bill caused consternation on the House floor, not because of its content, but because its handler, Rep. Jamie Burger, R-Benton, demanded it be added "clean."

Burger's amendment would create "Missouri Donate Life Day" each April 16. The intent is to increase public awareness of the need for organ donations.

Rep. LaKeySha Bosley, D-St. Louis, offered an amendment to Burger's amendment, requesting the week of April 11-17 each year be designated "Black Maternal Health Week." Her amendment also asked that April be designated as "Minority Health Month."

It's important to acknowledge the importance of organ donation, but it's also important to recognize health opportunities, in general, Bosley said. She said the designations align with Burger's legislation.

Burger agreed her causes were worthy, but asked the body vote down the amendment to the amendment, so his could go through the lawmaking process cleanly.

Supporters of Bosley's amendment reminded members a conference committee would likely select any legislation that should be removed from the bill. The amendment passed.

The next amendment added to the bill prevents a pharmacy benefits manager from discriminating against a pharmacy by reimbursing a covered entity or pharmacy for a quantity of 340 drugs (a federal act requiring pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations) at an amount less than it would pay to any other pharmacy. It prevents the manager from imposing any conditions on one entity that it wouldn't impose on another.

The next amendment requires all public health orders are to be approved by a vote of the local elected governing body of the city or county and shall not extend beyond 60 days. Any order that partially closes or places restrictions on a business, or that limits public and private gatherings, shall expire in 20 days.

No local elected governing body shall issue or authorize any order relating to a statewide pandemic pursuant to this section, unless the governor has by executive order, directed state health officials to set criteria for such an order.

"No public or charter school shall implement or enforce any student address requirements that include a mask or other face covering or respirator," the amendment states.

Another amendment creates the opportunity for dentists to enter medical retainer agreements -- in which patients pay a monthly retainer fee to the dentist, who provides services as the patient needs them.

The next amendment allows a pharmacist to dispense self-administered oral hormonal contraceptives to a person who is 18 or older, and who has a prescription. The pharmacist must complete a training program. Pharmacists must provide a self-screening risk assessment that the patient shall use prior to receiving the contraceptive. At least once every 12 months, the pharmacist must refer the patient to the patient's primary care practitioner.

The final amendment to the bill extends benefits for pregnant women receiving care under MO HealthNet from 60 postpartum to one year. Supporters pointed out that many of the deaths among postpartum women in Missouri occur after 60 days have passed.

Lawmakers amended this amendment with the "Stop the Bleed Act," which would require bleeding control kits to be placed in high-traffic areas of schools. It would require school personnel receive annual training in use of the kits.

Another amendment would require certain health care providers to focus on "time-critical diagnosis" in trauma care or stroke care. It changes makeup of and requires Missouri's State Advisory Council on Emergency Medical Services to develop trauma center designation criteria.

The Missouri Senate requested a conference committee meeting on the bill Friday.

Click the link below to read the full bill:

• SB 710: Modifies provisions relating to health care

Sponsor: Sen. Doug Beck


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