HB 2372

Published by the Missouri House as the official summary of the version that passed (source PDF). Reproduced here in full, unedited.

SS SCS HCS HB 2372 -- HEALTH CARE

AWARENESS DAYS (Sections 9.021, 9.025, 9.238, 9.412, 9.418, 9.501, and 9.502, RSMo)

This bill designates the month of January as "Blood Donor Awareness Month", each September as "Brain Aneurysm Awareness Month" and "Pediatric Cancer Awareness Month", the last full week of April each year as "Infertility Awareness Week", March 26th of each year as “Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)/Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) Awareness Day”, the first full week in September as "June's Week" and "Rare Pediatric Disease Week", and the week beginning the last Monday in September as "Frontotemporal Degeneration (FTD) Awareness Week".

HOSPITAL INVESTMENTS AND SERVICE AREAS (Sections 96.192, 96.196, 206.110, and 206.158)

This bill modifies the investment authority of boards of trustees of municipal hospitals in third class cities and hospital district hospitals. Current law permits investment of up to 25% of funds not required for operations of the hospital or other obligations. This bill permits investment of up to 50% of "available funds" defined as funds not required for operations or other obligations in the manner described in the bill, with the remaining portion to be invested into any investment in which the state Treasurer is allowed to invest. These provisions will only apply if the hospital receives less than 3% of its annual revenues from municipal, county, or state taxes, or appropriated funds from the municipality in which such hospital is located.

Under this bill, municipal hospitals in third class cities can operate in areas where hospital district hospitals and county hospitals operate. Hospital district hospitals can operate in areas where municipal hospitals in third and fourth class cities and county hospitals operate.

LYME DISEASE (Sections 103.190, 192.026, 192.027, 192.028, and 192.029)

This bill requires the Missouri consolidated health care plan to provide coverage for testing, treatment, and management of Lyme disease and post-treatment Lyme disease syndrome for certain participants. The bill requires health care providers, laboratories, and local health departments to report confirmed or suspected cases of Lyme disease to the Department of Health and Senior Services (DHSS) within seven days of diagnosis. The DHSS will then compile an annual report on the incidence and prevalence of Lyme disease in Missouri, as described in the bill. The DHSS will also collaborate with public four-year institutions of higher education to integrate Lyme disease surveillance data into existing tick-borne disease monitoring programs.

This bill creates the "Lyme Research and Eradication Fund" within the State Treasury. The DHSS will use the moneys in the Fund to distribute grants for the purposes of developing treatments, studying novel therapies, and researching eradication strategies. Grants will be prioritized as described in the bill, with no less than 20% of funds utilized to support eradication efforts in rural counties.

This bill also establishes within the Department the "Lyme Disease Task Force", with membership and responsibilities specified in the bill.

Under this bill, a health care provider will not be subject to any discipline, suspension, or revocation of license or denial of a license renewal, solely for prescribing, administering, or dispensing treatments or therapies for Lyme disease or Post- Treatment Lyme Disease Syndrome (PTLDS), including extended antibiotic therapy or similar treatment deemed medically necessary.

EPINEPHRINE PRODUCTS (Sections 167.627, 167.630, 190.246, 196.990, and 321.621)

This bill changes the term "epinephrine auto-injector" to "epinephrine delivery system" throughout statute, defined as a single-use device or system used for the delivery of a premeasured dose of epinephrine into the human body.

This bill adds epinephrine delivery systems to provisions of statute that permit the possession and self-administration of the medication to treat a student's chronic health condition, such as asthma or anaphylaxis.

The bill authorizes each Board of Education in this State to grant permission to pupils, as well as each school board in this State to grant permission to school nurses to use this medication.

This bill additionally modifies existing provisions for epinephrine possession, use limitations, and stock supply by adding epinephrine delivery systems as eligible products and nursing homes and facilities, as well as child care facilities, to the list of authorized entities.

Current law authorizes qualified first responders, as defined in the bill, to administer epinephrine auto-injectors to a person who is suffering from an apparent anaphylactic reaction. This bill extends that authorization to epinephrine delivery systems.

PEDIATRIC DISEASE TASK FORCE (Section 173.690)

This bill creates the "Pediatric Disease Task Force" within the Department of Higher Education and Workforce Development (DHEWD), with membership as described in the bill, including two members appointed by the Speaker of the House of Representatives and two members appointed by the President Pro Tem of the Senate. Beginning January 1, 2027, the Task Force will meet at least quarterly, and the Task Force is required to submit an annual public report to the Governor and the General Assembly by December 31st of each year. Such report will detail research initiatives within the sState focused on genetic and pediatric diseases, including rare pediatric diseases; summarize key outcomes achieved by the research initiatives; account for funds expended and leveraged by the research initiatives; and include any legislative recommendations.

This provision will expire on December 31, 2030.

COMMUNITY PARAMEDIC SERVICES (Sections 190.098 and 190.165)

This bill modifies provisions relating to certification of community paramedics and the provision of community paramedic services. "Community paramedic services" mean those services provided by an entity that employs licensed paramedics certified by DHSS as community paramedics for services that are provided in a nonemergent setting, consistent with the education and training of a community paramedic and the supervisory standard approved by the medical director, and documented in the entity's patient care plans or protocols. Ambulance services will enter into written contracts with other ambulance service providers to provide community paramedic services in that provider's service area.

The DHSS will establish regulations for the purpose of recognizing community paramedic services entities that have met the standards necessary to provide such services. The DHSS will endorse such entities to provide community paramedic services for a period of five years.

EMERGENCY MEDICAL SERVICE SCOPE OF PRACTICE (Section 190.142)

The bill authorizes each level of licensed emergency medical technicians to perform only patient care that is consistent with the current National EMS Scope of Practice Model.

SICKLE CELL STANDING COMMITTEE (Section 191.117)

This bill creates the "Lori Zena Baker Act". The bill establishes the "Sickle Cell Standing Committee" as a subcommittee of the Missouri Genetic Advisory Committee within DHSS, with membership as specified in the bill. The Director of DHSS will appoint the committee members. The Committee will assess the impact of sickle cell disease on the State and make recommendations to the General Assembly and Governor regarding services and policies to address the State's needs, as described in the bill.

DOULA SERVICES (Sections 191.708, 208.662, 208.1400, 208.1405, 208.1410, 208.1415, 208.1420, and 208.1425)

This bill allows for the chief medical officer or chief medical director of DHSS, the MO HealthNet division of the Department of Social Services (DSS), or any licensed physician acting with the written consent of any of the aforementioned department directors, to issue nonspecific recommendations for doula services, a medical standing order for prenatal vitamins, or a medical standing order for purposes not related to that of controlled substances or of nonemergency pregnancy termination.

Additionally, the bill adds childbirth education classes to covered services for unborn children enrolled in the Show-Me Healthy Babies Program. The bill also establishes the "Missouri Doula Reimbursement Act". Under the provisions of this bill, the MO HealthNet program is required to cover the following doula services:

(1) A combined total of six support sessions, provided that a participant who needs more than the six is entitled to up to 10 additional support sessions for a combined total of 16 support sessions;

(2) One birth attendance, including attendance at a scheduled cesarean section delivery;

(3) Up to two visits for general education and support on lactation at any time during the prenatal and postpartum periods; and

(4) Community navigation services, except that those services provided outside any of the above visits or sessions will only be billed up to 10 times total over the course of the pregnancy and postpartum period.

The bill specifies under what conditions a doula is eligible for participation as a provider of doula services and that once enrolled as a provider, a doula is eligible to enroll as a provider with fee-for-service, and managed care payers affiliated with MO HealthNet program, but that services must be reimbursed on a fee-for-service schedule.

The MO HealthNet division will promulgate all necessary rules and regulations for the administration of this provision.

TELEHEALTH (Sections 191.1146 and 334.108)

Currently, the establishment of a physician-patient relationship for purposes of telehealth must include an interview and a physical examination. Under this bill, an evaluation is required, but a physical examination will be required only if needed to meet the standard of care.

Current law prohibits the use of an internet or telephone questionnaire completed by a patient from constituting an acceptable medical interview for the provision of treatment by telehealth. This bill permits such questionnaires if the information provided is sufficient as though the medical evaluation was performed in person, with a report to be provided to the patient's primary health care provider within 14 days of evaluation, as described in the bill.

Additionally, current law requires a physician-patient relationship for purposes of telehealth to include a sufficient dialogue with the patient regarding treatment. This bill changes "dialogue" to "exchange" with the patient regarding treatment options.

Finally, current law prohibits a health care provider from prescribing any drug, controlled substance, or other treatment to a patient based solely on an internet request or questionnaire. Under this bill, a health care provider must not prescribe any drug, controlled substance, or other treatment to a patient in the absence of a proper provider-patient relationship and medical records of such prescriptions must be collected, stored, and maintained in accordance with the Health Insurance Portability and Accountability Act of 1996.

DISEASE SURVEILLANCE (Section 192.020)

This bill adds alpha-gal syndrome to the list of diseases that must be reported to DHSS. Any alpha-gal syndrome case report must be submitted to DHSS within seven days of receiving a positive laboratory confirmation.

Subject to appropriations, DHSS can follow up on reported cases by applying a random sampling method for confirmation that the cases meet the most current surveillance case definition of alpha-gal syndrome of the Centers for Disease Control and Prevention (CDC).

The bill requires DHSS to submit an annual report to the CDC summarizing its findings related to the reporting and incidence of alpha-gal syndrome.

The laboratory and DHSS are prohibited from disclosing the identifiable test result or other pr