RARE KIDNEY DISEASE AWARENESS MONTH (Section 9.388)

This act establishes March of each year as "Rare Kidney Disease" in Missouri.

This provision is similar to a provision in SS/HB 402 (2023).

OFFICE OF CHILD ADVOCATE (Section 37.725)

Currently, the identity of a complainant or recipient shall not be disclosed by the Office of Child Advocate unless they or their legal representative consents or a court orders the disclosure. This act permits disclosure of such identities if the Child Advocate determines that disclosure to law enforcement is necessary to ensure immediate child safety.

This provision is identical to a provision in SCS/HB 677 (2023) and substantially similar to SB 249 (2023).

"MISSOURI AS A MODEL EMPLOYER" INITIATIVE (Section 37.980)

The act requires the Office of Administration to submit a report to the General Assembly each year before December 31 regarding the progress made by the state with regards to the "Missouri as a Model Employer" initiative created by Executive Order 19-16.

This provision is identical to HCS/HB 971 (2023) and substantially similar to SB 978 (2020) and HB 2358 (2020).

SPECIAL EDUCATION RECORDS (Section 167.027)

Under this act, a student's special education record shall be deemed a permanent record and shall be maintained as a part of a child's cumulative scholastic record. No school district or pubic school shall destroy a child's most recent student special education record.

This provision is substantially similar to HB 1289 (2023).

OUTSIDE THE HOSPITAL DO-NOT-RESUSCITATE ORDERS (Sections 190.600-190.613)

This act modifies the "Outside the Hospital Do-Not-Resuscitate Act" by expanding the provisions to cover persons under 18 years of age who have do-not-resuscitate orders issued on their behalf by a parent or legal guardian or by a juvenile or family court under a current provision of law. Such orders shall function as outside the hospital do-not-resuscitate orders unless specifically stated otherwise. Persons who are not subject to civil, criminal, or administrative liability for certain actions taken upon the discovery of an adult outside the hospital do-no-resuscitate orders shall not be subject to such liability in the case of a minor child's do-not-resuscitate order. Emergency services personnel shall be authorized to comply with the minor child's do-not-resuscitate order, except when the minor child, either parent, the legal guardian, or the juvenile or family court expresses to such emergency services personnel in any manner, before or after the onset of a cardiac or respiratory arrest, the desire for the patient to be resuscitated.

Under this act, do-not-resuscitate orders from other states or territories, or Transportable Physician Orders for Patient Preferences/Physician Orders for Life-Sustaining Treatment (TPOPP/POLST) forms containing specific do-not-resuscitate provisions, as described in the act, shall be accepted under this provision and may be revoked by the patient or patient's representative at any time and by any means.

These provisions are substantially similar to provisions in SS/HB 402 (2023) and SS/SCS/SB 228 (2023) and similar to HB 2741 (2022).

HEALTH PROFESSIONAL LOANS AND GRANTS (Sections 191.430-191.450, 191.500-191.550, 191.592, 191.600, 191.828, 191.831, and 335.203-335.257)

This act repeals current law relating to student loans for certain health professional students and establishes the "Health Professional Loan Repayment Program". Under this program, the Department of Health and Senior Services shall provide forgivable loans in order to repay existing loans for eligible educational expenses for health professional students.

The Director of the Department shall have the discretion to select the health professionals who are eligible for the forgivable loans in accordance with the greatest need in the best interest of the public. Individuals receiving loans under this program shall agree to serve at least 2 years in an area of defined need as a condition of receipt of the funds, among other criteria that must be met as delineated in the act. An individual who fails to uphold the loan agreement shall be liable for the amount paid to the individual by the Department under this program. Furthermore, if an individual breaches a written contract executed pursuant to this provision by failing to begin or complete his or her service obligation, the state shall be entitled to recover from such person an amount equal to:

  The total amount of the loan awarded by the Department or, if the Department had already awarded partial forgiveness at the time of the breach, the amount of the loan not yet forgiven;

  The interest on the amount that would be payable if at the time the loan was awarded it was a loan bearing interest at the maximum prevailing rate as determined by the Treasurer of the United States;

  An amount equal to any damages incurred by the Department as a result of the breach; and

  Any legal fees or associated costs incurred by the Department or the state of Missouri in the collection of damages.

The act additionally creates the Health Professional Loan Incentive Fund for the purpose of allowing the Department to provide loans under this provision. The fund will consist of funds appropriated to it by the General Assembly.

These provisions are identical to provisions in SS/HB 402 (2023) and HB 542 (2023) and substantially similar to SB 555 (2023).

This act establishes a medical residency grant program to award grants, subject to appropriation, for eligible entities for the purpose of establishing and funding new general primary care and psychiatry medical residency positions in Missouri and continuing the funding of the new positions for the duration of the residency. Funding shall be available for 3 years for residency positions in family medicine, general internal medicine, and general pediatrics. The Department of Health and Senior Services shall establish criteria for the grants as described in the act and report on the program to the General Assembly.

This provision expires on January 1, 2038.

This provision has an emergency clause.

This provision is identical to HCS/HB 1162 (2023).

The act modifies the Nursing Education Incentive Program. Under current law, grant awards made under the program are limited to $150,000. This act repeals that limit. Additionally, the State Board of Nursing is required to collect, at the time of any license application or license renewal application, a Nursing Education Incentive Program surcharge from each person licensed or relicensed as a nurse under Missouri law. Such surcharge shall be equal to $1 for practical nurses and $5 for registered professional nurses.

The act repeals the Nursing Student Loan Program and the Nursing Student Loan Repayment Program.

These provisions are identical to provisions in SS/HB 402 (2023) and HB 775 (2023).

PATIENT EXAMINATIONS (Section 191.240)

Under this act, no health care provider, or any student or trainee under the supervision of a health care provider, shall perform a patient examination, defined as a prostate, anal, or pelvic examination, upon an anesthetized or unconscious patient in a health care facility, unless: (1) the patient or person authorized to make health care decisions for the patient gives specific informed consent for nonmedical purposes, (2) the patient examination is necessary for diagnostic or treatment purposes, (3) the collection of evidence through a forensic examination for a suspected sexual assault is necessary because the evidence will be lost or the patient is unable to give informed consent due to a medical condition, or (4) emergency implied consent, as described in the act, is present. A health care provider shall notify a patient of any such examination performed.

A health care provider who violates the provisions of this act, or who supervises a student or trainee who violates the provisions of this act, shall be subject to disciplinary action by the provider's licensing board.

This provision is substantially similar to SCS/HB 283 (2023), HCS/HB 1742 (2022), and SB 746 (2022).

TRANSITIONAL BENEFITS FOR TANF, SNAP, AND CHILD CARE (Sections 208.035 and 208.053)

This act establishes, subject to appropriations, a transitional benefits program for Temporary Assistance for Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP). Such transitional benefits shall be designed to assist recipients of such programs whose monthly income has exceeded the maximum allowable income for program eligibility to continue receiving reduced benefits, as described in the act. Recipients of transitional benefits shall comply with all requirements of each program for which they are eligible, including work requirements. Transitional benefits received under this act shall not be included in the lifetime limit for TANF benefits.

This act modifies provisions relating to transitional child care benefits by expanding the Hand-Up pilot program statewide for individuals whose incomes exceed the maximum allowable amount for the full child care subsidy benefit. Transitional child care benefits shall be reduced benefits determined on a sliding scale as the recipient's income increases, with the recipient paying the remainder of the fee to the child care provider. Additionally, this act removes the expiration date of the Hand-Up program.

These provisions are similar to provisions of the perfected SS/SB 82 (2023).

PUBLIC ASSISTANCE APPLICATIONS (Sections 208.066 and 208.072)

Under this act, the Department of Social Services, subject to federal approval, shall limit any initial application for SNAP, TANF, child care assistance, or any medical assistance or health insurance program to a concise, non-duplicative, and easily accessible form on the Department's website. Program participants who are required to complete a periodic eligibility review form may submit such form as an attachment to their Missouri state individual income tax return if the eligibility review form is due at the same time as the tax return. Such eligibility forms shall also be made accessible on the Department of Revenue's website.

This provision is substantially similar to a provisions in SS/SB 82 (2023), HB 1960 (2020) and similar to HB 2048 (2022).

BREAST EXAMINATIONS (Sections 192.775, 376.782, and 376.1183)

This act prohibits certain mammography facilities from requiring a referral from a primary care provider for a screening mammogram that is consistent with the recommendations in the most recent guidelines established by the American College of Radiology.

This act prohibits cost-sharing requirements under coverage for certain low-dose mammography screenings if a separate provision of law prohibits cost-sharing requirements with respect to such coverage. The act also prohibits health carriers from requiring a referral from a primary care provider to obtain a low-dose mammography screening required by law to be covered.

This act prohibits cost-sharing requirements under coverage provided for diagnostic breast examinations, supplemental breast examinations, or low-dose mammography screenings. If these provisions would result in health savings account (HSA) ineligibility, these provisions shall apply to HSA-qualified high-deductible health plans only after the deductible has been met.

These provisions are substantially similar to HCS/HBs 575 & 910 (2023) and similar to provisions in SB 461 (2023), SB 1166 (2022), and HB 2427 (2021).

PHARMACY SETTLEMENTS (Section 196.1050)

This act adds proceeds from opioid settlements with pharmacies to the Opioid Addiction Treatment and Recovery Fund.

This provision is identical to a provision in SS/HB 402 (2023).

RURAL EMERGENCY HOSPITALS (Section 197.020)

This act modifies the term "hospital" for purposes of licensure to include facilities designated as rural emergency hospitals by the Centers for Medicare and Medicaid Services.

This provision is identical to a provision in SS/HB 402 (2023) and substantially similar to SB 420 (2023).

SUPPLEMENTAL WELFARE ASSISTANCE (Section 208.030)

Under current law, certain persons may be eligible for up to $156 a month in supplemental welfare assistance for home care in licensed residential care facilities. This act removes that monthly cap and makes such assistance subject to appropriations.

This provision is identical to SB 336 (2023) and SB 1192 (2022), and to a provision in SS/HB 402 (2023), and is similar to provisions in CCS/HCS/SS/SB 690 (2022) and HCS/HB 2727 (2022).

TRANSITIONAL BENEFITS FOR TANF, SNAP, AND CHILD CARE (Sections 208.035 and 208.053)

This act establishes, subject to appropriations, a transitional benefits program for Temporary Assistance for Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP). Such transitional benefits shall be designed to assist recipients of such programs whose monthly income has exceeded the maximum allowable income for program eligibility to continue receiving reduced benefits, as described in the act. Recipients of transitional benefits shall comply with all requirements of each program for which they are eligible, including work requirements. Transitional benefits received under this act shall not be included in the lifetime limit for TANF benefits.

This act modifies provisions relating to transitional child care benefits by expanding the Hand-Up pilot program statewide for individuals whose incomes exceed the maximum allowable amount for the full child care subsidy benefit. Transitional child care benefits shall be reduced benefits determined on a sliding scale as the recipient's income increases, with the recipient paying the remainder of the fee to the child care provider. Additionally, this act removes the expiration date of the Hand-Up program.

These provisions are similar to provisions of the perfected SS/SB 82 (2023).

PUBLIC ASSISTANCE APPLICATIONS (Section 208.066 and 208.072)

Under this act, the Department of Social Services, subject to federal approval, shall limit any initial application for SNAP, TANF, child care assistance, or any medical assistance or health insurance program to a concise, non-duplicative, and easily accessible form on the Department's website. Program participants who are required to complete a periodic eligibility review form may submit such form as an attachment to their Missouri state individual income tax return if the eligibility review form is due at the same time as the tax return. Such eligibility forms shall also be made accessible on the Department of Revenue's website.

This provision is substantially similar to a provisions in SS/SB 82 (2023), HB 1960 (2020) and similar to HB 2048 (2022).

TICKET TO WORK HEALTH ASSURANCE PROGRAM (SECTION 208.146)

The Ticket to Work Health Assurance Program provides medical assistance through MO HealthNet for employed disabled persons who meet certain qualifications, including asset limits and earned, net, and gross income calculations. Under current law, disabled individuals whose income exceeds one hundred percent of the federal poverty level (FPL) pay a premium for participation in the program. If an eligible person's employer offers employer-sponsored health insurance and the Department of Social Services determines the employer-sponsored insurance is more cost effective, the Department will instead pay that person's costs for the employer-sponsored health insurance.

This act changes the program in the following ways: (1) excludes retirement accounts from asset limit calculations; (2) modifies the income calculation from a net/gross calculation to a broader definition that would consider income for those disabled persons with incomes up to 250% FPL, with earned income of the disabled worker from 250 to 300% FPL disregarded, and retaining the requirement that persons with incomes over 100% FPL pay a premium; (3) removes all earned income of the disabled worker from the list of disregards in income determinations; (4) adds to the list of disregards the first $50,000 of earned income of a spouse; (5) if the Department elects to pay the person's costs of employer-sponsored health insurance, MO HealthNet assistance shall be provided as a secondary or supplemental policy for only personal care assistance services and non-emergency medical transportation; and (6) the Department shall provide an annual report to the General Assembly concerning the number of participants and outreach and education efforts.

This provision is identical to HCS/HBs 971 & 970 (2023) and HB 194 (2023), and to a provision in CCS/HCS/SS/SCS/SBs 45 & 90 (2023), and substantially similar to SB 773 (2022), HB 1927 (2022), SB 607 (2021), SB 629 (2020), SB 432 (2019), and the perfected SS/SB 699 (2018), and similar to HB 1527 (2018), SCS/SB 203 (2017), and SB 925 (2016).

MO HEALTHNET FOR PREGNANT AND POSTPARTUM WOMEN (Sections 208.151 and 208.662)

Currently, low-income pregnant and postpartum women receiving benefits through MO HealthNet for Pregnant Women or Show-Me Healthy Babies are eligible for pregnancy-related coverage throughout the pregnancy and for 60 days following the end of the pregnancy. Under this act, MO HealthNet coverage for these low-income women will include full Medicaid benefits for the duration of the pregnancy and for one year following the end of the pregnancy. This coverage shall begin on the effective date of the act and shall continue during any period of time the federal authorization for such coverage is in effect.

These provisions have an emergency clause.

These provisions are substantially similar to CCS/HCS/SS/SCS/SBs 45 & 90 (2023), SCS/SBs 698 & 639 (2022) and provisions in HCS/SS#2/SB 823 (2022) and SCS/HCS/HB 2012 (2022).

OUT OF STATE MO HEALTHNET PAYMENTS (Section 208.186)

Under this act, 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