HOUSE BILL NO. 1304 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE AUNE.
2712H.02I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal sections 188.015, 188.017, 188.020, 188.021, 188.027, 188.030, 188.033, 188.038, 188.039, 188.047, 188.052, 188.056, 188.057, 188.058, 188.075, 188.080, 188.230, 188.375, 192.665, 192.667, 197.150, 197.152, 197.158, 197.160, 197.162, 197.165, 197.200, 197.205, 197.215, 197.220, 197.225, 197.230, 197.235, 197.240, 197.285, 197.287, 197.289, 197.293, 197.295, 334.100, 334.245, 334.735, 574.200, and 595.027, RSMo, and to enact in lieu thereof twenty-five new sections relating to abortion.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 188.015, 188.017, 188.020, 188.021, 188.027, 188.030, 188.033, 2 188.038, 188.039, 188.047, 188.052, 188.056, 188.057, 188.058, 188.075, 188.080, 188.230, 3 188.375, 192.665, 192.667, 197.150, 197.152, 197.158, 197.160, 197.162, 197.165, 197.200, 4 197.205, 197.215, 197.220, 197.225, 197.230, 197.235, 197.240, 197.285, 197.287, 197.289, 5 197.293, 197.295, 334.100, 334.245, 334.735, 574.200, and 595.027, RSMo, are repealed and 6 twenty-five new sections enacted in lieu thereof, to be known as sections 188.015, 192.665, 7 192.667, 197.150, 197.152, 197.158, 197.160, 197.162, 197.165, 197.200, 197.205, 197.215, 8 197.220, 197.225, 197.230, 197.235, 197.240, 197.285, 197.287, 197.289, 197.293, 197.295, 9 334.100, 334.735, and 595.027, to read as follows: 188.015. As used in this chapter, the following terms mean: 2 (1) "Abortion": 3 (a) The act of using or prescribing any instrument, device, medicine, drug, or any 4 other means or substance with the intent to [destroy the life of] terminate an embryo or fetus 5 [in his or her mother's womb]; or
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 1304 2
6 (b) The intentional termination of [the] a pregnancy [of a mother] by using or 7 prescribing any instrument, device, medicine, drug, or other means or substance with an 8 intention other than to increase the probability of a live birth or to remove a [dead unborn 9 child] deceased embryo or fetus; 10 (2) ["Abortion facility", a clinic, physician's office, or any other place or facility in 11 which abortions are performed or induced other than a hospital; 12 (3)] "Affiliate", a person who or entity that enters into, with an abortion facility, a 13 legal relationship created or governed by at least one written instrument, including a 14 certificate of formation, a franchise agreement, standards of affiliation, bylaws, or a license, 15 that demonstrates: 16 (a) Common ownership, management, or control between the parties to the 17 relationship; 18 (b) A franchise granted by the person or entity to the affiliate; or 19 (c) The granting or extension of a license or other agreement authorizing the affiliate 20 to use the other person's or entity's brand name, trademark, service mark, or other registered 21 identification mark; 22 [(4)] (3) "Conception", the fertilization of the ovum of a female by a sperm of a male; 23 [(5)] (4) "Department", the department of health and senior services; 24 [(6) "Down Syndrome", the same meaning as defined in section 191.923; 25 (7)] (5) "Gestational age", length of pregnancy as measured from the first day of the 26 woman's last menstrual period; 27 [(8)] (6) "Medical emergency", a condition which, based on reasonable medical 28 judgment, so complicates the medical condition of a pregnant woman as to necessitate the 29 immediate abortion of her pregnancy to avert the death of the pregnant woman or for which a 30 delay will create a serious risk of substantial and irreversible physical impairment of a major 31 bodily function of the pregnant woman; 32 [(9)] (7) "Physician", any person licensed to practice medicine in this state by the 33 state board of registration for the healing arts; 34 [(10)] (8) "Reasonable medical judgment", a medical judgment that would be made 35 by a reasonably prudent physician, knowledgeable about the case and the treatment 36 possibilities with respect to the medical conditions involved[; 37 (11) "Unborn child", the offspring of human beings from the moment of conception 38 until birth and at every stage of its biological development, including the human conceptus, 39 zygote, morula, blastocyst, embryo, and fetus; 40 (12) "Viability" or "viable", that stage of fetal development when the life of the 41 unborn child may be continued indefinitely outside the womb by natural or artificial life- 42 supportive systems; HB 1304 3
43 (13) "Viable pregnancy" or "viable intrauterine pregnancy", in the first trimester of 44 pregnancy, an intrauterine pregnancy that can potentially result in a liveborn baby]. 192.665. As used in this section, section 192.667, and sections 197.150 to 197.165, 2 the following terms mean: 3 (1) "Charge data", information submitted by health care providers on current charges 4 for leading procedures and diagnoses; 5 (2) "Charges by payer", information submitted by hospitals on amount billed to 6 Medicare, Medicaid, other government sources and all nongovernment sources combined as 7 one data element; 8 (3) "Department", the department of health and senior services; 9 (4) "Financial data", information submitted by hospitals drawn from financial 10 statements which includes the balance sheet, income statement, charity care and bad debt and 11 charges by payer, prepared in accordance with generally accepted accounting principles; 12 (5) "Health care provider", hospitals as defined in section 197.020 and ambulatory 13 surgical centers [and abortion facilities] as defined in section 197.200; 14 (6) "Nosocomial infection", as defined by the federal Centers for Disease Control and 15 Prevention and applied to infections within hospitals, ambulatory surgical centers, [abortion 16 facilities,] and other facilities; 17 (7) "Nosocomial infection incidence rate", a risk-adjusted measurement of new cases 18 of nosocomial infections by procedure or device within a population over a given period of 19 time, with such measurements defined by rule of the department pursuant to subsection 3 of 20 section 192.667 for use by all hospitals, ambulatory surgical centers, [abortion facilities,] and 21 other facilities in complying with the requirements of the Missouri nosocomial infection 22 control act of 2004; 23 (8) "Other facility", a type of facility determined to be a source of infections and 24 designated by rule of the department pursuant to subsection 11 of section 192.667; 25 (9) "Patient abstract data", data submitted by hospitals which includes but is not 26 limited to date of birth, sex, race, zip code, county of residence, admission date, discharge 27 date, principal and other diagnoses, including external causes, principal and other procedures, 28 procedure dates, total billed charges, disposition of the patient and expected source of 29 payment with sources categorized according to Medicare, Medicaid, other government, 30 workers' compensation, all commercial payors coded with a common code, self-pay, no 31 charge and other. 192.667. 1. All health care providers shall at least annually provide to the department 2 charge data as required by the department. All hospitals shall at least annually provide patient 3 abstract data and financial data as required by the department. Hospitals as defined in section 4 197.020 shall report patient abstract data for outpatients and inpatients. Ambulatory surgical HB 1304 4
5 centers [and abortion facilities] as defined in section 197.200 shall provide patient abstract 6 data to the department. The department shall specify by rule the types of information which 7 shall be submitted and the method of submission. 8 2. The department shall collect data on the incidence of health care-associated 9 infections from hospitals, ambulatory surgical centers, [abortion facilities,] and other facilities 10 as necessary to generate the reports required by this section. Hospitals, ambulatory surgical 11 centers, [abortion facilities,] and other facilities shall provide such data in compliance with 12 this section. In order to streamline government and to eliminate duplicative reporting 13 requirements, if the Centers for Medicare and Medicaid Services, or its successor entity, 14 requires hospitals to submit health care-associated infection data, then hospitals and the 15 department shall not be required to comply with the health care-associated infection data 16 reporting requirements of subsections 2 to 17 of this section applicable to hospitals, except 17 that the department shall post a link on its website to publicly reported data by hospitals on 18 the Centers for Medicare and Medicaid Services' Hospital Compare website, or its successor. 19 3. The department shall promulgate rules specifying the standards and procedures for 20 the collection, analysis, risk adjustment, and reporting of the incidence of health care- 21 associated infections and the types of infections and procedures to be monitored pursuant to 22 subsection 13 of this section. In promulgating such rules, the department shall: 23 (1) Use methodologies and systems for data collection established by the federal 24 Centers for Disease Control and Prevention's National Healthcare Safety Network, or its 25 successor; and 26 (2) Consider the findings and recommendations of the infection control advisory 27 panel established pursuant to section 197.165. 28 4. By January 1, 2017, the infection control advisory panel created by section 197.165 29 shall make recommendations to the department regarding the Centers for Medicare and 30 Medicaid Services' health care-associated infection data collection, analysis, and public 31 reporting requirements for hospitals, ambulatory surgical centers, and other facilities in the 32 federal Centers for Disease Control and Prevention's National Healthcare Safety Network, or 33 its successor, in lieu of all or part of the data collection, analysis, and public reporting 34 requirements of this section. The advisory panel recommendations shall address which 35 hospitals shall be required as a condition of licensure to use the National Healthcare Safety 36 Network for data collection; the use of the National Healthcare Safety Network for risk 37 adjustment and analysis of hospital submitted data; and the use of the Centers for Medicare 38 and Medicaid Services' Hospital Compare website, or its successor, for public reporting of the 39 incidence of health care-associated infection metrics. The advisory panel shall consider the 40 following factors in developing its recommendation: HB 1304 5
41 (1) Whether the public is afforded the same or greater access to facility-specific 42 infection control indicators and metrics; 43 (2) Whether the data provided to the public is subject to the same or greater accuracy 44 of risk adjustment; 45 (3) Whether the public is provided with the same or greater specificity of reporting of 46 infections by type of facility infections and procedures; 47 (4) Whether the data is subject to the same or greater level of confidentiality of the 48 identity of an individual patient; 49 (5) Whether the National Healthcare Safety Network, or its successor, has the 50 capacity to receive, analyze, and report the required data for all facilities; 51 (6) Whether the cost to implement the National Healthcare Safety Network infection 52 data collection and reporting system is the same or less. 53 5. After considering the recommendations of the infection control advisory panel, and 54 provided that the requirements of subsection 13 of this section can be met, the department 55 shall implement guidelines from the federal Centers for Disease Control and Prevention's 56 National Healthcare Safety Network, or its successor. It shall be a condition of licensure for 57 hospitals that meet the minimum public reporting requirements of the National Healthcare 58 Safety Network and the Centers for Medicare and Medicaid Services to participate in the 59 National Healthcare Safety Network, or its successor. Such hospitals shall permit the 60 National Healthcare Safety Network, or its successor, to disclose facility-specific infection 61 data to the department as required under this section, and as necessary to provide the public 62 reports required by the department. It shall be a condition of licensure for any ambulatory 63 surgical center [or abortion facility] which does not voluntarily participate in the National 64 Healthcare Safety Network, or its successor, to submit facility-specific data to the department 65 as required under this section, and as necessary to provide the public reports required by the 66 department. 67 6. The department shall not require the resubmission of data which has been 68 submitted to the department of health and senior services or the department of social services 69 under any other provision of law. The department of health and senior services shall accept 70 data submitted by associations or related organizations on behalf of health care providers by 71 entering into binding agreements negotiated with such associations or related organizations to 72 obtain data required pursuant to section 192.665 and this section. A health care provider shall 73 submit the required information to the department of health and senior services: 74 (1) If the provider does not submit the required data through such associations or 75 related organizations; HB 1304 6
76 (2) If no binding agreement has been reached within ninety days of August 28, 1992, 77 between the department of health and senior services and such associations or related 78 organizations; or 79 (3) If a binding agreement has expired for more than ninety days. 80 7. Information obtained by the department under the provisions of section 192.665 81 and this section shall not be public information. Reports and studies prepared by the 82 department based upon such information shall be public information and may identify 83 individual health care providers. The department of health and senior services may authorize 84 the use of the data by other research organizations pursuant to the provisions of section 85 192.067. The department shall not use or release any information provided under section 86 192.665 and this section which would enable any person to determine any health care 87 provider's negotiated discounts with specific preferred provider organizations or other 88 managed care organizations. The department shall not release data in a form which could be 89 used to identify a patient. Any violation of this subsection is a class A misdemeanor. 90 8. The department shall undertake a reasonable number of studies and publish 91 information, including at least an annual consumer guide, in collaboration with health care 92 providers, business coalitions and consumers based upon the information obtained pursuant to 93 the provisions of section 192.665 and this section. The department shall allow all health care 94 providers and associations and related organizations who have submitted data which will be 95 used in any publication to review and comment on the publication prior to its publication or 96 release for general use. The publication shall be made available to the public for a reasonable 97 charge. 98 9. Any health care provider which continually and substantially, as these terms are 99 defined by rule, fails to comply with the provisions of this section shall not be allowed to 100 participate in any program administered by the state or to receive any moneys from the state. 101 10. A hospital, as defined in section 197.020, aggrieved by the department's 102 determination of ineligibility for state moneys pursuant to subsection 9 of this section may 103 appeal as provided in section 197.071. An ambulatory surgical center [or abortion facility] as 104 defined in section 197.200 aggrieved by the department's determination of ineligibility for 105 state moneys pursuant to subsection 9 of this section may appeal as provided in section 106 197.221. 107 11. The department of health may promulgate rules providing for collection of data 108 and publication of the incidence of health care-associated infections for other types of health 109 facilities determined to be sources of infections; except that, physicians' offices shall be 110 exempt from reporting and disclosure of such infections. HB 1304 7
111 12. By January 1, 2017, the advisory panel shall recommend and the department shall 112 adopt in regulation with an effective date of no later than January 1, 2018, the requirements 113 for the reporting of the following types of infections as specified in this subsection: 114 (1) Infections associated with a minimum of four surgical procedures for hospitals 115 and a minimum of two surgical procedures for ambulatory surgical centers that meet the 116 following criteria: 117 (a) Are usually associated with an elective surgical procedure. An "elective surgical 118 procedure" is a planned, nonemergency surgical procedure that may be either medically 119 required such as a hip replacement or optional such as breast augmentation; 120 (b) Demonstrate a high priority aspect such as affecting a large number of patients, 121 having a substantial impact for a smaller population, or being associated with substantial cost, 122 morbidity, or mortality; or 123 (c) Are infections for which reports are collected by the National Healthcare Safety 124 Network or its successor; 125 (2) Central line-related bloodstream infections; 126 (3) Health care-associated infections specified for reporting by hospitals, ambulatory 127 surgical centers, and other health care facilities by the rules of the Centers for Medicare and 128 Medicaid Services to the federal Centers for Disease Control and Prevention's National 129 Healthcare Safety Network, or its successor; and 130 (4) Other categories of infections that may be established by rule by the department. 131 132 The department, in consultation with the advisory panel, shall be authorized to collect and 133 report data on subsets of each type of infection described in this subsection. 134 13. In consultation with the infection control