AWARENESS DAYS (Sections 9.412 and 9.418)

This act designates each September as "Brain Aneurysm Awareness Month" in Missouri and the last full week of April each year as "Infertility Awareness Week" in Missouri.

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

This act 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 act permits investment of up to 50% of funds not required for operations or other obligations in a manner described in the act, with the remaining portion to be invested into any investment in which the state Treasurer is allowed to invest. These provisions shall only apply if the hospital receives less than three percent of its annual revenues from municipal, county, hospital district, or state taxes or appropriated funds from the municipality in which such hospital is located.

Under this act, municipal hospitals in third class cities may operate in areas where hospital district hospitals and county hospitals operate. Hospital district hospitals may operate in areas where municipal hospitals in third class cities and county hospitals operate.

These provisions are identical to provisions in SCS/HCS/HB 943 (2025) and SCS/SB 317 (2025) and substantially similar to SB 244 (2025).

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

This act changes "epinephrine auto-injector" to "epinephrine delivery device" throughout statute.

These provisions are similar to provisions in HB 165 (2025) and HB 553 (2025).

COMMUNITY PARAMEDIC SERVICES (Sections 190.098)

This act modifies provisions relating to certification of community paramedics and the provision of community paramedic services. Community paramedic services shall mean those services provided by an entity that employs licensed paramedics certified by the Department of Health and Senior Services 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.

Any ambulance service that seeks to provide community paramedic services outside of its service area shall have a memorandum of understanding (MOU) with the ambulance service of that area if that ambulance service is already providing those services or shall notify the ambulance services of that area if that ambulance service is not providing community paramedic services. Emergency medical response agencies (EMRAs) may provide community paramedic services in a ground ambulance service's service area. If the ground ambulance service is already providing those services, then the EMRA and ground ambulance service may enter into a MOU for the coordination of services. If the ground ambulance service provides those services after the EMRA begins to provide them, then the ground ambulance service and EMRA shall enter into a MOU for the coordination of services.

The Department shall establish regulations for the purpose of recognizing community paramedic services entities that have met the standards necessary to provide such services. The Department shall endorse such entities to provide community paramedic services for a period of 5 years.

These provisions are similar to a provision in SCS/HCS/HB 943 (2025) and SCS/SB 317 (2025), SB 548 (2025), SB 206 (2025), and SCS/SB 1382 (2024).

DOULA SERVICES (Sections 191.708, 208.152, 208.662, and 208.1400-1425)

This act creates the "Missouri Doula Reimbursement Act". Under this act, the chief medical officer or chief medical director of the Department of Health and Senior Services, the Department of Mental Health, or the MO HealthNet Division of the Department of Social Services may issue nonspecific recommendations for doula services, a medical standing order for prenatal vitamins, or a medical standing order for a purpose promulgated in rule, to terminate as specified in the act.

Additionally, this act adds doula services and childbirth education classes for pregnant women and a support person to the list of covered MO Healthnet and "Show-Me Healthy Babies Program" services, to be reimbursed as described in the act. The Department of Social Services shall study the impact of the childbirth education classes on infant and maternal mortality and shall submit a report to the General Assembly prior to January 1, 2028.

These provisions are identical to provisions in HCS/SB 94 (2025) and HCS/HB 1095 (2025).

TELEHEALTH (Sections 191.1146, and 334.108)

Currently, the establishment of a physician-patient relationship for purposes of telehealth shall include an interview and a physical examination. Under this act, an evaluation is required, but a physical examination shall 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 act 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 fourteen days of evaluation, as described in the act.

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

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 act, a health care provider shall not prescribe any drug, controlled substance, or other treatment to a patient in the absence of a proper provider-patient relationship.

These provision are substantially similar to SB 108 (2025) and SB 851 (2024) and similar to SCS/SB 418 (2023) and HB 710 (2023).

DEPARTMENT OF HEALTH AND SENIOR SERVICES CONTRACTS FOR PUBLIC HEALTH (Section 192.021)

This act authorizes the Department of Health and Senior Services to contract with an entity on a qualified vendor list comprised of Missouri affiliates of national public health associations or public health institutes in order to assist in carrying out its duties to promote the health and well-being of Missouri residents. Such contracts may include efforts to assist in the delivery of health services throughout the state and the administration of grant funds and related programs. The Department and the designated affiliate shall provide a report to the General Assembly as specified in the act.

This provision is substantially similar to a provision in HCS/SB 94 (2025) and SB 549 (2025).

LIMITS ON SALE OF OVER-THE-COUNTER DRUGS (Sections 195.417 and 579.060)

Current law prohibits the sale, purchase, or dispensation of ephedrine, phenylpropanolamine, or pseudoephedrine to the same individual in a twelve-month period in any total amount greater than 43.2 grams without a valid prescription. This act changes the total amount to 61.2 grams.

These provisions are identical to provisions in SB 548 (2025), SB 143 (2025), SCS/HCS/HB 943 (2025), SCS/SB 317 (2025), SS/SCS/HCS/HB 1659 (2024), and SCS/SB 1485 (2024) and similar to HB 2824 (2024).

Beginning October 1, 2026, any manufacturer of any drug product containing any detectable amount of ephedrine, phenylpropanolamine, or pseudoephedrine sold in this state shall fees to the administrator of the real-time electronic pseudoephedrine tracking system, as specified in the act. A manufacturer who fails to knowingly pay such fee shall have committed the offense of unlawful sale, distribution, or purchase of over-the-counter methamphetamine precursor drugs, which is a Class A misdemeanor.

These provisions are identical to a provision in SB 725 (2025) and HB 1036 (2025).

ADMINISTRATION OF MEDICATIONS (Sections 196.990 and 335.081)

This act adds licensed long-term care facilities and child care facilities to the definition of "authorized entity" in current law permitting such entities to stock a supply of epinephrine delivery devices for use in an emergency. Additionally, the administration by technicians, nurses' aides, or their equivalent in long-term care facilities of epinephrine delivery devices and subcutaneous injectable medications to treat diabetes shall not be prohibited by nurse licensing laws.

These provisions are similar to provisions in SCS/HCS/HB 943 (2025), SB 548 (2025), SCS/SB 317 (2025), and HCS/HB 2824 (2024).

HOSPITAL WORKPLACE VIOLENCE (Section 197.708)

Under this act, each hospital shall prominently display a printed sign, in all capital letters, warning that assaulting a health care professional is a serious crime which may be punishable as a class A misdemeanor.

This provision is identical to a provision HCS/SB 94 (2025) and HCS/HB 1213 (2025) and substantially similar to SB 791 (2025).

INSPECTIONS OF LONG-TERM CARE FACILITIES (Sections 198.022 and 198.070)

Under this act, the Department of Health and Senior Services may accept, in lieu of an inspection conducted by the Department, a written report of a survey or inspection conducted by any state or federal agency, provided the survey or inspection is comparable in scope or method to the Department's inspections and conducted in accordance with Title XVIII of the Social Security Act. A residential care or assisted living facility shall be subject to an inspection by the Department if the facility fails to maintain an accredited status by a recognized accreditation entity. Finally, if a facility exempt from an annual inspection under this act has one or more violations of any class I standards, then the facility shall be subject to a full inspection by the Department.

This provision is substantially similar to a provision in SCS/HCS/HB 943 (2025) and similar to SB 689 (2025).

MO HEALTHNET COVERAGE OF CERTAIN CLINICAL PATHOLOGY SERVICES (Section 208.149)

This act requires that the fee for the professional component of clinical pathology services shall be paid by MO HealthNet for professional services provided by a hospital-based pathologist for inpatient clinical pathology services rendered to MO HealthNet patients. The reimbursement shall be set at thirty percent of the approved outpatient simplified fee schedule based on Medicare's clinical laboratory fee schedule, as described in the act.

This provision is identical to a provision in HCS/SB 94 (2025) and SCS/HCS/HB 943 (2025).

FOOD-BORNE ALLERGIES (Section 210.225)

This act establishes "Elijah's Law". Before July 1, 2028, each licensed child care provider shall adopt a policy on allergy prevention and response with a focus on potentially deadly food-borne allergies, as specified in the act. The Department of Elementary and Secondary Education shall develop a model policy or policies before July 1, 2027.

This provision is substantially similar to SB 783 (2025) and HB 580 (2025).

PRACTICE OF DENTISTRY IN CORRECTIONAL CENTERS (Section 332.081)

Current law provides that no corporation shall practice dentistry unless that corporation is a nonprofit corporation or a professional corporation under Missouri law. This act provides that such provision shall not apply to entities contracted with the state to provide care in correctional centers.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), SB 143 (2025), SB 548 (2025), SCS/SB 317 (2025), SS/SCS/HCS/HB 1659 (2024), SB 1287 (2024), and HB 2280 (2024).

ADMINISTRATION OF CERTAIN VACCINES (Section 338.010)

This act provides that the practice of pharmacy shall include the ordering and administering of vaccines, except for the vaccine for chikungunya and those vaccines approved by the U.S. Food and Drug Administration after January 1, 2026, instead those after January 1, 2023.

This provision is substantially similar to a provision in SCS/HCS/HB 943 (2025), SB 548 (2025), SCS/SB 317 (2025), SB 1455 (2024), SCS/HB 2280 (2024), and HB 2879 (2024).

LICENSURE OF WHOLESALE DRUG DISTRIBUTORS (Section 338.333)

Under this act, the Board of Pharmacy may permit an out-of-state wholesale drug distributor or third-party logistics provider to be licensed in this state despite not having a license issued by the distributor's or provider's resident state if the distributor or provider has a current and valid drug distributor accreditation from the National Association of Boards of Pharmacy.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), HCS/SB 94 (2025), and HB 1465 (2025).

RX CARES FOR MISSOURI PROGRAM (Section 338.710)

This act removes the expiration date of August 28, 2026, from the "RX Cares for Missouri Program".

This provision is identical to HB 1445 (2025).

340B DRUGS (Section 376.417)

Under this act, a health carrier, a pharmacy benefits manager, or an agent or affiliate of such, shall not discriminate against a covered entity, as defined in the act, including by reimbursing the covered entity for a quantity of a 340B drug in an amount less than it would pay similarly situated non-covered entities for such drugs, imposing different terms and conditions as compared to similarly situated entities, refusing to cover 340B drugs or discriminating in reimbursement for 340B drugs, and other situations described under this act. The Director of the Department of Commerce and Insurance shall impose a civil penalty on any health carrier, pharmacy benefits manager, or agent or affiliate of such, that violates this provision, not to exceed $5,000 per violation per day.

This provision is identical to a provision in SCS/HCS/HB 943 (2025) and HB 784 (2025).

INSURANCE COVERAGE OF ANESTHESIA SERVICES (Section 376.1245)

Under this act, no health carrier or health benefit plan shall establish, implement, or enforce any policy that imposes a time limit for the payment of anesthesia services provided during a medical or surgical procedure, as described in the act.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), HCS/SB 94 (2025), and HCS/HBs 1126 & 932 (2025).

INSURANCE COVERAGE OF ALTERNATIVES TO OPIOID DRUGS (Section 376.1280)

This act provides that if an enrollee has an elevated risk of opioid misuse, as defined in the act, the enrollee's health benefit plan shall not deny coverage of a non-opioid prescription drug in favor of an opioid drug, require the enrollee to try an opioid drug before covering the non-opioid prescription drug, or require a higher level of cost-sharing for a non-opioid prescription drug than for an opioid drug.

This act shall apply to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027.

This provision is substantially similar to SB 158 (2025).

PRIOR AUTHORIZATION OF HEALTH CARE SERVICES (Sections 376.2100 to 376.2108)

This act provides that a health carrier or utilization review entity shall not require health care providers to obtain prior authorization for health care services, except under certain circumstances described in the act.

The act specifies requirements for notifying the provider of determinations under the act, requires health carriers and utilization review entities to establish an appeals process for determinations under the act, and requires carriers and utilization review entities to maintain an online portal giving providers access to certain information.

Lastly, no health carrier or utilization review entity shall deny or reduce payments to a health care provider who had a prior authorization, unless the provider made a knowing and material misrepresentation with the intent to deceive the carrier or utilization review entity, or unless the health care service was not substantially performed.

These provisions shall not apply to Medicaid, except with regard to a Medicaid managed care organization as defined by law. These provisions also does not apply to providers who have not participated in a health benefit plan offered by the carrier for at least one full evaluation period. These provisions shall not be construed to authorize providers to provide services outside the scope of their licenses, nor to require health carriers or utilization review entities to pay for care provided outside the scope of a provider's license.

These provisions are substantially similar to HB 618 (2025) and similar to SB 230 (2025).

SARAH HASKINS