COMMITTEE OF ORIGIN: Standing Committee on Health and Mental Health
AWARENESS DAYS (Sections 9.025, 9.412, 9.418, and 9.502, RSMo)
This bill designates the month of January as "Blood Donor Awareness Month", each September as "Brain Aneurysm Awareness Month", the last full week of April each year as "Infertility Awareness Week", and March 26th of each year as “Pediatric Acute- Onset Neuropsychiatric Syndrome (PANS)/Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) Awareness Day”.
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 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, hospital district, 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.
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.
AMBULANCE DISTRICTS (Sections 190.050, 190.051, 190.052, 190.070, 190.089, and 191.090)
Currently, county commissions divide newly-formed ambulance districts into six subdistricts for the election of members to the district's board of directors.
This bill allows county commissions to choose between the above- mentioned district plan or for the election of an at-large board of directors. Members of the board must be elected at a regularly scheduled election date. A director holding office as of August 28, 2026, will continue as an at-large director for the remainder of the director's existing term.
The bill allows an ambulance district, by a vote of 2/3 approval of the board of directors, to abolish the boundaries of its existing subdistricts if the board is unable to find a qualified candidate to fill each subdistrict position. This must occur after a public hearing.
The bill allows an ambulance to establish subdistricts by a vote of 2/3 approval of the board of directors. The boundaries of the subdistricts will be established by the county commission. Currently, six-member ambulance district boards can adopt a resolution changing the size of the board to seven, with one board member running district wide, or decreased to five, or three members. This bill requires such a resolution to name any vacancy to be filled at a subsequent election, if the size of the board is increasing. If the size is decreasing, all existing board members will complete their terms.
This bill requires county commissions, upon written request of a majority of the remaining members of the ambulance board, to fill vacancies on the board by appointment within 30 calendar days.
Currently, if a question of annexation is submitted to voters and approved, the county commission declares by order the territory annexed. This bill requires the county commission to do this within 30 days of the filing of the petition.
The bill requires the Department of Health and Senior Services (DHSS) to prioritize and expedite any activities necessary to facilitate the consolidation of ambulance districts once the consolidation has been approved by voters.
This bill describes the necessary criteria that must be included on every petition or resolution calling for an ambulance district consolidation, as provided in the bill. The consolidation plan must be filed with the county clerk and presented to the county commission.
Notice of intent to consolidate is required to be published in a newspaper of general circulation in every county in which the consolidated district will be located. A joint public hearing will be held within 30 days after the date of the second publication. The bill details the formatting of the notice of intent.
Currently, consolidation of an ambulance district is only permissible if approved by voters. This bill requires a public vote on the consolidation if an objection is filed. If no objection is filed within 30 days of the public hearing, the county commission will order the districts consolidated. Objections must be signed by no less than 5% of the votes cast for Governor in the most recent gubernatorial election in the district.
A consolidated district can impose an initial tax levy up to the highest tax levy of the consolidating districts, provided the levy is specifically set forth in the ballot language and submitted to and approved by voters. If no vote occurs, the consolidated district can impose a tax equal to the lowest of any existing property or sales tax rate of the districts to be consolidated.
All assets and obligations of the existing ambulance districts will become assets and obligations of the consolidated district.
COMMUNITY PARAMEDIC SERVICES (Section 190.098)
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.
Any ambulance service that seeks to provide community paramedic services outside of its service area must have a memorandum of understanding (MOU) with the ambulance service of that area if that ambulance service is already providing those services or must notify the ambulance services of that area if that ambulance service is not providing community paramedic services. Emergency medical response agencies (EMRAs) can 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 can 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 must enter into a MOU for the coordination of services. A community paramedic program must notify the appropriate local ambulance service when providing services within the service area of an ambulance service.
DHSS will establish regulations for the purpose of recognizing community paramedic services entities that have met the standards necessary to provide such services. DHSS will endorse such entities to provide community paramedic services for a period of five years. ACCESS TO INDIVIDUALIZED INVESTIGATIONAL TREATMENT (Sections 191.455, 191.457, 191.459, 191.461, 191.463, 191.465, and 191.467)
This bill establishes the "Hope for Missouri Patients Act", which permits eligible manufacturers within eligible facilities to make available individualized investigational drugs, biological products, or devices for eligible patients, but does not mandate the provision of these drugs, products, or devices to patients.
The bill allows facilities or manufacturers to either provide these items to patients without receiving compensation or to require a patient to pay the costs of the manufacture of these drugs, products, or devices. The bill additionally permits, but does not require, health plans, third-party administrators, or governmental agencies to provide coverage for the costs of or associated with these drugs, products, or devices, and provides that hospitals or facilities licensed by DHSS are not required to provide new or additional services unless approved by the hospital or facility.
If a patient's death is proximately caused by treatment with these drugs, products, or devices, the patient's estate, heirs, or devisees are not liable for any remaining debt, but this is not construed to be an exemption to liability for any charges for nonexperimental treatments provided to the patient.
No licensing board or disciplinary subcommittee is to revoke, fail to renew, suspend, or take any action against a health care provider's license based solely on the provider's recommendations to an eligible patient regarding access to, or treatment with, these drugs, products, or devices, nor will an entity responsible for Medicare certification do the same for a provider's Medicare certification.
The bill additionally prohibits any state official, employee, or agent from blocking or attempting to block a patient's access to these drugs, products, or devices; provides that counseling from a licensed health care provider consistent with medical standards of care is not a violation of this bill; and that a private cause of action against a manufacturer of these drugs, products, or devices is not established through the provisions of this 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 ten 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.
DEPARTMENT OF HEALTH AND SENIOR SERVICES CONTRACTS FOR PUBLIC HEALTH (Section 192.021)
This bill authorizes DHSS to contract with an affiliate of a national public health associations or public health institutes in order to assist in carrying out its duties to promote the health and wellbeing of Missouri residents. Such contracts can include efforts to assist in the delivery of health services throughout the State and the administration of grant funds and related programs. The DHSS and the designated affiliate must provide a report to the General Assembly as specified in the bill.
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 12-month period in any total amount greater than 43.2 grams without a valid prescription. This bill changes the total amount to 61.2 grams.
Beginning October 1, 2026, any manufacturer of any drug product containing any detectable amount of ephedrine, phenylpropanolamine, or pseudoephedrine sold in this State must, on a monthly basis, pay fees to the administrator of the real- time electronic pseudoephedrine tracking system, as specified in the bill. A manufacturer who fails to knowingly pay such fee will have committed the offense of unlawful sale, distribution, or purchase of over-the-counter methamphetamine precursor drugs, which is a Class A misdemeanor.
IVERMECTIN AND HYDROXYCHLOROQUINE (Sections 195.1000 and 338.208)
This bill provides that ivermectin tablets and hydroxychloroquine tablets will be available to the public for purchase as over-the- counter drugs in the State without the need for a prescription or a consultation with a pharmacist or other health care professional. Under this bill, a pharmacist may dispense ivermectin and hydroxychloroquine to a person, without a prescription order, upon the approval of a warning label for the use and indication in accordance with any written, standardized procedures or protocols issued by the Board of Pharmacy.
HOSPITAL WORKPLACE VIOLENCE (Section 197.708)
This bill requires hospitals to display a printed sign in the waiting rooms of the emergency department and the labor and delivery department with the following text in all capital letters:
"WARNING: ASSAULTING A HEALTH CARE PROFESSIONAL WHO IS ENGAGED IN THE PERFORMANCE OF HIS OR HER OFFICIAL DUTIES, INCLUDING STRIKING A HEALTH CARE PROFESSIONAL WITH ANY BODILY FLUID, IS A SERIOUS CRIME AND WILL BE PROSECUTED TO THE FULLEST EXTENT OF THE LAW."
INSPECTIONS OF LONG-TERM CARE FACILITIES (Section 198.022)
Under this bill, DHSS can accept, in lieu of an inspection conducted by DHSS, 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 DHSS's inspections and conducted in accordance with Title XVIII of the Social Security Act. A residential care or assisted living facility will be subject to an inspection by DHSS 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 bill has one or more violations of any class I standards, then the facility must be subject to a full survey by DHSS.
MO HEALTHNET COVERAGE OF CERTAIN CLINICAL PATHOLOGY SERVICES (Section 208.149)
This bill requires the professional component of clinical pathology services provided by a hospital-based pathologist to be recognized as distinct physician services by the MO HealthNet program, which will reimburse the professional component of clinical pathology services provided to MO HealthNet participants. Payment will be made directly to the licensed physician providing the services or the entity that has been assigned by the right to receive payment for services provided.
If a state plan amendment is determined by DSS to be required, DSS must submit the amendment in a timely manner and make all reasonable efforts to obtain Federal approval.
MO HEALTHNET WAIVER FOR NUTRITION SERVICES (Section 208.270)
This bill establishes the "Food is Medicine Act", requiring DSS to apply to the Centers for Medicare and Medicaid Services, within the Federal Department of Health and Human Services, for a Section 1115 demonstration waiver to implement the "Food is Medicine" program.
The program must be designed to improve health outcomes for MO HealthNet participants with nutrition-related chronic diseases through nutrition services and to reduce the need for medical care for those participants.
The bill specifies the covered nutrition services under this program, and specifies that whenever feasible, the MO HealthNet Division, within DSS must prioritize the inclusion of community- based organizations and local growers to support the purchase o