Missouri Statute | Act | Code |Public Health And Welfare| US Code - US Statute

1. The departments of health and senior services and social
services shall promulgate rules and regulations requiring the exchange of
information, including regulatory violations, between the departments to
ensure the protection of individuals who are served by health care
providers regulated by either the department of health and senior
services or the department of social services.

2. No rule or portion of a rule promulgated pursuant to the provisions of
this section shall become effective unless it has been promulgated
pursuant to chapter 536, RSMo. (L. 1999 S.B. 8 & 173 § 3)

1. The director of the department of social services is hereby
authorized to lease real property operated by the department of social
services previously used for grazing or farming and determined by the
chief administrative authority at each facility to be in excess of the
immediate needs and requirements of the state facilities.

2. The state director of the division of purchasing shall offer for lease
such lands by sealed bids to the general public. The bids shall be opened
by the state director of the division of purchasing, but all bids may be
rejected.

3. The term of the lease shall be for a period of one year or less, and
the lessor shall have the option of renewing the lease from year to year,
and the lease shall include conditions that the lessee shall use and
maintain the land for agricultural purposes and will maintain all fences
and buildings on the leased land.

4. The administrative official of the state facility where the land is
located or his representative shall periodically inspect the property to
insure compliance with all provisions of the lease.

5. The director of the department of social services shall sign the lease
on behalf of the state. (L. 1972 H.B. 1071 §§ 1 to 5, A.L. 1980 H.B. 1724)

Any purchase of food in any institution under the control of the
department of social services, other than the usual quality purchased for
the inmates thereof, to be used by or for anyone other than the inmates
of the institution shall be charged directly to the individual
responsible for such purchase. (L. 1947 V. I p. 314 § 10c, A.L. 1980 H.B.
1724)

The department of social services may provide any employee in
any institution under its control with board and living quarters in
addition to salary, or wages, when the director shall determine that it
is for the best interest of the state to do so. (L. 1947 V. I p. 314 §
10d, A.L. 1980 H.B. 1724)

Every person who shall willfully beat, strike, wound or injure
any inmate of any institution under the control of the department of
social services, or who shall in any other manner whatsoever mistreat or
maltreat, handle or treat any such inmate in a brutal or inhuman manner,
or who, in the handling of any such inmate, shall use any more force than
is reasonably or apparently necessary for the proper control, treatment
or management of such inmate, shall, upon conviction, be punished by a
fine of not less than five dollars nor more than one hundred dollars, or
by imprisonment in the county or city jail for not less than ten days nor
more than six months, or by both such fine and imprisonment. (L. 1947 V.
I p. 314 § 10e, A.L. 1980 H.B. 1724)

Every person who shall knowingly furnish or deliver any
diseased, putrid or otherwise unwholesome meat, or the meat from any
animal or fowl that was diseased or otherwise unfit for food, to any
institution under the control of the department of social services, or
who shall furnish or deliver any other unwholesome food, vegetables or
provisions whatsoever to any such institution, to be used as food by the
inmates or employees thereof, and any employee of such institution who
knowingly shall receive, or consent to the receiving, of any such
diseased or unwholesome meat, food or provisions at or by such
institution, shall, upon conviction, be punished by a fine of not less
than five dollars nor more than one hundred dollars, or by imprisonment
in the county or city jail for not less than ten days nor more than six
months, or by both such fine and imprisonment. (L. 1947 V. I p. 314 §
10f, A.L. 1980 H.B. 1724)

If any person or employee of any institution under the control
of the department of social services shall be witness or shall in any
other manner have knowledge of any violation of the provisions of
sections 191.170 and 191.180, and shall fail to forthwith communicate
such fact or facts to the superintendent of the institution or to the
director of the department of social services, he or she shall be deemed
an accessory to such act and violation, and, upon conviction, shall be
punished by a fine of not less than five dollars nor more than one
hundred dollars. Any person convicted of a violation of this or of
section 191.170 or 191.180 shall be disqualified for holding any position
for a period of one year in any institution in this state under the
control of the state government. (L. 1947 V. I p. 314 § 10g, A.L. 1980
H.B. 1724)

Any person having any relative committed to the custody of any
institution under the control of the state department of social services
may, at their own expense, employ a licensed physician or other qualified
practitioner to administer treatments to such patients. Persons so
employed shall confine such treatment to the individual patient
concerned. The state shall not be liable for any additional cost incurred
as a result of the employment of such persons. (L. 1947 V. I p. 314 §
10i, A.L. 1980 H.B. 1724)

State expenditures for new programs and initiatives enacted by
sections 103.178, RSMo, 143.999, RSMo, 188.230, RSMo, 191.231, 191.825 to
191.839, RSMo, 208.177, 208.178, 208.179 and 208.181, RSMo, 211.490,
RSMo, 285.240, RSMo, 337.093, RSMo, 374.126, RSMo, 376.891 to 376.894,
RSMo, 431.064, RSMo, 660.016, 660.017 and 660.018, RSMo, and the state
expenditures for the new initiatives and expansion of programs enacted by
revising sections 105.711 and 105.721, RSMo, 191.520, 191.600, 198.090,
RSMo, 208.151, 208.152 and 208.215, RSMo, as provided by H.B. 564, 1993,
shall be funded exclusively by federal funds and the funding sources
established in sections 149.011, 149.015, 149.035, 149.061, 149.065,
149.160, 149.170, 149.180, 149.190 and 149.192, RSMo, and no future
general revenue shall be appropriated to fund such new programs or
expansions. (L. 1993 H.B. 564 § 36, A.L. 2001 S.B. 393)

State expenditures for programs and initiatives enacted by
section 191.411 and sections 167.600 to 167.621, RSMo, may be funded by
federal funds, general revenue funds and any other funds appropriated to
fund such programs. (L. 2001 S.B. 393)

1. The department of health and senior services shall make
payments to hospitals and physicians, out of appropriations made for that
purpose, to cover the cost of the medical examination not covered by
insurance, Medicare or Medicaid of persons who may be a victim of the
crime of rape as defined in section 566.030, RSMo, or a victim of a crime
as defined in chapter 566, RSMo, or sections 568.020, 568.050, 568.060,
568.080, 568.090, 568.110, and 568.175, RSMo, if:

(1) The victim or the victim's guardian consents in writing to the
examination;

(2) The report of the examination is made on a form approved by the
attorney general with the advice of the department of health and senior
services; and

(3) The report of the examination is filed by the victim with the
prosecuting attorney of the county in which the alleged incident occurred.

2. A minor may consent to examination under this section. Such consent is
not subject to disaffirmance because of minority, and consent of parent
or guardian of the minor is not required for such examination. The
hospital or physician making the examination shall give written notice to
the parent or guardian of a minor that such an examination has taken
place.

3. The attorney general, with the advice of the department of health and
senior services, shall develop the forms and procedures for gathering
evidence under the provisions of this section and shall furnish every
hospital and physician in this state with copies of such forms and
procedures.

4. Reasonable hospital and physicians charges for eligible examinations
shall be billed to and paid by the department of health and senior
services. (L. 1980 S.B. 661 § 1, A.L. 1989 S.B. 138)

The department of health and senior services shall pay for the
cost of conducting HIV testing for a victim of the crime of rape as
defined in section 556.030, RSMo, or of the crime of sodomy as defined in
section 566.060, RSMo, or of the crime of incest as defined in section
568.020, RSMo, if a person who is convicted of such crime is determined
to be infected with HIV based upon HIV testing conducted upon delivery of
the person to the department of corrections pursuant to section 191.659.
Such testing shall be limited to not more than two enzyme-linked
immunosorbent assay (ELISA) tests per year and such cost of such tests
shall not be paid by the department of health and senior services for
more than five years after the date the crime was committed. HIV testing
conducted pursuant to this section shall be performed by the public
health laboratory of the department of health and senior services. (L.
1989 S.B. 138 § 1)

1. All physicians, chiropractors, hospitals, dentists, and other
duly licensed practitioners in this state, herein called "providers",
shall, upon written request of a patient, or guardian or legally
authorized representative of a patient, furnish a copy of his or her
record of that patient's health history and treatment rendered to the
person submitting a written request, except that such right shall be
limited to access consistent with the patient's condition and sound
therapeutic treatment as determined by the provider. Beginning August 28,
1994, such record shall be furnished within a reasonable time of the
receipt of the request therefor and upon payment of a fee as provided in
this section.

2. Health care providers may condition the furnishing of the patient's
health care records to the patient, the patient's authorized
representative or any other person or entity authorized by law to obtain
or reproduce such records upon payment of a fee for:

(1) Copying, in an amount not more than seventeen dollars and five cents
plus forty cents per page for the cost of supplies and labor;

(2) Postage, to include packaging and delivery cost; and

(3) Notary fee, not to exceed two dollars, if requested.

3. Notwithstanding provisions of this section to the contrary, providers
may charge for the reasonable cost of all duplications of health care
record material or information which cannot routinely be copied or
duplicated on a standard commercial photocopy machine.

4. The transfer of the patient's record done in good faith shall not
render the provider liable to the patient or any other person for any
consequences which resulted or may result from disclosure of the
patient's record as required by this section.

5. Effective February first of each year, the fees listed in subsection 2
of this section shall be increased or decreased annually based on the
annual percentage change in the unadjusted, U.S. city average, annual
average inflation rate of the medical care component of the Consumer
Price Index for All Urban Consumers (CPI-U). The current reference base
of the index, as published by the Bureau of Labor Statistics of the
United States Department of Labor, shall be used as the reference base.
For purposes of this subsection, the annual average inflation rate shall
be based on a twelve-month calendar year beginning in January and ending
in December of each preceding calendar year. The department of health and
senior services shall report the annual adjustment and the adjusted fees
authorized in this section on the department's Internet web site by
February first of each year. (L. 1988 H.B. 925 § 1, A.L. 1994 H.B. 1427,
A.L. 2002 S.B. 923, et al., A.L. 2005 H.B. 232)

CROSS REFERENCE:

Child's medical records to be released to parents, attorney's fees and
costs assessed, when, RSMo 452.375

No physician or pharmacist licensed in this state shall be
subject to discipline for authorizing, assisting or cooperating with
other health care professionals licensed by this state who are practicing
their profession within the scope of their license. (L. 1992 S.B. 573 &
634 § 8)

When a not-for-profit human services organization providing
habilitative and rehabilitative services to people with disabilities in
this state has been accredited by the Commission on Accreditation of
Rehabilitative Facilities or the Accreditation Council on Services for
People with Disabilities, that specific accreditation shall be deemed in
lieu of and recognized as equivalent to any state licensure or
certification requirements by all state agencies when purchasing services
on behalf of persons with disabilities.

(L. 1994 S.B. 672 § 1)

1. The county commission may, by a majority vote, designate the
county as a community-based integrated delivery system or a member of a
community-based integrated delivery system. A standard metropolitan
statistical area, or any part thereof, which contains more than one
million persons shall not be designated as a community-based integrated
delivery system.

2. In order to qualify for a designation under this section, a
community-based integrated delivery system shall be established and
operated in accordance with this section. A community-based integrated
delivery system may:

(1) Improve access to health care for residents of the district;

(2) Coordinate the development of new health services in the district; and

(3) Consider various alternatives for integrating the services of the
health care delivery system in the district.

3. The boundaries of a community-based integrated delivery system may be
coextensive with the boundaries of a county or a group of member counties.

4. The community-based integrated delivery system shall be organized as a
not-for-profit corporation and shall be governed by a board of directors
of not more than eleven persons, except that, if a system includes more
than eleven counties, then the board of directors shall be comprised of
one member from each county. The members of the board shall represent a
cross section of community interests. The board of directors of a system
shall be chosen by the governor from lists submitted by county
commissioners whose districts are included in the community-based
integrated delivery system.

5. The board of directors of the community-based integrated delivery
system shall possess and exercise all of its legislative and executive
powers. Within thirty days after the appointment of the initial
directors, the board shall meet. At its first meeting the board shall
elect a chairman from its members and select a secretary and treasurer
and such officers or employees as it deems expedient or necessary for the
accomplishment of its corporate objectives. The secretary and treasurer
need not be members of the board. At the meeting, the board shall define
the first and subsequent fiscal years of the system and shall adopt a
corporate seal and bylaws, which shall determine the times for the annual
election of officers and of other regular and special meetings of the
board and shall contain the rules for the transaction of other business
of the system and for amending the bylaws. Each director of any system
shall serve without compensation.

6. A community-based integrated delivery system shall develop plans for
access to health care for residents of the system and shall determine
system health care needs. The community-based integrated delivery system
shall not have the power to tax. (L. 1993 H.B. 564 § 28)

1. Beginning April 1, 2007, immunizations administered in the
state of Missouri to knowingly pregnant women or children less than three
years of age shall not contain more than one microgram of mercury per
five-tenths-milliliter dose.

2. Beginning April 1, 2007, any health carrier as defined in section
376.1350, RSMo, doing business in the state of Missouri that provides
insurance coverage for immunizations on a fee schedule or on a percentage
reimbursement basis shall reimburse for immunizations not containing
mercury at the same percentage rate of the usual and customary charges
which were provided for immunizations containing mercury or other
preservatives immediately prior to April 1, 2007.

3. The director of the department of health and senior services shall
exempt the use of a vaccine from compliance with this section if the
director finds, and the governor concurs, that an actual or potential
public health emergency exists, including an epidemic, outbreak, or
shortage for which there does not exist a sufficient supply of vaccine
that complies with subsection 1 of this section that would prevent
knowingly pregnant women or children less than three years of age from
receiving the vaccine. The director shall determine the duration of such
exemption. (L. 2005 S.B. 74 & 49)

As used in sections 191.300 to 191.380, the following terms mean:

(1) "Committee", the Missouri genetic disease advisory committee;

(2) "Cystic fibrosis", a serious lung problem of children; an inherited
disorder which produces chronic involvement of the respiratory and
digestive systems;

(3) "Department", the department of health and senior services;

(4) "Director", the director of the state department of health and senior
services;

(5) "Genetic counseling", the provision and interpretation of medical
information based on expanding knowledge of human genetics;

(6) "Genetic disorders", abnormalities of structure, function, or body
metabolism which may be inherited or may result from damage to the fetus;

(7) "Genetic screening", the search through testing for persons with
genetic disorders;

(8) "Hemophilia", a bleeding tendency resulting from a genetically
determined deficiency factor in the blood;

(9) "Outreach clinics", medical clinics which provide genetic diagnosis
and counseling at sites away from the tertiary genetic centers;

(10) "Program", the genetic program authorized by the provisions of
sections 191.300 to 191.331, 191.340, and 191.365 to 191.380;

(11) "Sickle cell anemia", a blood disease characterized by the presence
of crescent shaped or sickle shaped erythrocytes in peripheral blood,
excessive hemolysis, and active hematopoiesis, resulting from a genetic
defect;

(12) "Sickle cell trait", the healthy state wherein one carries the gene
for sickle cell and could possibly pass that gene to his offspring;

(13) "Tertiary genetic centers", permanent genetic divisions that provide
comprehensive diagnostic treatment and counseling services. (L. 1985 H.B.
612)

1. The "Missouri Genetic Advisory Committee", consisting of
fifteen members, is hereby created to advise the department in all
genetic programs including metabolic disease screening programs,
hemophilia, sickle cell anemia, and cystic fibrosis programs. Members of
the committee shall be appointed by the governor, by and with the advice
and consent of the senate. The first appointments to the committee shall
consist of five members to serve three-year terms, five members to serve
two-year terms, and five members to serve one-year terms as designated by
the governor. Each member of the committee shall serve for a term of
three years thereafter.

2. The committee shall be composed of persons who reside in the state of
Missouri, and a majority shall be licensed physicians. At least one
member shall be a specialist in genetics; at least one member shall be a
licensed obstetrician/gynecologist; at least one member shall be a
licensed pediatrician in private practice; at least one member shall be a
consumer, family member of a consumer or representative of a consumer
group; at least one member shall be a licensed physician experienced in
the study and treatment of hemophilia; at least one member shall be a
specialist in sickle cell anemia; and at least one member shall be a
specialist in cystic fibrosis.

3. Members of the committee shall not receive any compensation for their
services, but they shall, subject to appropriations, be reimbursed for
actual and necessary expenses incurred in the performance of their duties
from funds appropriated for that purpose. (L. 1985 H.B. 612, A.L. 2002
H.B. 1953)

1. The committee shall advise the department on the provision of
genetic services to insure the following:

(1) That high quality is maintained;

(2) That genetic programs are responsive to the needs of the entire state;

(3) That funding is equitably allocated to all phases of the program;

(4) That the department is advised on methods of implementing genetic
services;

(5) That duplication of services is eliminated; and

(6) That a yearly evaluation of genetic programs is completed to
ascertain how successfully the goals of the programs are being achieved.

2. The director of the department of mental health shall designate an
employee of that department to provide liaison with services provided by
that department which relate to the genetic programs established under
the provisions of sections 191.300 to 191.331, 191.340, and 191.365 to
191.380.

3. The commissioner of education shall designate an employee of the
department of elementary and secondary education to provide liaison with
the genetic program established in sections 191.300 to 191.331, 191.340,
and 191.365 to 191.380. (L. 1985 H.B. 612)

1. The department is hereby designated as administrator of a
comprehensive genetics program which will provide genetic diagnosis,
counseling, treatment, education and research.

2. The director of the department shall establish regulations and
standards for genetic programs, as the director deems necessary, to
promote and protect the public health and safety, and may promulgate all
rules and regulations necessary to effectuate the provisions of sections
191.300 to 191.380 pursuant to this section and chapter 536, RSMo. No
rule or portion of a rule promulgated under the authority of this chapter
shall become effective unless it has been promulgated pursuant to the
provisions of section 536.024, RSMo. (L. 1985 H.B. 612 § 191.315 subsecs.
1, 2, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3)

All testing results and personal information obtained from any
individual, or from specimens from any individual, shall be held
confidential and be considered a confidential medical record, except for
such information as the individual, parent or guardian consents to be
released; but the individual must first be fully informed of the scope of
the information requests to be released, of the risks, benefits and
purposes for such release, and of the identity of those to whom the
information will be released. Statistical data compiled without reference
to the identity of any individual shall not be declared confidential. (L.
1985 H.B. 612 § 191.315 subsec. 3)

The department may contract with tertiary genetic centers to
provide genetic diagnostic and counseling services, to initiate and
conduct investigations of the causes, mortality, methods of treatment,
prevention and cure of genetic disorders and related birth defects, and
to develop and administer programs and activities which aid in the
prevention or treatment of a particular genetic disorder. It may
establish outreach clinics to be located throughout the state. The
department may divide the state into regions for this purpose. The
boundaries of such regions, to the extent practicable, shall be
contiguous with relevant boundaries of political subdivisions and health
service areas. These centers and clinics may provide genetic diagnostic
evaluations, treatment, counseling and follow-up for families with or at
high risk for a genetic disease, such as sickle cell anemia, cystic
fibrosis, inherited cardiovascular disease, inherited forms of mental
retardations, or hemophilia, provided that such evaluations, treatment,
and counseling shall not include referral for abortions unless such
abortions are certified in writing by a physician that, in his
professional judgment, the life of the mother would be endangered if the
fetus were carried to term. (L. 1985 H.B. 612 § 191.320 subsec. 1)

The department may:

(1) Develop and implement programs of professional education for
physicians, medical students, nurses, scientists, technicians and
therapists regarding the causes, methods of treatment, prevention and
cure of genetic diseases;

(2) Develop and implement public educational programs regarding genetic
diseases and birth defects and programs available for genetic diagnosis,
treatment and counseling;

(3) Conduct or support scientific research concerning the causes,
mortality, methods of treatment, prevention and cure of genetic diseases
which are considered to be of major importance to the problems of genetic
disease and birth defects in Missouri, in cooperation with other public
and private agencies, except as provided in section 188.037, RSMo;

(4) Maintain a central registry to collect and store data to facilitate
the compiling of statistical information on the causes, treatment,
prevention and cure of genetic diseases. Identifying information shall
remain confidential pursuant to the provisions of section 191.315.
Information will be reported to the Missouri board of health and other
health care agencies so that it may be used for the prevention and
treatment of genetic diseases and birth defects;

(5) Support genetic trainees annually for the pursuit of training in
institutions in the state;

(6) Support new program development and specialized services which are
not otherwise available and are considered by the department to be of
major importance to the public health of Missouri. (L. 1985 H.B. 612 §
191.320 subsec. 2)

Any person residing in the state of Missouri who is in need of
genetic services and, as a person, can probably benefit from such
services and who is otherwise financially unable to pay for such services
shall be entitled to health services without charge to the limit of the
appropriations provided for genetic services. Any patient who, or whose
parents, guardian or other person legally chargeable with the support of
the patient, is able to pay a portion but not all of the expenses for the
required services for the patient shall be entitled to the services if
the patient or parent, guardian or other person legally charged with the
support of the patient shall pay such portion of the expenses to the
provider as the patient or parent, guardian or other person legally
charged with the support of the patient is reasonably able to pay.
However, when the patient is eligible, payments will be made for such
services through Medicaid or other insurance benefits available to the
patient to the fullest possible extent. The benefits available under the
provisions of sections 191.300 to 191.331, 191.340, and 191.365 to
191.380 shall not replace those provided under other federal or state law
or under other contractual or legal entitlements of the persons receiving
them. This section does not apply to metabolic screenings. (L. 1985 H.B.
612)

1. Every infant who is born in this state shall be tested for
phenylketonuria and such other metabolic or genetic diseases as are
prescribed by the department. The test used by the department shall be
dictated by accepted medical practice and such tests shall be of the
types approved by the department. All newborn screening tests required by
the department shall be performed by the department of health and senior
services laboratories. The attending physician, certified nurse midwife,
public health facility, ambulatory surgical center or hospital shall
assure that appropriate specimens are collected and submitted to the
department of health and senior services laboratories.

2. All physicians, certified nurse midwives, public health nurses and
administrators of ambulatory surgical centers or hospitals shall report
to the department all diagnosed cases of phenylketonuria and other
metabolic or genetic diseases as designated by the department. The
department shall prescribe and furnish all necessary reporting forms.

3. The department shall develop and institute educational programs
concerning phenylketonuria and other metabolic and genetic diseases and
assist parents, physicians, hospitals and public health nurses in the
management and basic treatment of these diseases.

4. The provisions of this section shall not apply if the parents of such
child object to the tests or examinations provided in this section on the
grounds that such tests or examinations conflict with their religious
tenets and practices.

5. As provided in subsection 4 of this section, the parents of any child
who fail to have such test or examination administered after notice of
the requirement for such test or examination shall be required to
document in writing such refusal. All physicians, certified nurse
midwives, public health nurses and administrators of ambulatory surgical
centers or hospitals shall provide to the parents or guardians a written
packet of educational information developed and supplied by the
department of health and senior services describing the type of specimen,
how it is obtained, the nature of diseases being screened, and the
consequences of treatment and nontreatment. The attending physician,
certified nurse midwife, public health facility, ambulatory surgical
center or hospital shall obtain the written refusal and make such refusal
part of the medical record of the infant.

6. Notwithstanding the provisions of section 192.015, RSMo, to the
contrary, the department may, by rule, annually determine and impose a
reasonable fee for each newborn screening test made in any of its
laboratories. The department may collect the fee from any entity or
individual described in subsection 1 of this section in a form and manner
established by the department. Such fee shall be considered as a cost
payable to such entity by a health care third party payer, including, but
not limited to, a health insurer operating pursuant to chapter 376, RSMo,
a domestic health services corporation or health maintenance organization
operating pursuant to chapter 354, RSMo, and a governmental or
entitlement program operating pursuant to state law. Such fee shall not
be considered as part of the internal laboratory costs of the persons and
entities described in subsection 1 of this section by such health care
third party payers. No individual shall be denied screening because of
inability to pay. Such fees shall be deposited in a separate account in
the public health services fund created in section 192.900, RSMo, and
funds in such account shall be used for the support of the newborn
screening program and activities related to the screening, diagnosis, and
treatment, including special dietary products, of persons with metabolic
and genetic diseases; and follow-up activities that ensure that
diagnostic evaluation, treatment and management is available and
accessible once an at-risk family is identified through initial
screening; and for no other purpose. These programs may include education
in these areas and the development of new programs related to these
diseases.

7. Subject to appropriations provided for formula for the treatment of
inherited diseases of amino acids and organic acids, the department shall
provide such formula to persons with inherited diseases of amino acids
and organic acids subject to the conditions described in this subsection.
State assistance pursuant to this subsection shall be available to an
applicant only after the applicant has shown that the applicant has
exhausted all benefits from third party payers, including, but not
limited to, health insurers, domestic health services corporations,
health maintenance organizations, Medicare, Medicaid and other government
assistance programs. The department shall establish an income-based means
test to be used to determine eligibility for the formula made available
pursuant to this section. (L. 1965 p. 358 §§ 1 to 5; L. 1985 H.B. 612,
A.L. 1992 H.B. 995, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3, A.L. 1997 H.B.
600 & 388)

*Rulemaking authority, effective when, null and void, when, see RSMo
376.1399.

1. By January 1, 2002, the department of health and senior
services shall, subject to appropriations, expand the newborn screening
requirements in section 191.331 to include potentially treatable or
manageable disorders, which may include but are not limited to cystic
fibrosis, galactosemia, biotinidase deficiency, congenital adrenal
hyperplasia, maple syrup urine disease (MSUD) and other amino acid
disorders, glucose-6-phosphate dehydrogenase deficiency (G-6-PD), MCAD
and other fatty acid oxidation disorders, methylmalonic acidemia,
propionic acidemia, isovaleric acidemia and glutaric acidemia Type I.

2. The department of health and senior services may promulgate rules to
implement the provisions of this section. No rule or portion of a rule
promulgated pursuant to the authority of this section shall become
effective unless it has been promulgated pursuant to chapter 536, RSMo.
(L. 2001 H.B. 279, A.L. 2005 S.B. 74 & 49)

1. The department of health and senior services hereafter
referred to as the department shall establish a program for the care and
treatment of persons suffering from hemophilia. This program shall assist
persons who require continuing treatment with blood and blood derivatives
to avoid crippling, extensive hospitalization and other effects
associated with this critical chronic bleeding condition, but who are
unable to pay for the entire cost of such services on a continuing basis
after payment of claims from various types of hospital and medical
insurance coverages, Medicare, Medicaid, and other government assistance
programs in existence now or in the future, and private charitable
assistance programs.

2. State assistance pursuant to subsection 1 of this section shall be
available to an applicant only after he has shown that he has exhausted
all benefits from insurance coverage, Medicare, Medicaid, and other
government assistance programs, and private and charitable assistance
programs. (L. 1979 H.B. 182 § 2)

The department shall:

(1) Assist in the development and expansion of programs for the care and
treatment of persons suffering from hemophilia, including
self-administration, prevention, and home care and other medical and
dental procedures and techniques designed to provide maximum control over
bleeding episodes typical of this condition;

(2) Extend financial assistance to persons suffering from hemophilia in
obtaining blood, blood derivatives and concentrates, and other
efficacious agents for use in hospital, medical and dental facilities,
and at home, or participate in the cost of blood processing to the extent
that such support will facilitate the supplying of blood, blood
derivatives, and concentrates and other efficacious agents to hemophiliac
patients at an economical cost, thus increasing the effectiveness of the
moneys appropriated to carry out the provisions of sections 191.335 and
191.340;

(3) Institute and carry on educational programs among physicians,
dentists, hospitals, public health departments, and the public concerning
hemophilia, including dissemination of information and the conducting of
educational programs concerning the methods of care and treatment of
persons suffering from the condition. (L. 1979 H.B. 182 § 3, A.L. 1985
H.B. 612)

It shall not be considered an unlawful practice of medicine
pursuant to chapter 334, RSMo, or a violation of any provision of chapter
335, RSMo, for an employee of a certified end-stage renal disease
facility who has been appropriately trained in the dialysis techniques to
initiate dialysis within a certified end-stage renal disease facility
under the supervision of a licensed physician or a registered nurse as
those terms are defined by law. (L. 1983 S.B. 336 § 1)

"Appropriately trained" employees of certified end-stage renal
disease facilities, excluding licensed physicians and registered
professional nurses, who may initiate dialysis shall be those employees
who have successfully completed a course of study in the dialysis
techniques approved by the department of health and senior services. (L.
1983 S.B. 336 § 2)

1. The department shall establish a program for the care and
treatment of persons suffering from sickle cell anemia and the
identification and counseling of individuals that have sickle cell trait.
This program shall assist persons who require continuing treatment to
avoid crippling, extensive hospitalization, and other effects associated
with this critical blood disease, but who are unable to pay for the
entire cost of such services on a continuing basis after payment of
claims from various types of hospital and medical insurance coverages,
Medicare, Medicaid, and other government assistance programs in existence
now or in the future, and private charitable assistance programs.

2. State assistance for care and treatment pursuant to subsection 1 of
this section shall be available to an applicant only after he has shown
that he has exhausted all benefits from insurance coverage, Medicare,
Medicaid, and other government assistance programs, and private and
charitable assistance programs. (L. 1985 H.B. 612)

The department shall:

(1) Assist in the development and expansion of programs for the care and
treatment of persons suffering from sickle cell anemia;

(2) Assist in the development and expansion of screening and testing
programs for the detection and counseling of individuals with sickle cell
trait;

(3) Extend financial assistance to persons suffering from sickle cell
anemia in obtaining treatment of the disease;

(4) Institute and carry on educational programs among physicians,
hospitals, public health departments, and the public concerning sickle
cell anemia, including dissemination of information and the conducting of
educational programs concerning the methods of care and treatment of
persons suffering from the condition. (L. 1985 H.B. 612)

1. The department shall establish a program for early and
accurate diagnosis of persons suspected of having cystic fibrosis to
avoid increasing lung damage and death as a result of delayed diagnosis.

2. The department shall also establish a program for the care and
treatment of persons of low and moderate income with cystic fibrosis who
require quality medical care, which includes continuous drug therapy and
physician supervision, special inhalation equipment and treatment, but
who are unable to pay for the entire cost of such services so as to avoid
frequent hospitalizations which become necessary whenever lapses in
medical care occur.

3. State assistance pursuant to subsection 1 of this section shall be
available to an applicant only after he has shown that he has exhausted
all benefits from insurance coverage, Medicare, Medicaid, and other
government assistance programs, and private charitable assistance
programs. (L. 1985 H.B. 612)

The department shall:

(1) Assist in the development and expansion of programs for the care and
treatment of persons suffering from cystic fibrosis;

(2) Extend financial assistance to persons suffering from cystic fibrosis
in obtaining treatment of the disease;

(3) Institute and carry on educational programs among physicians,
hospitals, public health departments, and the public concerning cystic
fibrosis, including dissemination of information and the conducting of
educational programs concerning the methods of care and treatment of
persons suffering from the condition. (L. 1985 H.B. 612)

1. There is hereby created a "State Board of Health" which shall
consist of seven members, who shall be appointed by the governor, by and
with the advice and consent of the senate. No member of the state board
of health shall hold any other office or employment under the state of
Missouri other than in a consulting status relevant to the member's
professional status, licensure or designation. Not more than four of the
members of the state board of health shall be from the same political
party.

2. Each member shall be appointed for a term of four years; except that
of the members first appointed, two shall be appointed for a term of one
year, two for a term of two years, two for a term of three years, and one
for a term of four years. The successors of each shall be appointed for
full terms of four years. No person may serve on the state board of
health for more than two terms. The terms of all members shall continue
until their successors have been duly appointed and qualified. Three of
the persons appointed to the state board of health shall be persons who
are physicians and surgeons licensed by the state board of registration
for the healing arts of Missouri. One of the persons appointed to the
state board of health shall be a dentist licensed by the Missouri dental
board. One of the persons appointed to the state board of health shall be
a chiropractic physician licensed by the Missouri state board of
chiropractic examiners. Two of the persons appointed to the state board
of health shall be persons other than those licensed by the state board
of registration for the healing arts, the Missouri dental board, or the
Missouri state board of chiropractic examiners and shall be
representative of those persons, professions and businesses which are
regulated and supervised by the department of health and senior services
and the state board of health. If a vacancy occurs in the appointed
membership, the governor may appoint a member for the remaining portion
of the unexpired term created by the vacancy. If the vacancy occurs while
the senate is not in session, the governor shall make a temporary
appointment subject to the approval of the senate when it next convenes.
The members shall receive actual and necessary expenses plus twenty-five
dollars per day for each day of actual attendance.

3. The board shall elect from among its membership a chairperson and a
vice chairperson, who shall act as chairperson in his or her absence. The
board shall meet at the call of the chairperson. The chairperson may call
meetings at such times as he or she deems advisable, and shall call a
meeting when requested to do so by three or more members of the board.
(L. 1967 p. 284 § 1, A.L. 1982 H.B. 1086, A.L. 1989 S.B. 390, A.L. 2002
H.B. 1032 merged with S.B. 976)

1. The director of the department of health and senior services
shall develop and implement a plan to define a system of coordinated
health care services available and accessible to all persons, in
accordance with the provisions of this section. The plan shall encourage
the location of appropriate practitioners of health care services,
including dentists, in rural and urban areas of the state, particularly
those areas designated by the director of the department of health and
senior services as health resource shortage areas, in return for the
consideration enumerated in subsection 2 of this section. The department
of health and senior services shall have authority to contract with
public and private health care providers for delivery of such services.

2. There is hereby created in the state treasury the "Health Access
Incentive Fund". Moneys in the fund shall be used to implement and
encourage a program to fund loans, loan repayments, start-up grants,
provide locum tenens, professional liability insurance assistance,
practice subsidy, annuities when appropriate, or technical assistance in
exchange for location of appropriate health providers, including
dentists, who agree to serve all persons in need of health services
regardless of ability to pay. The department of health and senior
services shall encourage the recruitment of minorities in implementing
this program.

3. In accordance with an agreement approved by both the director of the
department of social services and the director of the department of
health and senior services, the commissioner of the office of
administration shall issue warrants to the state treasurer to transfer
available funds from the health access incentive fund to the department
of social services to be used to enhance Medicaid payments to physicians
or dentists in order to enhance the availability of physician or dental
services in shortage areas. The amount that may be transferred shall be
the amount agreed upon by the directors of the departments of social
services and health and senior services and shall not exceed the maximum
amount specifically authorized for any such transfer by appropriation of
the general assembly.

4. The general assembly shall appropriate money to the health access
incentive fund from the health initiatives fund created by section
191.831. The health access incentive fund shall also contain money as
otherwise provided by law, gift, bequest or devise. Notwithstanding the
provisions of section 33.080, RSMo, the unexpended balance in the fund at
the end of the biennium shall not be transferred to the general revenue
fund of the state.

5. The director of the department of health and senior services shall
have authority to promulgate reasonable rules to implement the provisions
of this section pursuant to chapter 536, RSMo. (L. 1993 H.B. 564, A.L.
2001 S.B. 393)

As used in sections 191.500 to 191.550, unless the context
clearly indicates otherwise, the following terms mean:

(1) "Area of defined need", a community or section of an urban area of
this state which is certified by the department of health and senior
services as being in need of the services of a physician to improve the
patient-doctor ratio in the area, to contribute professional physician
services to an area of economic impact, or to contribute professional
physician services to an area suffering from the effects of a natural
disaster;

(2) "Department", the department of health and senior services;

(3) "Eligible student", a full-time student accepted and enrolled in a
formal course of instruction leading to a degree of doctor of medicine or
doctor of osteopathy at a participating school;

(4) "Financial assistance", an amount of money paid by the state of
Missouri to a qualified applicant pursuant to sections 191.500 to 191.550;

(5) "Participating school", an institution of higher learning within this
state which grants the degrees of doctor of medicine or doctor of
osteopathy, and which is accredited in the appropriate degree program by
the American Medical Association or the American Osteopathic Association;

(6) "Primary care", general or family practice, internal medicine,
pediatric or obstetric and gynecological care as provided to the general
public by physicians licensed and registered pursuant to chapter 334,
RSMo;

(7) "Resident", any natural person who has lived in this state for one or
more years for any purpose other than the attending of an educational
institution located within this state;

(8) "Rural area", a town or community within this state which is not
within a "standard metropolitan statistical area", and has a population
of six thousand or fewer inhabitants as determined by the last preceding
federal decennial census or any unincorporated area not within a standard
metropolitan statistical area. (L. 1978 H.B. 884 § 1, A.L. 1988 H.B. 1380)

The department of health and senior services shall be the
administrative agency for the implementation of the program established
by sections 191.500 to 191.550. The department shall promulgate
reasonable rules and regulations for the exercise of its functions in the
effectuation of the purposes of sections 191.500 to 191.550. It shall
prescribe the form and the time and method of filing applications and
supervise the processing thereof. (L. 1978 H.B. 884 § 2, A.L. 1988 H.B.
1380)

The department shall enter into a contract with each applicant
receiving a state loan under sections 191.500 to 191.550 for repayment of
the principal and interest and for forgiveness of a portion thereof for
participation in the service areas as provided in sections 191.500 to
191.550. (L. 1978 H.B. 884 § 3, A.L. 1988 H.B. 1380)

An eligible student may apply to the department for a loan under
sections 191.500 to 191.550 only if, at the time of his application and
throughout the period during which he receives the loan, he has been
formally accepted as a student in a participating school in a course of
study leading to the degree of doctor of medicine or doctor of
osteopathy, and is a resident of this state. (L. 1978 H.B. 884 § 4, A.L.
1988 H.B. 1380)

No loan to any eligible student shall exceed seven thousand five
hundred dollars for each academic year, which shall run from August first
of any year through July thirty-first of the following year. All loans
shall be made from funds appropriated to the medical school loan and loan
repayment program fund created by section 191.600, by the general
assembly. (L. 1978 H.B. 884 § 5, A.L. 1988 H.B. 1380, A.L. 1993 H.B. 564)

No more than twenty-five loans shall be made to eligible
students during the first academic year this program is in effect.
Twenty-five new loans may be made for the next three academic years until
a total of one hundred loans are available. At least one-half of the
loans shall be made to students from rural areas as defined in section
191.500. An eligible student may receive loans for each academic year he
is pursuing a course of study directly leading to a degree of doctor of
medicine or doctor of osteopathy. (L. 1978 H.B. 884 § 6)

Interest at the rate of nine and one-half percent per year shall
be charged on all loans made under sections 191.500 to 191.550 but
one-fourth of the interest and principal of the total loan at the time of
the awarding of the degree shall be forgiven for each year of
participation by an applicant in the practice of his profession in a
rural area or an area of defined need. The department shall grant a
deferral of interest and principal payments to a loan recipient who is
pursuing an internship or a residency in primary care. The deferral shall
not exceed three years. The status of each loan recipient receiving a
deferral shall be reviewed annually by the department to ensure
compliance with the intent of this provision. The loan recipient will
repay the loan beginning with the calendar year following completion of
his internship or his primary care residency in accordance with the loan
contract. (L. 1978 H.B. 884 § 7, A.L. 1988 H.B. 1380)

If a student ceases his study prior to receiving a degree,
interest at the rate specified in section 191.530 shall be charged on the
amount received from the state under the provisions of sections 191.500
to 191.550. (L. 1978 H.B. 884 § 8)

1. The department shall establish schedules and procedures for
repayment of the principal and interest of any loan made under the
provisions of sections 191.500 to 191.550 and not forgiven as provided in
section 191.530.

2. A penalty shall be levied against a person in breach of contract. Such
penalty shall be twice the sum of the principal and the accrued interest.
(L. 1978 H.B. 884 § 9, A.L. 1988 H.B. 1380)

When necessary to protect the interest of the state in any loan
transaction under sections 191.500 to 191.550, the board may institute
any action to recover any amount due. (L. 1978 H.B. 884 § 10)

The contracts made with the participating students shall be
approved by the attorney general. (L. 1978 H.B. 884 § 11)

1. Sections 191.600 to 191.615 establish a loan repayment
program for graduates of approved medical schools, schools of osteopathic
medicine, schools of dentistry and accredited chiropractic colleges who
practice in areas of defined need and shall be known as the "Health
Professional Student Loan Repayment Program". Sections 191.600 to 191.615
shall apply to graduates of accredited chiropractic colleges when federal
guidelines for chiropractic shortage areas are developed.

2. The "Health Professional Student Loan and Loan Repayment Program Fund"
is hereby created in the state treasury. All funds recovered from an
individual pursuant to section 191.614 and all funds generated by loan
repayments and penalties received pursuant to section 191.540 shall be
credited to the fund. The moneys in the fund shall be used by the
department of health and senior services to provide loan repayments
pursuant to section 191.611 in accordance with sections 191.600 to
191.614 and to provide loans pursuant to sections 191.500 to 191.550. (L.
1988 H.B. 1380 §§ 1, 9, A.L. 1993 H.B. 564, A.L. 2001 H.B. 567 merged
with S.B. 393)

As used in sections 191.600 to 191.615, the following terms
shall mean:

(1) "Areas of defined need", areas designated by the department pursuant
to section 191.605, when services of a physician, chiropractor or dentist
are needed to improve the patient-health professional ratio in the area,
to contribute health care professional services to an area of economic
impact, or to contribute health care professional services to an area
suffering from the effects of a natural disaster;

(2) "Chiropractor", a person licensed and registered pursuant to chapter
331, RSMo;

(3) "Department", the department of health and senior services;

(4) "General dentist", dentists licensed and registered pursuant to
chapter 332, RSMo, engaged in general dentistry and who are providing
such services to the general population;

(5) "Primary care physician", physicians licensed and registered pursuant
to chapter 334, RSMo, engaged in general or family practice, internal
medicine, pediatrics or obstetrics and gynecology as their primary
specialties, and who are providing such primary care services to the
general population. (L. 1988 H.B. 1380 § 2, A.L. 2001 H.B. 567 merged
with S.B. 393)

The department shall designate counties, communities, or
sections of urban areas as areas of defined need for medical,
chiropractic or dental services when such county, community or section of
an urban area has been designated as a primary care health professional
shortage area or a dental health care professional shortage area by the
federal Department of Health and Human Services, or has been determined
by the director of the department of health and senior services to have
an extraordinary need for health care professional services, without a
corresponding supply of such professionals. (L. 1988 H.B. 1380 § 3, A.L.
2001 H.B. 567 merged with S.B. 393)

The department shall adopt and promulgate regulations
establishing standards for determining eligible persons for loan
repayment pursuant to sections 191.600 to 191.615. These standards shall
include, but are not limited to the following:

(1) Citizenship or permanent residency in the United States;

(2) Residence in the state of Missouri;

(3) Enrollment as a full-time medical student in the final year of a
course of study offered by an approved educational institution or
licensed to practice medicine or osteopathy pursuant to chapter 334, RSMo;

(4) Enrollment as a full-time dental student in the final year of course
study offered by an approved educational institution or licensed to
practice general dentistry pursuant to chapter 332, RSMo;

(5) Enrollment as a full-time chiropractic student in the final year of
course study offered by an approved educational institution or licensed
to practice chiropractic medicine pursuant to chapter 331, RSMo;

(6) Application for loan repayment. (L. 1988 H.B. 1380 § 4, A.L. 2001
H.B. 567 merged with S.B. 393)

1. The department shall enter into a contract with each
individual qualifying for repayment of educational loans. The written
contract between the department and an individual shall contain, but not
be limited to, the following:

(1) An agreement that the state agrees to pay on behalf of the individual
loans in accordance with section 191.611 and the individual agrees to
serve for a time period equal to two years, or such longer period as the
individual may agree to, in an area of defined need, such service period
to begin within one year of the signed contract;

(2) A provision that any financial obligations arising out of a contract
entered into and any obligation of the individual which is conditioned
thereon is contingent upon funds being appropriated for loan repayments;

(3) The area of defined need where the person will practice;

(4) A statement of the damages to which the state is entitled for the
individual's breach of the contract;

(5) Such other statements of the rights and liabilities of the department
and of the individual not inconsistent with sections 191.600 to 191.615.

2. The department may stipulate specific practice sites contingent upon
department generated health care professional need priorities where
applicants shall agree to practice for the duration of their
participation in the program. (L. 1988 H.B. 1380 § 5, A.L. 2001 H.B. 567
merged with S.B. 393)

1. A loan payment provided for an individual under a written
contract under the health professional student loan payment program shall
consist of payment on behalf of the individual of the principal,
interest, and related expenses on government and commercial loans
received by the individual for tuition, fees, books, laboratory, and
living expenses incurred by the individual.

2. For each year of obligated services that an individual contracts to
serve in an area of defined need, the director may pay an amount not to
exceed the maximum amounts allowed under the National Health Service
Corps Loan Repayment Program, 42 U.S.C. Section 2541-1, P.L. 106-213, on
behalf of the individual for loans described in subsection 1 of this
section.

3. The department may enter into an agreement with the holder of the
loans for which repayments are made pursuant to the health professional
student loan payment program to establish a schedule for the making of
such payments if the establishment of such a schedule would result in
reducing the costs to the state.

4. Any qualifying communities providing a portion of a loan repayment
shall be considered first for placement. (L. 1988 H.B. 1380 § 6, A.L.
2001 H.B. 567 merged with S.B. 393)

1. An individual who has entered into a written contract with
the department; and in the case of an individual who is enrolled in the
final year of a course of study and fails to maintain an acceptable level
of academic standing in the educational institution in which such
individual is enrolled or voluntarily terminates such enrollment or is
dismissed from such educational institution before completion of such
course of study or fails to become licensed pursuant to chapter 331, 332
or 334, RSMo, within one year shall be liable to the state for the amount
which has been paid on his or her behalf under the contract.

2. If an individual breaches the written contract of the individual by
failing either to begin such individual's service obligation or to
complete such service obligation, the state shall be entitled to recover
from the individual an amount equal to the sum of:

(1) The total of the amounts prepaid by the state on behalf of the
individual;

(2) The interest on the amounts which would be payable if at the time the
amounts were paid they were loans bearing interest at the maximum
prevailing rate as determined by the Treasurer of the United States;

(3) An amount equal to any damages incurred by the department as a result
of the breach;

(4) Any legal fees or associated costs incurred by the department or the
state of Missouri in the collection of damages.

3. The department may act on behalf of a qualified community to recover
from an individual described in subsections 1 and 2 of this section the
portion of a loan repayment paid by such community for such individual.
(L. 1988 H.B. 1380 § 7, A.L. 2001 H.B. 567 merged with S.B. 393)

1. The department shall submit a grant application to the
Secretary of the United States Department of Health and Human Services as
prescribed by the secretary to obtain federal funds to finance the health
professional student loan repayment program.

2. Sections 191.600 to 191.615 shall not be construed to require the
department to enter into contracts with individuals who qualify for the
health professional student loan repayment program when federal and state
funds are not available for such purpose. (L. 1988 H.B. 1380 § 8, A.L.
2001 H.B. 567 merged with S.B. 393)

As used in sections 191.630 and 191.631, the following terms
mean:

(1) "Care provider", a person who is employed as an emergency medical
care provider, firefighter, or police officer;

(2) "Contagious or infectious disease", hepatitis in any form and any
other communicable disease as defined in section 192.800, RSMo, except
AIDS or HIV infection as defined in section 191.650, determined to be
life- threatening to a person exposed to the disease as established by
rules adopted by the department, in accordance with guidelines of the
Centers for Disease Control and Prevention of the Department of Health
and Human Services;

(3) "Department", the Missouri department of health and senior services;

(4) "Emergency medical care provider", a licensed or certified person
trained to provide emergency and nonemergency medical care as a first
responder, EMT-B, or EMT-P as defined in section 190.100, RSMo, or other
certification or licensure levels adopted by rule of the department;

(5) "Exposure", a specific eye, mouth, other mucous membrane, nonintact
skin, or parenteral contact with blood or other potentially infectious
materials that results from the performance of an employee's duties;

(6) "HIV", the same meaning as defined in section 191.650;

(7) "Hospital", the same meaning as defined in section 197.020, RSMo. (L.
2002 S.B. 1107)

1. (1) Notwithstanding any other law to the contrary, if a care
provider sustains an exposure from a person while rendering emergency
health care services, the person to whom the care provider was exposed is
deemed to consent to a test to determine if the person has a contagious
or infectious disease and is deemed to consent to notification of the
care provider of the results of the test, upon submission of an exposure
report by the care provider to the hospital where the person is delivered
by the care provider.

(2) The hospital where the person is delivered shall conduct the test.
The sample and test results shall only be identified by a number and
shall not otherwise identify the person tested.

(3) A hospital shall have written policies and procedures for
notification of a care provider pursuant to this section. The policies
and procedures shall include designation of a representative of the care
provider to whom notification shall be provided and who shall, in turn,
notify the care provider. The identity of the designated representative
of the care provider shall not be disclosed to the person tested. The
designated representative shall inform the hospital of those parties who
receive the notification, and following receipt of such information and
upon request of the person tested, the hospital shall inform the person
of the parties to whom notification was provided.

2. If a person tested is diagnosed or confirmed as having a contagious or
infectious disease pursuant to this section, the hospital shall notify
the care provider or the designated representative of the care provider
who shall then notify the care provider.

3. The notification to the care provider shall advise the care provider
of possible exposure to a particular contagious or infectious disease and
recommend that the care provider seek medical attention. The notification
shall be provided as soon as is reasonably possible following
determination that the individual has a contagious or infectious disease.
The notification shall not include the name of the person tested for the
contagious or infectious disease unless the person consents. If the care
provider who sustained an exposure determines the identity of the person
diagnosed or confirmed as having a contagious or infectious disease, the
identity of the person shall be confidential information and shall not be
disclosed by the care provider to any other individual unless a specific
written release obtained by the person diagnosed with or confirmed as
having a contagious or infectious disease.

4. This section does not require or permit, unless otherwise provided, a
hospital to administer a test for the express purpose of determining the
presence of a contagious or infectious disease; except that testing may
be performed if the person consents and if the requirements of this
section are satisfied.

5. This section does not preclude a hospital from providing notification
to a care provider under circumstances in which the hospital's policy
provides for notification of the hospital's own employees of exposure to
a contagious or infectious disease that is not life-threatening if the
notice does not reveal a patient's name, unless the patient consents.

6. A hospital participating in good faith in complying with the
provisions of this section is immune from any liability, civil or
criminal, which may otherwise be incurred or imposed.

7. A hospital's duty of notification pursuant to this section is not
continuing but is limited to diagnosis of a contagious or infectious
disease made in the course of admission, care, and treatment following
the rendering of health care services to which notification pursuant to
this section applies.

8. A hospital that performs a test in compliance with this section or
that fails to perform a test authorized pursuant to this section is
immune from any liability, civil or criminal, which may otherwise be
incurred or imposed.

9. A hospital has no duty to perform the test authorized.

10. The department shall adopt rules to implement this section. The
department may determine by rule the contagious or infectious diseases
for which testing is reasonable and appropriate and which may be
administered pursuant to this section. No rule or portion of a rule
promulgated under the authority of this section shall become effective
unless it has been promulgated pursuant to chapter 536, RSMo.

11. The employer of a care provider who sustained an exposure pursuant to
this section shall pay the costs of testing for the person who is the
source of the exposure and of the testing of the care provider if the
exposure was sustained during the course of employment. (L. 2002 S.B.
1107)

1. As used in this section, the following terms shall mean:

(1) "Blood-borne pathogens", any pathogenic microorganisms that are
present in human blood and can cause disease in humans. These pathogens
include, but are not limited to, hepatitis B virus (HBV) and human
immunodeficiency virus (HIV);

(2) "Employer", any employer having public employees with occupational
exposure to blood or other material potentially containing blood-borne
pathogens;

(3) "Frontline health care worker", a nonmanagerial employee responsible
for direct patient care with potential occupational exposure to
sharps-related injuries;

(4) "Public employee", an employee of the state or local governmental
unit, or agency thereof, employed in a health care facility, home health
care organization or other facility providing health care related
services.

2. The department of health and senior services shall, no later than six
months from August 28, 2001, adopt a blood-borne pathogen standard
governing occupational exposure of public employees to blood and other
potentially infectious materials that meets the standard in 29 CFR
1910.1030 and shall include a requirement that the most effective
available needleless systems and sharps with engineered sharps injury
protection be included as engineering and work practice controls.
However, such engineering controls shall not be required if:

(1) None are available in the marketplace; or

(2) An evaluation committee, described in subsection 5 of this section,
determines by means of objective product evaluation criteria that use of
such devices will jeopardize patient or employee safety with regard to a
specific medical procedure.

3. The use of a drug or biologic that is prepackaged with an
administration system or used in a prefilled syringe and is approved for
commercial distribution or investigational use by the federal Food and
Drug Administration shall be exempt from the provisions of this section
until June 1, 2004.

4. The sharps injury log maintained pursuant to this section shall
include:

(1) The date and time of the exposure incident;

(2) The type and brand of sharp involved in the exposure incident;

(3) A description of the exposure incident to include:

(a) The job classification of the exposed employee;

(b) The department or work area where the exposure incident occurred;

(c) The number of hours worked at the time of the exposure incident;

(d) The procedure that the exposed employee was performing at the time of
the incident;

(e) How the incident occurred;

(f) The body part involved in the exposure incident; and

(g) If the sharp had engineered sharps injury protection, whether the
protective mechanism was activated, and whether the injury occurred
before the protective mechanism was activated, during activation of the
mechanism or after activation of the mechanism.

5. An evaluation committee established pursuant to this section shall
consist of at least five members but no more than ten members. At least
half of the members of the committee shall be frontline health care
workers at such facility from a variety of occupational classifications
and departments, including but not limited to nurses, nurse aides,
technicians, phlebotomists and physicians, who shall be selected by the
facility to advise the employer on the implementation of the requirements
of this section. In facilities where there are one or more
representatives certified by the state board of mediation to represent
frontline health care workers at such facility, the facility shall
consult with such representatives as to the composition and membership of
the committee. All members of the committee shall be trained in the
proper method of utilizing product evaluation criteria prior to the
commencement of any product evaluation. Committee members shall serve
two-year terms, with the initial terms beginning thirty days after the
formation of such committee and the subsequent terms beginning every two
years thereafter. Vacancies on the committee shall be filled for the
remainder of the term by the facility in the same manner as was used to
appoint the vacating member. Members may serve consecutive terms. Members
shall not be given additional compensation for their duties on such
committee.

6. Any reference in 29 CFR 1910.1030 to the assistant secretary shall,
for purposes of this section, mean the director of the department of
health and senior services.

7. Any person may report a suspected violation of this section or 29 CFR
1910.1030 to the department of health and senior services. If such report
involves a private employer, the department shall notify the federal
Occupational Safety and Health Administration of the alleged violation.

8. The department of health and senior services shall compile and
maintain a list of needleless systems and sharps with engineered sharps
injury protection which shall be available to assist employers in
complying with the requirements of the blood-borne pathogen standard
adopted pursuant to this section. The list may be developed from existing
sources of information, including but not limited to the federal Food and
Drug Administration, the federal Centers for Disease Control and
Prevention, the National Institute of Occupational Safety and Health and
the United States Department of Veterans Affairs.

9. By February first of each year, the department of health and senior
services shall issue an annual report to the governor, state auditor,
president pro tem of the senate, speaker of the house of representatives
and the technical advisory committee on the quality of patient care and
nursing practices on the use of needle safety technology as a means of
reducing needlestick injuries. By February fifteenth of each year, such
report shall be made available to the public on the department of health
and senior services' Internet site.

10. Any employer who violates the provisions of this section shall be
subject to a reduction in or loss of state funding as a result of such
violations. (L. 2001 S.B. 266 § 191.714)

1. Health care employers shall make information available to
their employees regarding the risk of exposure to hepatitis C. Such
information shall include but not be limited to the following:
availability of testing, including lists of several sites where testing
can be obtained; cost; the department of health and senior services web
site; protocol for accidental exposure; and any other information deemed
pertinent by the employer.

2. The department of health and senior services shall maintain a
"Missouri Hepatitis C" web site in conjunction with the department's
current web site that:

(1) Informs Missourians of the availability testing for the detection of
hepatitis C;

(2) Contains detailed information regarding hepatitis including, but not
limited to, the following:

(a) Facts about hepatitis C;

(b) Risk factors for the contraction of hepatitis C;

(c) Common routes of transmission for hepatitis C;

(d) Effects of hepatitis C on the liver and other organs;

(e) Current treatments for acute and chronic hepatitis C;

(f) Effects of untreated hepatitis C on the liver and other organs;

(3) Contains links to the following information and instructional web
sites:

(a) The American Liver Foundation (www.liverfoundation.org);

(b) Hepatitis Foundation International (www.hepatitisfoundation.org);

(c) Centers for Disease Control and Prevention
(www.cdc.gov/ncidod/diseases/hepatitis/resource/);

(d) Links to any other web site or sites the director deems appropriate
and informative for Missourians; and

(e) Information on hepatitis C support groups in Missouri, including but
not limited to meeting times, locations, and dates. (L. 2005 S.B. 74 & 49)

As used in sections 191.650 to 191.698*, the following terms
mean:

(1) "Disclose", to disclose, to release, transfer, disseminate or
otherwise communicate all or any part of any record orally, in writing,
or by electronic means to any person or entity;

(2) "HBV", the hepatitis B virus;

(3) "Health care facilities", those licensed under chapters 197, RSMo,
and 198, RSMo;

(4) "Health care professional", a member of the professional groups
regulated by chapters 330, RSMo, 332, RSMo, and 335, RSMo, and sections
334.010 to 334.210**, RSMo;

(5) "HIV", the human immunodeficiency virus that causes acquired
immunodeficiency syndrome;

(6) "HIV infection", the pathological state of the human body in response
to HIV;

(7) "HIV sampling", taking or ordering the taking of any biological
specimen from an individual for the purpose of subjecting such specimen
to analysis to determine the presence of HIV or infection;

(8) "HIV testing", performing a serological test or other tests upon a
biological specimen to determine the presence of HIV or its antibodies in
the specimen following HIV sampling;

(9) "Invasive procedures", those surgical or obstetric procedures that
involve surgical entry into tissues, cavities, or organs and dental
procedures involving manipulation, cutting, or removal of oral or
perioral tissues, including tooth structure. Routine health care
procedures such as physical examinations, blood pressure checks, eye
examination, or oral, rectal or vaginal examinations are not considered
as invasive procedures;

(10) "Person", private individuals and private and public bodies politic
and corporate, partnerships, trusts, and unincorporated associations and
their officers, directors, agents, or employees. (L. 1988 H.B. 1151 &
1044 § 1, A.L. 1992 S.B. 511 & 556, A.L. 1996 S.B. 858)

*Section 191.698 was repealed by S.B. 19 § A, 1989.

**Section 334.210 was repealed by S.B. 50 § A, 1959.

1. No person shall perform or conduct HIV testing except
physicians, hospitals, and those persons authorized by the department of
health and senior services. No person shall be authorized by the
department of health and senior services to perform or conduct HIV
testing unless such person provides suitable verification to the
department that such testing shall be performed in accordance with
departmental regulations governing the types of tests performed and the
manner in which they are administered. The department may monitor the
continued compliance of such persons with departmental regulations.
Hospitals licensed pursuant to chapter 197, RSMo, shall be deemed to be
in compliance with departmental regulations governing HIV testing.

2. All HIV testing shall be performed in accordance with the department
rules governing HIV testing procedures.

3. Except as provided in sections 191.671 and 191.686, all physicians,
hospitals, or other persons authorized by the department of health and
senior services who perform or conduct HIV sampling shall provide
consultation with the subject prior to taking the specimen and during the
reporting of the test results and shall report to the department of
health and senior services the identity of any individual confirmed to be
infected with HIV. (L. 1988 H.B. 1151 & 1044 § 2, A.L. 1996 S.B. 858)

1. (1) All information known to, and records containing any
information held or maintained by, any person, or by any agency,
department, or political subdivision of the state concerning an
individual's HIV infection status or the results of any individual's HIV
testing shall be strictly confidential and shall not be disclosed except
to:

(a) Public employees within the agency, department, or political
subdivision who need to know to perform their public duties;

(b) Public employees of other agencies, departments, or political
subdivisions who need to know to perform their public duties;

(c) Peace officers, as defined in section 590.100, RSMo, the attorney
general or any assistant attorneys general acting on his or her behalf,
as defined in chapter 27, RSMo, and prosecuting attorneys or circuit
attorneys as defined in chapter 56, RSMo, and pursuant to section 191.657;

(d) Prosecuting attorneys or circuit attorneys as defined in chapter 56,
RSMo, to prosecute cases pursuant to section 191.677 or 567.020, RSMo.
Prosecuting attorneys or circuit attorneys may obtain from the department
of health and senior services the contact information and test results of
individuals with whom the HIV-infected individual has had sexual
intercourse or deviate sexual intercourse. Any prosecuting attorney or
circuit attorney who receives information from the department of health
and senior services pursuant to the provisions of this section shall use
such information only for investigative and prosecutorial purposes and
such information shall be considered strictly confidential and shall only
be released as authorized by this section;

(e) *Persons other than public employees who are entrusted* with the
regular care of those under the care and custody of a state agency,
including but not limited to operators of day care facilities, group
homes, residential care facilities and adoptive or foster parents;

(f) As authorized by subsection 2 of this section;

(g) Victims of any sexual offense defined in chapter 566, RSMo, which
includes sexual intercourse or deviate sexual intercourse, as an element
of the crime or to a victim of a section 566.135, RSMo, offense, in which
the court, for good cause shown, orders the defendant to be tested for
HIV, hepatitis B, hepatitis C, syphilis, gonorrhea, or chlamydia, once
the charge is filed. Prosecuting attorneys or circuit attorneys, or the
department of health and senior services may release information to such
victims;

(h) Any individual who has tested positive or false positive to HIV,
hepatitis B, hepatitis C, syphilis, gonorrhea, or chlamydia, may request
copies of any and all test results relating to said infections.

(2) Further disclosure by public employees shall be governed by
subsections 2 and 3 of this section;

(3) Disclosure by a public employee or any other person in violation of
this section may be subject to civil actions brought under subsection 6
of this section, unless otherwise required by chapter 330, 332, 334, or
335, RSMo, pursuant to discipline taken by a state licensing board.

2. (1) Unless the person acted in bad faith or with conscious disregard,
no person shall be liable for violating any duty or right of
confidentiality established by law for disclosing the results of an
individual's HIV testing:

(a) To the department of health and senior services;

(b) To health care personnel working directly with the infected
individual who have a reasonable need to know the results for the purpose
of providing direct patient health care;

(c) Pursuant to the written authorization of the subject of the test
result or results;

(d) To the spouse of the subject of the test result or results;

(e) To the subject of the test result or results;

(f) To the parent or legal guardian or custodian of the subject of the
testing, if he is an unemancipated minor;

(g) To the victim of any sexual offense defined in chapter 566, RSMo,
which includes sexual intercourse or deviate sexual intercourse, as an
element of the crime or to a victim of a section 566.135, RSMo, offense,
in which the court, for good cause shown, orders the defendant to be
tested for HIV, B, hepatitis C, syphilis, gonorrhea, or chlamydia, once
the charge is filed;

(h) To employees of a state licensing board in the execution of their
duties under chapter 330, 332, 334, or 335, RSMo, pursuant to discipline
taken by a state licensing board;

The department of health and senior services and its employees shall not
be held liable for disclosing an HIV-infected person's HIV status to
individuals with whom that person had sexual intercourse or deviate
sexual intercourse;

(2) Paragraphs (b) and (d) of subdivision (1) of this subsection shall
not be construed in any court to impose any duty on a person to disclose
the results of an individual's HIV testing to a spouse or health care
professional or other potentially exposed person, parent or guardian;

(3) No person to whom the results of an individual's HIV testing has been
disclosed pursuant to paragraphs (b) and (c) of subdivision (1) of this
subsection shall further disclose such results; except that prosecuting
attorneys or circuit attorneys may disclose such information to defense
attorneys defending actions pursuant to section 191.677 or 567.020, RSMo,
under the rules of discovery, or jurors or court personnel hearing cases
pursuant to section 191.677 or 567.020, RSMo. Such information shall not
be used or disclosed for any other purpose;

(4) When the results of HIV testing, disclosed pursuant to paragraph (b)
of subdivision (1) of this subsection, are included in the medical record
of the patient who is subject to the test, the inclusion is not a
disclosure for purposes of such paragraph so long as such medical record
is afforded the same confidentiality protection afforded other medical
records.

3. All communications between the subject of HIV testing and a physician,
hospital, or other person authorized by the department of health and
senior services who performs or conducts HIV sampling shall be privileged
communications.

4. The identity of any individual participating in a research project
approved by an institutional review board shall not be reported to the
department of health and senior services by the physician conducting the
research project.

5. The subject of HIV testing who is found to have HIV infection and is
aware of his or her HIV status shall disclose such information to any
health care professional from whom such person receives health care
services. Said notification shall be made prior to receiving services
from such health care professional if the HIV-infected person is
medically capable of conveying that information or as soon as he or she
becomes capable of conveying that information.

6. Any individual aggrieved by a violation of this section or regulations
promulgated by the department of health and senior services may bring a
civil action for damages. If it is found in a civil action that:

(1) A person has negligently violated this section, the person is liable,
for each violation, for:

(a) The greater of actual damages or liquidated damages of one thousand
dollars; and

(b) Court costs and reasonable attorney's fees incurred by the person
bringing the action; and

(c) Such other relief, including injunctive relief, as the court may deem
appropriate; or

(2) A person has willfully or intentionally or recklessly violated this
section, the person is liable, for each violation, for:

(a) The greater of actual damages or liquidated damages of five thousand
dollars; and

(b) Exemplary damages; and

(c) Court costs and reasonable attorney's fees incurred by the person
bringing the action; and

(d) Such other relief, including injunctive relief, as the court may deem
appropriate.

7. No civil liability shall accrue to any health care provider as a
result of making a good faith report to the department of health and
senior services about a person reasonably believed to be infected with
HIV, or cooperating in good faith with the department in an investigation
determining whether a court order directing an individual to undergo HIV
testing will be sought, or in participating in good faith in any judicial
proceeding resulting from such a report or investigations; and any person
making such a report, or cooperating with such an investigation or
participating in such a judicial proceeding, shall be immune from civil
liability as a result of such actions so long as taken in good faith. (L.
1988 H.B. 1151 & 1044 § 3, A.L. 1992 S.B. 511 & 556 merged with S.B. 638,
A.L. 1993 S.B. 233, A.L. 1996 S.B. 858, A.L. 1999 H.B. 191, A.L. 2002
H.B. 1756)

*....* These words appear twice in original rolls.

(1998) Prosecutors, judges and juries are public employees with a need to
know for prosecutions pursuant to section 191.677. State v. Mahan, 971
S.W.2d 307 (Mo.banc).

1. No court shall issue an order for the disclosure of
confidential HIV-related information, except a court of record of
competent jurisdiction in accordance with the provisions of this section.

2. Pursuant to section 191.656, a court may grant an order for disclosure
of confidential HIV-related information to peace officers, the attorney
general or any assistant attorneys general acting on his or her behalf,
and prosecuting attorneys upon an application showing:

(1) A compelling need for disclosure of the information for the
adjudication of a criminal or civil proceeding;

(2) A clear and imminent danger to an individual whose life or health may
unknowingly be at significant risk as a result of contact with the
individual to whom the information pertains;

(3) Upon application of a state, county or local health officer, a clear
and imminent danger to the public health; or

(4) That the applicant is lawfully entitled to the disclosure and the
disclosure is consistent with the provisions of this section.

3. Upon receiving an application for an order authorizing disclosure
pursuant to this section, the court shall enter an order directing that
all pleadings, papers, affidavits, judgments, orders of the court, briefs
and memoranda of law which are part of the application or the decision
thereon, be sealed and not made available to any person, except to the
extent necessary to conduct any proceedings in connection with the
determination of whether to grant or deny the application, including any
appeal. Such an order shall further direct that all subsequent
proceedings in connection with the application shall be conducted in
camera, and, where appropriate to prevent the unauthorized disclosure of
confidential HIV-related information, that any pleadings, papers,
affidavits, judgments, orders of the court, briefs and memoranda of law
which are part of the application or the decision thereon not state the
name of the individual concerning whom confidential HIV-related
information is sought.

4. (1) The individual concerning whom confidential HIV- related
information is sought and any person holding records concerning
confidential HIV-related information from whom disclosure is sought shall
be given adequate notice of such application in a manner which will not
disclose to any other person the identity of the individual, and shall be
afforded an opportunity to file a written response to the application, or
to appear in person for the limited purpose of providing evidence on the
statutory criteria for the issuance of an order pursuant to this section.

(2) The court may grant an order without such notice and opportunity to
be heard, where an ex parte application by a state, county, or local
health officer shows that a clear and imminent danger to an individual,
whose life or health may unknowingly be at risk, requires an immediate
order.

(3) Service of a subpoena shall not be subject to this subdivision.

5. In assessing compelling need and clear and imminent danger, the court
shall provide written findings of fact, including scientific or medical
findings, citing specific evidence in the record which supports each
finding, and shall weigh the need for disclosure against the privacy
interest of the protected individual and the public interest which may be
disserved by disclosure which deters future testing or treatment or which
may lead to discrimination.

6. An order authorizing disclosure of confidential HIV- related
information shall:

(1) Limit disclosure to that information which is necessary to fulfill
the purpose for which the order is granted; and

(2) Limit disclosure to those persons whose need for the information is
the basis for the order, and specifically prohibit redisclosure by such
persons to any other persons, whether or not they are parties to the
action; and

(3) To the extent possible consistent with this section, conform to the
provisions of this section; and

(4) Include such other measures as the court deems necessary to limit any
disclosures not authorized by its order. (L. 1999 H.B. 191)

1. As used in this section, the following terms shall mean:

(1) "Disclose", to disclose, release, transfer, disseminate or otherwise
communicate all or any part of any record orally, in writing or by
electronic means to any person or entity;

(2) "Health care practitioner", any licensed physician, nurse
practitioner or physician's assistant;

(3) "HIV", the human immunodeficiency virus that causes acquired
immunodeficiency syndrome;

(4) "HIV infection", the pathological state of the human body in response
to HIV;

(5) "Medically significant exposure", a puncture through or laceration of
the skin, or contact of mucous membrane or nonintact skin with blood,
tissue, wound exudate or other body fluids, including semen, vaginal
secretions, cerebrospinal fluid, synovial fluid, pleural fluid,
peritoneal fluid, pericardial fluid, amniotic fluid or any body fluid
containing visible blood, or contact of intact skin with any such body
fluids when the duration of contact is prolonged or involves an extensive
area of skin;

(6) "Person", private individuals, private or public bodies politic, and
corporations, partnerships, trusts, and unincorporated associations and
their officers, directors, agents or employees;

(7) "Source individual", the person who is the source of the blood or
other body fluids to which medically significant exposure occurred.

2. A health care practitioner providing medical treatment for a health
care worker or law enforcement officer because of a medically significant
exposure to blood or other body fluids that occurred in the course of the
worker's or officer's employment may request from the department of
health and senior services information regarding the HIV infection status
of the source individual. The department of health and senior services
may disclose to the health care practitioner the HIV infection status of
the source individual if such information is on file with the department.

3. The health care practitioner shall disclose the HIV infection status
of the source individual to the exposed health care worker or law
enforcement officer if, in the professional judgment of the health care
practitioner, such disclosure is necessary to assure adherence to a
prescribed treatment regimen.

4. No person to whom information about an individual's HIV infection has
been disclosed pursuant to this section shall further disclose such
results.

5. Any person who knowingly releases information in violation of this
section is guilty of a class A misdemeanor. (L. 1999 H.B. 271 § 1)

1. Except as provided in subsection 2 of this section, all
individuals who are delivered to the department of corrections and all
individuals who are released or discharged from any correctional facility
operated by the department of corrections, before such individuals are
released or discharged, shall undergo HIV and tuberculosis testing
without the right of refusal. In addition, the department of corrections
may perform or conduct infectious disease testing on offenders without
the right of refusal.

2. The department of corrections shall not perform HIV testing on an
individual delivered to the department if similar HIV testing has been
performed on the individual subsequent to trial and if the department is
able to obtain the results of the prior HIV test.

3. The department shall inform the victim of any sexual offense defined
in chapter 566, RSMo, which includes sexual intercourse or deviate sexual
intercourse as an element of the crime, of any confirmed positive results
of HIV testing performed on an offender within the custody of the
department. If the victim is an unemancipated minor, the department shall
also inform the minor's parents or custodian, if any. (L. 1988 H.B. 1151
& 1044 § 4, A.L. 1990 H.B. 974, A.L. 1992 S.B. 638, A.L. 1999 H.B. 358,
A.L. 2002 H.B. 1756, A.L. 2003 H.B. 477)

1. The department of mental health may perform or conduct HIV
testing or HIV sampling without the right of refusal on:

(1) Any individual participating in a methadone treatment program for the
treatment of intravenous drug abuse and who has refused to undergo such
testing whenever there are reasonable grounds to believe that the
individual is infected with HIV and is a reasonable health threat to
others;

(2) Any individual under the care and custody of the department of mental
health who has refused to undergo testing whenever there are reasonable
grounds to believe that the individual is infected with HIV and is a
reasonable health threat to others, unless such testing is otherwise
prohibited by law.

2. The department of mental health shall not report to the department of
health and senior services the identity of any individual for whom HIV
testing pursuant to this section confirms HIV infection if such reporting
is prohibited by federal law or regulation. (L. 1988 H.B. 1151 & 1044 § 5)

Effective 6-1-88

1. As used in this section and section 191.659, the term "HIV
testing" means serological test or other test upon a biological specimen
to determine the presence of the human immunodeficiency virus that causes
acquired immunodeficiency syndrome or its antibodies in the specimen.

2. Any person who is convicted or who pleads guilty or nolo contendere to
any sexual offense defined in chapter 566, RSMo, or any juvenile who is
adjudicated pursuant to subsection 3 of section 211.181, RSMo, for an
offense which would have been a sexual offense defined in chapter 566,
RSMo, if committed by an adult, which includes, in accordance with
subsection (f) of 42 U.S.C. 3756, a sexual act as defined in
subparagraphs (A) and (B) of paragraph (2) of 18 U.S.C. 2245 as an
element of the offense, shall be ordered by the court to undergo HIV
testing prior to incarceration without the right of refusal.

3. Costs of such HIV testing shall be taxed to the defendant as costs in
the criminal proceeding. Such testing costs may be retained by the court
from the bond filed by the defendant pursuant to subsection 4 of this
section. Costs of such HIV testing for juveniles may be collected as
provided for in section 211.281, RSMo.

4. Any defendant charged in a court of general jurisdiction with a sexual
offense defined in chapter 566, RSMo, which includes, in accordance with
subsection (f) of 42 U.S.C. 3756, a sexual act as defined in
subparagraphs (A) and (B) of paragraph (2) of 18 U.S.C. 2245 as an
element of the crime, shall be required to post a minimum bond amount for
his or her release prior to trial. The minimum bond amount shall be
sufficient to cover the cost of any post-trial HIV testing ordered by the
court.

5. Notwithstanding any provision of section 191.656, or any other law to
the contrary, the victim of any crime defined in chapter 566, RSMo, which
includes, in accordance with subsection (f) of 42 U.S.C. 3756, a sexual
act as defined in subparagraphs (A) and (B) of paragraph (2) of 18 U.S.C.
2245 as an element, shall have a right to access to the results of any
HIV testing performed pursuant to the provisions of this section, and the
victim shall be informed of any confirmed positive results of the HIV
testing. If the victim is an unemancipated minor, the minor's parents or
custodian, if any, shall also be informed. The administrator of the jail
or correctional facility in which the defendant is confined shall also
have access to the test results. (L. 1990 H.B. 974, A.L. 1992 S.B. 638,
A.L. 1993 H.B. 233, A.L. 1996 S.B. 858, A.L. 1999 H.B. 358)

1. Provisions of chapter 213, RSMo, shall apply to individuals
with HIV infection, acquired immunodeficiency syndrome and acquired
immunodeficiency syndrome-related complex; provided that such protection
shall not include an individual who has a currently contagious disease or
infection and who, by reason of such disease or infection, would
constitute a direct threat to the health or safety of other individuals
or who, by reason of the currently contagious disease or infection, is
unable to perform the duties of their employment.

2. Subsection 1 of this section shall not be construed to mean that any
action taken by the Missouri commission on human rights prior to June 1,
1988, concerning discrimination against any individual on the basis that
such individual has HIV infection or is perceived to have HIV infection
to be an improper exercise of authority by the commission. (L. 1988 H.B.
1151 & 1044 § 6)

Effective 6-1-88

1. The department of health and senior services shall prepare
public education and awareness plans and programs for the general public,
and the department of elementary and secondary education shall prepare
educational programs for public schools, regarding means of transmission
and prevention and treatment of the HIV virus. The plans and programs
shall include, but not be limited to:

(1) Medically correct, age specific, transmission and prevention programs
for use at the discretion of the public schools beginning with students
at the sixth grade level. The educational programs shall stress moral
responsibility in and restraint from sexual activity and avoidance of
controlled substance use whereby HIV can be transmitted;

(2) Risk reduction programs for specific populations at high risk of HIV
infection;

(3) Educational programs on transmission and prevention of HIV infection
in the workplace for use by employers;

(4) Personal protection procedures for use by health care providers and
others in close contact with potentially infected individuals;

(5) General public information programs and circulars containing factual
information that will allow the public at large to assess its risk and
develop informed individual judgment and behavior. The department shall
prepare for free distribution among the residents of the state printed
information concerning the means of transmission of the HIV virus, the
dangers from HIV infection, means of prevention, and the necessity for
testing; and

(6) Develop presentations for community service and school organizations
describing the medical and psychosocial aspects of HIV infection,
including information on how infection is transmitted and can be
prevented.

2. None of the plans, programs or printed information prepared or
provided under this section shall promote behavior that is an offense in
violation of chapter 566, RSMo, concerning sexual offenses; is an offense
involving the use of a controlled substance as defined in chapter 195,
RSMo; is an offense in violation of section 568.020, RSMo, concerning
incest; or is an offense in violation of any city, county or state law
prohibiting prostitution or patronizing prostitution. (L. 1988 H.B. 1151
& 1044 § 7)

Effective 6-1-88

1. No other section of this act* shall apply to any insurer,
health services corporation, or health maintenance organization licensed
by the department of insurance which conducts HIV testing only for the
purposes of assessing a person's fitness for insurance coverage offered
by such insurer, health services corporation, or health maintenance
corporation, except that nothing in this section shall be construed to
exempt any insurer, health services corporation or health maintenance
organization in their capacity as employers from the provisions of
section 191.665 relating to employment practices.

2. Upon renewal of any individual or group insurance policy, subscriber
contractor health maintenance organization contract covering medical
expenses, no insurer, health services corporation or health maintenance
organization shall deny or alter coverage to any previously covered
individual who has been diagnosed as having HIV infection or any
HIV-related condition during the previous policy or contract period only
because of such diagnosis, nor shall any such insurer, health services
corporation or health maintenance organization exclude coverage for
treatment of such infection or condition with respect to any such
individual.

3. The director of the department of insurance shall establish by
regulation standards for the use of HIV testing by insurers, health
services corporations and health maintenance organizations.

4. A laboratory certified by the U.S. Department of Health and Human
Services under the Clinical Laboratory Improvement Act of 1967,
permitting testing of specimens obtained in interstate commerce, and
which subjects itself to ongoing proficiency testing by the College of
American Pathologists, the American Association of Bio Analysts, or an
equivalent program approved by the Centers for Disease Control shall be
authorized to perform or conduct HIV testing for an insurer, health
services corporation or health maintenance organization pursuant to this
section.

5. The result or results of HIV testing of an applicant for insurance
coverage shall not be disclosed by an insurer, health services
corporation or health maintenance organization, except as specifically
authorized by such applicant in writing. Such result or results shall,
however, be disclosed to a physician designated by the subject of the
test. If there is no physician designated, the insurer, health services
corporation, or health maintenance organization shall disclose the
identity of individuals residing in Missouri having a confirmed positive
HIV test result to the department of health and senior services.
Provided, further, that no such insurer, health services corporation or
health maintenance organization shall be liable for violating any duty or
right of confidentiality established by law for disclosing such identity
of individuals having a confirmed positive HIV test result to the
department of health and senior services. Such disclosure shall be in a
manner that ensures confidentiality. Disclosure of test results in
violation of this section shall constitute a violation of sections
375.930 to 375.948, RSMo, regulating trade practices in the business of
insurance. Nothing in this subsection shall be construed to foreclose any
remedies existing on June 1, 1988. (L. 1988 H.B. 1151 & 1044 § 8)

Effective 6-1-88

*"This act" (H.B. 1151 & 1044, 1988) contained numerous sections. Consult
Disposition of Sections table for a definitive listing.

1. The department of health and senior services may seek in its
own name in a court of competent jurisdiction a court order directing an
individual to undergo HIV testing without the right of refusal after
reasonable efforts have been made by the department to obtain informed
consent to HIV testing. The court shall grant such order whenever there
are reasonable grounds to believe that an individual is infected with HIV
and there is clear and convincing evidence of a serious and present
health threat to others posed by the individual if infected.

2. The record of any suit filed pursuant to this section shall be closed
to the public and, at the request of the individual, any hearing shall be
held in camera. (L. 1988 H.B. 1151 & 1044 § 9)

Effective 6-1-88

1. It shall be unlawful for any individual knowingly infected
with HIV to:

(1) Be or attempt to be a blood, blood products, organ, sperm or tissue
donor except as deemed necessary for medical research;

(2) Act in a reckless manner by exposing another person to HIV without
the knowledge and consent of that person to be exposed to HIV, in one of
the following manners:

(a) Through contact with blood, semen or vaginal secretions in the course
of oral, anal or vaginal sexual intercourse; or

(b) By the sharing of needles; or

(c) By biting another person or purposely acting in any other manner
which causes the HIV-infected person's semen, vaginal secretions, or
blood to come into contact with the mucous membranes or nonintact skin of
another person.

Evidence that a person has acted recklessly in creating a risk of
infecting another individual with HIV shall include, but is not limited
to, the following:

a. The HIV-infected person knew of such infection before engaging in
sexual activity with another person, sharing needles with another person,
biting another person, or purposely causing his or her semen, vaginal
secretions, or blood to come into contact with the mucous membranes or
nonintact skin of another person, and such other person is unaware of the
HIV-infected person's condition or does not consent to contact with
blood, semen or vaginal fluid in the course of such activities;

b. The HIV-infected person has subsequently been infected with and tested
positive to primary and secondary syphilis, or gonorrhea, or chlamydia; or

c. Another person provides evidence of sexual contact with the HIV-
infected person after a diagnosis of an HIV status.

2. Violation of the provisions of subdivision (1) or (2) of subsection 1
of this section is a class B felony unless the victim contracts HIV from
the contact in which case it is a class A felony.

3. The department of health and senior services or local law enforcement
agency, victim or others may file a complaint with the prosecuting
attorney or circuit attorney of a court of competent jurisdiction
alleging that a person has violated a provision of subsection 1 of this
section. The department of health and senior services shall assist the
prosecutor or circuit attorney in preparing such case, and upon request,
turn over to peace officers, police officers, the prosecuting attorney or
circuit attorney, or the attorney general records concerning that
person's HIV-infected status, testing information, counseling received,
and the identity and available contact information for individuals with
whom that person had sexual intercourse or deviate sexual intercourse and
those individuals' test results.

4. The use of condoms is not a defense to a violation of paragraph (a) of
subdivision (2) of subsection 1 of this section. (L. 1988 H.B. 1151 &
1044 § 10, A.L. 1997 S.B. 347, A.L. 2002 H.B. 1756)

(1998) Statute is not unconstitutionally broad or void for vagueness as
applied. State v. Mahan, 971 S.W.2d 307 (Mo.banc).

1. Any person who shall erect, establish, continue, maintain,
use, own, or lease any building, structure, or place used for the purpose
of lewdness, assignation, or illegal purpose involving sexual or other
contact through which transmission of HIV infection can occur is guilty
of maintaining a nuisance.

2. The building, structure, or place, or the ground itself, in or upon
which any such lewdness, assignation, or illegal purpose is conducted,
permitted, carried on, continued, or exists, and the furniture, fixtures,
musical instruments, and movable property used in conducting or
maintaining such nuisance, are hereby declared to be a nuisance and shall
be enjoined and abated as provided in subsection 3 of this section.

3. If the existence of a nuisance is admitted or established in an action
pursuant to this section or in a criminal proceeding in any court, an
order of abatement shall be entered as part of the judgment in the case.
The order shall direct the effectual closing of the business for any
purpose, and so keeping it closed for a period of one year.

4. The department of health and senior services, a county prosecutor, or
a circuit attorney shall file suit in its own name in any court of
competent jurisdiction to enforce the provisions of this section. (L.
1988 H.B. 1151 & 1044 § 14, A.L. 2002 S.B. 1102)

The department of health and senior services shall regularly
report to the appropriate committees of both houses of the general
assembly:

(1) The number of individuals with HIV infection for whom a health care
plan has been developed detailing the form and impact of such health care
plans in a manner that does not identify or provide identifying
characteristics of an individual infected with HIV;

(2) The nature and extent to which the department has utilized judicial
proceedings in a manner that does not identify or provide identifying
characteristics of any individual subject to such proceedings;

(3) The form and extent of the handling of federal funds available to the
department of health and senior services for disbursement;

(4) The form and extent of programs and efforts funded by state funds; and

(5) Any other information such committees shall seek. (L. 1988 H.B. 1151
& 1044 § 11)

Effective 6-1-88

1. The department of health and senior services shall designate
one HIV testing site in the St. Louis area, one in the Kansas City area,
one in the central Missouri area and one in the Springfield area where
those persons not required to undergo HIV testing without the right of
refusal may be tested anonymously.

2. All physicians, hospitals, or other persons authorized by the
department of health and senior services who perform or conduct HIV
sampling may refuse to perform or conduct anonymous HIV sampling for an
individual and may refer such person to the designated HIV testing sites.

3. A coded system that does not link individual identity with the request
or result shall be used to report the results of such testing to the
department of health and senior services.

4. All designated HIV testing sites shall be required to initiate contact
notification when submitting test results to individuals who request
anonymous testing and who test positive for HIV infection. (L. 1988 H.B.
1151 & 1044 § 13, A.L. 1996 S.B. 858, A.L. 1999 H.B. 607)

1. Only after a school has adopted a policy consistent with
recommendations of the Centers for Disease Control on school children who
test positive for HIV shall the department of health and senior services
give prompt and confidential notice of the identity of any child reported
to the department to have HIV infection and the parent or guardian of any
child confirmed by the department of health and senior services standards
to have HIV infection shall also give prompt and confidential notice of
the identity of such child to the superintendent of the school district
in which the child resides, and if the child attends a nonpublic
elementary or secondary school, to the chief administrative officer of
such school.

2. The superintendent or chief administrative officer may disclose the
identity of an infected child to those persons:

(1) Who are designated by the school district to determine the fitness of
an individual to attend school; and

(2) Who have a reasonable need to know the identity of the child in order
to provide proper health care. (L. 1988 H.B. 1151 & 1044 § 15)

Effective 6-1-88

The department of health and senior services may promulgate
rules providing for mandatory premarital HIV testing if the Centers for
Disease Control so indicates. (L. 1988 H.B. 1151 & 1044 § 12)

Effective 6-1-88

1. All health care professionals and health care facilities
shall adhere to universal precautions, as defined by the Centers for
Disease Control of the United States Public Health Service, including the
appropriate use of hand washing, protective barriers, and care in the use
and disposal of needles and other sharp instruments, to minimize the risk
of transmission of HIV, HBV and other blood-borne infections to patients.
Health care professionals and health care facilities shall comply with
current guidelines, established by the Centers for Disease Control, for
disinfection and sterilization of reusable devices used in invasive
procedures.

2. Health care professionals who have exudative lesions or weeping
dermatitis of the hands, forearms, or other locations that may contact
patients, particularly on exposed areas such as hands or forearms, shall
refrain from performing all invasive procedures, and from handling
patient-care equipment and devices used in performing invasive procedures
until the condition resolves.

3. As a condition for renewal of a certificate of registration or
authority, permit, or license, all health care facilities shall provide
satisfactory evidence that periodic training in infection control
procedures, including universal precautions, is provided to all personnel
who perform patient care services at or from such facilities. Regulations
for such training shall be promulgated by the state regulatory
authorities or bodies responsible for licensing the respective health
care facilities.

4. All health care professionals who perform invasive procedures shall
receive training on infection control procedures relevant to HIV and
related diseases, including universal precautions and prevention of
percutaneous injuries, appropriate for their specialty and approved by
the department of health and senior services. The department of health
and senior services, in cooperation with appropriate state regulatory
authorities responsible for licensing the respective health care
professionals and in cooperation with professional societies, shall
develop regulations for such training. The requirements set forth in this
subsection shall be deemed satisfied if the health care professional
completes the training provided in accordance with the provisions of
subsection 3 of this section. (L. 1992 S.B. 511 & 556 § 191.694 subsecs.
1 to 4)

No rule or portion of a rule promulgated under the authority of
sections 191.650 to 191.700 shall become effective unless it has been
promulgated pursuant to the provisions of section 536.024, RSMo. (L. 1988
H.B. 1151 & 1044 § 17, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3)

Any health care professional who, after disclosure has been made
by a patient of HIV infection, discriminates against the patient on the
basis of that HIV infection or who, prior to such disclosure, makes HIV
testing a condition of treatment shall be subject to administrative
disciplinary action for violation of a professional trust or confidence
or the commission of an act of unprofessional conduct as those terms are
used in sections 330.160, RSMo, 332.321, RSMo, 334.100, RSMo, and
335.066, RSMo. (L. 1992 S.B. 511 & 556 § 191.694 subsec. 5)

1. The current assessment by the Centers for Disease Control of
the risk that infected health care professionals will transmit HIV or HBV
to patients during invasive procedures does not justify mandatory testing
to detect infection with those viruses. Health care professionals who
perform invasive procedures are advised, however, to know their HIV
antibody status and their hepatitis B antigen status.

2. (1) The department of health and senior services shall establish and
oversee a voluntary evaluation process for health care professionals
infected with HIV or HBV who perform invasive procedures. This evaluation
process may be accessed directly by an infected health care professional,
or by the director of a health care facility with the consent of the
infected health care professional and after consultation with his private
physician.

(2) The confidential and individualized evaluation shall be conducted by
an expert review panel appointed by the department of health and senior
services. Each panel shall include at least such individuals as:

(a) The health care professional's private physician;

(b) An infectious disease specialist with expertise in the epidemiology
of HIV and HBV transmission who is not involved in the care of the health
care professional;

(c) A health care professional with expertise in the procedures performed
by the infected health care professional; and

(d) A state or local public health official.

(3) The department of health and senior services, in cooperation with
appropriate state regulatory authorities or bodies responsible for
licensing the respective health care professionals and with professional
societies, shall develop uniform evaluation criteria which shall be used
in determining whether, and under what circumstances, any restrictions or
limitations should be placed on an individual health care professional's
medical practice. These criteria shall, consistent with guidelines from
the Centers for Disease Control, include at least the following inquiries:

(a) Whether the health care professional performs procedures in which
injury could result in that individual's blood contamination of a
patient's body cavity, subcutaneous tissues, or mucous membranes;

(b) The nature of the invasive procedures performed by the health care
professional and the techniques used, skill and experience, and
compliance with infection control practices demonstrated by that
individual; and

(c) Whether the presence of physical or mental impairments may interfere
with the health care professional's ability to perform such invasive
procedures safely.

(4) (a) The individualized evaluation and the recommendations of the
panel shall be based on the premise that HIV or HBV infection alone does
not justify limiting the health care professional's duties.

(b) The panel may determine which procedures the health care professional
may or may not perform, or perform with modifications. If the panel is
uncertain about whether a procedure may pose some risk of HIV or HBV
transmission, it may recommend that such procedures be performed only
after the patients have been informed of the health care professional's
infection status.

(5) (a) Information obtained during the evaluation process shall be
confidential and shall not be disclosed except to health care facilities
where the health care professional provides patient care. The department
of health and senior services may only notify or disclose to such
facilities the practice restrictions and limitations imposed on the
health care professional. Such restrictions and limitations shall be
disclosed only to those employed by such health care facilities who have
a reasonable need to know the information.

(b) Practice restrictions or limitations recommended by the department of
health and senior services shall be monitored by the health care
facilities in which the infected health care professional is employed. If
practice restrictions or limitations are placed on community based health
care professionals, periodic monitoring to ensure compliance shall be
performed by the department of health and senior services.

(c) Health care professionals whose practices are restricted or limited
because of their HIV or HBV infection status shall, whenever possible, be
provided opportunities to continue appropriate patient care activities.

(d) Health care facilities regulated under sections 197.010 to 197.120,
RSMo, may maintain or establish peer review panels that operate under the
regulations developed by the department of health and senior services and
the recommendations of the Centers for Disease Control of the United
States Public Health Service.

(e) Any violation of practice restrictions or limitations by a health
care professional shall constitute either an act violative of
professional trust and confidence, or failure or refusal to properly
guard against contagious infections or communicable diseases or the
spread thereof, or both, as these terms are used in sections 330.160,
RSMo, 332.321, RSMo, 334.100, RSMo, and 335.066, RSMo. Complaints of
possible violations of practice restrictions or limitations may be made
to the appropriate state board, as provided under chapter 330, RSMo,
chapter 332, RSMo, chapter 334, RSMo, or chapter 335, RSMo.

3. The department of health and senior services shall, from time to time,
review established standards for preventing the transmission of HIV or
HBV from health care professionals to patients and, consistent with
current medical knowledge and revised or updated guidelines from the
Centers for Disease Control, modify existing standards and require
additional minimum standards, as appropriate.

4. Notwithstanding the provisions of sections 191.650 to 191.698, the
department of health and senior services may exercise the general
authority and power under section 192.020, RSMo, to intervene in
instances where there is reason to believe that a health care
professional is practicing in a manner that creates a grave and
unjustifiable risk of injury to others. (L. 1992 S.B. 511 & 556 § 191.694
subsecs. 6 to 9)

A licensed health care facility that treats a patient having HIV
or HBV infection or any other reportable infectious or contagious disease
as defined by the department of health and senior services shall notify
the funeral establishment personnel, coroner or medical examiner involved
of such disease prior to the removal of the patient, when deceased, from
the licensed health care facility. Notification shall be conducted in a
manner that protects the confidentiality of the deceased patient. (L.
1993 S.B. 233)

Beginning January 1, 1992, every licensed physician who provides
obstetrical or gynecological care to a pregnant woman shall counsel all
patients as to the perinatal effects of smoking cigarettes, the use of
alcohol and the use of any controlled substance as defined in section
195.017, RSMo, schedule I, II, or III for nonmedical purposes. Such
physicians shall further have all patients sign a written statement, the
form of which will be prepared by the director of the department of
health and senior services, certifying that such counseling has been
received. All such executed statements shall be maintained as part of
that patient's medical file. The director of the department of health and
senior services, in cooperation with the department of mental health,
division of alcohol and drug abuse, shall further provide educational
materials and guidance to such physicians for the purpose of assuring
accurate and appropriate patient education. (L. 1991 S.B. 190 § 1)

Effective 7-1-92

The director of the department of health and senior services and
the director of the department of mental health shall create and
administer an educational program that shall:

(1) Provide education to all physicians providing obstetrical and
gynecological care in taking accurate and complete drug histories from
their pregnant patients;

(2) Provide education to all such physicians concerning the effects of
cigarettes, alcohol and schedules I, II and III controlled substances on
pregnancy and fetal outcome;

(3) Provide education to all such physicians concerning counseling
techniques for drug abusing women so as to improve referral to and
compliance with drug treatment programs. (L. 1991 S.B. 190 § 2)

Effective 7-1-92

Upon receipt of federal funds for such program, the commissioner
of the department of elementary and secondary education shall develop and
make available to all school districts for inclusion in their drug and
alcohol education programs in grades one through twelve, age-appropriate
drug education curricula concerning the physiological effects and
problems before and after birth caused by the use of cigarettes, alcohol
and schedules I, II and III controlled substances as listed in section
195.017, RSMo. (L. 1991 S.B. 190 § 3)

Effective 7-1-92

A pregnant woman referred for substance abuse treatment shall be
a first-priority user of available treatment. All records and reports
regarding such pregnant woman shall be kept confidential. The division of
alcohol and drug abuse shall ensure that family-oriented substance abuse
treatment be available, as appropriations allow. Substance abuse
treatment facilities which receive public funds shall not refuse to treat
women solely because they are pregnant. (L. 1991 S.B. 190 § 4)

Effective 7-1-92

The department of health and senior services shall establish and
maintain a toll-free information line for the purpose of providing
information on resources for substance abuse treatment and for assisting
with referral for substance abusing pregnant women. (L. 1991 S.B. 190 § 5)

Effective 7-1-92

1. The directors of the department of health and senior
services, mental health and social services and the commissioner of the
department of elementary and secondary education shall establish
multidisciplinary teams in areas deemed appropriate. Such teams shall act
in an advisory capacity for local physicians or health care providers and
shall include as a minimum a public health nurse, a representative of a
hospital staff, an experienced child protection supervisor from the
division of family services, an obstetrician, a neonatologist,
pediatrician or a family practice physician with an interest in perinatal
medicine, a medical social worker, a child psychologist and a drug
treatment provider. No compensation shall be paid to the members of the
multidisciplinary teams. These teams shall report to the director of the
department of health and senior services. Necessary expenses of the teams
may be paid from appropriations of the department of health and senior
services upon approval by the director.

2. The director, in conjunction with the department of mental health, the
department of elementary and secondary education, and the department of
social services, shall ensure that these teams are trained in health
issues affecting pregnant mothers and their babies, care in the home for
medically complex infants, developmental impairments of exposed infants
and treatment resources for drug-abusing families. The teams should also
receive training in child protection aspects of intervention in child
abuse and neglect cases and the various types of alternative resources
available.

3. The local multidisciplinary teams shall ensure local cooperation in
the implementation of sections 191.725 to 191.735. (L. 1991 S.B. 190 § 6)

Effective 7-1-92

1. Notwithstanding the physician-patient privilege, any
physician or health care provider may refer to the department of health
and senior services families in which children may have been exposed to a
controlled substance listed in section 195.017, RSMo, schedules I, II and
III, or alcohol as evidenced by:

(1) Medical documentation of signs and symptoms consistent with
controlled substances or alcohol exposure in the child at birth; or

(2) Results of a confirmed toxicology test for controlled substances
performed at birth on the mother or the child; and

(3) A written assessment made or approved by a physician, health care
provider, or by the division of family services which documents the child
as being at risk of abuse or neglect.

2. Nothing in this section shall preclude a physician or other mandated
reporter from reporting abuse or neglect of a child as required pursuant
to the provisions of section 210.115, RSMo.

3. Upon notification pursuant to subsection 1 of this section, the
department of health and senior services shall offer service coordination
services to the family. The department of health and senior services
shall coordinate social services, health care, mental health services,
and needed education and rehabilitation services. Service coordination
services shall be initiated within seventy-two hours of notification. The
department of health and senior services shall notify the department of
social services and the department of mental health within seventy-two
hours of initial notification.

4. Any physician or health care provider complying with the provisions of
this section, in good faith, shall have immunity from any civil liability
that might otherwise result by reason of such actions.

5. Referral and associated documentation provided for in this section
shall be confidential and shall not be used in any criminal prosecution.
(L. 1991 S.B. 190 § 7)

Effective 7-1-92

1. The department of social services shall provide protective
services for children that meet the criteria established in section
191.737. In addition the department of social services may provide
preventive services for children that meet the criteria established in
section 191.737.

2. No department shall cease providing services for any child exposed to
substances as set forth in section 191.737 wherein a physician or health
care provider has made or approved a written assessment which documents
the child as being at risk of abuse or neglect until such physician or
health care provider, or his designee, authorizes such file to be closed.
(L. 1991 S.B. 190 § 8)

Effective 7-1-92

1. The department of health and senior services shall promulgate
protocols based on a risk assessment profile based on substance abuse, to
be used by physicians or health care providers to identify high risk
pregnancies.

2. Upon notification by a physician or health care provider that a
pregnant woman has been identified as having a high risk pregnancy based
on such protocols, the department of health and senior services shall
offer service coordination services to such woman. Service coordination
services shall include a coordination of social services, health care and
mental health services. (L. 1991 S.B. 190 § 9)

Effective 7-1-92

1. Any physician or health care provider who provides services
to pregnant women shall identify all such women who are high risk
pregnancies by use of protocols developed by the department of health and
senior services pursuant to section 191.741. The physician or health care
provider shall upon identification inform such woman of the availability
of services and the option of referral to the department of health and
senior services.

2. Upon consent by the woman identified as having a high risk pregnancy,
the physician or health care provider shall make a report, within
seventy-two hours, to the department of health and senior services on
forms approved by the department of health and senior services.

3. Any physician or health care provider complying with the provisions of
this section, in good faith, shall have immunity from any civil liability
that might otherwise result by reason of such actions.

4. Referral and associated documentation provided for in this section
shall be confidential and shall not be used in any criminal prosecution.

5. The consent required by subsection 2 of this section shall be deemed a
waiver of the physician-patient privilege solely for the purpose of
making the report pursuant to subsection 2 of this section. (L. 1991 S.B.
190 § 10)

Effective 7-1-92

Beginning July 1, 1992, the director of the department of health
and senior services shall conduct periodic and scientifically appropriate
prevalence tests on a statistically significant sample of women or
infants at the time of delivery. Upon request from the department of
health and senior services, physicians who provide obstetrical or
gynecological care shall obtain from their patients at time of delivery,
test samples and forward the same to a central laboratory designated by
the director of the department of health and senior services. These
samples shall be forwarded to such laboratory without any identifying
information as to the donor. The director may, however, require
demographic information necessary to interpret results. The director of
the department of health and senior services shall then conduct such
studies, through this and other means, as he deems appropriate to
determine the extent of use and harmful perinatal effects of cigarettes,
alcohol and schedules I, II and III controlled substances as defined in
section 195.017, RSMo. Periodic screening results shall be compared to
those of the preceding series of tests to determine trends in pregnancy
substance abuse and to assist in monitoring the effectiveness of sections
191.725 to 191.735. Prevalence testing during the prenatal period may be
conducted in the same manner at the discretion of the director of the
department of health and senior services. (L. 1991 S.B. 190 § 11)

Effective 7-1-92

Every hospital and any health care facility licensed in this
state that provides obstetrical services shall offer to all new mothers
an opportunity to view with the father and other persons of the mother's
choosing a video on the dangers of shaking a baby and shaken baby
syndrome before the mother's discharge from the facility. Such video
shall be approved by the department of health and senior services. (L.
2004 H.B. 1453)

As used in sections 191.765 to 191.773 and section 290.145,
RSMo, the following terms mean:

(1) "Bar" or "tavern", any licensed establishment which serves liquor on
the premises for which not more than ten percent of the gross sales
receipts of the business are supplied by food purchases, either for
consumption on the premises or elsewhere;

(2) "Other person in charge", the agent of the proprietor authorized to
give administrative directions to and general supervision of the
activities within the public place, work place or public meeting at any
given time;

(3) "Proprietor", the party who ultimately controls, governs or directs
the activities within the public place, work place or public meeting,
regardless of whether he is the owner or lessor of such place or site.
The term does not mean the owner of the property unless he ultimately
controls, governs or directs the activities within the public place or
public meeting. The term "proprietor" shall apply to a corporation as
well as an individual;

(4) "Public meeting", a gathering in person of members of a governmental
body, whether an open or closed session, as defined in chapter 610, RSMo;

(5) "Public place", any enclosed indoor area used by the general public
or serving as a place of work including, but not limited to:

(a) Any retail or commercial establishments;

(b) Health care facilities, health clinics or ambulatory care facilities
including, but not limited to, laboratories associated with health care
treatment, hospitals, nursing homes, physicians' offices and dentists'
offices;

(c) Any vehicle used for public transportation including, but not limited
to, buses, taxicabs and limousines for hire;

(d) Rest rooms;

(e) Elevators;

(f) Libraries, educational facilities, day care facilities, museums,
auditoriums and art galleries;

(g) All public areas and waiting rooms of public transportation
facilities including, but not limited to, bus and airport facilities;

(h) Any enclosed indoor place used for entertainment or recreation
including, but not limited to, gymnasiums, theater lobbies, concert
halls, arenas and swimming pools;

(i) Any other enclosed indoor areas used by the general public including,
but not limited to, corridors and shopping malls;

(6) "Restaurant", any building, structure or area used, maintained or
advertised as or held out to the public to be an enclosure where meals
for consideration of payment are made available to be consumed on the
premises;

(7) "Smoking", possession of burning tobacco in the form of a cigarette,
cigar, pipe or other smoking equipment. (L. 1992 S.B. 509, et al. § 1)

1. A person shall not smoke in a public place or in a public
meeting except in a designated smoking area.

2. A smoking area may be designated by persons having custody or control
of public places, except in places in which smoking is prohibited by the
fire marshal or by other law, ordinance or regulation.

3. No public place shall have more than thirty percent of its entire
space designated as a smoking area.

4. A designated smoking area where state employees may smoke during the
work day shall be provided by each state executive department and
institution of higher education, provided such area can be adequately
ventilated at minimum cost, within the physical confines of each facility.

5. A proprietor or other person in charge of a restaurant shall designate
an area of sufficient size to accommodate usual and customary demand for
nonsmoking areas by customers or patrons. (L. 1992 S.B. 509, et al. § 2)

The following areas are not considered a public place:

(1) An entire room or hall which is used for private social functions,
provided that the seating arrangements are under the control of the
sponsor of the function and not of the proprietor or other person in
charge;

(2) Limousines for hire and taxicabs, where the driver and all passengers
agree to smoking in such vehicle;

(3) Performers on the stage, provided that the smoking is part of the
production;

(4) A place where more than fifty percent of the volume of trade or
business carried on is that of the blending of tobaccos or sale of
tobaccos, cigarettes, pipes, cigars or smoking sundries;

(5) Bars, taverns, restaurants that seat less than fifty people, bowling
alleys and billiard parlors, which conspicuously post signs stating that
"Nonsmoking Areas are Unavailable";

(6) Private residences; and

(7) Any enclosed indoor arena, stadium or other facility which may be
used for sporting events and which has a seating capacity of more than
fifteen thousand persons. (L. 1992 S.B. 509, et al. § 3)

The person having custody or control of a public place or public
meeting shall:

(1) Make reasonable efforts to prevent smoking in the public place or
public meeting by posting appropriate signs indicating no-smoking or
smoking area and arrange seating accordingly. These signs shall be placed
at a height and location easily seen by a person entering the public
place or public meeting and not obscured in any way;

(2) Arrange seating and utilize available ventilation systems and
physical barriers to isolate designated smoking areas;

(3) Make a reasonable request of persons smoking to move to a designated
smoking area;

(4) Allow smoking in designated areas of theater lobbies only. (L. 1992
S.B. 509, et al. § 4)

The following persons shall be guilty of an infraction:

(1) A person who smokes in those areas where smoking is prohibited
pursuant to the provisions of sections 191.765 to 191.773 and section
290.145, RSMo;

(2) A proprietor or other person in charge of a public place or public
meeting who permits, causes, suffers or allows a person to smoke in those
areas where smoking is prohibited pursuant to sections 191.765 to 191.773
and section 290.145, RSMo. (L. 1992 S.B. 509, et al. § 5)

No person shall smoke or otherwise use tobacco or tobacco
products in any indoor area of a public elementary or secondary school
building or educational facility, excluding institutions of higher
education, or on buses used solely to transport students to or from
school or to transport students to or from any place for educational
purposes. Any school board of any school district may set policy on the
permissible uses of tobacco products in any other nonclassroom or
nonstudent occupant facility, and on the school grounds or outdoor
facility areas as the school board deems proper. Any person who violates
the provisions of this section shall be guilty of an infraction. (L. 1993
H.B. 348 § 1)

No person shall smoke or otherwise use tobacco products in any
area of a child care facility licensed by the department of health and
senior services pursuant to the provisions of sections 210.201 to
210.245, RSMo, during the period of time when the children cared for
under that license are present. Any person who violates the provisions of
this section shall be guilty of an infraction. (L. 1993 H.B. 348 § 2)

Nothing in sections 191.775 and 191.776 shall prohibit local
political subdivisions or local boards of education from enacting more
stringent ordinances or rules. (L. 1993 H.B. 348 § 3)

As used in sections 191.800 to 191.815, the following terms mean:

(1) "Hunger", the lack of sufficient nutritious food to maintain health
or morale or to achieve optimal human potential;

(2) "Outreach", a public education activity the purpose of which is to
inform:

(a) Hungry people about available food programs and how to gain access to
them;

(b) The general public about the nature and extent of hunger problems in
the state and specific communities and the programs which address them.
(L. 1992 S.B. 449 § 1)

1. By July 1, 1993, the board of education of each school in
this state in which thirty-five percent or more of the students enrolled
in the school on October first of the preceding school year were eligible
for free or reduced price meals shall establish a school breakfast
program.

2. The department of elementary and secondary education may promulgate
rules and regulations necessary for implementation of sections 191.800 to
191.815 in compliance with federal guidelines pursuant to the provisions
of 42 U.S.C. 1773.

3. A school shall receive a waiver from the requirements of this section
if the school board of the school district by majority vote adopts a
resolution requesting a waiver.

4. A school district requesting a waiver must file in writing
notification that it has adopted a resolution which excuses the district
from the requirements of this section. Such writing shall be filed with
the Missouri department of elementary and secondary education. Such a
waiver shall be valid for a period of three years. (L. 1992 S.B. 449 § 2)

1. Subject to appropriations, the state board of education shall
establish a hardship grant program. Hardship grants shall be distributed
to provide state supplemental funding of the federal school breakfast
program. Hardship grants shall be awarded to schools based on the highest
need factor. The department of elementary and secondary education shall
promulgate rules and regulations necessary for the implementation of a
formula to determine need factor, and such rules and regulations shall be
consistent with federal guidelines for the school breakfast program as
authorized by 42 U.S.C. 1773.

2. Any school that participates, or is eligible to participate, in the
federal school breakfast program may apply for a hardship grant. The
combined amount received by a school from the federal school breakfast
program and the hardship grant shall not exceed the cost of the actual
operation of the school breakfast program.

3. No money from the public school fund shall be used to provide hardship
grants. (L. 1992 S.B. 449 § 3)

1. State supplemental funding for the Special Supplemental Food
Program or Women, Infants and Children Special Supplemental Food Program
(WIC) is hereby authorized, subject to appropriations, with the goal to
be one hundred percent coverage of all eligible women and children by the
year 2002.

2. One percent of the state supplemental funding authorized by this
section shall be set aside in a separate fund to be used by the
department of health and senior services to fund grants to county health
offices that operate a special supplemental food program for women,
infants and children* (WIC). Grants from this fund shall be used by such
county health offices for extending hours of service in order that
services will be available to WIC clients during evening hours or on
Saturdays. The maximum grant allowable pursuant to this program is ten
thousand dollars per county, and no county may receive a grant for more
than three consecutive years. The department of health and senior
services shall establish rules and regulations to administer the grant
program which would ensure distribution of grants according to county
poverty levels and projected increase in participation in counties. (L.
1992 S.B. 449 § 4)

*Words "Children's Program" appear here in original rolls.

1. By January 1, 1993, the department of health and senior
services shall establish standards for a summer food service program for
eligible children pursuant to the provisions of 42 U.S.C. 1761.

2. By July 1, 1993, those areas of the state whose perimeters are defined
by school districts which have fifty percent or more of their children
eligible for free or reduced price lunches, and where more than forty
children congregate at a service institution, shall have at least one
summer food service program in operation providing meals to all children,
both breakfast and lunch, if practicable. For the purposes of this
section:

(1) "Program" means the summer food service program for children
authorized by 42 U.S.C. 1761;

(2) "Service institution" means public or private nonprofit school food
authorities, local, municipal, or county governments, public or private
nonprofit higher education institutions participating in the National
Youth Sports Program, and residential public or private nonprofit summer
camps that develop special summer or school vacation programs providing
food service similar to that made available to children during the school
year under the school lunch program or the school breakfast program under
the Child Nutrition Act of 1966, 42 U.S.C. 1771 et seq.

3. The following order of priority shall be used in determining
participation where more than one service institution is eligible to
serve the same area:

(1) Local schools or service institutions that have demonstrated
successful program performance in a prior year;

(2) Service institutions that prepare meals at their own facilities or
operate only one site;

(3) Service institutions that use local school food facilities for the
preparation of meals;

(4) Other service institutions that have demonstrated ability for
successful program operation;

(5) Service institutions that plan to integrate the program with federal,
state or local employment programs; and

(6) Private nonprofit organizations eligible under 42 U.S.C. 1761(7).

4. A school shall receive a waiver from the requirements of this section
if the school board of the school district by majority vote adopts a
resolution requesting a waiver.

5. A school district requesting a waiver must file in writing
notification that it has adopted a resolution which excuses the district
from the requirements of this section. Such writing shall be filed with
the Missouri department of elementary and secondary education. Such a
waiver shall be valid for a period* of three years. (L. 1992 S.B. 449 § 5)

*Word "period" inadvertently omitted from original rolls.

1. Those agencies responsible for administering emergency and
supplemental food programs shall collaborate in designing and
implementing outreach programs focused on populations at risk of hunger,
that effectively describe the programs, their purposes and how to apply
for them.

2. Those programs for which outreach will be designed and implemented are
food stamps, school breakfast, summer food service programs and the
special supplemental food program for women, infants and children.

3. Outreach programs shall be culturally and linguistically appropriate
for the populations most at risk.

4. In addition to brochures and other written materials, the designated
agencies shall design public service announcements for distribution to
the electronic media and instructional videos to help persons understand
the opportunities, rights, limitations, and obligations under the
programs and how to apply for them. (L. 1992 S.B. 449 § 6)

No rule or portion of a rule promulgated under the authority of
sections 191.800 to 191.813 shall become effective unless it has been
promulgated pursuant to the provisions of section 536.024, RSMo. (L. 1992
S.B. 449 § 7, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3)

1. The following departments shall conduct on-going evaluations
of the effect of the initiatives enacted by the following sections:

(1) The department of insurance shall evaluate the effect of revising
section 376.782, RSMo, and sections 143.999, RSMo, 208.178, RSMo,
374.126, RSMo, and 376.891 to 376.894, RSMo;

(2) The department of health and senior services shall evaluate the
effect of revising sections 105.711, RSMo, and sections 191.520 and
191.600 and enacting section 191.411, and sections 167.600 to 167.621,
RSMo, 191.231, RSMo, 208.177, RSMo, 431.064, RSMo, and 660.016, RSMo. In
collaboration with the state board of registration for the healing arts,
the state board of nursing, and the state board of pharmacy, the
department of health and senior services shall also evaluate the effect
of revising section 195.070, RSMo, section 334.100, RSMo, and section
335.016, RSMo, and of sections 334.104 and 334.112, RSMo, and section
338.095 and 338.198, RSMo;

(3) The department of social services shall evaluate the effect of
revising section 198.090, RSMo, and sections 208.151, 208.152 and
208.215, RSMo, and section 383.125, RSMo, and of sections 167.600 to
167.621, RSMo, 208.177, 208.178, 208.179, 208.181, RSMo, and 211.490,
RSMo;

(4) The office of administration shall evaluate the effect of revising
sections 105.711 and 105.721, RSMo;

(5) The Missouri consolidated health care plan shall evaluate the effect
of section 103.178, RSMo; and

(6) The department of mental health shall evaluate the effect of section
191.831 as it relates to substance abuse treatment and of section 191.835.

2. The department of revenue and office of administration shall make
biannual reports to the joint committee on health care policy and
planning and the governor concerning the income received into the health
initiatives fund and the level of funding required to operate the
programs and initiatives funded by the health initiatives fund at an
optimal level. (L. 1993 H.B. 564 § 22)

1. There is hereby established in the state treasury a "Health
Initiatives Fund", to which shall be deposited all revenues designated
for the fund under subsection 8 of section 149.015, RSMo, and subsection
3 of section 149.160, RSMo, and section 167.609, RSMo, and all other
funds donated to the fund or otherwise deposited pursuant to law. The
state treasurer shall administer the fund. Money in the fund shall be
appropriated to provide funding for implementing the new programs and
initiatives established by sections 105.711 and 105.721, RSMo. The moneys
in the fund may further be used to fund those programs established by
sections 191.411, 191.520 and 191.600, sections 208.151 and 208.152,
RSMo, and sections 103.178, RSMo, 143.999, RSMo, 167.600 to 167.621,
RSMo, 188.230, RSMo, 191.211, 191.231, 191.825 to 191.839, 192.013, RSMo,
208.177, 208.178, 208.179 and 208.181, RSMo, 211.490, RSMo, 285.240,
RSMo, 337.093, RSMo, 374.126, RSMo, 376.891 to 376.894, RSMo, 431.064,
RSMo, 660.016, 660.017 and 660.018, RSMo; in addition, not less than
fifteen percent of the proceeds deposited to the health initiative fund
pursuant to sections 149.015 and 149.160, RSMo, shall be appropriated
annually to provide funding for the C-STAR substance abuse rehabilitation
program of the department of mental health, or its successor program, and
a C-STAR pilot project developed by the director of the division of
alcohol and drug abuse and the director of the department of corrections
as an alternative to incarceration, as provided in subsections 2, 3, and
4 of this section. Such pilot project shall be known as the "Alt-care"
program. In addition, some of the proceeds deposited to the health
initiatives fund pursuant to sections 149.015 and 149.160, RSMo, shall be
appropriated annually to the division of alcohol and drug abuse of the
department of mental health to be used for the administration and
oversight of the substance abuse traffic offenders program defined in
section 302.010, RSMo, and section 577.001, RSMo. The provisions of
section 33.080, RSMo, to the contrary notwithstanding, money in the
health initiatives fund shall not be transferred at the close of the
biennium to the general revenue fund.

2. The director of the division of alcohol and drug abuse and the
director of the department of corrections shall develop and administer a
pilot project to provide a comprehensive substance abuse treatment and
rehabilitation program as an alternative to incarceration, hereinafter
referred to as "Alt-care". Alt-care shall be funded using money provided
under subsection 1 of this section through the Missouri Medicaid program,
the C-STAR program of the department of mental health, and the division
of alcohol and drug abuse's purchase-of-service system. Alt-care shall
offer a flexible combination of clinical services and living arrangements
individually adapted to each client and her children. Alt-care shall
consist of the following components:

(1) Assessment and treatment planning;

(2) Community support to provide continuity, monitoring of progress and
access to services and resources;

(3) Counseling from individual to family therapy;

(4) Day treatment services which include accessibility seven days per
week, transportation to and from the Alt-care program, weekly drug
testing, leisure activities, weekly events for families and companions,
job and education preparedness training, peer support and self-help and
daily living skills; and

(5) Living arrangement options which are permanent, substance-free and
conducive to treatment and recovery.

3. Any female who is pregnant or is the custodial parent of a child or
children under the age of twelve years, and who has pleaded guilty to or
found guilty of violating the provisions of chapter 195, RSMo, and whose
controlled substance abuse was a precipitating or contributing factor in
the commission of the offense, and who is placed on probation may be
required, as a condition of probation, to participate in Alt-care, if
space is available in the pilot project area. Determinations of
eligibility for the program, placement, and continued participation shall
be made by the division of alcohol and drug abuse, in consultation with
the department of corrections.

4. The availability of space in Alt-care shall be determined by the
director of the division of alcohol and drug abuse in conjunction with
the director of the department of corrections. If the sentencing court is
advised that there is no space available, the court shall consider other
authorized dispositions. (L. 1993 H.B. 564 § 23, A.L. 2003 H.B. 600)

Effective 7-01-03

1. The division of alcohol and drug abuse of the department of
mental health shall establish a community grants program, to be known as
"Community 2000", which shall make funds available to municipalities for
the purpose of preventing alcohol and drug abuse.

2. To be eligible for grant moneys, municipalities shall establish local
commissions to coordinate and evaluate local alcohol and drug abuse
prevention programs and strategies. Such commissions shall represent law
enforcement, education, health, mental health, clergy, civic
organizations, parents, elected officials and other community residents
having a special interest in prevention and early intervention in
substance abuse problems. The commissions shall participate in a
statewide coalition of local commissions for information sharing,
coordination of resources and mutual support. Grant awards shall be based
on an impartial review of applications submitted to the division of
alcohol and drug abuse, and amounts shall be based on population.

3. The goals of each local commission shall be:

(1) The reduction of prenatal and perinatal exposure to alcohol and other
drugs;

(2) Reduction of alcohol and other drug use by children and youth by
increasing school children's understanding of effects and by employing
basic strategies of resistance, coping skills and healthy alternatives;

(3) The development of social structures which promote health and
well-being and support healthy behavior; and

(4) Maximizing opportunities for early intervention and access to
appropriate treatment services for persons who need such services.

4. The local commission's objectives shall be to assess the
appropriateness of and coordinate the community's alcohol and other drug
education and prevention activities, such as drug awareness resistance
education (DARE) programs, school curricula, community-based services and
juvenile justice programs. The commission shall develop an annual plan
and report of progress for the city council or other municipal authority.
The plan shall describe educational needs and resources, and referral
resources for individuals and families who need intervention services.
Funds may be used to support coordinating staff, community training,
media, policy analysis and development, and other related local program
functions.

5. The division of alcohol and drug abuse shall conduct annual
evaluations of the effectiveness of the community 2000 program. Up to ten
percent of the funds appropriated for the program may be used for
evaluation.

6. Funding for the community 2000 program shall be appropriated annually
by the general assembly from revenues available in the health initiatives
fund established in section 191.831. (L. 1993 H.B. 564 § 24)

The department of social services, in cooperation with the
department of health and senior services, shall design and implement an
ongoing public education program for those with no health insurance or
inadequate health insurance. The purpose of the program shall be to
identify and inform eligible citizens of the existence, eligibility
criteria, means of access, and geographic location of existing federal
and state health service programs. The program may be designed to:

(1) Offer grants to not-for-profit service agencies to provide public
education activities;

(2) Disseminate brochures and other publications;

(3) Conduct informational seminars at appropriate geographic locations
with a disproportionate concentration of low-income persons. (L. 1993
H.B. 564 § 25)

Regional research consortia within a city which lies partially
or wholly within an area designated as a distressed community may apply
for grants from the state for the purpose of conducting health research,
including research into the prevention and cessation of smoking. (L. 2000
H.B. 1238 § 2)

As used in sections 191.850 to 191.863, the following terms mean:

(1) "Accessibility", compliance with nationally accepted accessibility
and usability standards, such as those established in Section 255 of the
Telecommunications Act of 1996 and Section 508 of the Workforce
Investment Act of 1998;

(2) "Assistive technology device", any item, piece of equipment, or
product system, whether acquired commercially off the shelf, modified, or
customized, that is used to increase, maintain or improve functional
capabilities of individuals with disabilities;

(3) "Assistive technology service", any service that directly assists an
individual with a disability in the selection, acquisition or use of an
assistive technology device. Such term includes:

(a) The evaluation of the needs of an individual with a disability,
including a functional evaluation of the individual in the individual's
customary environment;

(b) Purchasing, leasing or otherwise providing for the acquisition of
assistive technology devices by individuals with disabilities;

(c) Selecting, designing, fitting, customizing, adapting, applying,
maintaining, repairing or replacing assistive technology devices;

(d) Coordinating and using other therapies, interventions or services
with assistive technology devices, such as those associated with existing
education and rehabilitation plans and programs;

(e) Training or technical assistance for an individual with disabilities,
or, where appropriate, the family of an individual with disabilities; and

(f) Training or technical assistance for professionals, including
individuals providing education and rehabilitation services, employers,
or other individuals who provide services to, who employ, or who are
otherwise substantially involved in the major life functions of
individuals with disabilities;

(4) "Individual with disabilities", any individual who is considered to
have a disability or handicap for the purposes of any federal or Missouri
law;

(5) "Information technology", any electronic information equipment or
interconnected system that is used in the acquisition, storage,
manipulation, management, movement, control, display, switching,
interchange, transmission, or reception of data or information, including
audio, graphic and text;

(6) "State department or agency", each department, office, board, bureau,
commission, or other unit of the executive, legislative or judicial
branch of state government, including public four-year and two-year
colleges and universities;

(7) "Undue burden", significant difficulty or expense, including, but not
limited to, difficulty or expense associated with technical feasibility.
(L. 1993 H.B. 589 § 1, A.L. 1999 H.B. 201)

1. The "Missouri Assistive Technology Advisory Council" is
hereby established, as created pursuant to the Missouri state grant under
Title I of the Technology-Related Assistance for Individuals with
Disabilities Act of 1988, P.L. 100-407.

2. The voting membership of the advisory council shall be composed of
twenty-three members. The members of the council that are serving on
August 28, 1993, shall continue to serve in their normal capacities. The
original twenty-one members shall determine by lot which seven are to
have a one-year term, which seven are to have a two-year term, and which
seven are to have a three-year term. Thereafter, the successors to each
of the twenty-one members shall serve a three-year term and until his
successor is appointed by the governor. The members appointed by the
governor shall include twelve consumer representatives, the group
consisting of individuals with disabilities, parents, spouses, or
guardians of individuals with disabilities and shall include a variety of
types of disabilities across the age span from all geographic areas of
the state, and nine agency representatives, the group consisting of one
representative of the division of vocational rehabilitation, one
representative of the division of special education, one representative
of the department of insurance, one representative of rehabilitation
services for the blind, one representative of the division of medical
services, one representative of the department of health and senior
services, one representative of the department of mental health, and two
representatives of other agencies or organizations responsible for the
service delivery, policy implementation, and funding of assistive
technology. In addition, one member who is a member of the house of
representatives shall be appointed by the speaker of the house and one
member who is a member of the senate shall be appointed by the president
pro tempore of the senate. The appointment of individuals representing
state agencies shall be conditioned on their continued employment with
their respective agencies.

3. A chairperson shall be elected by the council. The council shall meet
at the call of the chairperson, but not less often than four times each
year. (L. 1993 H.B. 589 § 2 subsecs. 1, 2, 3)

1. The council shall adopt written bylaws to govern its
activities.

2. Members shall receive no additional compensation for their service to
the council, but shall be reimbursed for reasonable and necessary
expenses actually incurred in the performance of official duties. (L.
1993 H.B. 589 § 2 subsecs. 4, 5)

The Missouri assistive technology advisory council is assigned
to the lead agency for the Technology-Related Assistance for Individuals
with Disabilities Act as designated by the governor so long as funds are
available under such act. (L. 1993 H.B. 589 § 2 subsec. 6, A.L. 1999 H.B.
201)

At such time that federal funds are no longer provided pursuant
to the Technology-Related Assistance for Individuals with Disabilities
Act, as amended, the council shall be assigned to the office of
administration as if by a type III transfer, as this term is defined in
paragraph (c) of subdivision (1) of subsection 7 of section 1 of the
omnibus state reorganization act of 1974. The council may not take any
official action after the assignment to the office of administration
unless or until funds are specifically appropriated by line item to fund
the actions of the council and to provide the staff and expenses
necessary to carry out the official duties and responsibilities of the
council. (L. 1993 H.B. 589 § 2 subsec. 7, A.L. 1999 H.B. 201)

The council shall advocate for assistive technology policies,
regulations and programs, and shall establish a consumer-responsive,
comprehensive assistive technology service delivery system. The council
shall:

(1) Promote awareness of the needs of individuals with disabilities for
assistive technology devices and services and the efficacy of providing
such devices and services to allow persons with disabilities to be
productive and independent;

(2) Gain an understanding of current policies, practices, and procedures
that facilitate or impede the availability or provision of assistive
technology and recommend methods to streamline such policies;

(3) Research and study data from the major public and private providers
of assistive technology regarding numbers and types of devices and
services delivered;

(4) Establish interagency coordination mechanisms among state agencies
and public and private entities that provide assistive technology devices
and services in an effort to eliminate gaps and reduce duplication of
such services to individuals with disabilities;

(5) Foster the capacity of public and private entities to provide
assistive technology devices and services so that individuals with
disabilities of all ages will, to the extent appropriate, be able to
secure and maintain possession of assistive technology as needed to
function independently and productively;

(6) Recommend and implement specific methods and programs to increase
availability of and funding for assistive technology devices and
assistive technology services for individuals with disabilities;

(7) Employ staff necessary to implement assistive technology services and
programs assigned to the council, with all employees exempt from the
state merit system under chapter 36, RSMo;

(8) Enter into grants or contracts with public or private agencies,
schools, or qualified individuals or organizations to deliver federally
required or otherwise necessary assistive technology programs and
services, including but not limited to assistive device demonstration
programs, device recycling programs, device loan programs, financial loan
programs, and assistive technology assessments, installation, and usage
training for individuals with disabilities, with or without utilizing the
procurement procedures of the office of administration;

(9) Administer the assistive technology trust fund created in section
191.861, including the formation of a not-for-profit corporation that
qualifies as a Section 501(c)(3) organization under the Internal Revenue
Code of 1986, as amended;

(10) Accept, administer, and disburse federal moneys as the lead agency
for the federal Assistive Technology Act of 2004, P.L. 108-364, and any
amendments or successors thereto, as well as moneys from the assistive
technology trust fund created in section 191.861, and any other moneys
appropriated, granted, or given for the purpose of implementing assistive
technology programs and services; and

(11) Report annually by January first to the governor and the general
assembly on council activities and the results of its studies, programs,
services, and recommendations to increase access to assistive technology.
(L. 1993 H.B. 589 §§ 3, 4, A.L. 1999 H.B. 201, A.L. 2005 S.B. 518)

1. There is hereby created in the state treasury the "Assistive
Technology Trust Fund" which shall be a public/private partnership fund
administered by the advisory assistive technology council. The fund shall
consist of gifts, donations, grants, and bequests from individuals,
private organizations, foundations, or other sources granted or given for
the specific purpose of assistive technology, and moneys transferred or
paid to the council in return for goods and services provided by the
council.

2. Upon appropriation, moneys in the fund shall be used to establish and
maintain assistive technology programs and services provided by the
council under section 191.859 and shall not be used to supplant any
existing program or service.

3. Notwithstanding the provisions of section 33.080, RSMo, to the
contrary, any moneys remaining in the fund at the end of the biennium
shall not revert to the credit of the general revenue fund.

4. The state treasurer shall invest moneys in the fund in the same manner
as other funds are invested. Any interest and moneys earned on such
investments shall be credited to the fund. (L. 2005 S.B. 518)

1. The council shall work in conjunction with the office of
information technology to assure state compliance with the provisions of
Section 508 of the Workforce Investment Act of 1998 regarding
accessibility of information technology for individuals with disabilities.

2. When developing, procuring, maintaining or using information
technology, or when administering contracts or grants that include the
procurement, development, or upgrading of information technology, each
state department or agency shall ensure, unless an undue burden would be
imposed on the department or agency, that the information technology
allows employees, program participants and members of the general public
access to and use of information and data that is comparable to the
access by individuals without disabilities.

3. To assure accessibility, the council and the office of information
technology shall:

(1) Adopt accessibility standards to be used by each state department or
agency in the procurement of information technology, and in the
development and implementation of custom-designed information technology
systems, web sites and other emerging information technology systems;

(2) Establish and implement a review procedure to be used to evaluate the
accessibility of custom-designed information technology systems proposed
by a state department or agency prior to expenditure of state funds;

(3) Review and evaluate accessibility of information technology commonly
purchased by state departments and agencies, and provide accessibility
reports on such products to those responsible for purchasing decisions;

(4) Provide training and technical assistance for state departments and
agencies to assure procurement of information technology that meets
adopted accessibility standards;

(5) Involve individuals with disabilities in accessibility reviews of
information technology and in the delivery of training and technical
assistance;

(6) Establish complaint procedures, consistent with Section 508 of the
Workforce Development Act of 1998 to be used by an individual with a
disability who alleges that a state department or agency fails to comply
with the provisions of this section. (L. 1999 H.B. 201, A.L. 2002 H.B.
2117)

1. The Missouri assistive technology advisory council,
established in section 191.853, shall establish an assistive technology
loan program. The loan program shall be funded from the assistive
technology loan revolving fund established pursuant to section 191.867.
The fund shall receive any appropriation and grant moneys received
pursuant to subsection 2 of this section to provide loans for the
purchase of assistive technology devices and services, as defined in
section 191.850.

2. The loan program shall provide loans for the first fiscal year
following appropriation. Any matching grant moneys received by the state
pursuant to * Title III of the federal Assistive Technology Act of 1998
or through any other applicable sources shall be used to fund the loan
program. The state treasurer shall provide the assistive technology
advisory council with information on the amount of moneys in the
assistive technology loan revolving fund at the beginning of each fiscal
year. The council shall quarterly expend such moneys in four equal shares
to ensure that the loan program will provide loans throughout the entire
fiscal year. Any repayments or interest earned during a fiscal year shall
not be used for loans in the current fiscal year, but shall be carried
over for use in the next fiscal year.

3. The interest rates for loans shall be lower than comparable commercial
lending rates and shall be established by the council based on the
borrower's ability to pay. Loans may be made with no interest. Loan
repayment periods shall not exceed ten years.

4. The council shall:

(1) Promulgate rules relating to borrower eligibility, interest rates,
repayment terms and other matters necessary to implement the purpose of
this section, including limits on the number and amounts of loans to
assure the continued solvency of the fund; and

(2) File annual reports with the governor and general assembly which
shall include an accounting of the loans and repayments to the fund
during the preceding fiscal year.

5. The council may enter into contracts as necessary to carry out the
purposes of this section, including but not limited to contracts with
disability organizations and lending institutions.

6. By no later than January 1, 2001, the council shall submit a report to
the general assembly regarding any rules proposed or promulgated for the
implementation of this program.

7. No rule or portion of a rule promulgated pursuant to the authority of
this section shall become effective unless it has been promulgated
pursuant to chapter 536, RSMo. (L. 2000 S.B. 721 § 191.862)

*Word "the" appears in original rolls.

1. In order to allow Missourians with disabilities to take
advantage of Title III of the federal Assistive Technology Act of 1998,
there is hereby created in the state treasury the "Assistive Technology
Loan Revolving Fund" which shall be administered by the Missouri
assistive technology advisory council and the state treasurer.

2. Moneys in the fund shall, upon appropriation, be used to establish and
maintain the assistive technology loan program established in section
191.865.

3. The fund shall consist of any moneys appropriated to the fund,
repayments of principal and interest by qualified borrowers, and interest
earned on the moneys in the fund.

4. The fund may accept federal, state and other public funds, public or
private grants, contributions and loans to the fund with the approval of
the Missouri assistive technology advisory council.

5. Notwithstanding the provisions of section 33.080, RSMo, to the
contrary, moneys in the fund shall not revert to the general revenue fund
at the end of the biennium. (L. 2000 S.B. 721 § 191.865)

As used in sections 191.900 to 191.910, the following terms mean:

(1) "Abuse", the infliction of physical, sexual or emotional harm or
injury. "Abuse" includes the taking, obtaining, using, transferring,
concealing, appropriating or taking possession of property of another
person without such person's consent;

(2) "Claim", any attempt to cause a health care payer to make a health
care payment;

(3) "False", wholly or partially untrue. A false statement or false
representation of a material fact means the failure to reveal material
facts in a manner which is intended to deceive a health care payer with
respect to a claim;

(4) "Health care", any service, assistance, care, product, device or
thing provided pursuant to a medical assistance program, or for which
payment is requested or received, in whole or part, pursuant to a medical
assistance program;

(5) "Health care payer", a medical assistance program, or any person
reviewing, adjusting, approving or otherwise handling claims for health
care on behalf of or in connection with a medical assistance program;

(6) "Health care payment", a payment made, or the right under a medical
assistance program to have a payment made, by a health care payer for a
health care service;

(7) "Health care provider", any person delivering, or purporting to
deliver, any health care, and including any employee, agent or other
representative of such a person;

(8) "Medical assistance program", any program to provide or finance
health care to recipients which is established pursuant to title 42 of
the United States Code, any successor federal health insurance program,
or a waiver granted thereunder. A medical assistance program may be
funded either solely by state funds or by state and federal funds
jointly. The term "medical assistance program" shall include the medical
assistance program provided by section 208.151, RSMo, et seq., and any
state agency or agencies administering all or any part of such a program;

(9) "Person", a natural person, corporation, partnership, association or
any legal entity. (L. 1994 H.B. 1427 § 1)

1. No health care provider shall knowingly make or cause to be
made a false statement or false representation of a material fact in
order to receive a health care payment, including but not limited to:

(1) Knowingly presenting to a health care payer a claim for a health care
payment that falsely represents that the health care for which the health
care payment is claimed was medically necessary, if in fact it was not;

(2) Knowingly concealing the occurrence of any event affecting an initial
or continued right under a medical assistance program to have a health
care payment made by a health care payer for providing health care;

(3) Knowingly concealing or failing to disclose any information with the
intent to obtain a health care payment to which the health care provider
or any other health care provider is not entitled, or to obtain a health
care payment in an amount greater than that which the health care
provider or any other health care provider is entitled;

(4) Knowingly presenting a claim to a health care payer that falsely
indicates that any particular health care was provided to a person or
persons, if in fact health care of lesser value than that described in
the claim was provided.

2. No person shall knowingly solicit or receive any remuneration,
including any kickback, bribe, or rebate, directly or indirectly, overtly
or covertly, in cash or in kind in return for:

(1) Referring another person to a health care provider for the furnishing
or arranging for the furnishing of any health care; or

(2) Purchasing, leasing, ordering or arranging for or recommending
purchasing, leasing or ordering any health care.

3. No person shall knowingly offer or pay any remuneration, including any
kickback, bribe, or rebate, directly or indirectly, overtly or covertly,
in cash or in kind, to any person to induce such person to refer another
person to a health care provider for the furnishing or arranging for the
furnishing of any health care.

4. Subsections 2 and 3 of this section shall not apply to a discount or
other reduction in price obtained by a health care provider if the
reduction in price is properly disclosed and appropriately reflected in
the claim made by the health care provider to the health care payer, or
any amount paid by an employer to an employee for employment in the
provision of health care.

5. Exceptions to the provisions of subsections 2 and 3 of this subsection
shall be provided for as authorized in 42 U.S.C. Section 1320a-7b(3)(E),
as may be from time to time amended, and regulations promulgated pursuant
thereto.

6. No person shall knowingly abuse a person receiving health care.

7. A person who violates subsections 1 to 4 of this section is guilty of
a class D felony upon his first conviction, and shall be guilty of a
class C felony upon his second and subsequent convictions. A prior
conviction shall be pleaded and proven as provided by section 558.021,
RSMo. A person who violates subsection 6 of this section shall be guilty
of a class C felony, unless the act involves no physical, sexual or
emotional harm or injury and the value of the property involved is less
than five hundred dollars, in which event a violation of subsection 6 of
this section is a class A misdemeanor.

8. Each separate false statement or false representation of a material
fact proscribed by subsection 1 of this section or act proscribed by
subsection 2 or 3 of this section shall constitute a separate offense and
a separate violation of this section, whether or not made at the same or
different times, as part of the same or separate episodes, as part of the
same scheme or course of conduct, or as part of the same claim.

9. In a prosecution pursuant to subsection 1 of this section,
circumstantial evidence may be presented to demonstrate that a false
statement or claim was knowingly made. Such evidence of knowledge may
include but shall not be limited to the following:

(1) A claim for a health care payment submitted with the health care
provider's actual, facsimile, stamped, typewritten or similar signature
on the claim for health care payment;

(2) A claim for a health care payment submitted by means of computer
billing tapes or other electronic means;

(3) A course of conduct involving other false claims submitted to this or
any other health care payer.

10. Any person convicted of a violation of this section, in addition to
any fines, penalties or sentences imposed by law, shall be required to
make restitution to the federal and state governments, in an amount at
least equal to that unlawfully paid to or by the person, and shall be
required to reimburse the reasonable costs attributable to the
investigation and prosecution pursuant to sections 191.900 to 191.910.
All of such restitution shall be paid and deposited to the credit of the
"Medicaid Fraud Reimbursement Fund", which is hereby established in the
state treasury. Moneys in the Medicaid fraud reimbursement fund shall be
divided and appropriated to the federal government and affected state
agencies in order to refund moneys falsely obtained from the federal and
state governments. All of such cost reimbursements attributable to the
investigation and prosecution shall be paid and deposited to the credit
of the "Medicaid Fraud Prosecution Revolving Fund", which is hereby
established in the state treasury. Moneys in the Medicaid fraud
prosecution revolving fund may be appropriated to the attorney general,
or to any prosecuting or circuit attorney who has successfully prosecuted
an action for a violation of sections 191.900 to 191.910 and been awarded
such costs of prosecution, in order to defray the costs of the attorney
general and any such prosecuting or circuit attorney in connection with
their duties provided by sections 191.900 to 191.910. No moneys shall be
paid into the Medicaid fraud protection revolving fund pursuant to this
subsection unless the attorney general or appropriate prosecuting or
circuit attorney shall have commenced a prosecution pursuant to this
section, and the court finds in its discretion that payment of attorneys'
fees and investigative costs is appropriate under all the circumstances,
and the attorney general and prosecuting or circuit attorney shall prove
to the court those expenses which were reasonable and necessary to the
investigation and prosecution of such case, and the court approves such
expenses as being reasonable and necessary. The provisions of section
33.080, RSMo, notwithstanding, moneys in the Medicaid fraud prosecution
revolving fund shall not lapse at the end of the biennium.

11. A person who violates subsections 1 to 4 of this section shall be
liable for a civil penalty of not less than five thousand dollars and not
more than ten thousand dollars for each separate act in violation of such
subsections, plus three times the amount of damages which the state and
federal government sustained because of the act of that person, except
that the court may assess not more than two times the amount of damages
which the state and federal government sustained because of the act of
the person, if the court finds:

(1) The person committing the violation of this section furnished
personnel employed by the attorney general and responsible for
investigating violations of sections 191.900 to 191.910 with all
information known to such person about the violation within thirty days
after the date on which the defendant first obtained the information;

(2) Such person fully cooperated with any government investigation of
such violation; and

(3) At the time such person furnished the personnel of the attorney
general with the information about the violation, no criminal
prosecution, civil action, or administrative action had commenced with
respect to such violation, and the person did not have actual knowledge
of the existence of an investigation into such violation.

12. Upon conviction pursuant to this section, the prosecution authority
shall provide written notification of the conviction to all regulatory or
disciplinary agencies with authority over the conduct of the defendant
health care provider.

13. The attorney general may bring a civil action against any person who
shall receive a health care payment as a result of a false statement or
false representation of a material fact made or caused to be made by that
person. The person shall be liable for up to double the amount of all
payments received by that person based upon the false statement or false
representation of a material fact, and the reasonable costs attributable
to the prosecution of the civil action. All such restitution shall be
paid and deposited to the credit of the Medicaid fraud reimbursement
fund, and all such cost reimbursements shall be paid and deposited to the
credit of the Medicaid fraud prosecution revolving fund. No reimbursement
of such costs attributable to the prosecution of the civil action shall
be made or allowed except with the approval of the court having
jurisdiction of the civil action. No civil action provided by this
subsection shall be brought if restitution and civil penalties provided
by subsections 10 and 11 of this section have been previously ordered
against the person for the same cause of action. (L. 1994 H.B. 1427 § 2,
A.L. 2002 H.B. 1888)

1. The attorney general shall have authority to investigate
alleged or suspected violations of sections 191.900 to 191.910, and shall
have all powers provided by sections 407.040 to 407.090, RSMo, in
connection with investigations of alleged or suspected violations of
sections 191.900 to 191.910, as if the acts enumerated in subsections 1
to 3 of section 191.905 are unlawful acts proscribed by chapter 407,
RSMo, provided that if the attorney general exercises such powers, the
provisions of section 407.070, RSMo, shall also be applicable; and may
exercise all of the powers provided by subsections 1 and 2 of section
578.387, RSMo, in connection with investigations of alleged or suspected
violations of sections 191.900 to 191.910, as if the acts enumerated in
subsections 1 to 3 of section 191.905 involve "public assistance" as
defined by section 578.375, RSMo. The attorney general and his authorized
investigators shall be authorized to serve all subpoenas and civil
process related to the enforcement of sections 191.900 to 191.910 and
chapter 407, RSMo. In order for the attorney general to commence a state
prosecution for violations of sections 191.900 to 191.910, the attorney
general shall prepare and forward a report of the violations to the
appropriate prosecuting attorney. Upon receiving a referral, the
prosecuting attorney shall either commence a prosecution based on the
report by the filing of a complaint, information, or indictment within
sixty days of receipt of said report or shall file a written statement
with the attorney general explaining why criminal charges should not be
brought. This time period may be extended by the prosecuting attorney
with the agreement of the attorney general for an additional sixty days.
If the prosecuting attorney commences a criminal prosecution, the
attorney general or his designee shall be permitted by the court to
participate as a special assistant prosecuting attorney in settlement
negotiations and all court proceedings, subject to the authority of the
prosecuting attorney, for the purpose of providing such assistance as may
be necessary. If the prosecuting attorney fails to commence a prosecution
and fails to file a written statement listing the reasons why criminal
charges should not be brought within the appropriate time period, or
declines to prosecute on the basis of inadequate office resources, the
attorney general shall have authority to commence prosecutions for
violations of sections 191.900 to 191.910. In cases where a defendant
pursuant to a common scheme or plan has committed acts which constitute
or would constitute violations of sections 191.900 to 191.910 in more
than one state, the attorney general shall have the authority to
represent the state of Missouri in any plea agreement which resolves all
criminal prosecutions within and without the state, and such agreement
shall be binding on all state prosecutors.

2. In any investigation, hearing or other proceeding pursuant to sections
191.900 to 191.910, any record in the possession or control of a health
care provider, or in the possession or control of another person on
behalf of a health care provider, including but not limited to any record
relating to patient care, business or accounting records, payroll records
and tax records, whether written or in an electronic format, shall be
made available by the health care provider to the attorney general or the
court, and shall be admissible into evidence, regardless of any statutory
or common law privilege which such health care provider, record custodian
or patient might otherwise invoke or assert. The provisions of section
326.151, RSMo, shall not apply to actions brought pursuant to sections
191.900 to 191.910. The attorney general shall not disclose any record
obtained pursuant to this section, other than in connection with a
proceeding instituted or pending in any court or administrative agency.
The access, provision, use, and disclosure of records or material subject
to the provisions of 42 U.S.C. section 290dd-2 shall be subject to said
section, as may be amended from time to time, and to regulations
promulgated pursuant to said section.

3. Sections 191.900 to 191.910 shall not be construed to prohibit or
limit any other criminal or civil action against a health care provider
for the violation of any other law. Any complaint, investigation or
report received or completed pursuant to sections 198.070 and 198.090,
RSMo, subsection 2 of section 205.967, RSMo, sections 375.991 to 375.994,
RSMo, section 578.387, RSMo, or sections 660.300 and 660.305, RSMo, which
indicates a violation of sections 191.900 to 191.910, shall be referred
to the attorney general. A referral to the attorney general pursuant to
this subsection shall not preclude the agencies charged with enforcing
the foregoing sections from conducting investigations, providing
protective services or taking administrative action regarding the
complaint, investigation or report referred to the attorney general, as
may be provided by such sections; provided that all material developed by
the attorney general in the course of an investigation pursuant to
sections 191.900 to 191.910 shall not be subject to subpoena, discovery,
or other legal or administrative process in the course of any such
administrative action. Sections 191.900 to 191.910 take precedence over
the provisions of sections 198.070 and 198.090, RSMo, subsection 2 of
section 205.967, RSMo, sections 375.991 to 375.994, RSMo, section
578.387, RSMo, and sections 660.300 and 660.305, RSMo, to the extent such
provisions are inconsistent or overlap. (L. 1994 H.B. 1427 § 3)

1. Every hospital, as defined in section 197.020, RSMo, and
ambulatory surgical center, as defined in section 197.200, RSMo, that
provides obstetrical care shall:

(1) Provide new mothers, where appropriate as determined by the attending
physician, with information on breast-feeding and the benefits to the
child; and

(2) Provide new mothers, where appropriate as determined by the attending
physician, with information on local breast-feeding support groups; or

(3) Offer breast-feeding consultations to new mothers, where appropriate
as determined by the attending physician.

2. Beginning January 1, 2000, every licensed physician who provides
obstetrical or gynecological consultation shall, where appropriate as
determined by such physician, inform patients as to the prenatal
preparation for and postnatal benefits of breast-feeding a child.

3. The department of health and senior services shall produce written
information on breast-feeding and the health benefits to the child, and
shall distribute such information to physicians described in subsection 2
of this section and to hospitals and ambulatory surgical centers
described in subsection 1 of this section upon request. (L. 1999 S.B. 8 &
173 § 5)

Notwithstanding any other provision of law to the contrary, a
mother may, with as much discretion as possible, breast-feed her child in
any public or private location where the mother is otherwise authorized
to be. (L. 1999 S.B. 8 & 173 § 6)

1. Effective January 1, 2002, every infant born in this state
shall be screened for hearing loss in accordance with the provisions of
sections 191.925 to 191.937 and section 376.1220, RSMo.

2. The screening procedure shall include the use of at least one of the
following physiological technologies:

(1) Automated or diagnostic auditory brainstem response (ABR);

(2) Otoacoustic emissions (OAE); or

(3) Other technologies approved by the department of health and senior
services.

3. Every newborn delivered on or after January 1, 2002, in an ambulatory
surgical center or hospital shall be screened for hearing loss prior to
discharge of the infant from the facility. Any facility that transfers a
newborn for further acute care prior to completion of the newborn hearing
screening shall notify the receiving facility of the status of the
newborn hearing screening. The receiving facility shall be responsible
for the completion of the newborn hearing screening. Such facilities
shall report the screening results on all newborns to the parents or
guardian of the newborn, and the department of health and senior services
in a manner prescribed by the department.

4. If a newborn is delivered in a place other than the facilities listed
in subsection 3 of this section, the physician or person who
professionally undertakes the pediatric care of the infant shall ensure
that the newborn hearing screening is performed within three months of
the date of the infant's birth. Such physicians and persons shall report
the screening results on all newborns to the parents or guardian of the
newborn, and the department of health and senior services in a manner
prescribed by the department.

5. The provisions of this section shall not apply if the parents of the
newborn or infant object to such testing on the grounds that such tests
conflict with their religious tenets and practices.

6. As provided in subsection 5 of this section, the parent of any child
who fails to have the hearing screening test administered after notice of
the requirement for such test shall have such refusal documented in
writing. Such physicians, persons or administrators shall obtain the
written refusal and make such refusal part of the medical record of the
infant, and shall report such refusal to the department of health and
senior services in a manner prescribed by the department.

7. The physician or person who professionally undertakes the pediatric
care of the newborn, and administrators of ambulatory surgical centers or
hospitals shall provide to the parents or guardians of newborns a written
packet of educational information developed and supplied by the
department of health and senior services describing the screening, how it
is conducted, the nature of the hearing loss, and the possible
consequences of treatment and nontreatment for hearing loss prior to
administering the screening.

8. All facilities or persons described in subsections 3 and 4 of this
section who voluntarily provide hearing screening to newborns prior to
January 1, 2002, shall report such screening results to the department of
health and senior services in a manner prescribed by the department.

9. All facilities or persons described in subsections 3 and 4 of this
section shall provide the parents or guardians of newborns who fail the
hearing screening with educational materials that:

(1) Communicate the importance of obtaining further hearing screening or
diagnostic audiological assessment to confirm or rule out hearing loss;

(2) Identify community resources available to provide rescreening and
diagnostic audiological assessments; and

(3) Provide other information as prescribed by the department of health
and senior services.

10. Any person who acts in good faith in complying with the provisions of
this section by reporting the newborn hearing screening results to the
department of health and senior services shall not be civilly or
criminally liable for furnishing the information required by this section.

11. The department of health and senior services shall provide
audiological and administrative technical support to facilities and
persons implementing the requirements of this section, including, but not
limited to, assistance in:

(1) Selecting state-of-the-art newborn hearing screening equipment;

(2) Developing and implementing newborn hearing screening procedures that
result in appropriate failure rates;

(3) Developing and implementing training for individuals administering
screening procedures;

(4) Developing and distributing educational materials for families;

(5) Identifying community resources for delivery of rescreening and
pediatric audiological assessment services; and

(6) Implementing reporting requirements.

Such audiological technical support shall be provided by individuals
qualified to administer newborn and infant hearing screening, rescreening
and diagnostic audiological assessment. (L. 1999 H.B. 401 § 191.250, A.L.
2002 H.B. 1548 merged with S.B. 923, et al. merged with S.B. 1244)

1. The department of health and senior services shall establish
and maintain a newborn hearing screening surveillance and monitoring
system for newborns who have been reported with possible hearing loss for
the purpose of confirming the presence or absence of hearing loss, and
referring those with hearing loss for early intervention services.

2. The department of health and senior services shall establish standards
and follow-up procedures for all newborns reported with possible hearing
loss pursuant to the provisions of section 191.925, as necessary to
assure appropriate and timely diagnosis of hearing loss, delivery of
amplification, and referral for early intervention services. Such
standards and procedures shall include:

(1) Rescreening;

(2) Diagnostic audiological assessment;

(3) Individuals qualified to administer rescreening and diagnostic
audiological assessment;

(4) Time lines for administering rescreening and diagnostic pediatric
audiological assessment; and

(5) Time lines and content of contacts to be made by the surveillance and
monitoring system.

3. The results of rescreening and diagnostic audiological assessment
procedures shall be reported to the department of health and senior
services in a manner prescribed by the department. Any person who acts in
good faith in complying with this section in reporting rescreening or
diagnostic audiological assessment procedures to the department of health
and senior services, or the parents or guardians of a newborn shall not
be civilly or criminally liable for furnishing the information required
by this section.

4. Any newborn with a confirmed hearing loss in the surveillance and
monitoring system shall be referred to the appropriate point of contact
for the Part C of the Individuals with Disabilities Education Act (IDEA)
system of early intervention services (First Steps) and shall be reported
to the Missouri commission for the deaf and hard of hearing for census
purposes.

5. Except as provided in this section, the information contained in the
surveillance and monitoring system shall be confidential and shall not be
divulged or made public in a manner that discloses the identity of an
individual. The department of health and senior services may disclose and
exchange such information as is necessary to provide follow-up services
for newborns identified with hearing loss to the following persons
without a parent's or guardian's written release:

(1) Employees of public agencies, departments and political subdivisions
who need to know such information to carry out their public duties; or

(2) Health care professionals or their agents who undertake the pediatric
care of the newborn.

If any person discloses such information for any other purposes, such
person is guilty of an unauthorized release of confidential information
and the person who discloses is liable for civil damages. (L. 1999 H.B.
401 § 191.253, A.L. 2002 H.B. 1783)

The IDEA Part C data system shall monitor the delivery of early
intervention services to those infants identified by the newborn hearing
screening program and report annually to the department of health and
senior services. Information collected shall be sufficient to document
the early intervention services provided, including the type of
amplification or other assistive technologies, and the status of outcomes
as identified on the individualized family service plan (IFSP). (L. 1999
H.B. 401 § 191.256)

1. There is hereby established a "Newborn Hearing Screening
Advisory Committee".

2. The committee shall advise and assist the department of health and
senior services in:

(1) Developing rules, regulations and standards for screening,
rescreening and diagnostic audiological assessment;

(2) Developing forms for reporting screening, rescreening and diagnostic
audiological assessment results to the surveillance and monitoring system;

(3) Designing a technical assistance program to support facilities
implementing the screening program and those conducting rescreening and
diagnostic audiological assessment;

(4) Developing educational materials to be provided to families; and

(5) Evaluating program outcomes to increase effectiveness and efficiency.

The committee shall also report information concerning the newborn
hearing screening program to the state interagency coordinating council,
as requested, to ensure coordination of programs within the state's early
intervention system, and to identify and eliminate areas of duplication.

3. The committee shall be composed of the following sixteen members, with
no less than two such members being deaf or hard of hearing, appointed by
the director of the department of health and senior services:

(1) Three consumers, including one deaf individual who experienced
hearing loss in early childhood, one hard-of-hearing individual who
experienced hearing loss in early childhood and one parent of a child
with a hearing loss;

(2) Two audiologists who have experience in evaluation and intervention
of infants and young children;

(3) Two physicians who have experience in the care of infants and young
children, one of which shall be a pediatrician;

(4) One representative of an organization with experience in providing
early intervention services for children with hearing loss;

(5) One representative of the Missouri school for the deaf;

(6) One representative of a hospital with experience in the care of
newborns;

(7) One representative of the Missouri commission for the deaf and hard
of hearing;

(8) One representative from each of the departments of health and senior
services, elementary and secondary education, mental health, social
services and insurance.

4. The department of health and senior services member shall chair the
first meeting of the committee. At the first meeting, the committee shall
elect a chairperson from its membership. The committee shall meet at the
call of the chairperson, but not less than four times a year.

5. The department of health and senior services shall provide technical
and administrative support services as required by the committee. Such
services shall include technical support from individuals qualified to
administer infant hearing screening, rescreening and diagnostic
audiological assessments.

6. Members of the committee shall receive no compensation for their
services as members but shall be reimbursed for expenses incurred as a
result of their duties as members of the committee.

7. The committee shall adopt written bylaws to govern its activities.

8. The newborn hearing screening advisory committee shall be terminated
on August 28, 2001. (L. 1999 H.B. 401 § 191.259, A.L. 2002 H.B. 1783)

1. The director of the department of health and senior services
may promulgate rules and regulations to implement the provisions of
sections 191.925, 191.928 and 191.934. The director of the department of
elementary and secondary education may promulgate rules and regulations
to implement the provisions of section 191.931. The directors of the
departments of insurance and social services may promulgate rules and
regulations to implement the provisions of section 376.685, RSMo.

2. Any rule or portion of a rule, as that term is defined in section
536.010, RSMo, that is created under the authority delegated in sections
191.925 to 191.937 or section 376.685, RSMo, shall become effective only
if it complies with and is subject to all of the provisions of chapter
536, RSMo, and, if applicable, section 536.028, RSMo. All rulemaking
authority delegated prior to August 28, 1999, is of no force and effect
and repealed. Nothing in this section shall be interpreted to repeal or
affect the validity of any rule filed or adopted prior to August 28,
1999, if it fully complied with all applicable provisions of law. This
section and chapter 536, RSMo, are nonseverable and if any of the powers
vested with the general assembly pursuant to chapter 536, RSMo, to
review, to delay the effective date or to disapprove and annul a rule are
subsequently held unconstitutional, then the grant of rulemaking
authority and any rule proposed or adopted after August 28, 1999, shall
be invalid and void. (L. 1999 H.B. 401 § 191.265)

1. There is hereby established an "Automated External
Defibrillator Advisory Committee" within the department of health and
senior services, subject to appropriations.

2. The committee shall advise the department of health and senior
services, the office of administration and the general assembly on the
advisability of placing automated external defibrillators in public
buildings, especially in public buildings owned by the state of Missouri
or housing employees of the state of Missouri, with special consideration
to state office buildings accessible to the public.

3. The committee shall issue an initial report no later than June 1,
2002, and a final report no later than December 31, 2002, to the
department of health and senior services, the office of administration
and the governor's office. The issues to be addressed in the report shall
include, but need not be limited to:

(1) The advisability of placing automated external defibrillators in
public buildings and the determination of the criteria as to which public
buildings should have automated external defibrillators and how such
automated external defibrillators' placement should be accomplished;

(2) Projections of the cost of the purchase, placement and maintenance of
any recommended automated external defibrillator placement;

(3) Discussion of the need for, and cost of, training personnel in the
use of automated external defibrillators and in cardiopulmonary
resuscitation;

(4) The integration of automated external defibrillators with existing
emergency service.

4. The committee shall be composed of the following members appointed by
the director of the department of health and senior services:

(1) A representative of the department of health and senior services;

(2) A representative of the division of facilities management in the
office of administration;

(3) A representative of the American Red Cross;

(4) A representative of the American Heart Association;

(5) A physician who has experience in the emergency care of patients.

5. The department of health and senior services member shall be the chair
of the first meeting of the committee. At the first meeting, the
committee shall elect a chairperson from its membership. The committee
shall meet at the call of the chairperson, but not less than four times a
year.

6. The department of health and senior services shall provide technical
and administrative support services as required by the committee. The
office of administration shall provide technical support to the committee
in the form of information and research on the number, size, use and
occupancy of buildings in which employees of the state of Missouri work.

7. Members of the committee shall receive no compensation for their
services as members, but shall be reimbursed for expenses incurred as a
result of their duties as members of the committee.

8. The committee shall adopt written bylaws to govern its activities.

9. The automated external defibrillator advisory committee shall
terminate on June 1, 2003. (L. 2001 H.B. 567 merged with S.B. 266)

1. This section shall be known and may be cited as the "Adoption
Awareness Law".

2. To raise public awareness and to educate the public, the department of
social services, with the assistance of the department of health and
senior services, shall be responsible for:

(1) Collecting and distributing resource materials to educate the public
about foster care and adoption;

(2) Developing and distributing educational materials, including but not
limited to videos, brochures and other media as part of a comprehensive
public relations campaign about the positive option of adoption and
foster care. The materials shall include, but not be limited to,
information about:

(a) The benefits of adoption and foster care;

(b) Adoption and foster care procedures;

(c) Means of financing the cost of adoption and foster care, including
but not limited to adoption subsidies, foster care payments and special
needs adoption tax credits;

(d) Options for birth parents in choosing adoptive parents;

(e) Protection for and rights of birth parents and adoptive parents prior
to and following the adoption;

(f) Location of adoption and foster care agencies;

(g) Information regarding various state health and social service
programs for pregnant women and children, including but not limited to
medical assistance programs and temporary assistance for needy families
(TANF); and

(h) Referrals to appropriate counseling services, including but not be
limited to counseling services for parents who are considering retaining
custody of their children, placing their children for adoption, or
becoming foster or adoptive parents; but excluding any referrals for
abortion or to abortion facilities;

(3) Making such educational materials available through state and local
public health clinics, public hospitals, family planning clinics,
abortion facilities as defined in section 188.015, RSMo, maternity homes
as defined in section 135.600, RSMo, child-placing agencies licensed
pursuant to sections 210.481 to 210.536, RSMo, attorneys whose practice
involves private adoptions, in vitro fertilization clinics and private
physicians for distribution to their patients who request such
educational materials. Such materials shall also be available to the
public through the department of social services' Internet web site;

(4) Establishing a toll-free telephone number for information on adoption
and foster care, and to answer questions and assist persons inquiring
about becoming adoptive or foster parents.

3. In addition, the department may establish and implement an ongoing
advertising campaign for the recruitment of adoptive and foster care
families, with a special emphasis on the recruitment of qualified
adoptive and foster care families for special needs children. Such
advertising campaign may utilize, but shall not be limited to, the
following media: television, radio, outdoor advertising, newspaper,
magazines and other print media, web sites, and the Internet. The
department may contract with professional advertising agencies or other
professional entities to conduct such advertising campaign on behalf of
the department.

4. The provisions of this section shall be subject to appropriations.

5. The department of social services shall promulgate rules for the
implementation of this section in accordance with chapter 536, RSMo. (L.
2001 S.B. 266, A.L. 2005 S.B. 21)

1. The "Missouri Area Health Education Centers" program is
hereby established as a collaborative partnership of higher educational
institutions and regional area health education centers and other
entities that have entered into a written agreement with the program.
These higher educational institutions and regional area health education
centers shall be those that are recognized as program offices or regional
centers by the federal area health education centers program pursuant to
42 U.S.C. Section 294a. The program is designed to improve the supply,
distribution, availability, and quality of health care personnel in
Missouri communities and promote access to primary care for medically
underserved communities and populations.

2. The Missouri area health education centers council is hereby
established within the department of health and senior services. The
council shall consist of twelve members that are residents of Missouri.
The members of the council shall include:

(1) The director of the department of health and senior services or the
director's designee;

(2) The commissioner of the department of higher education or the
commissioner's designee;

(3) Two members of the senate appointed by the president pro tempore of
the senate;

(4) Two members of the house of representatives appointed by the speaker
of the house of representatives; and

(5) Six members to be appointed by the governor with the advice and
consent of the senate, four of whom shall represent the federally
recognized regional area health education centers and two of whom shall
represent the federally recognized higher educational institution program
offices. Each representative of the regional area health education
centers shall be a member of the governing or advisory board of a
regional center and shall be nominated jointly by the chairs of the
governing or advisory boards of all such centers. No two representatives
shall be members of the same regional center governing or advisory board.
Each representative of the federally recognized higher educational
institution program offices shall be an employee or faculty of a medical
school in which a program office resides and shall be nominated jointly
by the deans of all such medical schools. The two program office
representatives shall not be employees or faculty of the same medical
school.

Members of the council shall be appointed by February 1, 2005. Of the
members first appointed to the council, six shall serve a term of four
years and six shall serve a term of two years, and thereafter, members
shall serve a term of four years. Members shall continue to serve until
their successor is duly appointed and qualified. Any vacancy on the
council shall be filled in the same manner as the original appointment.

3. The council shall have discretionary authority to monitor and
recommend policy direction for the Missouri area health education centers
program, including policies to ensure that all applicable requirements of
the federal area health education centers program are met.

4. The area health education centers program shall:

(1) Develop and enhance health careers recruitment programs for Missouri
students, especially underrepresented and disadvantaged students;

(2) Enhance and support community-based training of health professions
students and medical residents;

(3) Provide educational and other programs designed to support practicing
health professionals; and

(4) Collaborate with health, education, and human services organizations
to design, facilitate, and promote programs to improve access to health
care and health status in Missouri.

5. The Missouri area health education centers council shall report
annually to the governor and the general assembly on the status and
progress of the Missouri area health education centers program. (L. 2004
S.B. 1274 § 191.1015)

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