Missouri Statute | Act | Code |Public Health And Welfare| US Code - US Statute | Chapter 192 Department Of Health And Senior Services

The department of health shall be known as the "Department of
Health and Senior Services". (L. 2001 H.B. 603)

There is hereby created and established as a department of state
government the "Department of Health and Senior Services". The department
of health and senior services shall supervise and manage all public
health functions and programs. The department shall be governed by the
provisions of the Omnibus State Reorganization Act of 1974, Appendix B,
RSMo, unless otherwise provided in sections 192.005 to 192.014. The
division of health of the department of social services, chapter 191,
RSMo, this chapter, and others, including, but not limited to, such
agencies and functions as the state health planning and development
agency, the crippled children's service, chapter 201, RSMo, the bureau
and the program for the prevention of mental retardation, the hospital
subsidy program, chapter 189, RSMo, the state board of health, section
191.400, RSMo, the student loan program, sections 191.500 to 191.550,
RSMo, the family practice residency program, sections 191.575 to 191.590,
RSMo, the licensure and certification of hospitals, chapter 197, RSMo,
the Missouri chest hospital, sections 199.010 to 199.070, RSMo, are
hereby transferred to the department of health and senior services by a
type I transfer, and the state cancer center and cancer commission,
chapter 200, RSMo, is hereby transferred to the department of health and
senior services by a type III transfer as such transfers are defined in
section 1 of the Omnibus State Reorganization Act of 1974, Appendix B,
RSMo Supp. 1984. The provisions of section 1 of the Omnibus State
Reorganization Act of 1974, Appendix B, RSMo Supp. 1984, relating to the
manner and procedures for transfers of state agencies shall apply to the
transfers provided in this section. The division of health of the
department of social services is abolished. (L. 1985 S.B. 25 § 1, A.L.
1993 S.B. 52)

The department of health and senior services may adopt, appeal
and amend rules necessary to carry out the duties assigned to it. All
rules shall be promulgated pursuant to the provisions of 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. 1993
S.B. 52, A.L. 1995 S.B. 3)

1. The director of the department of health and senior services
shall be appointed by the governor by and with the advice and consent of
the senate. The director shall serve at the pleasure of the governor and
the director's salary shall not exceed appropriations made for that
purpose.

2. The director shall be a person of recognized character, integrity and
executive ability, shall be a graduate of an institution of higher
education approved by recognized accrediting agencies, and shall have had
the administrative experience necessary to enable him to successfully
perform the duties of his office. He shall have experience in public
health management and agency operation and management. (L. 1985 S.B. 25 §
2 subsecs. 1, 2)

1. The department of health and senior services shall have such
duties and powers as are assigned by law. The department of health and
senior services shall also have control and administration over the
Missouri rehabilitation center at Mt. Vernon as provided by law. The
department of health and senior services shall also have such
jurisdiction over the accounts of city and county tuberculosis hospitals
as is imposed by law. The cancer commission of the state of Missouri is
hereby assigned to the department of health and senior services.

*2. This section shall terminate thirty days following the date notice is
provided to the revisor of statutes that an agreement has been executed
which transfers the Missouri rehabilitation center from the department of
health and senior services to the board of curators of the University of
Missouri. (L. 1945 p. 945 § 13, A. 1949 S.B. 1051, A.L. 1971 H.B. 581,
A.L. 1996 S.B. 540)

Effective 7-1-96

*Contingent expiration date thirty days after the transfer of the
Missouri rehabilitation center to the University of Missouri. Termination
on 3-27-97 of section 192.010. The Revisor of Statutes received notice on
2-25-97.

1. The department shall monitor the adverse health effects of
the environment and prepare population risk assessments regarding
environmental hazards including but not limited to those relating to
water, air, toxic waste, solid waste, sewage disposal and others. The
department shall make recommendations to the department of natural
resources for improvement of public health as related to the environment.

2. The department of health and senior services shall develop a
comprehensive disease prevention plan to expand existing and to develop
new programs. Health insurers shall be consulted in an attempt to develop
the disease prevention plan so that it will be cost effective in relation
to the cost of medical care. (L. 1985 S.B. 25 § 2 subsecs. 3, 4)

The state board of health shall advise the department of health
and senior services in the:

(1) Promulgation of rules and regulations by the department of health and
senior services. At least sixty days before the rules and regulations
prescribed by the department or any subsequent changes in them become
effective, a copy shall be filed in the office of the secretary of state.
All rules and regulations promulgated by the department shall, as soon as
practicable after their adoption, be submitted to the general assembly.
The rules and regulations shall continue in force and effect until
disapproved by the general assembly;

(2) Formulation of the budget for the department of health and senior
services;

(3) Planning for and operation of the department of health and senior
services. (L. 1985 S.B. 25 § 3)

The department may, by rule, impose a reasonable handling charge
for each test made in any of its laboratories. All proceeds from such
charges shall be deposited in the general revenue fund. (L. 1982 S.B. 575)

1. The department of health and senior services shall establish
a putative father registry which shall record the names and addresses of:

(1) Any person adjudicated by a court of this state to be the father of a
child born out of wedlock;

(2) Any person who has filed with the registry before or after the birth
of a child out of wedlock, a notice of intent to claim paternity of the
child;

(3) Any person adjudicated by a court of another state or territory of
the United States to be the father of an out-of-wedlock child, where a
certified copy of the court order has been filed with the registry by
such person or any other person.

2. A person filing a notice of intent to claim paternity of a child or an
acknowledgment of paternity shall file the acknowledgment affidavit form
developed by the state registrar which shall include the minimum
requirements prescribed by the Secretary of the United States Department
of Health and Human Services pursuant to 42 U.S.C. Section 652(a)(7).

3. A person filing a notice of intent to claim paternity of a child shall
notify the registry of any change of address.

4. A person who has filed a notice of intent to claim paternity may at
any time revoke a notice of intent to claim paternity previously filed
therewith and, upon receipt of such notification by the registry, the
revoked notice of intent to claim paternity shall be deemed a nullity
nunc pro tunc.

5. An unrevoked notice of intent to claim paternity of a child may be
introduced in evidence by any party, other than the person who filed such
notice, in any proceeding in which such fact may be relevant.

6. Lack of knowledge of the pregnancy does not excuse failure to timely
file pursuant to paragraph (b) or (c) of subdivision (2) of subsection 3
of section 453.030, RSMo.

7. Failure to timely file pursuant to paragraph (b) or (c) of subsection
3 of section 453.030, RSMo, shall waive a man's right to withhold consent
to an adoption proceeding unless:

(1) The person was led to believe through the mother's misrepresentation
or fraud that:

(a) The mother was not pregnant when in fact she was; or

(b) The pregnancy was terminated when in fact the baby was born; or

(c) After the birth, the child died when in fact the child is alive; and

(2) The person upon the discovery of the misrepresentation or fraud
satisfied the requirements of paragraph (b) or (c) of subsection 3 of
section 453.030, RSMo, within fifteen days of that discovery.

8. The department shall, upon request and within two business days of
such request, provide the names and addresses of persons listed with the
registry to any court or authorized agency, or entity or person named in
section 453.014, RSMo, and such information shall not be divulged to any
other person, except upon order of a court for good cause shown.

9. The department of health and senior services shall:

(1) Prepare forms for registration of paternity and an application for
search of the putative father registry;

(2) Produce and distribute a pamphlet or publication informing the public
about the putative father registry, including the procedures for
voluntary acknowledgment of paternity, the consequences of acknowledgment
and failure to acknowledge paternity pursuant to section 453.010, RSMo, a
copy of a statement informing the public about the putative father
registry, including to whom and under what circumstances it applies, the
time limits and responsibilities for filing, protection of paternal
rights and associated responsibilities, and other provisions of this
section, and a detachable form meeting the requirements of subsection 2
of this section addressed to the putative father registry. Such pamphlet
or publication shall be made available for distribution at all offices of
the department of health and senior services. The department shall also
provide such pamphlets or publications to the department of social
services, hospitals, libraries, medical clinics, schools, universities,
and other providers of child-related services upon request;

(3) Provide information to the public at large by way of general public
service announcements, or other ways to deliver information to the public
about the putative father registry and its services.

10. Pursuant to subdivision (2) of subsection 9 of this section, a
statement prepared by the department of health and senior services shall
be contained in any pamphlet or publication informing the public about
the putative father registry.

11. There is hereby created in the state treasury the "Putative Father
Registry Fund", which shall consist of moneys collected under section
453.020, RSMo. Upon appropriation, moneys in the fund shall be used
solely for the administration of the putative father registry.
Notwithstanding the provisions of section 33.080, RSMo, to the contrary,
moneys in the fund shall not revert to the credit of general revenue at
the end of the biennium, but shall be used upon appropriations by the
general assembly for the purpose of carrying out the provisions of this
chapter. (L. 1988 H.B. 1272, et al. § 9, A.L. 1997 H.B. 343, A.L. 1998
S.B. 674, A.L. 2002 H.B. 1443 merged with S.B. 923, et al., A.L. 2004
H.B. 1453, A.L. 2005 S.B. 21)

CROSS REFERENCE: Application of law to adoption petitions filed on or
after August 28, 1997, RSMo 453.012

This act* shall be known and may be cited as the "Missouri
Nosocomial Infection Control Act of 2004". The purpose of the act* is to
decrease the incidence of infection within health care facilities in this
state. (L. 2004 S.B. 1279 § 192.021)

*This "act" (S.B. 1279, 2004) contained numerous sections. Consult
Disposition of Sections table for a definitive listing.

1. It shall be the general duty and responsibility of the
department of health and senior services to safeguard the health of the
people in the state and all its subdivisions. It shall make a study of
the causes and prevention of diseases. It shall designate those diseases
which are infectious, contagious, communicable or dangerous in their
nature and shall make and enforce adequate orders, findings, rules and
regulations to prevent the spread of such diseases and to determine the
prevalence of such diseases within the state. It shall have power and
authority, with approval of the director of the department, to make such
orders, findings, rules and regulations as will prevent the entrance of
infectious, contagious and communicable diseases into the state.

2. The department of health and senior services shall include in its list
of communicable or infectious diseases which must be reported to the
department methicillin-resistant staphylococcus aureus (MRSA) and
vancomycin-resistant enterococcus (VRE). (RSMo 1939 §§ 9735, 9736, A.L.
1945 p. 945 § 14, A.L. 1951 p. 784, A.L. 2004 S.B. 1279)

Prior revisions: 1929 §§ 9015, 9016; 1919 §§ 5772, 5773; 1909 § 6653)

The department of health and senior services is hereby
designated the official agency of the state of Missouri to receive
federal funds for health purposes. The department shall comply with the
acts of congress and with any rules and conditions made by any federal
agency in regard to the use and distribution of such funds. Such funds
shall be deposited in the state treasury and kept in such separately
designated funds as may be required to carry out the purposes for which
the federal grants are made. Disbursements of such funds from the
treasury shall be made on warrants duly issued on requisitions of the
department. The general assembly shall appropriate such funds to the use
of the department for such purposes. (L. 1951 p. 761 § 1)

The department of health and senior services shall:

(1) Establish and promote hepatitis C education programs as an integral
part of its health promotion and disease prevention efforts in order to
raise public awareness, educate consumers, and educate and train health
care professionals and human services providers; and

(2) Identify resources for hepatitis C education, screening and treatment
and to coordinate the efforts of existing organizations with new programs
and with each other so as to maximize education and access to services.
(L. 1999 S.B. 8 & 173)

The department of health and senior services may, in conjunction
with existing or future health awareness programs for similar at-risk
populations, use the following strategies for raising public awareness of
the causes, including personal risk factors, and nature of hepatitis C,
the value of prevention and early detection, and options for diagnosing
and treating the disease:

(1) An outreach campaign utilizing print, radio, and television public
service announcements, advertisements, posters, and other materials;

(2) Community forums;

(3) Health information and risk-factor assessment at public events;

(4) Targeting at-risk populations;

(5) Providing reliable information to policy makers;

(6) Distributing information through local health agencies, schools,
employer wellness programs, physicians, hospitals, health maintenance
organizations, prisons, sports leagues, nonprofit organizations,
community- based organizations, state fairs and department of health and
senior services offices;

(7) Identifying and obtaining educational materials, including brochures
and videotapes, that translate accurately the latest scientific
information on hepatitis C in easy-to-understand terms; and

(8) Building a statewide capacity to provide information and referrals on
all aspects of hepatitis C, including, but not limited to, educational
materials, counseling, and patient support groups. (L. 1999 S.B. 8 & 173)

1. The department of health and senior services shall use the
strategies, protocols, and guidelines adopted by the National Institutes
of Health on hepatitis C for educating physicians and health
professionals and training providers on the most recent scientific and
medical information on hepatitis C detection, diagnosis, treatment, and
therapeutic decision making. The guidelines may include, but not be
limited to the following:

(1) Tracking and reporting of both acute and chronic cases of hepatitis C
by public health officials;

(2) A cost-efficient plan to screen the prison population subject to
specific line item appropriation; and

(3) After one year of screening, a report shall be issued to the general
assembly regarding the results of the screening.

2. The duties prescribed in this section shall be subject to
appropriations by the general assembly. (L. 1999 S.B. 8 & 173)

The department of health and senior services, with the approval
of the director of the department and within the limits of appropriations
made for the department, shall compile and issue reports and summaries of
accomplishments and projects within the department as may be of benefit
and advantage to the public, including information concerning vital and
mortuary statistics, respecting diseases, and instructing in the subject
of hygiene. Such reports shall include information and statistics on
Black health and the mortality of minority groups. (RSMo 1939 § 9743,
A.L. 1945 p. 945 § 1721, A. 1949 S.B. 1051, A.L. 1988 H.B. 1565)

Prior revisions: 1929 § 9023; 1919 § 5780; 1909 § 6661

The department of health and senior services shall maintain a
bureau of vital statistics, a bureau of laboratories, a bureau of
communicable diseases, a bureau of food and drug inspection, a bureau of
child hygiene, a bureau of public health nursing, a bureau of
tuberculosis control, a bureau of cancer control, a bureau of dental
health, and other bureaus as may be necessary from time to time. The
director of the department shall formulate orders and findings for the
proper conduct of the bureaus. (RSMo 1939 § 9737, A.L. 1945 p. 945 § 15)

Prior revisions: 1929 § 9017; 1919 § 5774

It shall be the duty of the department of health and senior
services to have charge of the state system of registration of births and
deaths; to prepare the necessary methods, forms and blanks for obtaining
and preserving such records, and to insure the faithful registration of
the same in the registration districts and in the central bureau of vital
statistics at the capital of the state. The said department shall be
charged with the uniform and thorough enforcement of the said law
throughout the state and shall, from time to time, promulgate any
additional forms and amendments that may be necessary for this purpose.
Suitable provision shall be made, including fireproof vaults and filing
cases, for the permanent and safe preservation of all official records
and other matters pertaining to vital statistics for which the bureau of
vital statistics may be responsible. (RSMo 1939 § 9760, A.L. 1945 p. 945
§ 20)

Prior revisions: 1929 § 9040; 1919 § 5706; 1909 § 6664

CROSS REFERENCE: Vital statistics, generally, Chap. 193, RSMo

1. The department of health and senior services, for purposes of
conducting epidemiological studies to be used in promoting and
safeguarding the health of the citizens of Missouri under the authority
of this chapter is authorized to receive information from patient medical
records. The provisions of this section shall also apply to the
collection, analysis, and disclosure of nosocomial infection data from
patient records collected pursuant to section 192.667.

2. The department shall maintain the confidentiality of all medical
record information abstracted by or reported to the department. Medical
information secured pursuant to the provisions of subsection 1 of this
section may be released by the department only in a statistical aggregate
form that precludes and prevents the identification of patient,
physician, or medical facility except that medical information may be
shared with other public health authorities and coinvestigators of a
health study if they abide by the same confidentiality restrictions
required of the department of health and senior services and except as
otherwise authorized by the provisions of sections 192.665 to 192.667.
The department of health and senior services, public health authorities
and coinvestigators shall use the information collected only for the
purposes provided for in this section and section 192.667.

3. No individual or organization providing information to the department
in accordance with this section shall be deemed to be or be held liable,
either civilly or criminally, for divulging confidential information
unless such individual organization acted in bad faith or with malicious
purpose.

4. The department of health and senior services is authorized to
reimburse medical care facilities, within the limits of appropriations
made for that purpose, for the costs associated with abstracting data for
special studies.

5. Any department of health and senior services employee, public health
authority or coinvestigator of a study who knowingly releases information
which violates the provisions of this section shall be guilty of a class
A misdemeanor and, upon conviction, shall be punished as provided by law.
(L. 1988 H.B. 1134 § 3, A.L. 2004 S.B. 1279)

1. Any entity subject to the provisions of sections 354.400 to
354.636, RSMo, shall provide data regarding quality of care, access to
care, member satisfaction and member health status to the director of the
department of health and senior services. Failure to provide such data
shall be reported to the director of the department of insurance and
shall be subject to the penalties provided in section 354.444, RSMo. Any
entity subject to the provisions of sections 354.400 to 354.636, RSMo,
which continually or substantially fails to comply with the provisions of
this section may be prohibited by the director of the department of
insurance from participating in any health program administered by the
state. The department of health and senior services shall promulgate
rules defining continual or substantial failure to comply with the
provisions of this section.

2. The department of health and senior services shall specify by rule the
types of data which shall be submitted and the methods of collection and
submission. In defining data standards for the measurement of the quality
of care, access to care, member satisfaction and member health status,
the director of the department of health and senior services may:

(1) Use as the data set the Health Plan Employer Data and Information Set
(HEDIS) or an equivalent data set as determined by the department of
health and senior services;

(2) Consider published standards developed by nationally recognized
accreditation organizations including, but not limited to, the National
Committee for Quality Assurance and the Joint Committee on Accreditation
of Health Care Organizations;

(3) Consult with other state agencies and interested parties responsible
for delivering, financing and purchasing health care in the state; and

(4) Use available department of health and senior services data and other
agency data wherever appropriate.

3. Data or other information obtained by the department of health and
senior services pursuant to the provisions of this section shall not be
public information. Reports and studies prepared by the department based
upon such information shall be public information and may identify
individual entities in the business of delivering or financing health
care. The department of health and senior services may authorize the use
of the data for other research pursuant to the provisions of section
192.067. The department shall not release data in a form which could be
used to identify a patient.

4. The department may choose to perform studies and shall publish
information, including at least an annual consumer guide, based upon the
information obtained pursuant to the provisions of this section. The
department shall allow health care financing entities or health care
providers who have submitted data which will be used in any report to
review and comment on the report prior to its publication or release for
public use. With the permission of the entity or the health care
provider, the department may include any comments of a health care
financing entity or health care provider in the publication. The reports
shall be made available to the public. The department may charge a
reasonable fee to any entity in the business of delivering or financing
health care for specialized reports or services requested by such entity.
The fees shall be credited to the public health services fund established
in section 192.900. (L. 1997 H.B. 335)

The department of health and senior services shall issue
educational literature on the care of the baby and the hygiene of the
child including, but not limited to, the importance of routine dental
care for children; study the causes of infant mortality and the
application of measures for the prevention and suppression of the
diseases of infancy and childhood; and inspect the sanitary and hygienic
conditions in public school buildings and grounds. (RSMo 1939 § 9738,
A.L. 1945 p. 945 § 18, A.L. 1961 p. 463, A.L. 2001 H.B. 567 merged with
S.B. 393)

Prior revisions: 1929 § 9018; 1919 § 5775

Effective 7-10-01

1. The bureau of immunization of the department of health and
senior services shall develop educational materials which strongly
recommend that infants and young children receive complete immunization
vaccines in accordance with current standard medical practice, including,
but not limited to, the following vaccine or series of vaccines:

(1) Haemophilus influenza type b conjugate vaccine before the age of two
years;

(2) Hepatitis B vaccine in accordance with section 334.157, RSMo;

(3) A tuberculin skin test.

2. Such educational materials shall be distributed to parents of infants
and young children by the department of health and senior services
through hospitals and city, county and district health units and by the
department of elementary and secondary education through the parent
education program established pursuant to sections 178.691 to 178.699,
RSMo. Such educational materials shall conform to the National Childhood
Vaccine Injury Act, PL 99-660, and shall include information regarding
possible risks and benefits and requirements regarding informed consent
associated with childhood vaccines, which shall be provided to parents or
legal guardians of the child. (L. 1993 H.B. 522 § 2)

All powers and duties pertaining to administration of laws
relating to food and drugs shall be exercised by the department of health
and senior services. The director of health may appoint a deputy who,
under the director, shall be chiefly responsible for administration of
laws pertaining to food and drugs, and particularly to enforce all laws
that now exist or that may hereafter be enacted regarding the production,
manufacture or sale of any food products, or any ingredients that are
used in the preparation of foodstuffs, or the misbranding of the same;
and personally, or by his assistants, inspect any article of food or drug
made or offered for sale in this state which he may, through himself or
his assistants, suspect or have reason to believe is impure, unhealthful,
adulterated or misbranded, and shall have power to cause to be arrested
and prosecuted, any person or persons engaged in the manufacture or sale
of foods or drugs or any food ingredients contrary to the laws of this
state. The director shall make orders and findings for carrying out the
provisions of this chapter and such orders and findings shall conform as
nearly as practicable to the orders and findings at present established
or which may hereafter be established for the enforcement of the act of
congress, approved and known as "The Food and Drug Act", together with
any amendments thereto. (RSMo 1939 §§ 9855, 9856, 9857, A.L. 1945 p. 945
§ 22, A. 1949 S.B. 1051)

Prior revisions: 1929 §§ 13003, 13005, 13006; 1919 §§ 5729, 5731, 5732;
1909 §§ 6606, 6608, 6609

CROSS REFERENCE: Food and drugs, regulation and inspection, Chap. 196,
RSMo

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

(1) "Canned food", food that is commercially processed in hermetically
sealed containers;

(2) "Donor", any restaurant, cafeteria, fast food restaurant,
delicatessen, or other facility principally engaged in selling food for
consumption on the premises;

(3) "Food", any raw, cooked, canned, perishable, or prepared edible
substance, ice, beverage, or ingredient used or intended for use in whole
or in part for human consumption;

(4) "Hermetically sealed container", a container that is designed and
intended to be secure against the entry of microorganisms and thereby to
maintain the commercial sterility of its content after processing;

(5) "Perishable food", any food having a significant risk of spoilage,
loss of value, or loss of palatability within ninety days of the date of
packaging;

(6) "Prepared food", any food prepared, designed, or intended for human
consumption including, without limitation, those foods prepared
principally from agricultural, dairy, or horticultural produce or with
meat, fish, or poultry.

2. Each potential donor, to the greatest extent possible and practicable,
may make available to any bona fide charitable or nonprofit organization,
to any representative or volunteer acting on behalf of such organization,
to an uncompensated person acting in a philanthropic manner providing
services similar to those of such an organization, or to a transporter of
any surplus or excess canned or perishable food for use by such
organization or person to feed homeless persons or other persons who are
in need of food and are otherwise unable to provide food for themselves.
In achieving this intent, the following provisions shall apply:

(1) Each donor may contact charitable or nonprofit organizations in the
community in which the donor operates in order to provide for the
collection by such organizations of any surplus or excess canned food or
perishable food from the donor;

(2) Each charitable or nonprofit organization in this state which
provides to the community in which it operates food for persons who are
in need of food or are otherwise unable to provide food for themselves,
or which collects and transports such food to such organizations, shall
make every reasonable effort to contact any donors within the
organization's area of operations for purposes of collecting any surplus
or excess canned food or perishable food for use in providing such
services.

3. A good faith donor of any canned or perishable food, apparently fit
for human consumption, to a bona fide charitable or nonprofit
organization for free distribution shall not be subject to criminal
penalty or civil damages arising from the condition of the food, unless
an injury is caused by the gross negligence, recklessness, or intentional
misconduct of the donor.

4. A bona fide charitable or nonprofit organization, or any
representative or volunteer acting on behalf of such organization or an
uncompensated person acting in a philanthropic manner providing services
similar to those of such an organization or transporter of any surplus or
excess canned or perishable food for use by such organization which in
good faith accepts, collects, transports, or distributes any canned or
perishable food for free distribution and which reasonably inspects the
food at the time of the donation and finds the food apparently fit for
human consumption shall not be subject to criminal penalty or civil
damages arising from the condition of the food, unless an injury is
caused by the gross negligence, recklessness, or intentional misconduct
of an agent of the charitable or nonprofit organization.

5. The department of health and senior services shall make available
information detailing the need of food-recovery programs, the benefit of
food-recovery programs, the manner in which such organizations may become
involved in food-recovery programs and the food-recovery entities or food
banks that exist in the state. This information must be updated annually.
(L. 2003 S.B. 175)

There is hereby established in the department of health and
senior services an "Office of Minority Health". The office of minority
health shall monitor the progress of all programs in the department for
their impact on eliminating the health status disparity between
minorities and the general population and shall:

(1) Address new issues related to minority health;

(2) Instill cultural sensitivity and awareness into all existing programs
of the department of health and senior services;

(3) Develop health education programs specifically for minorities;

(4) Promote constituency development;

(5) Coordinate programs provided by other agencies;

(6) Develop culturally sensitive health education materials;

(7) Seek extramural funding for programs;

(8) Develop resources within communities;

(9) Establish interagency communication to assure that agreements are
established and carried out;

(10) Ensure that personnel within the department of health and senior
services have cultural understanding and sensitivity;

(11) Ensure that all programs are designed to be responsive to unique
needs of minorities;

(12) Provide necessary health and medical information, data, and staff
resources to the Missouri minority health issues task force;

(13) Review all programs of the department, their impact on the health
status of minorities;

(14) Assist in the design of programs targeted specifically to improving
the health of minorities;

(15) Develop programs that can attract other public and private funds;

(16) Analyze federal and state legislation for its impact on the health
status of minorities;

(17) Advise the director of the department of health and senior services
on health matters that affect minorities;

(18) Coordinate the development of educational programs designed to
reduce the incidence of disease in the minority population. (L. 1988 H.B.
1565 § 1)

The department of health and senior services shall exercise such
powers and duties pertaining to inspection of hotels, inns and
boardinghouses as is imposed by law and such powers and duties may be
delegated by the director of the department of health and senior services
to a deputy who may be the deputy of food and drug administration and
who, under the director, shall be chiefly responsible for the
administration of laws, orders and findings relating to the inspection of
hotels, inns and boardinghouses. (L. 1945 p. 945 § 23, A. 1949 S.B. 1051)

CROSS REFERENCE: Hotels, motels, resorts and other public lodging,
regulations of, Chap. 315, RSMo

The department of health and senior services shall have the
power and duty to administer all laws, orders and findings pertaining to
inspection of beverages, except such as are administered by the
supervisor of liquor control, and the director of health shall delegate
such administration to the bureau of food and drug inspection. (L. 1945
p. 945 § 24)

CROSS REFERENCE: Regulation of soft drink manufacturers, RSMo 196.365 to
196.435

The department of health and senior services shall take
cognizance of any contagious diseases which may be prevalent among
domestic animals of the state which diseases may be communicable to human
beings; shall ascertain the nature and causes of such diseases; publish
the results of its investigations, with suggestions for the proper
safeguards and treatment of such animals. (RSMo 1939 § 9741, A.L. 1945 p.
945 § 19)

Prior revisions: 1929 § 9021; 1919 § 5778; 1909 § 6659

The department of health and senior services is hereby
authorized to provide for the teaching and training of children who are
resident patients confined in the Missouri rehabilitation center at Mt.
Vernon by employing certified teachers and instructors and purchasing
equipment from any moneys appropriated for that purpose. (L. 1949 p. 290
§ 1, A.L. 1971 H.B. 581)

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

(1) "Advisory panel", the infection control advisory panel created by
section 197.165, RSMo;

(2) "Antibiogram", a record of the resistance of microbes to various
antibiotics;

(3) "Antimicrobial", the ability of an agent to destroy or prevent the
development of pathogenic action of a microorganism;

(4) "Department", the department of health and senior services.

2. Every laboratory performing culture and sensitivity testing on humans
in Missouri shall submit data on health care associated infections to the
department in accordance with this section. The data to be reported shall
be defined by regulation of the department after considering the
recommendations of the advisory panel. Such data may include antibiograms
and, not later than July 1, 2005, shall include but not be limited to the
number of patients or isolates by hospital, ambulatory surgical center,
and other facility or practice setting with methicillin-resistant
staphylococcus aureus (MRSA) or vancomycin-resistant enterococcus (VRE).

3. Information on infections collected pursuant to this section shall be
subject to the confidentiality protections of this chapter but shall be
available in provider-specific form to appropriate facility and
professional licensure authorities.

4. The advisory panel shall develop a recommended plan to use laboratory
and health care provider data provided pursuant to this chapter to create
a system to:

(1) Enhance the ability of health care providers and the department to
track the incidence and distribution of preventable infections, with
emphasis on those infections that are most susceptible to interventions
and that pose the greatest risk of harm to Missouri residents;

(2) Monitor trends in the development of antibiotic-resistant microbes,
including but not limited to methicillin-resistant staphylococcus aureus
(MRSA) and vancomycin-resistant enterococcus (VRE) infections.

5. In implementing this section, the advisory panel and the department
shall conform to guidelines and standards adopted by the Centers for
Disease Control and Prevention. The advisory panel's plan may provide for
demonstration projects to assess the viability of the recommended
initiatives. (L. 2004 S.B. 1279)

Other provisions of the law to the contrary notwithstanding,
requirements imposed by state law or regulation that institutions defined
under chapters 197, RSMo, and 198, RSMo, make notifications concerning
patients who are diagnosed as having reportable infectious or contagious
diseases shall apply to such institutions provided that such
notifications are consistent with federal laws and rules and regulations
imposed thereunder governing the confidentiality of records of patients
receiving medical assistance under the provisions of federal law. (L.
1988 S.B. 602 § 1, A.L. 2004 S.B. 1279)

The communicable disease reporting requirements established by
the department of health and senior services shall be in accordance with
guidelines, funding requirements, or recommendations established by the
federal Centers for Disease Control. (L. 1988 S.B. 602 § 2)

Whenever the department of health and senior services considers
it necessary to secure the aid and services of a visiting public health
nurse, or to disinfect any building, residence or room in any hotel or
dormitory, or other place in such city or county infected with infectious
or contagious diseases, such department shall make formal written report
of such fact to the county commission or mayor of any city of the second,
third, or fourth class, or both such commission and mayor, and therein
recommend the course of action necessary and advisable to be taken in
relation thereto to prevent the spread of such infectious or contagious
diseases; and in case said report is made to the mayor of any city he
shall lay the same before the city council at its next meeting, and the
said city council and the said county commission at its next meeting
after said report has been made as aforesaid, shall consider said report
and recommendation and act upon it, and such city council and county
commission shall each be authorized to employ, at a fixed monthly
compensation, a public health nurse, qualified for such service by
registration as such according to the laws of this state, to visit any
family, home, boardinghouse, dormitory or club in which is a member or
members, a person or persons afflicted with a contagious or infectious
disease, and upon the consent of such person or family or parent or
guardian, if a minor, to assist in nursing said person and to advise such
person and the persons or members of the family, boardinghouse, dormitory
or club, as to the proper methods to be pursued to prevent the spread of
such infectious or contagious disease, and also to authorize some other
proper person or persons to visit and disinfect any building, residence,
room in any hotel or dormitory or other place therein infected with such
infectious or contagious disease upon the consent of the owner thereof.
(RSMo 1939 § 9756)

Prior revisions: 1929 § 9036; 1919 § 5792

When the owner or occupant of any building, residence, room in a
hotel or dormitory or other place designated in the report or written
statement contemplated by section 192.140, refuses to consent that the
same be disinfected by the person designated by the city or county
commission, report of that fact shall be made by such person to the
mayor, if such person was appointed by the mayor, and to the county
commission, if such person was appointed by said commission, and
thereupon the mayor or the county commission shall have power and it
shall be his or their duty, either by taking of testimony or a personal
inspection of the place charged to be infected, to make an examination
into the truth of the statements contained in said reports and determine
whether said place is infected with an infectious or contagious disease,
and if it is found to be so infected it shall be the duty of the mayor or
of the county commission, as the case may be, by a written order of the
mayor, and by an order spread upon its record if the county commission,
to appoint some proper person to disinfect said place, designating in
said order the building, residence, room in the hotel or dormitory or
other place to be disinfected and said written order of the mayor, or a
copy of said order of the county commission, under its seal, shall be
furnished to said person and shall be his authority to enter upon said
premises and to disinfect the same in a proper manner using such force as
may be necessary to accomplish that purpose, proper regard being had for
the rights of the owner or occupant of said premises and the beneficent
purposes to be accomplished; and any needless interference by the owner
or occupant of said premises or by any other person with the person so
appointed, in the performance of the duties required of him by said
order, shall be a misdemeanor, and shall be punished in the manner
provided by law for interference with an officer in the performance of
his duties. (RSMo 1939 § 9757)

Prior revisions: 1929 § 9037; 1919 § 5793

In case a petition is signed by two hundred and fifty taxpayers
and presented to any city council of the second, third or fourth class or
any county commission, for the appointment of a public health nurse or
nurses or that any place infected with infectious or contagious disease
be disinfected, as designated in section 192.140, it shall be the duty of
said city council or county commission, as the case may be, to provide
for the appointment of said nurse or nurses and for the disinfecting of
any infected place and to pay for the same as provided for in section
192.170. (RSMo 1939 § 9759)

Prior revisions: 1929 § 9039; 1919 § 5795

The county commission or city council in any such city shall
have power to appropriate money out of the current revenues of the county
or city, as the case may be, for the purpose of carrying out the
provisions of sections 192.140 to 192.170. (RSMo 1939 § 9758)

Prior revisions: 1929 § 9038; 1919 § 5794

The department of health and senior services shall be empowered
and authorized to conduct a complete survey of all of the hospitals, both
public and private, and all health centers and units in the state, and to
make a public report of such survey and findings, and recommending a
state plan for the construction of such additional hospital and health
center facilities as may be deemed advisable by the department of health
and senior services after consultation with the state board of health,
described in section 192.240. (L. 1945 p. 972 § 1)

1. There is created a "State Hospital Advisory Council" of ten
members who shall be appointed by the governor by and with the consent of
the senate.

2. The advisory council shall be composed of citizens who have resided in
this state not less than five years immediately prior to their
appointment and shall include two members representing nongovernmental
organizations or groups, two members representing state governmental
agencies concerned with the operation, construction or utilization of
hospital or other facilities for the diagnosis, prevention or treatment
of illness or disease or for the provision of rehabilitation services,
one member particularly concerned with the education or training of
health professions personnel and five members who are representatives of
consumers familiar with the need for the services provided by such
facilities.

3. Each member of the advisory council shall serve for a term of two
years from and after his appointment and confirmation.

4. The members of the council shall not receive any compensation for
their services but shall be reimbursed for actual and necessary travel
and subsistence expenses incurred when acting officially as members of
the advisory council.

5. The state board of health is empowered to consult with the department
of health and senior services on the official state plan for construction
and modernization of hospitals and other medical facilities, as well as
with state agencies and nongovernmental organizations or groups concerned
with rehabilitation services.

6. The director of the department of health and senior services will
approve such applications for federal assistance in the construction and
modernization of hospitals and other medical facilities as may be
considered advisable after consultation with the state board of health.
(L. 1945 p. 972 § 2, A.L. 1965 p. 322, A.L. 1972 H.B. 1428)

The department of health and senior services is hereby
designated the official state agency to receive any and all federal and
other grants and aids for making a survey and for the construction of
hospitals and health centers, provided, that private grants and aids to
private hospitals, health centers and units in this state, by will, deed
or gift shall vest in such private institutions under the terms and
provisions of such will, deed or gift and the department of health and
senior services shall have no right, title, interest or control over
grants and aids to private hospitals so granted, unless granted in said
will, deed or gift. It shall be empowered to receive any and all such
grants and aids under the terms of such grants and aids and to pay them
out under any and all provisions as may be attached to such grants and
aids. It shall be authorized to render such reports as may be required
under any and all grants and aids; provide such minimum standards for
maintenance and operation of hospitals and health centers as may be
required under the terms of such grants and aids; and to require
compliance with such standards in the case of hospitals and health
centers which shall have received such grants and aids. (L. 1945 p. 972 §
3)

1. All funds received by the state of Missouri from the federal
government or from any other source which are granted for the purpose of
purchasing prophylactic drugs for distribution to persons certified by a
physician to be victims of rheumatic fever, and all money received by the
department of health and senior services as proceeds from the sale of the
drugs to the victims, shall be deposited in the state treasury to the
credit of the "Medical Services Fund", which is hereby created.

2. All moneys credited to the medical services fund shall be appropriated
by the general assembly only for the purchase of prophylactic drugs to be
distributed to persons certified by a physician to be victims of
rheumatic fever, for the distribution of the drugs and for the
administration of the program.

3. The unexpended balance in medical services fund at the end of the
biennium shall not be transferred to the general revenue fund of the
state treasury and accordingly shall be exempt from the provisions of
section 33.080, RSMo, relating to the transfer of funds to the general
revenue fund of the state by the state treasurer.

4. The director of the department of health and senior services shall
make and promulgate necessary rules and regulations for the
administration of the funds appropriated pursuant to this section. (L.
1965 p. 323 §§ 1 to 4)

CROSS REFERENCE: Medical services fund abolished subject to exemption,
RSMo 33.571

The county commissions of the several counties of this state may
appoint a duly licensed qualified physician as a county health officer
for a term of one year, and in the event a vacancy is created in the
office of the county health officer, such commission may appoint a duly
licensed qualified physician for the unexpired term. If the county
commission of any county decides to appoint a county health officer as
empowered in this law, it shall agree with the officer as to the
compensation and expenses to be paid for such service, which amount shall
be paid out of the county treasury of the county. Nothing contained
herein shall be construed to require the county commission of any county
to appoint a county health officer in any county. (RSMo 1939 § 9745, A.L.
1945 p. 975, A. 1949 S.B. 1051)

Prior revisions: 1929 § 9025; 1919 § 5782

CROSS REFERENCE: Director of public county health center to be county
health officer, RSMo 205.100

In all counties of class one, except counties of the first class
not having a charter form of government, and in any county of the second
class in which the circuit court sits in more than one city and which has
a population of at least fifty-eight thousand but not more than
sixty-five thousand, the county commission of such county may appoint
such deputies or assistants to or for the county health officer of such
county, and when appointed shall fix a reasonable compensation, including
expenses of such deputies and assistants, all of which shall be paid out
of the county treasury. (RSMo 1939 § 9746, A.L. 1945 p. 975, A. 1949 S.B.
1051, A.L. 1973 H.B. 627, A.L. 1982 H.B. 1069)

Prior revision: 1929 § 9026

It shall be the duty of the county health officers to enforce
the rules and regulations of the department of health and senior services
throughout their respective counties outside of incorporated cities which
maintain a health officer. The health officers for incorporated cities of
less than seventy-five thousand population shall enforce the rules and
regulations of the department of health and senior services within their
respective cities. Any county health officer who neglects or refuses to
perform his duties as required by this chapter shall be deemed guilty of
a misdemeanor. In case of dereliction of duty or refusal to act on the
part of the county health officer of any county, the department of health
and senior services may at its discretion declare the office of county
health officer for that county vacant. (RSMo 1939 § 9746, A. 1949 S.B.
1051)

Prior revisions: 1929 § 9027; 1919 § 5783

All rules and regulations authorized and made by the department
of health and senior services in accordance with this chapter shall
supersede as to those matters to which this chapter relates, all local
ordinances, rules and regulations and shall be observed throughout the
state and enforced by all local and state health authorities. Nothing
herein shall limit the right of local authorities to make such further
ordinances, rules and regulations not inconsistent with the rules and
regulations prescribed by the department of health and senior services
which may be necessary for the particular locality under the jurisdiction
of such local authorities. (RSMo 1939 § 9748)

Prior revisions: 1929 § 9028; 1919 § 5784

The county commissions and the county health center boards of
the several counties may make and promulgate orders, ordinances, rules or
regulations, respectively as will tend to enhance the public health and
prevent the entrance of infectious, contagious, communicable or dangerous
diseases into such county, but any orders, ordinances, rules or
regulations shall not be in conflict with any rules or regulations
authorized and made by the department of health and senior services in
accordance with this chapter or by the department of social services
under chapter 198, RSMo. The county commissions and the county health
center boards of the several counties may establish reasonable fees to
pay for any costs incurred in carrying out such orders, ordinances, rules
or regulations, however, the establishment of such fees shall not deny
personal health services to those individuals who are unable to pay such
fees or impede the prevention or control of communicable disease. Fees
generated shall be deposited in the county treasury. All fees generated
under the provisions of this section shall be used to support the public
health activities for which they were generated. After the promulgation
and adoption of such orders, ordinances, rules or regulations by such
county commission or county health board, such commission or county
health board shall make and enter an order or record declaring such
orders, ordinances, rules or regulations to be printed and available for
distribution to the public in the office of the county clerk, and shall
require a copy of such order to be published in some newspaper in the
county in three successive weeks, not later than thirty days after the
entry of such order, ordinance, rule or regulation. Any person, firm,
corporation or association which violates any of the orders or ordinances
adopted, promulgated and published by such county commission is guilty of
a misdemeanor and shall be prosecuted, tried and fined as otherwise
provided by law. The county commission or county health board of any such
county has full power and authority to initiate the prosecution of any
action under this section. (L. 1945 p. 974 § 9748a, A.L. 1973 H.B. 627,
A.L. 1987 S.B. 397, A.L. 1989 S.B. 68 merged with S.B. 112, et al.)

Nothing in sections 192.260 to 192.320 shall apply to cities
which now have, or may hereafter have, a population of seventy-five
thousand or over which are maintaining organized health departments;
provided, that such cities shall furnish the department of health and
senior services reports of contagious, infectious, communicable or
dangerous diseases, which have been designated by them as such and such
other statistical information as the board may require. (RSMo 1939 § 9749)

Prior revisions: 1929 § 9029; 1919 § 5785

Any person or persons violating any of the provisions of
sections 192.010, 192.020 to 192.490, 192.600 to 192.620 or who shall
leave any pesthouse, or isolation hospital, or quarantined house or place
without the consent of the health officer having jurisdiction, or who
evades or breaks quarantine or knowingly conceals a case of contagious,
infectious, or communicable disease, or who removes, destroys, obstructs
from view, or tears down any quarantine card, cloth or notice posted by
the attending physician or by the health officer, or by direction of a
proper health officer, shall be deemed guilty of a class A misdemeanor.
(RSMo 1939 § 9750, A.L. 1951 p. 784, A.L. 1961 p. 463, A.L. 1978 S.B. 509)

Prior revisions: 1929 § 9030; 1919 § 5786

1. The "Department of Health and Senior Services Document
Services Fund" is hereby created. All funds received by the department of
health and senior services from the fees charged for reports, studies,
records and other publications and documents including data tapes and
audiovisual products produced or reproduced by the department shall be
credited to the fund. The director of the department shall administer the
fund. The state treasurer is the custodian of the fund and shall approve
disbursements from the fund requested by the director of the department.
When appropriated by the general assembly, moneys from the fund shall be
used to pay costs, including personnel costs, as follows:

(1) To pay costs associated with the collection, processing, storage, and
access to documents and data;

(2) To produce publications or other documents including data tapes and
audiovisual products requested by governmental agencies or members of the
general public;

(3) To publish the publications or other documents or to purchase
reports, publications or other documents including data tapes and
audiovisual products for reproduction; and

(4) To pay shipping charges.

2. An unexpended balance in the fund at the end of the fiscal year not
exceeding fifty thousand dollars is exempt from the provisions of section
33.080, RSMo, relating to the transfer of unexpended balances to the
general revenue fund. (L. 1987 S.B. 144 § 1, A.L. 2002 H.B. 1812)

There is hereby created in the state treasury the "Department of
Health and Senior Services Administrative and Cost Allocation Fund". The
state treasurer shall be the custodian of the fund and the fund shall be
administered by the director of the department of health and senior
services. The fund shall be funded annually by appropriations, and
deposits and transfers thereto. The fund shall contain moneys transferred
or paid to the department in return for goods and services provided
internally by the department, or to any governmental entity or the
public. The commissioner of administration shall approve disbursements
from the fund at the request of the director of the department or the
director's designee in accordance with the appropriations made therefor.
Notwithstanding the provisions of section 33.080, RSMo, moneys in the
fund shall not lapse to the credit of general revenue at the end of the
biennium. All interest earned on the fund shall be deposited in and
credited to the fund. (L. 2005 S.B. 74 & 49)

Effective 6-29-05

There is hereby created in the state treasury the "Department of
Health and Senior Services Disaster Fund", to which the general assembly
may appropriate moneys and from which moneys may be appropriated annually
to the department of health and senior services. Moneys in the fund shall
be expended during a state of emergency at the direction of the governor
and upon issuance of an emergency declaration which shall set forth the
emergency and shall state that it requires the expenditure of public
funds to furnish immediate aid and relief. The state treasurer shall be
the custodian of the fund and the fund shall be administered by the
department of health and senior services. Notwithstanding the provisions
of section 33.080, RSMo, moneys in the fund shall not lapse to the credit
of general revenue at the end of the biennium. All interest earned on the
fund shall be deposited in and credited to the fund. (L. 2005 S.B. 74 &
49)

Effective 6-29-05

1. There is hereby established within the department of health
and senior services the "Missouri State Advisory Council on Pain and
Symptom Management". The council shall consist of nineteen members that
are residents of this state. The members of the council shall include:

(1) The director of the department of health and senior services, or the
director's designee, who shall serve as chair of the council;

(2) The state attorney general, or the attorney general'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;

(5) One physician, appointed by the Missouri state board of registration
for the healing arts, that is certified and accredited in pain management;

(6) One physician, appointed by the Missouri state board of registration
for the healing arts, that is certified and accredited in palliative care;

(7) Two registered nurses, appointed by the Missouri board of nursing,
with expertise in hospice, oncology, long-term care, or pain and symptom
management and are certified by the National Board for Certification of
Hospice and Palliative Nurses;

(8) One dentist, appointed by the Missouri board of dentistry, with
training in pain and symptom management and is associated with the
education and training of dental students;

(9) One pharmacist, appointed by the Missouri board of pharmacy, with
training in pain and symptom management and is associated with the
education and training of pharmacists;

(10) One representative of the Pharmaceutical Research and Manufacturers
of America, appointed by the governor, with the advice and consent of the
senate;

(11) One mental health services provider, appointed by the governor, with
the advice and consent of the senate;

(12) One physician assistant, appointed by the Missouri advisory
commission for physician assistants, with training in pain and symptom
management;

(13) One chiropractic physician, appointed by the Missouri state board of
chiropractic examiners, with training in pain and symptom management;

(14) One physical therapist, appointed by the Missouri Physical Therapy
Association, that specializes in pain management;

(15) One advocate representing voluntary health organizations or advocacy
groups with an interest in pain management, appointed by the governor,
with the advice and consent of the senate; and

(16) One member who has been diagnosed with chronic pain, appointed by
the governor, with the advice and consent of the senate.

2. Members of the council shall be appointed by February 1, 2004. Of the
members first appointed to the council, seven members shall serve a term
of two years, and eight members shall serve a term of one year, and
thereafter, members shall serve a term of two 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. (L. 2003 H.B. 59 & 269)

1. Members shall serve without compensation but shall, subject
to appropriations, be reimbursed for reasonable and necessary expenses
actually incurred in the performance of the member's official duties.

2. The department of health and senior services with existing resources
shall provide administrative support and current staff as necessary for
the effective operation of the council. (L. 2003 H.B. 59 & 269)

1. Meetings shall be held at least every ninety days or at the
call of the council chair.

2. The advisory council shall:

(1) Hold public hearings pursuant to chapter 536, RSMo, to gather
information from the general public on issues pertaining to pain and
symptom management;

(2) Make recommendations on acute and chronic pain management treatment
practices;

(3) Analyze statutes, rules, and regulations regarding pain management;

(4) Study the use of alternative therapies regarding pain and symptom
management and any sanctions imposed;

(5) Review the acute and chronic pain management education provided by
professional licensing boards of this state;

(6) Examine the needs of adults, children, the terminally ill, racial and
ethnic minorities, and medically underserved populations that have acute
and chronic pain;

(7) Make recommendations on integrating pain and symptom management into
the customary practice of health care professionals;

(8) Identify the roles and responsibilities of health care professionals
in pain and symptom management;

(9) Make recommendations on the duration and content of continuing
education requirements for pain and symptom management;

(10) Review guidelines on pain and symptom management issued by the
United States Department of Health and Human Services;

(11) Provide an annual report on the activities of the council to the
director of the department of health and senior services, the speaker of
the house of representatives, the president pro tempore of the senate,
and the governor by February first of every year. Such report shall
include, but not be limited to the following:

(a) Issues and recommendations developed by the council;

(b) Pain management educational curricula and continuing education
requirements for institutions providing health care education;

(c) Information regarding the impact and effectiveness of prior
recommendations, if any, that have been implemented; and

(d) Review of current policies regarding pain and symptom management and
any changes thereto occurring in pain and symptom management.

3. The department of health and senior services may accept on behalf of
the council any federal funds, gifts, and donations from individuals,
private organizations, and foundations, and any other funds that may
become available. (L. 2003 H.B. 59 & 269)

1. There is hereby established within the department of health
and senior services the "Missouri Senior Advocacy and Efficiency
Commission". The commission shall consist of the following fifteen
members, or their designees, who are residents of this state:

(1) The director of the department of health and senior services;

(2) Two members of the Missouri senate, appointed by the president pro
tem of the senate;

(3) Two members of the Missouri house of representatives, appointed by
the speaker of the house;

(4) A pharmacist licensed in the state of Missouri, recommended by the
Missouri board of pharmacy and appointed by the governor;

(5) A representative of the Pharmaceutical Research and Manufacturers of
America, appointed by the governor;

(6) One member of the Missouri silver-haired legislature, appointed by
the governor;

(7) One member of the Missouri senior Rx commission, appointed by the
governor;

(8) One representative from the assisted living community who currently
serves on the personal independence commission, appointed by the governor;

(9) One representative of the Missouri area agency on aging, appointed by
the governor;

(10) One member of the special health, psychological, and social needs of
minority older individuals commission;

(11) One member of the governor's advisory council on aging, appointed by
the governor;

(12) The lieutenant governor, who shall serve as chair of the commission;
and

(13) One member from the Missouri council for in-home services, appointed
by the governor.

In making the initial appointment to the committee, the governor,
president pro tem, and speaker shall stagger the terms of the appointees
so that five members serve an initial term of one year, five members
serve initial terms of two years and five members serve initial terms of
three years. All members appointed thereafter shall serve three-year
terms. All members shall be eligible for reappointment. Members of the
commission shall be appointed by October 1, 2005. Members shall continue
to serve until their successor is appointed and qualified. Any vacancy on
the commission shall be filled in the same manner as the original
appointment. The commission shall be dissolved on December 31, 2008.

2. Service on the commission shall be voluntary. Subject to
appropriations, members of the commission shall receive with reasonable
reimbursement for expenses actually incurred in the performance of the
member's official duties for members who are not employees of the state
of Missouri.

3. Subject to appropriations, the department of health and senior
services shall provide administrative support and resources as is
necessary for the effective operation of the commission.

4. Meetings shall be held at least every ninety days or at the call of
the commission chair.

5. The senior advocacy and efficiency commission shall:

(1) Hold public hearings in accordance with chapter 536, RSMo, to gather
information from any state agency, commission, or public entity on issues
pertaining to the quality and efficiency of all senior services offered
by the state of Missouri;

(2) Analyze state statutes, commissions, and administrative rules
regarding services offered by the state of Missouri for senior citizens
and designate which programs provide effective and efficient support to
seniors and the programs that lack quality;

(3) Establish a mechanism to educate the staff of the members of the
Missouri general assembly to assist seniors, including but not limited to
assisting seniors in applying for any and all prescription drug
assistance offered under the federal Medicare Prescription Drug
Modernization Act of 2003;

(4) Develop a plan that delays the need for the provisions of long- term
care outside the residence of senior citizens and allows seniors to
remain at home for as long as possible;

(5) Maintain a web site with detailed information regarding all programs
and services offered by the state of Missouri which are available to
seniors;

(6) Maintain a toll-free senior advocacy support telephone number which
directs seniors to all services offered by the state of Missouri which
are available to seniors;

(7) Submit an annual report on the activities of the commission to the
director of the department of health and senior services, the members of
the Missouri general assembly, and the governor by February 1, 2007, and
every February first thereafter. Such report shall include, but not be
limited to, the following:

(a) Efficiencies that can be realized by consolidation of senior services
offered by Missouri;

(b) Effectiveness of all senior services, programs, and commissions
offered by the state of Missouri;

(c) Information regarding the impact and effectiveness of prior
recommendations, if any, that have been implemented; and

(d) Measurable data to identify the cost-effectiveness of the services,
programs, and commissions evaluated.

6. Unless reauthorized, the provisions of this section shall sunset on
December 31, 2008. (L. 2005 S.B. 74 & 49)

Sunset date 12-31-08, unless reauthorized.

The following words and terms as used in sections 192.400 to
192.490 mean:

(1) "Committee on radiation control", a subcommittee of the Missouri
atomic energy commission;

(2) "Radiation", any or all of the following forms of ionizing radiation:
gamma and X rays, alpha and beta particles, high speed electrons,
neutrons, protons and other nuclear or atomic particles or rays, and
other radiant energies including, by way of extension but not of
limitation, radium, strontium 90, cesium 137 and cobalt 60, but radiation
as herein defined does not include sound or radio waves or visible,
infrared or ultraviolet light;

(3) "Radiation machine", any device that produces radiation;

(4) "Unnecessary radiation", the use of radiation as herein defined in
such a manner as to be hazardous to the health of the people or the
industrial or agricultural potentials of the state. (L. 1963 p. 359 § 1)

The department of health and senior services, with the guidance
and advice of the committee on radiation, shall

(1) Develop comprehensive policies and programs for the evaluation and
determination of hazards associated with the use of radiation and for
their abatement or elimination;

(2) Employ, and, if necessary, train the personnel needed to carry out
the provisions of sections 192.400 to 192.490;

(3) Advise, consult and cooperate with other agencies of this state, the
federal government, other states, and interstate agencies, and with
affected groups, political subdivisions and industries in furtherance of
the purposes of sections 192.400 to 192.490;

(4) Accept and administer loans, grants or other funds or gifts from the
federal government and from other sources, public or private, for
carrying out any of its functions;

(5) Encourage, participate in or conduct studies, investigations,
training, research and demonstrations relating to the control of
radiation hazards, the measurement of radiation, the effects on health of
exposure to radiation and related problems as it may deem necessary or
advisable for the discharge of its duties under sections 192.400 to
192.490 or for the protection of public health;

(6) Collect and disseminate information relating to the determination and
control of radiation exposure and hazards;

(7) Review and approve plans and specifications for radiation sources
submitted pursuant to rules and regulations promulgated under sections
192.400 to 192.490;

(8) Inspect radiation sources, their shielding and immediate surroundings
and records for the determination of any possible radiation hazard and
may examine any records or memoranda pertaining to the question of
radiation machines and the use of radioactive materials. (L. 1963 p. 359
§ 2)

The department of health and senior services shall administer
sections 192.400 to 192.490 and may, with the approval of the committee
on radiation control, formulate and promulgate rules on radiation,
including registration of radiation sources and machines, as may be
necessary to prohibit and prevent unnecessary radiation. Rules shall be
promulgated pursuant to the provisions of this section and chapter 536,
RSMo. No rule or portion of a rule promulgated under the authority of
sections 192.400 to 192.490 shall become effective unless it has been
promulgated pursuant to the provisions of section 536.024, RSMo. (L. 1963
p. 359 § 3, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3)

All sources of radiation shall be shielded, transported,
handled, used and kept so as to prevent all users thereof and all persons
within effective range of them from being exposed to unnecessary
radiation. (L. 1963 p. 359 § 4)

1. It is unlawful for any person to produce radiation, or
produce, use, store or dispose of radioactive materials or radiation
machines, or to modify, extend or alter these activities unless he
registers in writing with the department of health and senior services in
accordance with the procedures prescribed by the department, except that
the department may exempt from registration certain classes of radiation
machines or radioactive materials known to be without hazard.

2. It is unlawful for any person to produce radiation, or to produce,
use, store or dispose of radioactive materials or radiation machines
except in accordance with sections 192.400 to 192.490 and the rules and
regulations adopted pursuant to these sections. (L. 1963 p. 359 § 5)

1. Whenever the department of health and senior services finds,
upon inspection and examination of a source of radiation as constructed,
operated or maintained, that there is a violation of any of the
provisions of sections 192.400 to 192.490 or of any of the rules or
regulations promulgated under these sections, the department shall notify
the person found to be causing, allowing or permitting the violation of
the nature of the violation and order that prior to a time fixed by the
department, which time shall not be later than thirty days from the date
of service of the notice, the person shall cease and abate causing,
allowing or permitting the violation and to take such action as is
necessary to comply with sections 192.400 to 192.490 and the rules or
regulations promulgated under these sections.

2. Agents of the department of health and senior services charged with
the enforcement of the provisions of sections 192.400 to 192.490 have the
right of entry and free access at reasonable times to any building or
structure for the purposes of inspection and examination.

3. All data obtained as a result of registration, inspection or
investigation shall be kept confidential by the department. (L. 1963 p.
359 § 6)

Whenever the department of health and senior services finds that
an emergency exists requiring immediate action to protect the public
health or welfare, it may issue an order reciting the existence of an
emergency and requiring that such action be taken as it deems necessary
to meet the emergency. The order shall be effective immediately. Any
person to whom the order is directed shall comply therewith immediately,
but on application to the department shall be afforded a hearing within
ten days. On the basis of the hearing the department shall continue such
order in effect, revoke it, or modify it. (L. 1963 p. 359 § 7)

Any person aggrieved by any finding or order of the department
under sections 192.400 to 192.490 may appeal as provided in chapter 536,
RSMo. (L. 1963 p. 359 § 8)

Nothing in sections 192.400 to 192.490 is interpreted as
limiting intentional exposure of persons to radiation for the purpose of
diagnosis or therapy, or medical research, as authorized by law. (L. 1963
p. 359 § 9)

1. Any person who violates any of the provisions of, or fails to
perform any duty imposed by, sections 192.400 to 192.490, or who violates
any rule or regulation of the department of health and senior services
promulgated pursuant to sections 192.400 to 192.490, is guilty of a
misdemeanor and, in addition, may be enjoined in a civil action by a
court of competent jurisdiction from continuing the violation.

2. Each day upon which the violation occurs constitutes a separate
violation.

3. The attorney general, on request of the department of health and
senior services, shall bring an action for injunctive relief to prevent
the violation of the provisions of sections 192.400 to 192.490 or rules
or regulations promulgated under these sections. (L. 1963 p. 359 § 10)

The department of health and senior services shall develop and
implement a responsible data management program of collecting and
analyzing statistical information necessary to protect the public health
and safety or the environment, and maintain a list of the persons
authorized to use, possess, store, treat, or transfer sources of
radiation within the state, and disseminate information relating to
sources of radiation except when such information constitutes trade
secrets or confidential information of the person from whom it is
obtained, unless disclosure of such information is required by federal
law. (L. 1985 H.B. 295 § 2)

CROSS REFERENCE: Environmental radiation monitoring program and fund,
RSMo 260.750

The department of health and senior services shall develop and
maintain radiological laboratory capabilities for analyzing radioactivity
as necessary to insure the protection of the public health. (L. 1985 H.B.
295 § 3)

The department of health and senior services shall respond to
all radiation emergencies. The department shall coordinate its radiation
emergency response activities and plans with the state emergency
management agency, the department of natural resources and other
agencies, and provide a memorandum of agreement documenting
responsibilities. This section does not in any way alter or change the
provisions of chapter 44, RSMo, concerning response during an emergency
by the office of the adjutant general or its successor agency. (L. 1985
H.B. 295 § 4)

The department of health and senior services shall establish a
toll-free telephone number for the use of parents to access information
about health care providers and practitioners who provide health care
services under the maternal and child health block grant and the medical
assistance program and about other relevant health care providers, as
required by 42 U.S.C. 705(a)(5)(E). Unless otherwise prohibited by
federal law or regulation, the cost of establishing and maintaining the
cost of the toll-free telephone number, including the cost of personnel
to operate or support it, shall be appropriated from the federal maternal
and child health block grant. The division of medical services of the
department of social services shall provide the department of health and
senior services with information it has otherwise compiled concerning
health care providers who participate in the medical assistance program.
The department of health and senior services shall coordinate the
operation of the toll-free telephone numbers operated by the department
so as to minimize duplication of administrative expense. (L. 1990 S.B.
765 § 9)

There is hereby established in the department of health and
senior services an "Office of Rural Health". The office of rural health,
under the supervision of the director of the department of health and
senior services, shall assume a leadership role in working or contracting
with state and federal agencies, universities, private interest groups,
communities, foundations, and local health centers to develop rural
health initiatives and maximize the use of existing resources without
duplicating existing effort. The office shall provide a central
information and referral source and serve as the primary state resource
in coordinating, planning and advocating for the continued access to
rural health care services in Missouri for the poor, the uninsured, the
underinsured, the medically indigent, maternity, newborn, child care and
for the elderly. The office shall:

(1) Educate the public and recommend appropriate public policies
regarding the continued viability of rural health care delivery in
Missouri and the quality and cost-effectiveness of such care and identify
conditions obstructing or hindering that delivery of essential health
care services to rural Missouri;

(2) Monitor and work with state and federal agencies to assess the impact
of proposed rules and regulations on rural areas, streamline regulations
to assist in the development of service diversification of health care
facilities, and target state and federal programs to rural areas;

(3) Promote and develop diverse and innovative health care service models
in rural areas;

(4) Encourage the use of advanced communications technology to provide
access to speciality expertise, clinical consultation and continuing
education;

(5) Assist rural health care providers, communities, and individuals in
applying for public and private grants and programs;

(6) Disseminate information and provide technical assistance to
communities, health care providers, and individual consumers of health
care services;

(7) Report to the federal Office of Rural Health Policy concerning its
activities and cooperate with rural health research centers established
by the federal Office of Rural Health Policy;

(8) Biennially report its activities and recommendations to the governor
and members of the general assembly on or before November fifteenth of
odd-numbered years. (L. 1990 S.B. 765 § 12)

(Expiration date of 8-28-95 was repealed, L. 1995 S.B. 299)

1. There is hereby established in the department of health and
senior services an "Advisory Committee on Childhood Immunization". The
advisory committee shall be comprised of a physician who is
board-certified in pediatrics, a physician who is board-certified in
family practice, one nurse who is active in the delivery of nursing
services in public schools, one nurse who is active in the delivery of
community health nursing services in a local health department, the
director of the department of health and senior services or his designee,
the chief of the office of minority health and the chief of the office of
rural health in the department of health and senior services, and a
representative from each of the regions listed in subdivisions (1) to (7)
of this subsection, the boundaries of which shall be determined by the
director of the department of health and senior services:

(1) Greater St. Louis area;

(2) Southeast;

(3) Northeast;

(4) Central;

(5) Southwest;

(6) Northwest; and

(7) Greater Kansas City area.

2. Each representative from the various regions listed in subdivisions
(1) to (7) of subsection 1 of this section shall organize, publicize, and
participate in at least one public meeting within that region which is
designed to gather information regarding childhood immunization in that
region. The costs of holding such meetings shall be paid by the
department of health and senior services using funds appropriated to the
department for that purpose.

3. The members of the committee, other than the ex officio members, shall
be appointed by the director of the department of health and senior
services and shall serve for three-year terms. Members shall serve on
the* committee without compensation but may be reimbursed for their
actual and necessary expenses from moneys appropriated to the department
of health and senior services for that purpose. The advisory committee
shall:

(1) Identify existing immunization record-keeping systems and their
suitability for inclusion in a comprehensive monitoring system,
computerized and linked to regional, state or federal systems;

(2) Determine how demographic and immunization data on all children under
the age of five years shall be obtained and entered into the computer
system and how it shall be kept up to date;

(3) Determine how the data collected on immunizations shall be analyzed
and communicated to parents, health care providers, and public officials
while maintaining the confidentially of patient records;

(4) Develop plans for increasing the rate of childhood immunization in
this state, giving due consideration to factors related to cultural
differences among the various population groups in this state. (L. 1993
H.B. 522 § 1)

*Word "a" appears in original rolls.

As used in sections 192.640 to 192.644, the following terms mean:

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

(2) "Osteoporosis", a bone disease characterized by a reduction in bone
density accompanied by increasing porosity and brittleness and associated
with loss of calcium from the bones. (L. 1995 H.B. 212 § 1)

1. The department may establish, promote, and maintain an
osteoporosis prevention and education program to promote public awareness
of causes of osteoporosis, options for prevention, the value of early
detection and possible treatments, including the benefits and risks of
those treatments.

2. The program shall include the following:

(1) Development of a public education and outreach campaign to promote
osteoporosis prevention and education, including but not limited to:

(a) Causes and nature of the disease;

(b) Risk factors;

(c) The role of hysterectomy;

(d) Prevention of the disease, including nutrition, diet, and physical
exercise;

(e) Diagnostic procedures and appropriate indications for their use;

(f) Hormone replacement, including benefits and risks;

(g) Environmental safety and injury prevention; and

(h) The availability of osteoporosis diagnostic treatment services in the
community;

(2) Development of educational materials to be made available for
consumers, particularly targeted toward high-risk groups, through local
health departments, local physicians, other health care providers and
women's organizations;

(3) Development of professional education programs for health care
providers to assist them in understanding research findings and the
subjects set forth in subdivision (2) of this subsection; and

(4) Development and maintenance of a list of current providers of
specialized services for the prevention and treatment of osteoporosis.
Dissemination of the list shall be accompanied by a description of
diagnostic procedures, appropriate indications for their use, and a
cautionary statement about the current status of osteoporosis research,
prevention and treatment. The statement shall also indicate that the
department does not license, certify or in any other way approve
osteoporosis programs or centers in the state.

3. The department may conduct a needs assessment to identify:

(1) Available technical assistance and educational materials and programs
nationwide;

(2) The level of public and professional awareness about osteoporosis;

(3) The needs of osteoporosis patients, their families and caregivers;

(4) Needs of health care providers, including physicians, nurses,
managed-care organizations and other health care providers;

(5) The services available to osteoporosis patients;

(6) Existence of osteoporosis treatment programs;

(7) Existence of osteoporosis support groups;

(8) Existence of rehabilitation services; and

(9) Number and location of bone density testing equipment. (L. 1995 H.B.
212 § 2)

1. The department may establish an osteoporosis advisory council
to be appointed by the director of the department. The purpose of the
advisory council is to assist the department in implementing sections
192.640 to 192.644.

2. The advisory council shall include:

(1) A person with osteoporosis;

(2) A representative from a women's health organization;

(3) A public health educator;

(4) An expert in bone and osteoporosis research, prevention and
treatment; and

(5) Five health care providers, representing the following professions:

(a) Radiology;

(b) Orthopedics;

(c) Nursing;

(d) Physical therapy; and

(e) Nutrition.

3. The members of the advisory council may not be compensated or
reimbursed from state funds for their expenses in performing council
duties. (L. 1995 H.B. 212 § 3)

1. The department of health and senior services shall establish
and maintain a cancer information reporting system to collect data
required for the receipt of federal grant funds pursuant to the Cancer
Registries Amendment Act of 1992 (42 U.S.C. 280e, et seq.), as amended.

2. The director of the department shall promulgate rules and regulations
specifying the malignant neoplasms which shall be reported and
accompanying information to be reported in each case. Such rules and
regulations shall provide for collection of the following data:

(1) For inpatient hospital settings, the data items collected by the
department of health and senior services as of August 28, 1999, and
additional data items required to be collected as a condition of federal
funding for state cancer registries pursuant to the Cancer Registries
Amendment Act of 1992 (42 U.S.C. 280e, et seq.), as amended; and

(2) For outpatient hospital settings, physician offices, pathology
laboratories, ambulatory surgical centers, residential care facilities I
and II, intermediate care facilities, skilled nursing facilities, and
free- standing cancer clinics and treatment centers, the data items
required to be collected as a condition of federal funding for state
cancer registries pursuant to the Cancer Registries Amendment Act of 1992
(42 U.S.C. 280e, et seq.), as amended. Reports of malignant neoplasms,
exclusive of nonmelanomatous cutaneous malignancies, shall be filed with
the director within six months of the diagnosis or treatment. The
department director shall prescribe the form and manner in which the
information shall be reported. (L. 1983 S.B. 163 § 1, A.L. 1993 S.B. 52,
A.L. 1999 H.B. 454)

1. The administrator or designated representative of hospitals,
pathology laboratories, physician offices, ambulatory surgical centers,
residential care facilities I or II, intermediate care facilities or
skilled nursing facilities, and free-standing cancer clinics and
treatment centers shall report to the department of health and senior
services every case of malignant neoplasm as required pursuant to section
192.650. Physicians' offices shall be exempt from reporting cases that
are directly referred to or have been previously admitted to any other
facility which is required by this subsection to report malignant
neoplasms.

2. The attending physician or other health care provider responsible for
a patient's diagnosis or treatment for a malignant neoplasm shall
provide, in writing, to the administrator or the administrator's
designated representative, the information required pursuant to section
192.650.

3. Reports filed with the director may be submitted through a data system
designated by the person or organization filing the report.

4. If a facility described in subsection 1 of this section is currently
submitting reports of cases to the department of health and senior
services through a centralized reporting system, duplicate reporting
shall not be required. (L. 1983 S.B. 163 § 2, A.L. 1999 H.B. 454)

1. The department of health and senior services shall protect
the identity of the patient, physician , health care provider, hospital,
pathology laboratory, ambulatory surgical center, residential care
facilities I or II, intermediate care facilities or skilled nursing
facilities, and free-standing cancer clinic or treatment center which is
involved in the reporting required by section 192.653, and such identity
shall not be revealed except that the identity of the patient may be
released only upon written consent of the patient, the identity of the
physician or health care provider may be released only upon written
consent of the physician or health care provider, and the identity of the
hospital, pathology laboratory, ambulatory surgical center, residential
care facilities I or II, intermediate care facilities or skilled nursing
facilities, or free- standing cancer clinic or treatment center may be
released only upon written consent of the facility.

2. The department shall request consent for release from a patient,
physician, health care provider, hospital, pathology laboratory,
ambulatory surgical center, residential care facilities I or II,
intermediate care facilities or skilled nursing facilities, or
free-standing cancer clinic or treatment center only upon a showing by
the applicant for such release that obtaining the identities of certain
patients, physicians, health care providers, hospitals, pathology
laboratories, ambulatory surgical centers, residential care facilities I
or II, intermediate care facilities or skilled nursing facilities, or
free-standing cancer clinics or treatment centers is necessary for his or
her cancer research and that his or her cancer research is worthwhile.

3. The department shall use or publish reports based upon materials
reported pursuant to sections 192.650 to 192.657 to advance research,
education and treatment. The department shall provide qualified
researchers with data from the reported information upon the researcher's
compliance with appropriate conditions as provided by rule and upon
payment of a fee to cover the cost of processing the data.

4. The department may enter into an exchange of data agreement with other
cancer registries maintained by federal, state or local governmental
entities. The provisions of subsection 1 of this section shall not apply
to such an agreement if the agreement provides that the federal, state or
local governmental cancer registry shall protect the identity of the
patient, physician, health care provider, hospital, pathology laboratory,
ambulatory surgical center, residential care facilities I or II,
intermediate care facilities or skilled nursing facilities, and free-
standing cancer clinic or treatment center in all data received from the
Missouri department of health and senior services. (L. 1983 S.B. 163 § 3,
A.L. 1987 S.B. 164, A.L. 1999 H.B. 454)

1. No individual or organization providing information or access
to information in accordance with sections 192.650 to 192.657 shall be
deemed to be or be held liable, either civilly or criminally, for
divulging or permitting access to confidential information unless such
individual or organization acted in bad faith or with malicious purpose.

2. Nothing in sections 192.650 to 192.657 shall be construed to compel
any individual to submit to medical or health department examination,
treatment or supervision of any kind.

3. Violation of any provisions of sections 192.650 to 192.657 shall be an
infraction. (L. 1963 S.B. 163 §§ 4, 5, A.L. 1999 H.B. 454)

As used in this section, section 192.667, and sections 197.150
to 197.165, RSMo, the following terms mean:

(1) "Charge data", information submitted by health care providers on
current charges for leading procedures and diagnoses;

(2) "Charges by payer", information submitted by hospitals on amount
billed to Medicare, Medicaid, other government sources and all
nongovernment sources combined as one data element;

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

(4) "Financial data", information submitted by hospitals drawn from
financial statements which includes the balance sheet, income statement,
charity care and bad debt and charges by payer, prepared in accordance
with generally accepted accounting principles;

(5) "Health care provider", hospitals as defined in section 197.020,
RSMo, and ambulatory surgical centers as defined in section 197.200, RSMo;

(6) "Nosocomial infection", as defined by the national Centers for
Disease Control and Prevention and applied to infections within
hospitals, ambulatory surgical centers, and other facilities;

(7) "Nosocomial infection incidence rate", a risk-adjusted measurement of
new cases of nosocomial infections by procedure or device within a
population over a given period of time, with such measurements defined by
rule of the department pursuant to subsection 3 of section 192.667 for
use by all hospitals, ambulatory surgical centers, and other facilities
in complying with the requirements of the Missouri nosocomial infection
control act of 2004;

(8) "Other facility", a type of facility determined to be a source of
infections and designated by rule of the department pursuant to
subsection 11 of section 192.667;

(9) "Patient abstract data", data submitted by hospitals which includes
but is not limited to date of birth, sex, race, zip code, county of
residence, admission date, discharge date, principal and other diagnoses,
including external causes, principal and other procedures, procedure
dates, total billed charges, disposition of the patient and expected
source of payment with sources categorized according to Medicare,
Medicaid, other government, workers' compensation, all commercial payors
coded with a common code, self-pay, no charge and other. (L. 1992 H.B.
1574 § 5 merged with S.B. 721 § 1 merged with S.B. 796 § 14, A.L. 2004
S.B. 1279)

1. All health care providers shall at least annually provide to
the department charge data as required by the department. All hospitals
shall at least annually provide patient abstract data and financial data
as required by the department. Hospitals as defined in section 197.020,
RSMo, shall report patient abstract data for outpatients and inpatients.
Within one year of August 28, 1992, ambulatory surgical centers as
defined in section 197.200, RSMo, shall provide patient abstract data to
the department. The department shall specify by rule the types of
information which shall be submitted and the method of submission.

2. The department shall collect data on required nosocomial infection
incidence rates from hospitals, ambulatory surgical centers, and other
facilities as necessary to generate the reports required by this section.
Hospitals, ambulatory surgical centers, and other facilities shall
provide such data in compliance with this section.

3. No later than July 1, 2005, the department shall promulgate rules
specifying the standards and procedures for the collection, analysis,
risk adjustment, and reporting of nosocomial infection incidence rates
and the types of infections and procedures to be monitored pursuant to
subsection 12 of this section. In promulgating such rules, the department
shall:

(1) Use methodologies and systems for data collection established by the
federal Centers for Disease Control and Prevention National Nosocomial
Infection Surveillance System, or its successor; and

(2) Consider the findings and recommendations of the infection control
advisory panel established pursuant to section 197.165, RSMo.

4. The infection control advisory panel created by section 197.165, RSMo,
shall make a recommendation to the department regarding the
appropriateness of implementing all or part of the nosocomial infection
data collection, analysis, and public reporting requirements of this act*
by authorizing hospitals, ambulatory surgical centers, and other
facilities to participate in the federal Centers for Disease Control and
Prevention's National Nosocomial Infection Surveillance System, or its
successor. The advisory panel shall consider the following factors in
developing its recommendation:

(1) Whether the public is afforded the same or greater access to
facility-specific infection control indicators and rates than would be
provided under subsections 2, 3, and 6 to 12 of this section;

(2) Whether the data provided to the public are subject to the same or
greater accuracy of risk adjustment than would be provided under
subsections 2, 3, and 6 to 12 of this section;

(3) Whether the public is provided with the same or greater specificity
of reporting of infections by type of facility infections and procedures
than would be provided under subsections 2, 3, and 6 to 12 of this
section;

(4) Whether the data are subject to the same or greater level of
confidentiality of the identity of an individual patient than would be
provided under subsections 2, 3, and 6 to 12 of this section;

(5) Whether the National Nosocomial Infection Surveillance System, or its
successor, has the capacity to receive, analyze, and report the required
data for all facilities;

(6) Whether the cost to implement the nosocomial infection data
collection and reporting system is the same or less than under
subsections 2, 3, and 6 to 12 of this section.

5. Based on the affirmative recommendation of the infection control
advisory panel, and provided that the requirements of subsection 12 of
this section can be met, the department may or may not implement the
federal Centers for Disease Control and Prevention Nosocomial Infection
Surveillance** System, or its successor, as an alternative means of
complying with the requirements of subsections 2, 3, and 6 to 12 of this
section. If the department chooses to implement the use of the federal
Centers for Disease Control Prevention Nosocomial Infection
Surveillance** System, or its successor, as an alternative means of
complying with the requirements of subsections 2, 3, and 6 to 12 of this
section, it shall be a condition of licensure for hospitals and
ambulatory surgical centers which opt to participate in the federal
program to permit the federal program to disclose facility-specific data
to the department as necessary to provide the public reports required by
the department. Any hospital or ambulatory surgical center which does not
voluntarily participate in the National Nosocomial Infection Surveillance
System, or its successor, shall be required to abide by all of the
requirements of subsections 2, 3, and 6 to 12 of this section.

6. The department shall not require the resubmission of data which has
been submitted to the department of health and senior services or the
department of social services under any other provision of law. The
department of health and senior services shall accept data submitted by
associations or related organizations on behalf of health care providers
by entering into binding agreements negotiated with such associations or
related organizations to obtain data required pursuant to section 192.665
and this section. A health care provider shall submit the required
information to the department of health and senior services:

(1) If the provider does not submit the required data through such
associations or related organizations;

(2) If no binding agreement has been reached within ninety days of August
28, 1992, between the department of health and senior services and such
associations or related organizations; or

(3) If a binding agreement has expired for more than ninety days.

7. Information obtained by the department under the provisions of section
192.665 and this section shall not be public information. Reports and
studies prepared by the department based upon such information shall be
public information and may identify individual health care providers. The
department of health and senior services may authorize the use of the
data by other research organizations pursuant to the provisions of
section 192.067. The department shall not use or release any information
provided under section 192.665 and this section which would enable any
person to determine any health care provider's negotiated discounts with
specific preferred provider organizations or other managed care
organizations. The department shall not release data in a form which
could be used to identify a patient. Any violation of this subsection is
a class A misdemeanor.

8. The department shall undertake a reasonable number of studies and
publish information, including at least an annual consumer guide, in
collaboration with health care providers, business coalitions and
consumers based upon the information obtained pursuant to the provisions
of section 192.665 and this section. The department shall allow all
health care providers and associations and related organizations who have
submitted data which will be used in any report to review and comment on
the report prior to its publication or release for general use. The
department shall include any comments of a health care provider, at the
option of the provider, and associations and related organizations in the
publication if the department does not change the publication based upon
those comments. The report shall be made available to the public for a
reasonable charge.

9. Any health care provider which continually and substantially, as these
terms are defined by rule, fails to comply with the provisions of this
section shall not be allowed to participate in any program administered
by the state or to receive any moneys from the state.

10. A hospital, as defined in section 197.020, RSMo, aggrieved by the
department's determination of ineligibility for state moneys pursuant to
subsection 9 of this section may appeal as provided in section 197.071,
RSMo. An ambulatory surgical center as defined in section 197.200, RSMo,
aggrieved by the department's determination of ineligibility for state
moneys pursuant to subsection 9 of this section may appeal as provided in
section 197.221, RSMo.

11. The department of health may promulgate rules providing for
collection of data and publication of nosocomial infection incidence
rates for other types of health facilities determined to be sources of
infections; except that, physicians' offices shall be exempt from
reporting and disclosure of infection incidence rates.

12. In consultation with the infection control advisory panel established
pursuant to section 197.165, RSMo, the department shall develop and
disseminate to the public reports based on data compiled for a period of
twelve months. Such reports shall be updated quarterly and shall show for
each hospital, ambulatory surgical center, and other facility a risk-
adjusted nosocomial infection incidence rate for the following types of
infection:

(1) Class I surgical site infections;

(2) Ventilator-associated pneumonia;

(3) Central line-related bloodstream infections;

(4) Other categories of infections that may be established by rule by the
department.

The department, in consultation with the advisory panel, shall be
authorized to collect and report data on subsets of each type of
infection described in this subsection.

13. In the event the provisions of this act* are implemented by requiring
hospitals, ambulatory surgical centers, and other facilities to
participate in the federal Centers for Disease Control and Prevention
National Nosocomial Infection Surveillance System, or its successor, the
types of infections to be publicly reported shall be determined by the
department by rule and shall be consistent with the infections tracked by
the National Nosocomial Infection Surveillance System, or its successor.

14. Reports published pursuant to subsection 12 of this section shall be
published on the department's Internet web site. The initial report shall
be issued by the department not later than December 31, 2006. The reports
shall be distributed at least annually to the governor and members of the
general assembly.

15. The Hospital Industry Data Institute shall publish a report of
Missouri hospitals' and ambulatory surgical centers' compliance with
standardized quality of care measures established by the federal Centers
for Medicare and Medicaid Services for prevention of infections related
to surgical procedures. If the Hospital Industry Data Institute fails to
do so by July 31, 2008, and annually thereafter, the department shall be
authorized to collect information from the Centers for Medicare and
Medicaid Services or from hospitals and ambulatory surgical centers and
publish such information in accordance with subsection 14 of this section.

16. The data collected or published pursuant to this section shall be
available to the department for purposes of licensing hospitals and
ambulatory surgical centers pursuant to chapter 197, RSMo.

17. The department shall promulgate rules to implement the provisions of
section 192.131 and sections 197.150 to 197.160, RSMo. 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 this section 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. 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,
2004, shall be invalid and void. (L. 1992 H.B. 1574 § 6 and S.B. 721 § 2
merged with S.B. 796 § 15, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3, A.L. 2004
S.B. 1279)

*"This act" (S.B. 1279, 2004) contained numerous sections. Consult
Disposition of Sections table for a definitive listing.

**Word "Surveillance" does not appear in original rolls.

There is hereby established a state arthritis program. The board
and the committee established by sections 192.700 to 192.727 are to
administer state, federal and private grants and programs dealing with
arthritis and related diseases as a part of this arthritis program.
Regional arthritis centers established pursuant to sections 192.700 to
192.727 constitute part of the state arthritis program. (L. 1984 H.B.
1028 § 2)

As used in sections 192.700 to 192.727, the following terms mean:

(1) "Board", the Missouri arthritis advisory board;

(2) "Committee", the arthritis program review committee;

(3) "Director", director of the department of health and senior services.
(L. 1984 H.B. 1028 § 1)

The director shall appoint an arthritis program coordinator to
administer the state arthritis program. Compensation for this position
shall be set by the director within the limit of the appropriation for
that purpose. (L. 1984 H.B. 1028 § 3)

1. The "Missouri Arthritis Advisory Board" is established within
the department of health and senior services, as a continuation of the
arthritis advisory board in existence on August 13, 1984. The board shall
consist of twenty-five members. The members of the board that are serving
on August 13, 1984, shall continue until the expiration of this term. The
board shall submit a list of names to the director as recommendations to
fill expired terms on the board. The director shall fill each expired
membership on the board, each of the appointees to serve for a term of
four years and until his successor is appointed and confirmed. Vacancies
on the board arising from reasons other than expiration of the member's
term shall be filled by the director for the time remaining in the
unexpired term.

2. The board shall meet semiannually and at other such times as called by
the chairman of the board. The chairman shall be elected from the board
membership at the first board meeting, and shall serve as chairman until
a new chairman is elected, or until his term on the board expires,
whichever occurs first.

3. The board shall serve in an advisory capacity to the committee, and
report annually to the department and to the state board of health
regarding the implementing of the statewide arthritis plan, making
recommendations for necessary changes in content and direction.

4. The board shall be responsible for development and recommendations of
guidelines for programs supported under the state arthritis program, and
make recommendations on program relevance of grant applications funded
under the state arthritis program. The board will make final
recommendations to the director regarding programs and grants of the
state arthritis program.

5. Any reimbursement of members of the board for their actual and
necessary expenses shall be subject to appropriations. (L. 1984 H.B. 1028
§ 4, A.L. 2002 H.B. 1953)

1. The "Arthritis Program Review Committee" is hereby created
within the department of health and senior services. This committee shall
consist of fifteen members, two from each of the seven regions set forth
in section 192.714 and one at-large member. The fourteen regional members
shall be nominated to the committee by the board. The one at-large member
shall be nominated by the state board of health. The members of the
committee shall include at least one from each of the following
categories: rheumatology educators, practicing rheumatologists, primary
care practitioners, nurses, allied health professionals, arthritis
patients, and members of the general public. Members of the committee
shall be appointed by the director in consultation with the board of
health. Of the fifteen initial members, five shall have a two-year term,
five shall have a three-year term, and five shall have a four-year term.
Thereafter, each member shall serve a four-year term and until his
successor is appointed and confirmed. Vacancies on the committee arising
from reasons other than expiration of the member's term shall be filled
by the director for the time remaining in the unexpired term.

2. The committee shall meet annually and at other such times as called by
the chairman of the committee. The chairman shall be elected annually
from the committee membership at the first committee meeting and shall
serve as chairman until a new chairman is elected, or until his term on
the committee expires, whichever occurs first.

3. The committee shall review, make site visits and determine and make
recommendations to the board on the merit of regional arthritis center
applications. No program or other activity will be recommended for
funding by the board without the favorable review of the committee.

4. The arthritis program coordinator shall serve the committee as its
executive administrator. (L. 1984 H.B. 1028 § 5)

Committee and board members shall serve without compensation,
but their expenses incurred in carrying out their official duties shall,
subject to appropriations, be reimbursed by the state. (L. 1984 H.B. 1028
§ 6, A.L. 2002 H.B. 1953)

1. Beginning October 1, 1984, there shall be established within
this state, and within the department of health and senior services, a
network of regional arthritis centers designed to demonstrate and
stimulate the prompt and effective application of available knowledge for
the treatment of patients with arthritis and related musculoskeletal
diseases, and to develop new knowledge essential for the control of these
disorders.

2. The arthritis centers established pursuant to sections 192.700 to
192.727 shall operate programs in the area of education of patients,
their families, and the public.

3. At least one regional arthritis center shall be established in each of
the following seven regions, the boundaries of which shall be determined
by the board:

(1) Greater St. Louis area;

(2) Southeast;

(3) Northeast;

(4) Central;

(5) Southwest;

(6) Northwest; and

(7) Greater Kansas City area. (L. 1984 H.B. 1028 § 7)

Beginning upon receipt of appropriations for that purpose and
subject to the availability of appropriations, but not before October 1,
1984, the arthritis centers established pursuant to section 192.714 shall
operate programs in the following areas:

(1) Education at all levels for various health professionals; and

(2) Improved patient care and other arthritis control activities aimed at
benefiting communities served by the center. (L. 1984 H.B. 1028 § 8)

1. Beginning upon receipt of appropriations for that purpose and
subject to the availability of appropriations, but not before October 1,
1984, each year the board may grant three one-year, state-supported
clinical rheumatology fellowships which might include four to six months
of a community-based experience in one or more of the regional arthritis
centers and six to eight months at an academic institution in this state
which is willing and qualified to train rheumatology fellows.

2. A candidate for a fellowship granted pursuant to this section shall be
approved by the director, the board, the academic institution, and the
regional arthritis center director.

3. Each fellowship granted pursuant to this section shall consist of an
appropriate stipend and either adequate housing or a housing allowance in
an amount to be determined by the board. (L. 1984 H.B. 1028 § 9)

1. Beginning upon receipt of appropriations for that purpose and
subject to the availability of appropriations, but not before October 1,
1984, support shall be provided for three academic rheumatology trainees
annually, for pursuit of training with academic institutions in the state.

2. Such support shall consist of an appropriate stipend and an additional
budget for expenses for each trainee each year as recommended by the
board.

3. A candidate for academic rheumatology training granted pursuant to
this section shall be approved by the director, the board and the
academic institution. (L. 1984 H.B. 1028 § 10)

Beginning upon receipt of appropriations for that purpose and
subject to the availability of appropriations, but not before July 1,
1985, innovative research feasibility studies which cannot be funded by
traditional mechanisms and which have significance for having impact on
the state arthritis problem may be carried out by arthritis centers
established pursuant to section 192.714. (L. 1984 H.B. 1028 § 11)

Beginning upon receipt of appropriations for that purpose and
subject to the availability of appropriations, but not before July 1,
1985, a statewide "Arthritis Information Network" shall be established,
consisting of a statewide WATS telephone system, staffed by volunteers
insofar as possible. (L. 1984 H.B. 1028 § 12)

1. The chemical substance DMSO may be manufactured, processed,
distributed, sold, possessed, and used in the state of Missouri for the
treatment and control of arthritis consistent with the objectives of the
arthritis program established pursuant to sections 192.700 to 192.727.

2. As used in this section, the term "DMSO" means a product whose major
component or ingredient is the chemical dimethyl sulfoxide or derivatives
or compounds of dimethyl sulfoxide.

3. No physician licensed under the provisions of chapter 334, RSMo, may
be subject to disciplinary action by the Missouri state board of
registration for the healing arts for prescribing or administering DMSO
to a patient suffering from or being treated for arthritis under his
care, provided the prescription and administration of DMSO is carried out
according to acceptable standards of medical practice.

4. No nurse licensed under the provisions of chapter 335, RSMo, who is
under the supervision and direction of a licensed physician may be
subjected to disciplinary action by the Missouri state board of nursing
for administering DMSO to a patient suffering from or being treated for
arthritis under proper orders, provided the administration of DMSO is
carried out according to acceptable standards of medical practice.

5. No pharmacist licensed under the provisions of chapter 338, RSMo, may
be subjected to disciplinary action by the Missouri board of pharmacy for
selling or dispensing DMSO pursuant to a proper prescription to a person
suffering from or being treated for arthritis, provided the selling or
dispensing is carried out according to acceptable standards of
professional practice.

6. No hospital or other health care facility shall interfere with the
physician-patient relationship by restricting or forbidding the use of
DMSO when prescribed or administered by a licensed physician or
administered by a licensed nurse under the supervision and direction of a
licensed physician to a person suffering from or being treated for
arthritis.

7. The prescription, administration, and dispensing of DMSO to a person
suffering from or being treated for arthritis when carried out according
to acceptable standards of professional practice shall not in itself
constitute grounds for negligent malpractice.

8. Any DMSO manufactured or distributed in the state of Missouri pursuant
to the passage of sections 192.700 to 192.727 shall be prominently
labeled in the following manner: "Notice: The State of Missouri takes no
position regarding the value of this product in the treatment of human
illness. This product is authorized solely for the treatment or control
of rheumatoid arthritis under the supervision and direction of a licensed
physician." (L. 1984 H.B. 1028 § 13)

1. There is hereby established a state systemic lupus
erythematosus program in the department of health and senior services.
Subject to appropriations, the lupus program shall:

(1) Track and monitor the prevalence and incidents of lupus occurring
throughout the state;

(2) Identify medical professionals and providers that are knowledgeable
or specialize in the treatment of lupus and related diseases or
illnesses; and

(3) Promote lupus research and public awareness through collaborations
with academic partners throughout the state and local boards, including
the Missouri chapter of the lupus foundation.

2. The department may utilize or expand existing programs such as the
office on* women's health, the office of minority health and the state
arthritis program established in sections 192.700 to 192.727 to meet the
requirements of this section.

3. The department 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. 106 merged with
S.B. 266)

*Word "of" appears in original rolls.

As used in sections 192.735 to 192.745, unless the context
clearly indicates otherwise, the following terms shall mean:

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

(2) "Head injury" or "traumatic head injury", a sudden insult or damage
to the brain or its coverings, not of a degenerative nature. Such insult
or damage may produce an altered state of consciousness and may result in
a decrease of one or more of the following: mental, cognitive, behavioral
or physical functioning resulting in partial or total disability.
Cerebral vascular accidents, aneurisms and congenital deficits are
specifically excluded from this definition;

(3) "Spinal cord injury", an injury that occurs as a result of trauma,
which may involve spinal vertebral fracture, and where the injured person
suffers two or more of the following effects either immediately or within
forty-eight hours of injury:

(a) Effects on the sensory system including numbness, tingling or loss of
sensation in the body or in one or more extremities;

(b) Effects on the motor system including weakness or paralysis in one or
more extremities;

(c) Effects on the visceral system including bowel or bladder dysfunction
or hypotension. (L. 1986 H.B. 1243 § 1)

1. The department of health and senior services shall establish
and maintain an information registry and reporting system for the purpose
of data collection and needs assessment of head and spinal cord injured
persons in this state.

2. Reports of traumatic head and spinal cord injuries shall be filed with
the department by a treating physician or his designee within seven days
of identification. The attending physician of any patient with traumatic
head or spinal cord injury who is in the hospital shall provide in
writing to the chief administrative officer the information required to
be reported by this section. The chief administrative officer of the
hospital shall then have the duty to submit the required reports.

3. Reporting forms and the manner in which the information is to be
reported shall be provided by the department. Such reports shall include,
but shall not be limited to, the following information: name, age, and
residence of the injured person, the date and cause of the injury, the
initial diagnosis and such other information as required by the
department. (L. 1986 H.B. 1243 § 2)

1. All reports and records made pursuant to sections 192.735 to
192.744 and maintained by the department and other appropriate persons,
officials and institutions pursuant to sections 192.735 to 192.744 shall
be confidential. Information shall not be made available to any
individual or institution except to:

(1) Appropriate staff of the department;

(2) Any person engaged in a bona fide research project, with the
permission of the director of the department, except that no information
identifying the subjects of the reports or the reporters shall be made
available to researchers unless the department requests and receives
consent for such release pursuant to the provisions of this section;

(3) The Missouri head injury advisory council, except that no information
identifying the subjects of the reports or the reporters shall be made
available to the council unless consent for release is requested and
received pursuant to the provisions of this section. Only information
pertaining to head injuries as defined in section 192.735 shall be
released to the council.

2. The department shall not reveal the identity of a patient, a reporting
physician or hospital, except that the identity of the patient may be
released upon written consent of the patient, parent or guardian, the
identity of the physician may be released upon written consent of the
physician, and the identity of the hospital may be released upon written
consent of the hospital.

3. The department shall request consent for release from a patient, a
reporting physician or hospital only upon a showing by the applicant for
such release that obtaining the identities of certain patients,
physicians or hospitals is necessary for his research.

4. The department shall at least annually compile a report of the data
accumulated through the reporting system established under section
192.737 and shall submit such data relating to head injuries as defined
in section 192.735 and in accordance with confidentiality restrictions
established pursuant to sections 192.735 to 192.744 to the director of
the Missouri head injury advisory council. (L. 1986 H.B. 1243 § 3)

No individual or organization providing information to the
department in accordance with sections 192.735 to 192.744 shall be held
liable in a civil or criminal action for divulging confidential
information unless such individual or organization acted in bad faith or
with malicious purpose. (L. 1986 H.B. 1243 § 4)

The department, in consultation with the Missouri head injury
advisory council, shall promulgate rules and regulations necessary to
carry out the provisions of sections 192.735 to 192.744, pursuant to the
provisions of section 192.006 and chapter 536, RSMo. (L. 1986 H.B. 1243 §
5, A.L. 1993 S.B. 52)

1. Nothing in sections 192.735 to 192.744 shall be construed to
compel any individual to submit to any medical or department of health
and senior services examination, treatment or supervision of any kind.

2. Violation of any provisions of sections 192.735 to 192.739 shall be an
infraction. (L. 1986 H.B. 1243 § 6)

1. The "Missouri Head Injury Advisory Council" is hereby
established as created by executive order of the governor on March 5,
1985. The council shall consist of twenty-five members. The members of
the council that are serving on August 13, 1986, shall continue serving
on the following basis: the two members of the council who are members of
the house of representatives and appointed by the speaker of the house of
representatives shall serve for the remainder of their terms; the two
members of the council who are members of the senate appointed by the
president pro tempore of the senate shall serve for the remainder of
their terms; and the remaining 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 these twenty-one members shall serve a
three-year term and until the member's successor is appointed by the
governor with the advice and consent of the senate. In addition, two
members who are members of the house of representatives shall be
appointed by the speaker of the house and two members who are members of
the senate shall be appointed by the president pro tempore of the senate.
The members appointed by the governor shall represent people with head
injuries, relatives of persons with head injuries, proprietary schools as
defined in section 173.600, RSMo, professional groups, health
institutions, or private industry and state agencies which administer
programs regarding mental health, education, public health, public
safety, insurance, and Medicaid. The appointment of individuals
representing state agencies shall be conditioned on their continued
employment with their respective agencies.

2. The Missouri head injury advisory council is assigned to the division
of general services in the office of administration. The office of
administration shall submit estimates of requirements for appropriations
on behalf of the council for the necessary staff and expenses to carry
out the duties and responsibilities assigned by the council. Such staff
shall consist of a director and other support staff.

3. Meetings shall be held at least every ninety days or at the call of
the council chairperson, who shall be elected by the council.

4. Each member shall, subject to appropriations, be reimbursed for
reasonable and necessary expenses actually incurred in the performance of
the member's official duties.

5. The council shall adopt written procedures to govern its activities.
Staff and consultants shall be provided for the council from
appropriations requested by the commissioner of the office of
administration for such purpose.

6. The council shall make recommendations to the governor for developing
and administering a state plan to provide services for head injured
persons.

7. No member of the council may participate in or seek to influence a
decision or vote of the council if the member would be directly involved
with the matter or if the member would derive income from it. A violation
of the prohibition contained herein shall be grounds for a person to be
removed as a member of the council by the governor.

8. The council shall be advisory and shall:

(1) Promote meetings and programs for the discussion of reducing the
debilitating effects of head injuries and disseminate information in
cooperation with any other department, agency or entity on the
prevention, evaluation, care, treatment and rehabilitation of persons
affected by head injuries;

(2) Study and review current prevention, evaluation, care, treatment and
rehabilitation technologies and recommend appropriate preparation,
training, retraining and distribution of manpower and resources in the
provision of services to head-injured persons through private and public
residential facilities, day programs and other specialized services;

(3) Recommend what specific methods, means and procedures should be
adopted to improve and upgrade the state's service delivery system for
head-injured citizens of this state;

(4) Participate in developing and disseminating criteria and standards
which may be required for future funding or licensing of facilities, day
programs and other specialized services for head-injured persons in this
state;

(5) Report annually to the commissioner of administration, the governor,
and the general assembly on its activities, and on the results of its
studies and the recommendations of the council.

9. The office of administration may accept on behalf of the council
federal funds, gifts and donations from individuals, private
organizations and foundations, and any other funds that may become
available. (L. 1986 H.B. 1243 § 7, A.L. 2002 H.B. 1953)

As used in sections 192.760 and 192.762 and sections 208.175 and
208.176, RSMo, the following terms mean:

(1) "General license", a license, effective pursuant to rules promulgated
by the department of health and senior services, without the filing of an
application, to transfer, acquire, own, possess, or use quantities of, or
devices or equipment utilizing, radioactive material;

(2) "Ionizing radiation", gamma rays and X rays, alpha particles, beta
particles, high-speed electrons, neutrons, protons, high-speed ions and
other high-speed nuclear particles;

(3) "Mammography", radiography of the breast for the purpose of enabling
a physician to determine the presence, size, location and extent of
cancerous or potentially cancerous tissue in the breast;

(4) "Mammography authorization", authorization under section 208.176 to
use a radiation machine for mammography;

(5) "Mammography system", the radiation machine used for mammography;
automatic exposure control devices; films, screens, and cassettes; image
processor; darkroom; and view boxes;

(6) "Person", any person, firm, partnership, limited partnership,
corporation, association, institution, political subdivision or other
organization;

(7) "Radiation machine", a machine, other than those exempted by
department rule, that emits ionizing radiation;

(8) "Radiation physicist", a person who is certified by the American
Board of Radiology in radiological physics or one of the specialties of
radiological physics;

(9) "Radioactive material", a solid, liquid, or gas which emits ionizing
radiation spontaneously;

(10) "Radiography", the making of a film or other record of an internal
structure of the body by passing X rays or gamma rays through the body to
act on film or other image receptor;

(11) "Registration", registration of a source of ionizing radiation in
writing with the department of health and senior services;

(12) "Source of ionizing radiation", a device or material that emits
ionizing radiation;

(13) "Specific license", a license issued to use, manufacture, produce,
transfer, receive, acquire, own, or possess quantities of, or devices or
equipment utilizing, radioactive material. (L. 1992 S.B. 721 § 5)

1. The department of health and senior services shall promulgate
rules providing for general or specific licenses or registration, or
exemption from licensing or registration, for radioactive materials and
other sources of ionizing radiation used to perform mammography, pursuant
to the provisions of section 192.006 and chapter 536, RSMo. The rules
shall provide for amendment, suspension or revocation of licenses. In
connection with those rules, the department of health and senior services
may promulgate rules to establish requirements for record keeping,
permissible levels of exposure, notification and reports of accidents,
protective measures, technical qualifications of personnel, handling,
transportation, interpretation, storage, waste disposal, posting and
labeling of hazardous sources and areas, surveys and monitoring. The
department shall promulgate rules and regulations specifying a patient
notification/recall system when deficiencies are found in mammography.
These rules and regulations shall be fairly consistent with recall
criteria of national accrediting programs where available.

2. The rules promulgated pursuant to sections 192.760 to 192.766 shall
not limit the intentional exposure of patients to radiation for the
purpose of lawful therapy or research, as authorized by law.

3. The department of health and senior services shall promulgate rules
specifying the minimum training and performance standards for an
individual using a radiation machine for mammography as set forth in
section 192.766.

4. In promulgating rules pursuant to sections 192.760 to 192.766, the
department shall avoid requiring dual licensing, insofar as practical.
Rules promulgated by the department may provide for recognition of other
state or federal licenses as the department considers desirable, subject
to registration requirements prescribed by the department. (L. 1992 S.B.
721 § 6, A.L. 1993 S.B. 52)

1. The department of health and senior services shall promulgate
rules to establish a schedule of fees to be paid by an applicant for a
specific license for sources of ionizing radiation and the renewal of the
specific license, or by a person possessing sources of ionizing radiation
which are subject to registration pursuant to sections 192.760 to
192.766, pursuant to the provisions of section 192.006 and chapter 536,
RSMo. The department may accept a written certification from the licensee
or registrant that the items of noncompliance have been corrected instead
of a follow-up inspection. If the department does not inspect a source of
ionizing radiation for a period of five consecutive years, the licensee
or registrant of the source of ionizing radiation shall be excused from
payment of further license or registration fees as to that source of
ionizing radiation until the first license or registration renewal date
following the time an inspection of the source of ionizing radiation is
made.

2. Except as otherwise provided in subsection 3 of this section, the
department of health and senior services shall assess the following
nonrefundable fees in connection with mammography authorization:

(1) Initial inspection, per radiation

machine .................................... $100.00

(2) Annual inspection, per radiation

machine .................................... $100.00

(3) Reinspection for reinstatement

of mammography authorization, per

radiation machine .......................... $100.00

(4) Department evaluation of compliance

with subdivision (1) of subsection 2

of section 192.762, first

radiation machine .......................... $500.00

(5) Each additional radiation machine .......... $400.00

3. If an applicant for mammography authorization submits an accreditation
certificate issued by the American College of Radiology that evidences
compliance with subdivision (1) of subsection 2 of section 192.766, the
department shall waive the fee under subsection 2 of this section for
department evaluation of compliance with that provision.

4. All fees provided for in this section shall be collected by the
director of the department of health and senior services who shall
deposit the same with the state treasurer in a fund to be known as the
"Mammography Fund". The provisions of section 33.080, RSMo, to the
contrary notwithstanding, money in this fund shall not be transferred and
placed to the credit of general revenue at the end of the biennium, but
shall be used, upon appropriation by the general assembly, for the sole
purpose of carrying out the provisions of sections 192.760 to 192.766.
(L. 1992 S.B. 721 § 7, A.L. 1993 S.B. 52)

1. Beginning sixty days after August 28, 1992, a person shall
not use a radiation machine to perform mammography unless the radiation
machine is registered with the department of health and senior services
under department rules for registration of radiation machines and is
specifically authorized under this section for use for mammography.

2. The department of health and senior services shall authorize a
radiation machine for use for mammography if the radiation machine meets
all of the following standards:

(1) The radiation machine meets the criteria for the American College of
Radiology mammography accreditation program as adopted in June 1987, and
amended in September 1988, and published by the American College of
Radiology, which criteria are incorporated by reference. The department
of health and senior services shall make copies of those criteria
available to the public and may by rule adopt modified criteria. The
department may accept an accreditation certificate issued by the American
College of Radiology as evidence that a radiation machine meets those
criteria. If at any time the department determines that it will not
accept any accreditation certificates issued by the American College of
Radiology as evidence that a radiation machine meets those criteria, the
department shall promptly notify each person who has registered a
radiation machine under sections 192.760 to 192.766* and the rules
promulgated under sections 192.760 to 192.766*;

(2) The radiation machine, the film or other image receptor used in the
radiation machine, and the facility where the radiation machine is used
meet the requirements set forth in department of health and senior
services rules for radiation machines;

(3) The radiation machine is specifically designed to perform mammography;

(4) The radiation machine is used exclusively to perform mammography;

(5) The radiation machine is used in a facility that does all of the
following:

(a) At least annually has a radiation physicist provide on-site
consultation to the facility, including, but not limited to, a complete
evaluation of the entire mammography system to ensure compliance with
sections 192.760 to 192.766* and the rules promulgated under sections
192.760 to 192.766*;

(b) Maintains for at least sixty months, records of the consultation
required in paragraph (a) and the findings of the consultation;

(6) The radiation machine is used according to department of health and
senior services rules on patient radiation exposure and radiation dose
levels;

(7) The radiation machine is operated only by an individual who can
demonstrate to the department that he is specifically trained in
mammography. Beginning sixty days after the rules required under
subsection 3 of section 192.762** are promulgated, the radiation machine
is operated only by an individual who can demonstrate to the department
that he meets the standards required by those rules. If the department
promulgates emergency rules covering the subject matter described in
subsection 3 of section 192.762**, then for a period beginning sixty days
after those emergency rules are promulgated and ending on the day that
those emergency rules cease to be in effect, the radiation machine is
operated only by an individual who can demonstrate to the department that
he meets the standards required by those emergency rules.

3. The department may issue a nonrenewable temporary authorization for a
radiation machine for use for mammography if additional time is needed to
allow submission of evidence satisfactory to the department that the
radiation machine meets the standards set forth in subsection 2 of this
section for approval for mammography. A temporary authorization granted
under this subsection during the first eighteen months after August 28,
1992, shall be effective for no more than twelve months. A temporary
authorization granted under this subsection after eighteen months after
August 28, 1992, shall be effective for no more than six months. The
department may withdraw a temporary authorization prior to its expiration
if the radiation machine does not meet one or more of the standards set
forth in subsection 2 of this section.

4. To obtain authorization from the department of health and senior
services to use a radiation machine for mammography, the person who owns
or leases the radiation machine, or an authorized agent of the person,
shall apply to the department for mammography authorization on an
application form provided by the department and shall provide all of the
information required by the department as specified on the application
form. A person who owns or leases more than one radiation machine used
for mammography shall obtain authorization for each radiation machine.
The department shall process and respond to an application within thirty
days after the date of receipt of the application. Upon determining to
grant mammography authorization for a radiation machine, the department
shall issue a certificate of registration specifying mammography
authorization for each authorized radiation machine. A mammography
authorization is effective for three years.

5. The department shall annually inspect the radiation machine and may
inspect the radiation machine more frequently. The department shall make
reasonable efforts to coordinate the inspections under this section with
the department's other inspections of the facility in which the radiation
machine is located.

6. After each satisfactory inspection by the department, the department
shall issue a certificate of radiation machine inspection or a similar
document identifying the facility and radiation machine inspected and
providing a record of the date the radiation machine was inspected. The
facility shall post the certificate issued by the American College of
Radiology or the department of health and senior services near the
inspected radiation machine.

7. The department may withdraw the mammography authorization for a
radiation machine if it does not meet one or more of the standards set
forth in subsection 2 of this section.

8. The department shall provide an opportunity for a hearing in
connection with a denial or withdrawal of mammography authorization.

9. Upon a finding that a deficiency in a radiation machine used for
mammography or a violation of sections 192.760 to 192.766* or the rules
promulgated under sections 192.760 to 192.766* seriously affects the
health, safety, and welfare of individuals upon whom the radiation
machine is used for mammography, the department may issue an emergency
order summarily withdrawing the mammography authorization of the
radiation machine. The department shall incorporate its findings in the
order and shall provide an opportunity for a hearing within five working
days after issuance of the order. The order shall be effective during the
proceedings.

10. If the department withdraws the mammography authorization of a
radiation machine, the radiation machine shall not be used for
mammography. An application for reinstatement of a mammography
authorization shall be filed and processed in the same manner as an
application for mammography authorization under subsection 4 of this
section, except that the department shall not issue a reinstated
certificate of mammography registration until the department receives the
reinspection fee required under subsection 2 of section 192.764***,
inspects the radiation machine, and determines that it meets the
standards set forth in subsection 2 of this section. The department shall
conduct an inspection required under this subsection no later than sixty
days after receiving a proper application for reinstatement of a
mammography authorization.

11. In addition to the reinspection fee required under subsection 2 of
section 192.764***, if a person violates subsection 1 of this section,
the department of health and senior services may impose an administrative
penalty against the owner of the radiation machine or, if a lessee of the
radiation machine has effective control of the radiation machine, the
lessee, of not more than five hundred dollars for each calendar week in
which a mammography is performed in violation of subsection 1 of this
section. If a person continues to violate subsection 1 of this section
for a period of two weeks after a fine is imposed under this subsection,
the department shall post a conspicuous notice on the unauthorized
radiation machine and at the entry to the facility where the radiation
machine is located warning the public that the facility is performing
mammography using a radiation machine that is not in compliance with
state regulations and may pose a potential hazard to the public health.

12. The attorney general, on request of the department of health and
senior services, shall bring an action for injunctive relief to prevent
the violation of the provisions of sections 192.760 to 192.766* or rules
or regulations promulgated under sections 192.760 to 192.766*.

13. Rules and regulations promulgated by the department of health and
senior services pursuant to sections 192.760 to 192.766* shall be fairly
consistent with rules promulgated by the Health Care Financing
Administration for the Medicare Program: Medicare Coverage of Screening
Mammography to implement mammography screening requirements contained in
the Omnibus Reconciliation Act of 1990.

(L. 1992 S.B. 721 § 8)

*Words "sections 3 to 6" (renumbered 208.175, 208.176, 192.760, 192.762)
appear in original rolls, but sections 5 to 8 (renumbered 192.760 to
192.766) seem to be germane, a manifest clerical error.

**Words "section 4" (renumbered 208.176) appear in original rolls, but
section 6 (renumbered 192.762) seems to be germane, a manifest clerical
error.

***Words "section 5" (renumbered 192.760) appear in original rolls, but
section 7 (renumbered 192.764) seems to be germane, a manifest clerical
error.

As used in this section, the following terms mean:

(1) "Communicable disease", an illness due to an infectious agent or its
toxic products and transmitted directly or indirectly to a susceptible
host from an infected person, animal or arthropod or through the agency
of an intermediate host or a vector or through the inanimate environment;

(2) "Designated officer", an employee of the department or a city or
county health officer, or designee, located in or employed by appropriate
agencies serving geographical regions and appointed by the director of
the department of health and senior services, whose duties consist of:

(a) Collecting, upon request, facts surrounding possible exposure of a
first responder or Good Samaritan to a communicable disease or infection;

(b) Contacting facilities that receive patients or clients of potentially
exposed first responders or Good Samaritans to ascertain if a
determination has been made as to whether the patient or client has had a
communicable disease or infection and to ascertain the results of that
determination; and

(c) Notifying the first responder or Good Samaritan as to whether or not
there is reason for concern regarding possible exposure;

(3) "First responder", any person trained and authorized by law or rule
to render emergency medical assistance or treatment. Such persons may
include, but shall not be limited to, emergency first responders, police
officers, sheriffs, deputy sheriffs, firefighters, ambulance attendants
and attendant drivers, emergency medical technicians, mobile emergency
medical technicians, emergency medical technician-paramedics, registered
nurses or physicians;

(4) "Good Samaritan", any person who renders emergency medical assistance
or aid until such time as relieved of these duties by a first responder;

(5) "Licensed facility", a facility licensed under chapter 197, RSMo, or
a state medical facility. (L. 1992 S.B. 511 & 556 § 1 subsec. 1)

The department of health and senior services shall ensure that
first responders or Good Samaritans are notified if there is reason to
believe an exposure has occurred which may present a significant risk of
a communicable disease as a result of attending or transporting a patient
to a licensed facility. At the request of any first responder, the
licensed facility shall notify any such first responder and at the
request of any Good Samaritan, the designated officer shall notify such
Good Samaritan. Notification will be made as soon as practicable, but not
later than forty-eight hours, to the department of health and senior
services or a designated officer. (L. 1992 S.B. 511 & 556 § 1 subsec. 2)

1. First responders or Good Samaritans who attended or
transported a patient who believe that they may have received an exposure
which may present a significant risk of a communicable disease by a
patient may provide a written request concerning the suspected exposure
to either the licensed facility that received the patient or the
designated officer, detailing the nature of the alleged exposure. The
form shall inform the first responder or Good Samaritan, in bold print,
of the provisions of subsections 1 and 6 of section 191.656, RSMo,
regarding confidentiality and consequences of violation of
confidentiality provisions. The first responder or Good Samaritan shall
be given a copy of the request form.

2. If the licensed facility, designated officer, coroner or medical
examiner makes a determination that there was an exposure to a
communicable disease, the report to the first responder or Good Samaritan
shall provide the name of the communicable disease involved, the date on
which the patient was assisted or transported, and any advice or
information about the communicable disease as provided by rule by the
department of health and senior services and shall, in addition, inform
the first responder or the Good Samaritan of the provisions of
subsections 1 and 6 of section 191.656, RSMo, regarding confidentiality
and consequences of violation of confidentiality provisions. This section
shall not be construed to authorize the disclosure of any identifying
information with respect to the patient, first responder or Good
Samaritan. (L. 1992 S.B. 511 & 556 § 1 subsecs. 3, 4)

1. The department of health and senior services shall promulgate
regulations, pursuant to the provisions of section 192.006 and chapter
536, RSMo, concerning:

(1) The type of exposure that would prompt notification of the first
responder or Good Samaritan, which shall cover at a minimum, methods of
potential transmission of any diseases designated under P.L. 101-381 or
diseases additionally identified from the department of health and senior
services' list of communicable diseases;

(2) The process to be used by the first responder, Good Samaritan,
licensed facility, coroner, medical examiner and designated officer for
the reports required by this section, the process to be used to evaluate
requests received from first responders and Good Samaritans, and for
informing first responders and Good Samaritans as to their obligations to
maintain the confidentiality of information received;

(3) The method by which first responders and Good Samaritans shall be
provided information and advice in a timely manner related to the risk of
infection from communicable diseases as a result of provision of aid or
medical care;

(4) The need for employers of first responders to provide training to
employees regarding the use of universal precautions.

2. All licensed facilities, medical examiners, coroners, first responders
and Good Samaritans shall be required to comply with the regulations
promulgated pursuant to sections 192.800 to 192.808. (L. 1992 S.B. 511 &
556 § 1 subsecs. 5, 6, A.L. 1993 S.B. 52)

1. Sections 192.800 to 192.808 shall not be construed to
authorize or require a licensed facility to test any patient for any
communicable disease, nor shall mandatory testing of any person be
required, except as provided for in sections 191.659, 191.662 and
191.674, RSMo.

2. All emergency response employees are required to respond to and treat
any patient regardless of HIV or other communicable disease infection.

3. Sections 192.800 to 192.808 shall not be construed to require or
permit the department of health and senior services or its designated
officers to collect information concerning HIV infection in a form that
permits the identity of the patient to be determined, except as otherwise
provided by law. (L. 1992 S.B. 511 & 556 § 1 subsecs. 7, 8, 9)

The "Missouri Public Health Services Fund" is hereby created.
All moneys deposited in the Missouri public health services fund, subject
to appropriation, shall be used for public health purposes, including the
contracting for the accomplishment of such purposes by local health
departments. Notwithstanding the provisions of section 33.080, RSMo,
moneys in the fund shall not lapse to the credit of general revenue at
the end of the biennium. Any interest earned on the fund shall accrue to
the fund. (L. 1992 H.B. 894 merged with H.B. 995, A.L. 2005 S.B. 74 & 49)

Effective 6-29-05

CROSS REFERENCE: Moneys are deposited in the fund pursuant to the
provisions of sections 191.331, 192.068, 193.265, 701.040, 701.046,
701.049, 701.051, 701.052 and 701.322, RSMo

1. To increase awareness of the risks associated with use of
over-the-counter weight loss pills by persons under the age of eighteen,
the department of health and senior services shall implement an education
and awareness program. Such program shall provide accurate information
regarding weight loss and the dangers of using over-the-counter weight
loss pills by the teenage population without the consultation of a
licensed physician. Such program shall focus on education and awareness
programs for teenagers, parents, siblings and other family members of
teenagers, teachers, guidance counselors, superintendents and principals.

2. The department of health and senior services may use the following
strategies for raising public awareness of the risks associated with use
of over-the- counter weight loss pills by persons under the age of
eighteen:

(1) An outreach campaign utilizing print, radio, and television public
service announcements, advertisements, posters, and other materials;

(2) Community forums; and

(3) Health information and risk-factor assessment at public events.

3. The department of elementary and secondary education, in conjunction
with the department of health and senior services, shall distribute
information pursuant to this program.

4. The department may promulgate rules and regulations 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. 1999 S.B. 8 &
173 § 7)

1. To increase public awareness of the problem of elder abuse
and neglect, the department of health and senior services shall implement
an education and awareness program. Such program shall have the goal of
reducing the incidences of elder abuse and neglect, and may focus on:

(1) The education and awareness of mandatory reporters on their
responsibility to report elder abuse and neglect;

(2) Targeted education and awareness for the public on the problem,
identification and reporting of elder abuse and neglect;

(3) Publicizing the elder abuse and neglect hot line telephone number;

(4) Education and awareness for law enforcement agencies and prosecutors
on the problem and identification of elder abuse and neglect, and the
importance of prosecuting cases pursuant to chapter 565, RSMo; and

(5) Publicizing the availability of background checks prior to hiring an
individual for caregiving purposes.

2. The department of social services and facilities licensed pursuant to
chapters 197 and 198, RSMo, shall cooperate fully with the department of
health and senior services in the distribution of information pursuant to
this program. (L. 1999 H.B. 316, et al. § 1 merged with S.B. 8 & 173 § 1)

1. There is hereby created in the state treasury the "Blindness
Education, Screening and Treatment Program Fund". The fund shall consist
of moneys donated pursuant to subsection 7 of section 301.020, RSMo, and
subsection 3 of section 302.171, RSMo. Unexpended balances in the fund at
the end of any fiscal year shall not be transferred to the general
revenue fund or any other fund, the provisions of section 33.080, RSMo,
to the contrary notwithstanding.

2. Subject to the availability of funds in the blindness education,
screening and treatment program fund, the department shall develop a
blindness education, screening and treatment program to provide blindness
prevention education and to provide screening and treatment for persons
who do not have adequate coverage for such services under a health
benefit plan.

3. The program shall provide for:

(1) Public education about blindness and other eye conditions;

(2) Screenings and eye examinations to identify conditions that may cause
blindness; and

(3) Treatment procedures necessary to prevent blindness.

4. The department may contract for program development with any
department-approved nonprofit organization dealing with regional and
community blindness education, eye donor and vision treatment services.

5. The department may adopt rules to prescribe eligibility requirements
for the program.

6. 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 the provisions of chapter 536, RSMo. (L. 2000 S.B. 721 §
192.936)

Effective 1-1-01

There is hereby created the "Office on Women's Health" within
the department of health and senior services. The duties of the office
shall include, without limitation, to:

(1) Assist in the assessment of the health and senior services needs of
women in the state;

(2) Provide policy analysis and recommendations to the director of the
department of health and senior services on issues affecting the health
and well-being of women across the life cycle;

(3) Assist the director of the department of health and senior services
in identifying issues and establishing priorities for programs, services
and resources the department of health and senior services should provide;

(4) Serve as a central location for information, resources, technical
assistance and consultation about women's health for the department of
health and senior services, other state agencies, local health
departments and community-based organizations;

(5) Promote coordination of and collaborative efforts among programs and
services for women in the department of health and senior services, other
state agencies, local health departments and community organizations; and

(6) Increase visibility of the many diverse factors affecting the health
and well-being of women in Missouri. (L. 2000 H.B. 1568)

*Word "to" does not appear in original rolls.

To advise the chief of the office on women's health, the
director of the department of health and senior services shall appoint a
committee comprised of persons who have expertise in the varied issues
affecting the health and well-being of women in Missouri, who reflect the
geographic, racial, ethnic and socioeconomic diversity of Missouri, and
who speak for communities with specific health care risks, needs and
concerns.

(1) The advisory committee and the chief of the office on women's health
shall jointly identify issues pertinent to the health of women for
consideration by the director of the department of health and senior
services.

(2) The advisory committee shall assist the office on women's health in
analyzing issues, as requested, and providing policy advice to the chief
of the office on women's health. (L. 2000 H.B. 1568)

Usa-missouri Law Firm / Lawyers Services Provided in Usa-missouri :

Usa-missouri Divorce Laws, custody, Usa-missouri Corporate Lawyers, Agreement, provident fund, Registered marriage, Court marriage Lawyers, Special/ Foreign marriage, Incorporation of company, Rent, eviction, tenancy, Lease Lawyers, Usa-missouri Labour laws, Appeals, Supreme Court Lawyers, High Court Lawyers, Bail, medical, negligence, Insurance claims/ accidents Lawyer, Usa-missouri Citizenship/ immigration Lawyers, Copyright Laws, Consumer, district Lawyer, State, national, Dowry, Wills & Probate, Trust & Estates Lawyers, Intellectual Property Lawyer, Bankrupt Lawyers, Banking & Finance, Corporate, Private Business Law, Recovery, Joint Venture & Mergers, Consumer, Civil Right Law Usa-missouri, Medical Negligence, Medical Malpractice, legal notice, summons, Income Tax Lawyers, sales, Custom Law, Excise Law, octroi, cess Civil, Criminal Solicitor Usa-missouri, Registration of property, Title search, mutation relationship, Conveyance, Transfer of Property Law, Usa-missouri Property lawyer, deeds, drafts, power of attorney, Recovery, Taxation Laws in Usa-missouri

LEGAL SERVICES

Add Lawyer
Legal Enquiry
Find a Lawyer
Bare Acts / India Codes
Statutes / Code

LAWYER BY LOCATION

India Lawyer
United State Lawyer
UAE Lawyer
Canada Lawyer
Find More...

LAW PRACTICE AREA

Business Law
Employment & Labor Law
Govt. Agencis & Taxtion
Family Law
Real Estate Property Law
Immigration Law

ABOUT HELPLINELAW

About Us
Contact Us
Services
Site Map
Recommend to Friends

This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship. Persons accessing this site are encouraged to seek independent counsel for advice in India abroad regarding their individual legal, civil criminal issues or consult one of the experts online.