(636) 519-9300 executive@slahu.org

After weeks of filibusters, extreme infighting among Republicans, and a couple days grinding to a halt, the legislature passed 49 pieces of legislation plus the Budget bills.  A record low. 

Five hours prior to the 6:00 p.m. adjournment deadline, Sen. Maria Chappelle-Nadal made good on her threat to filibuster and kill all other bills if her legislation didn’t pass.  At 1:00 p.m., the House voted to defeat Sen. Chappelle Nadal’s bill and at 1:10 p.m. she began her filibuster.  She was cut off when leadership chose to have the bill laid over around 2:00 p.m.

Then full chaos and tempers erupted when legislation was brought to the floor that would repeal St. Louis’s wage hike, stop Kansas City’s from going into effect and prohibit every other city, town village, and county from raising their minimum wage. Leadership cut off all debate by calling the previous question (PQ). The Democrats spent the next three hours trying to be recognized and attempting every procedural maneuver available within Senate Rules to stall the vote on the bill.  After 21 motions and points of order, the Republicans moved the previous question three times to get the votes they needed to pass the bill and send it to the House for one final vote. The Senate then promptly adjourned an hour before the 6:00 pm deadline.

GOP Priorities Pass the Last Week of Session

The GOP saw success this session sending several priority issues to the Governor. Right to work, expert witness, and statewide ride-sharing regulations (Uber/Lyft). Here is a highlight of a few others:

  • Minimum Wage

Earlier in the week Sen. Jamilah Nasheed’s spent two hours on the floor filibustering the legislation to repeal St. Louis’s minimum wage hike. Despite her efforts and the efforts of the other Democrat Senators, House Bill 1194 & 1193 was Truly Agreed and Finally Passed in the last ten minutes of the legislative session. Sponsored by Rep. Jason Chipman (R-Steelville) and handled by Sen. Dan Hegeman (R-Cosby) HB 1194 & 1193 prohibits any political subdivision from requiring a minimum wage that exceeds the requirements of state law. They failed to pass the emergency clause so the bill will go into effect August 28, 2017.

  • Budget/Circuit Breaker

In the last few minutes before the constitutional deadline, the House finally agreed to and passed the Senate Substitute for House Committee Bill 3.  The Senate version of the legislation will maintain circuit breaker tax credits for senior citizens and persons with disabilities and replace it with a one-time fund sweep to fund the $35 million gap in the budget.  These monies will be deposited into the Senior Services Protection Fund to restore cuts to in-home health care and nursing home services and restore the 21 points.

  • Discrimination

Senate Bill 43, sponsored by Sen. Gary Romine (R-Farmington) modifies the Missouri Human Rights Act by raising the standard an employee would have to prove in discrimination claims. The passage of SB 43 will require employees to explicitly prove their protected status motivated the discriminating act. The bill also includes changes to whistleblower statutes and caps punitive damages a victim can be awarded.

  • Blue Alert System

Prior to chaos erupting, the Senate passed Senate Bill 34, sponsored by Sen. Mike Cunningham (R-Rogersville) creating the Blue Alert System which will provide notification to the public when law enforcement officers are killed or injured. SB 34 was introduced to create the crime of illegal entry for immigrants. The Blue Alert System provision was added as an amendment in the house along with 20 other crime-related bills.  One of those 20 amendments adds hospital personnel to the definition of “special victim”.  Certain offenses carry enhanced penalties when committed against a special victim.

  • Real Id

In 2009, the legislature passed a law prohibiting the Department of Revenue from complying with the federal Real ID Act. The federal government set a deadline of January 2018, to come into compliance or Missourians would no longer be able to use their driver’s licenses to enter military bases, federal facilities or board a commercial airplane. House Bill 151, sponsored by Rep. Kevin Corlew (R-Kansas City) and handled in the Senate by Sen. Ryan Silvey (R-Kansas City), gives Missourians the option to apply for a driver’s license or identification card to comply with the Real ID act.  The law will go into effect August 28, 2017.

  • Collateral Source Rule

One of the GOPs biggest tort reform priorities was Truly Agreed and Finally Passed on Thursday and is on the Governor’s desk for his signature. Senate Bill 31, sponsored by Sen. Ed Emery (R- Lamar) and handled in the House by Rep. Joe Don McGaugh (R-Carrollton) changes the collateral source rule to only allow parties to introduce evidence of the actual cost of medical care rendered instead of the value of the costs. SB 31 also prohibits a person from recovering damages that have already been paid by their insurance.

Issues That Didn’t Pass

Although the GOP had a good year, there were a few issues they couldn’t get passed the finish line; ethics reform, education reform, paycheck protection for union members, venue and joinder, and tax reform. Here is a highlight of others:

  • PDMP

Missouri will remain the only state in the country that does not have a prescription drug monitoring program. House Bill 90, sponsored by Rep. Holly Rehder (R-Sikeston) and handled in the Senate by Sen. Dave Schatz (R-Sullivan) looked like it was going to pass after the main opponent, Sen. Rob Schaaf (R-St. Joseph), agreed he would not filibuster the bill if a provision was added to mandate doctors and nurses use the program. Several other amendments were added in the Senate, which was the reason for the demise of the bill in the last few days of the session.

  • West Lake Landfill

A bill that was the cause of some controversy in both the House and Senate was Senate Bill 22, sponsored by Sen. Maria Chappelle-Nadal (R-University City).  Subject to appropriations, SB22 would fund a program to buy out any homeowner whose home is determined by a governmental health or environmental agency to be uninhabitable due to contamination, or whose home is located within 3 miles from the radioactive West Lake landfill.  SB 22 passed the Senate, however, it was defeated in the House the last day of the session, leading to the beginning of the aforementioned chaos in the Senate.  This also prompted a series of tweets from the Senator posting pictures those that lobbied against her bill and calling them “baby killers” and suggesting they will “burn in hell.”

TAFP Bills

To access a complete list of the Truly Agreed and Finally Passed legislation, go to http://www.senate.mo.gov/17info/BTS_Web/TrulyAgreed.aspx?SessionType=R


Rep. Justin Hill’s House Bill 708, failed to make it out of the House or Senate.  This bill exempts short-term major medical policies from several health insurance mandates in Chapter 376, RSMo, and allows such policies to have a term of less than one year. Currently, the term limit is up to six months duration.  There was no opposition to the bill and it was amended on to an omnibus insurance bill, however, that never made final passage.

Rep. Justin Hill also sponsored House Bill 780, which garnered more debate and made it through the House and Senate Committee prior to running out of time in the Senate. 

House Bill 780 created the “State Innovation Waiver Task Force,” for the purpose of developing a health care reform plan that meets requirements for obtaining a state innovation waiver from the Patient Protection and Affordable Care Act.  To be eligible, a state must demonstrate that its proposed health insurance reforms are as comprehensive and affordable as the federal requirements for insurance sold in its state budget neutral for the federal government. States receiving grant waivers may receive federal assistance to operate their reform programs in an amount that is equivalent to the amount the federal government would have paid for individuals enrolled in the state. The task force members were outlined in the bill.  This drew questions from Senator Schaaf, who Chairs the Senate Health & Pensions Committee.


Only one bill relating to banking powers contained a provision relating to insurance companies.  The bill was House Bill 292, sponsored by Rep. Sandy Crawford, which stipulates that if the Director of the Department of Insurance, Financial Institutions and Professional Registration determines that an insurance company should pay interest upon any claims, refunds, or payments due to an examination, investigation, settlement agreement, or other action that the interest charged shall be determined as provided under current law, but not to exceed 9% (Section 374.191).

No other legislation relating to insurance issues passed.  However, I am including a list of items included in three omnibus health care bills that may be of interest.



This act modifies several provisions relating to health care, including: (1) STEMI and trauma center designations; (2) newborn screening; (3) neonatal and maternal levels of care; (4) x-ray inspections; (5) a health care directives registry; (6) hospital licensure; (7) hospital employment of dentists; (8) assistant physicians; and (9) speech-language pathologists and audiologists.

STEMI AND TRAUMA CENTER DESIGNATIONS (Sections 190.241 and 190.242)

Under this act, the Department shall promulgate rules for the designation of a trauma center and a STEMI center without site review if such hospital is certified by a national body.

Additionally, a hospital may apply for STEMI center designation as follows: (1) a Level I STEMI center if such hospital has been certified as a Joint Commissions Comprehensive Cardiac Center or another approved nationally-recognized organization or (2) a Level II STEMI center if such hospital has been accredited as a Mission: Lifeline STEMI Receiving Center by the American Heart Association or another approved nationally-recognized organization.

No rule or regulation promulgated by the Department of Health and Senior Services shall require hospitals, as a condition of trauma, STEMI, or stroke center designation, to obtain emergency medical services data, unless such data may be obtained from the state database for emergency medical services. Additionally, a hospital shall not be required to comply with an interpretation of a specific provision in a regulation concerning trauma, STEMI, or stroke centers if the hospital can demonstrate that the interpretation of such provision was different for a similarly-situated hospital unless the Department has subsequently and consistently interpreted such provision for similarly-situated hospitals. The Department shall attend meetings with trauma, STEMI, and stroke centers for the benefit of improved communications, best-practice identification, and facilitation of improvements to the designation process.

Finally, this act removes the requirement that the Department generate quarterly regional and state outcome data reports for trauma, stroke, and STEMI centers, the State Advisory Council on EMS, and regional EMS committees.

NEWBORN SCREENING (Section 191.332)

This act requires the Department of Health and Senior Services, beginning January 1, 2019, and subject to appropriations, to expand current newborn screening requirements to include spinal muscular atrophy and Hunter syndrome.


Under this act, the Department of Health and Senior Services shall hold public hearings and establish criteria for levels of maternal care designations and neonatal care designations for birthing facilities. Beginning January 1, 2019, any hospital with a birthing facility and any such hospital operated by a state university shall report to the Department its appropriate level of maternal care and neonatal care designations. The Department may partner with nationally-recognized nonprofit organizations with the relevant expertise to administer the provisions of this act.

X-RAY INSPECTIONS (Section 192.500)

This act provides that inspections of cone beam computed tomography systems and panoramic x-ray systems that cannot produce radiation intensity greater than thirty milligrays shall not be required to be inspected more frequently than every 3 years. Cone beam computed tomography systems that can produce radiation intensity greater than thirty milligrays shall be inspected annually. Additionally, all cone beam computed tomography systems and panoramic x-ray systems shall be inspected within thirty days of installation and whenever moved within an office.

A cone beam computed tomography system is a medical imaging device which uses x-ray computed tomography to capture data using a cone-shaped x-ray beam. A panoramic x-ray system is an imaging device that captures the entire mouth in a single, 2-dimensional image that includes the teeth, upper and lower jaws, and surrounding structures and tissues.

This act also provides that inspections of conventional x-ray equipment used exclusively on animals by a licensed veterinarian or veterinary facility shall not be required to be inspected more frequently than every 4 years.


This provision requires the Department of Health and Senior Services to contract with a third party for the establishment of a health care directives registry for the purpose of providing a place to securely store an advance health care directive online and to give authorized health care providers immediate access to the directive. The third party contractor shall be solely responsible for the administration and maintenance of the registry. All data and information contained in the registry shall remain confidential and shall be exempt from the Sunshine law. An “advance health care directive” is defined as either a power of attorney for health care or a declaration signed by an adult declarant containing the person’s direction concerning a health care decision.

All documents shall be submitted electronically to the registry at intake points, such as licensed health care providers and licensed attorneys, and signed electronically with a unique identifier, such as a Social Security number, a driver’s license number, or another unique government-issued identifier. The electronic submission will be accompanied by a fee not to exceed ten dollars.

The Department may promulgate rules to carry out theses provisions, which may include, but not be limited to, a determination of who may access the registry, including physicians, other licensed health care providers, the declarant, and his or her legal representative or designee.

HOSPITAL LICENSURE (Sections 197.005, 197.040, 197.050, 197.070, 197.071, 197.080, and 197.100)

Under this act and beginning, July 1, 2018, compliance with Medicare conditions of participation shall be deemed to constitute compliance with the standards for hospital licensure in this state. Nothing in this act shall preclude the Department of Health and Senior Services from promulgating regulations, with specific statutory authorization, to define separate regulatory standards that do not duplicate the Medicare conditions of participation. Regulations promulgated by the Department that duplicate or conflict with Medicare conditions of participation shall lapse and expire on and after July 1, 2018.

This provision contains a delayed effective date of July 1, 2018.


Under this act, licensed hospitals shall be permitted to employ any of the following providers to treat certain conditions for hospital patients: (1) licensed dentists, (2) licensed oral and maxillofacial surgeons, and (3) licensed maxillofacial prosthodontists.


This act modifies the definition of “assistant physician” to allow any medical school graduate who has met the requirements to be an assistant physician between August 28, 2014, and August 28, 2017, to be deemed to be in compliance with the requirements of becoming an assistant physician. 


This act provides that license renewal for speech-language pathologists and audiologists shall occur no less frequently than every three years. Additionally, the continued competence requirements for licensed speech-language pathologists and audiologists may include up to 30 hours triennially of continuing education, examination, self-evaluation, peer review, performance appraisal, or practical simulation.


This act modifies provisions relating to health care.

EMERGENCY ADMINISTRATION EPINEPHRINE (Section 196.990): This act allows a physician to prescribe epinephrine (EPI) auto-injectors in the name of an authorized entity for use in certain emergency situations. Pharmacists, physicians, and other persons authorized to dispense prescription medications may dispense EPI auto-injectors under a prescription issued in the name of an authorized entity. An “authorized entity” is defined as any entity or organization at or in connection with locations where allergens capable of causing anaphylaxis may be present, including but not limited to restaurants, recreation camps, youth sports leagues, amusement parks, and sports arenas.

This act also allows such authorized entities to acquire and stock a supply of EPI auto-injectors under a prescription issued in accordance with the provisions of the act. An employee or agent of an authorized entity or any other person who has completed the required training shall be allowed to use the EPI auto-injector on the premises of or in connection with the authorized entity to provide it to any individual who the employee, agent or other person believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for the EPI auto-injector or has been previously diagnosed with an allergy. The employee or agent shall not administer or provide the auto-injector to a person who is eighteen years of age or younger without the verbal consent of a parent or guardian who is present at the time unless the child will be in imminent danger without the use of the auto-injector.

The act specifies the required training and the procedures for making the EPI auto-injectors available to individuals other than trained persons, as long as the auto-injectors are secured and properly stored. The act also requires all basic life support ambulances and stretcher vans to be equipped with EPI auto-injectors and staffed by at least one person trained in the use of the auto-injectors.

This act exempts certain persons and entities from liability for any injuries or related damages that result from the administration or self-administration of an EPI auto-injector in accordance with the provisions of the act that may constitute ordinary negligence. The immunity shall not apply to acts or omissions constituting reckless disregard for the safety of others, or willful or wanton conduct, and shall be in addition to and not in lieu of the protections provided under the Good Samaritan emergency law. No trained person who is in compliance with this law and who in good faith and with reasonable care fails to administer the EPI auto-injector shall be liable for that failure.

POLYPHARMACY & ANTIPSYCHOTIC MEDICATIONS (Section 208.227): This act repeals existing language relating to psychotropic medications and adds new language relating to the establishment of a polypharmacy program and the prescribing of antipsychotic medications. The MO HealthNet Division shall establish a polypharmacy program for high-risk MO HealthNet participants with numerous or multiple prescribed drugs. The Division shall also establish a behavioral health pharmacy and opioid surveillance program to encourage the use of best medical evidence-supported prescription practices. The Division shall issue provider updates to enumerate specified treatment and utilization principles for MO HealthNet providers, including treatment principles relating to antipsychotic drugs.

If the Division implements any new policy or clinical edit for an antipsychotic drug, the Division shall continue to allow MO HealthNet participants access to any antipsychotic drug that they use and on which they are stable or that they have successfully used in the past.

Additionally, the following shall apply to the prescribing of antipsychotics:

(1) If an antipsychotic drug is listed as “non-preferred” by the Division and is considered clinically appropriate for an individual patient, prior authorization shall be simple and flexible;

(2) If an antipsychotic drug is listed as “non-preferred” and is known or found to be safe and effective for a patient, the Division shall not restrict the patient’s access to the drug and such drug shall be considered “preferred” for that patient;

(3) A patient shall not be required to change antipsychotic drugs due to changes in medication management policy, prior authorization, or a change in the payor responsible for the benefit; and

(4) Patients transferring from state psychiatric hospitals to community-based settings shall be permitted to continue their medication regimens.

The Division’s medication policy and clinical edits shall provide MO HealthNet participants initial access to multiple FDA-approved antipsychotic drugs that have substantially the same clinical differences and adverse effects that are predictable across patients and whose manufacturers have entered into rebate agreements with the federal Department of Health and Human Services. The act specifies the categories of available drugs that shall be made available to participants.

PRESCRIPTION DRUG REBATES (Section 208.229): Under this act, pharmaceutical manufacturers shall pay to the state of Missouri, in accordance with federal law, rebates on eligible utilization of covered outpatient drugs dispensed to MO HealthNet participants as follows: (1) for single source drugs and innovator multiple source drugs, rebates shall reflect the manufacturer’s best price; and (2) for single source drugs and innovator and noninnovator multiple source drugs, any additional rebates as necessary to account for certain price increases in excess of inflation.

MISSOURI RX PROGRAM (Sections 208.790 & 208.798): The act modifies provisions relating to the Missouri Rx Prescription Drug Program by requiring applicants’ household income limits for eligibility to only apply to Medicaid dual eligible individuals.

The provisions of the Missouri Rx Program are extended and shall sunset on August 28, 2022.

DELEGATION OF PHYSICAL THERAPY TREATMENT (Section 334.506): Currently, a physical therapist may delegate physical therapy treatment to a person in an entry level of a professional education program approved by the Commission for Accreditation of Physical Therapists and Physical Therapist Assistant Education. This act modifies the name of the relevant commission to the Commission on Accreditation in Physical Therapy Education (CAPTE).

RX CARES FOR MISSOURI PROGRAM (Sections 338.700 & 338.710): This act also creates the Rx Cares for Missouri Program to be administered by the Board of Pharmacy in consultation with the Department of Health and Senior Services. The goals of the program are to promote medication safety and prevent prescription drug abuse. The Board may expend funds appropriated to the Board to private and public entities for the development of programs and education in order to meet these goals. Funds shall not be used for any state prescription drug monitoring program.

The Board of Pharmacy may enter into interagency agreements with the Department of Health and Senior Services so that the Department may assist in the operation of the program. The program shall expire on August 28, 2019.


This act modifies several provisions relating to health care, including: (1) health care records; (2) a health care directives registry; (3) drug or alcohol overdoses; (4) epinephrine auto-injectors; (5) hospital licensure; (6) immunization education; (7) sports medicine; (8) assistant physicians; (9) physician assistants; (10) psychologist internships; (11) vaccine protocols; (12) speech-language pathologists and audiologists; (13) medication-assisted treatment; and (14) a drug take-back program.

HEALTH CARE RECORDS (Section 191.227)

This act changes the fees for the search, retrieval, and copying of a patient’s health care records by a health care provider. Additionally, a health care provider may disclose a deceased patient’s health care records or payment records to specified persons in the act.


This provision is identical to a provision in CCS/SB 50.

DRUG OR ALCOHOL OVERDOSES (Sections 195.205 and 195.206)

Under this act, a person who, in good faith, seeks or obtains medical assistance for himself or herself or someone else who is experiencing a drug or alcohol overdose or other medical emergency shall not be arrested, charged, prosecuted, convicted, or have his or her property subject to civil forfeiture or otherwise penalized for offenses specified in the act if the evidence, charge, prosecution, conviction, seizure, or penalty was gained as a result of seeking or obtaining medical assistance.

This act shall not prevent a police officer from arresting a person for an outstanding warrant or prevent a person from being arrested, charged, or prosecuted based on an offense other than the specified offenses in the act, whether the offense arises from the same circumstances as the seeking of medical assistance. Additionally, the protection from prosecution under this act for possession offenses shall not be grounds for suppression of evidence or dismissal on charges unrelated to this act.

Finally, any police officer who is in contact with any person or persons in need of emergency medical assistance under this act shall provide appropriate information and resources for substance-related assistance.

Additionally, this act gives the Director of the Department of Health and Senior Services, or a licensed physician with the express written consent of the Director if the Director is not a licensed physician, the authority to issue a statewide standing order for an opioid antagonist. A physician issuing such an order shall not be subject to any criminal or civil liability or professional disciplinary action associated with the order.


This provision is identical to SB139.

HOSPITAL LICENSURE (Sections 197.005, 197.040, 197.050, 197.070, 197.071, 197.080, and 197.100)

Under this act and beginning, July 1, 2018, compliance with Medicare conditions of participation shall be deemed to constitute compliance with the standards for hospital licensure in this state. Nothing in this act shall preclude the Department of Health and Senior Services from promulgating regulations, with specific statutory authorization, to define separate regulatory standards that do not duplicate the Medicare conditions of participation. Regulations promulgated by the Department that duplicate or conflict with Medicare conditions of participation shall lapse and expire on and after July 1, 2018.

These provisions contain a delayed effective date of July 1, 2018.


Under this act, all Missouri assisted living facilities shall, no later than October 1 each year, notify residents and staff where in the facility the latest edition of the Vaccine Informational Sheet published by the Centers for Disease Control and Prevention has been posted. Nothing in this act shall be construed to require any assisted living facility to pay for an influenza vaccination, allow the Department of Health and Senior Services to promulgate any rules to implement this provision or cite any facility for acting in good faith to post the Vaccine Informational Sheet.


This act provides the acceptable ways in which a professional licensee may submit payment, application, requests for educational time extensions, or notify his or her licensing board for changes to items required as part of licensure to the Division of Professional Registration or its component boards, committees, offices, and commissions.

SPORTS MEDICINE (Section 334.010)

This act permits a physician to travel to Missouri with an athletic team and provide sports-related medical services to specified individuals related to the athletic team, band, dance team, or cheerleading squad, so long as the physician is currently licensed to practice medicine in another state and has a written agreement with an athletic team located in the state where the physician is licensed. The act prohibits such physician from providing medical services at a health care facility in Missouri.


This provision is identical to a provision in CCS/SB 50.


Under current law, physician assistants may only dispense drugs, medicines, devices, or therapies pursuant to a physician supervision agreement. This act removes this requirement.

PSYCHOLOGIST INTERNSHIPS (Sections 337.010 and 337.025)

This act changes the experience requirements for initial licensure as a psychologist. Under the provisions of the act, supervised professional experience may be accrued through pre-internship, internship, predoctoral post internship, or postdoctoral experiences. Each applicant shall complete 1,500 hours or supervised professional experience as part of his or her required internship, along with an additional 2,000 hours through pre-internship, predoctoral post-internship, internship, or postdoctoral experiences.

VACCINE PROTOCOLS (Section 338.010)

This act requires pharmacists to administer vaccines by protocol in accordance with treatment guidelines established by the Centers for Disease Control and Prevention.


This provision is identical to a provision contained in CCS/SB 50.

MEDICATION-ASSISTED TREATMENT (Sections 478.004 and 487.200)

This act allows participants in drug courts, family courts, and veterans courts to receive medication-assisted treatment under the care of a licensed physician if the participant requires such treatment for substance abuse dependence. A participant assigned to a substance abuse treatment program for substance abuse or dependence shall not be in violation of the terms or conditions of the program on the basis of his or her participation in medication-assisted treatment.


This act gives the Missouri Board of Pharmacy the ability to allocate funds to develop a drug take-back program to collect and dispose of Schedule II and III controlled substances.


Threat of Special Session

During the last part of session, Governor Greitens threatened to call a special session to pass more of his priorities.  Greitens’ post-session conference was vague in answering the press when asked, “round two is sooner than you think.”  The question is… what would be the call for a special session.  Many of the Governor’s priorities mentioned in his state of the state address are either signed or on his desk awaiting his signature.

“THANK YOU FOR THE OPPORTUNITY TO REPRESENT SLAHU DURING THE LEGISLATIVE SESSION!  If you have any questions, please do not hesitate to contact me at kynaiman@earthlink.net “