HB0191 - SS Bill Text
S0178.07S
SENATE SUBSTITUTE
FOR
SENATE COMMITTEE SUBSTITUTE
FOR
HOUSE BILL NO. 191
AN ACT
To repeal section 630.003, RSMo 1994, and sections
191.656, 376.779 and 376.811, RSMo Supp. 1998, relating
to health services, and to enact in lieu thereof
fourteen new sections relating to the same subject,
with an expiration date for certain sections.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI,
AS FOLLOWS:
Section A. Section 630.003, RSMo 1994, and sections
191.656, 376.779 and 376.811, RSMo Supp. 1998, are repealed and
fourteen new sections enacted in lieu thereof, to be known as
sections 191.656, 191.657, 376.779, 376.811, 376.825, 376.826,
376.827, 376.828, 376.829, 376.833, 376.835, 630.003, 1 and 2, to
read as follows:
191.656. 1. (1) All information known to, and records
containing any information held or maintained by, any person, or
by any agency, department, or political subdivision of the state
concerning an individual's HIV infection status or the results of
any individual's HIV testing shall be strictly confidential and
shall not be disclosed except to:
(a) Public employees within the agency, department, or
political subdivision who need to know to perform their public
duties;
(b) Public employees of other agencies, departments, or
political subdivisions who need to know to perform their public
duties;
(c) Peace officers, as defined in section 590.100, RSMo,
the attorney general or any assistant attorneys general acting on
his or her behalf, as defined in chapter 27, RSMo, and
prosecuting attorneys as defined in chapter 56, RSMo, and
pursuant to section 191.657;
(d) Persons other than public employees who are entrusted
with the regular care of those under the care and custody of a
state agency, including but not limited to operators of day care
facilities, group homes, residential care facilities and adoptive
or foster parents;
[(d)] (e) As authorized by subsection 2 of this section;
(2) Further disclosure by public employees shall be
governed by subsections 2 and 3 of this section;
(3) Disclosure by a public employee or any other person in
violation of this section may be subject to civil actions brought
under subsection 6 of this section, unless otherwise required by
chapter 330, 332, 334 or 335, RSMo, pursuant to discipline taken
by a state licensing board.
2. (1) Unless the person acted in bad faith or with
conscious disregard, no person shall be liable for violating any
duty or right of confidentiality established by law for
disclosing the results of an individual's HIV testing:
(a) To the department of health;
(b) To health care personnel working directly with the
infected individual who have a reasonable need to know the
results for the purpose of providing direct patient health care;
(c) Pursuant to the written authorization of the subject of
the test result or results;
(d) To the spouse of the subject of the test result or
results;
(e) To the subject of the test result or results;
(f) To the parent or legal guardian or custodian of the
subject of the testing, if he is an unemancipated minor;
(g) To the victim of any sexual offense defined in chapter
566, RSMo, which includes sexual intercourse as an element of the
crime;
(h) To employees of a state licensing board in the
execution of their duties under chapter 330, 332, 334 or 335,
RSMo, pursuant to discipline taken by a state licensing board;
(2) Paragraphs (b) and (d) of subdivision (1) of this
subsection shall not be construed in any court to impose any duty
on a person to disclose the results of an individual's HIV
testing to a spouse or health care professional or other
potentially exposed person, parent or guardian;
(3) No person to whom the results of an individual's HIV
testing has been disclosed pursuant to paragraphs (b) and (c) of
subdivision (1) of this subsection shall further disclose such
results;
(4) When the results of HIV testing, disclosed pursuant to
paragraph (b) of subdivision (1) of this subsection, are included
in the medical record of the patient who is subject to the test,
the inclusion is not a disclosure for purposes of such paragraph
so long as such medical record is afforded the same
confidentiality protection afforded other medical records.
3. All communications between the subject of HIV testing
and a physician, hospital, or other person authorized by the
department of health who performs or conducts HIV sampling shall
be privileged communications.
4. The identity of any individual participating in a
research project approved by an institutional review board shall
not be reported to the department of health by the physician
conducting the research project.
5. The subject of HIV testing who is found to have HIV
infection shall disclose such information to any health care
professional from whom such person receives health care services.
Said notification shall be made prior to receiving services from
such health care professional.
6. Any individual aggrieved by a violation of this section
or regulations promulgated by the department of health may bring
a civil action for damages. If it is found in a civil action
that:
(1) A person has negligently violated this section, the
person is liable, for each violation, for:
(a) The greater of actual damages or liquidated damages of
one thousand dollars; and
(b) Court costs and reasonable attorney's fees incurred by
the person bringing the action; and
(c) Such other relief, including injunctive relief, as the
court may deem appropriate; or
(2) A person has willfully or intentionally or recklessly
violated this section, the person is liable, for each violation,
for:
(a) The greater of actual damages or liquidated damages of
five thousand dollars; and
(b) Exemplary damages; and
(c) Court costs and reasonable attorney's fees incurred by
the person bringing the action; and
(d) Such other relief, including injunctive relief, as the
court may deem appropriate.
7. No civil liability shall accrue to any health care
provider as a result of making a good faith report to the
department of health about a person reasonably believed to be
infected with HIV, or cooperating in good faith with the
department in an investigation determining whether a court order
directing an individual to undergo HIV testing will be sought, or
in participating in good faith in any judicial proceeding
resulting from such a report or investigations; and any person
making such a report, or cooperating with such an investigation
or participating in such a judicial proceeding, shall be immune
from civil liability as a result of such actions so long as taken
in good faith.
191.657. 1. No court shall issue an order for the
disclosure of confidential HIV related information, except a
court of record of competent jurisdiction in accordance with the
provisions of this section.
2. Pursuant to section 191.656, a court may grant an order
for disclosure of confidential HIV related information to peace
officers, the attorney general or any assistant attorneys general
acting on his or her behalf, and prosecuting attorneys upon an
application showing:
(1) A compelling need for disclosure of the information for
the adjudication of a criminal or civil proceeding;
(2) A clear and imminent danger to an individual whose life
or health may unknowingly be at significant risk as a result of
contact with the individual to whom the information pertains;
(3) Upon application of a state, county or local health
officer, a clear and imminent danger to the public health; or
(4) That the applicant is lawfully entitled to the
disclosure and the disclosure is consistent with the provisions
of this section.
3. Upon receiving an application for an order authorizing
disclosure pursuant to this section, the court shall enter an
order directing that all pleadings, papers, affidavits,
judgments, orders of the court, briefs and memoranda of law which
are part of the application or the decision thereon, be sealed
and not made available to any person, except to the extent
necessary to conduct any proceedings in connection with the
determination of whether to grant or deny the application,
including any appeal. Such an order shall further direct that
all subsequent proceedings in connection with the application
shall be conducted in camera, and, where appropriate to prevent
the unauthorized disclosure of confidential HIV related
information, that any pleadings, papers, affidavits, judgments,
orders of the court, briefs and memoranda of law which are part
of the application or the decision thereon not state the name of
the individual concerning whom confidential HIV related
information is sought.
4. (1) The individual concerning whom confidential HIV
related information is sought and any person holding records
concerning confidential HIV related information from whom
disclosure is sought shall be given adequate notice of such
application in a manner which will not disclose to any other
person the identity of the individual, and shall be afforded an
opportunity to file a written response to the application, or to
appear in person for the limited purpose of providing evidence on
the statutory criteria for the issuance of an order pursuant to
this section.
(2) The court may grant an order without such notice and
opportunity to be heard, where an ex parte application by a
state, county, or local health officer shows that a clear and
imminent danger to an individual, whose life or health may
unknowingly be at risk, requires an immediate order.
(3) Service of a subpoena shall not be subject to this
subdivision.
5. In assessing compelling need and clear and imminent
danger, the court shall provide written findings of fact,
including scientific or medical findings, citing specific
evidence in the record which supports each finding, and shall
weigh the need for disclosure against the privacy interest of the
protected individual and the public interest which may be
disserved by disclosure which deters future testing or treatment
or which may lead to discrimination.
6. An order authorizing disclosure of confidential HIV
related information shall:
(1) Limit disclosure to that information which is necessary
to fulfill the purpose for which the order is granted; and
(2) Limit disclosure to those persons whose need for the
information is the basis for the order, and specifically prohibit
redisclosure by such persons to any other persons, whether or not
they are parties to the action; and
(3) To the extent possible consistent with this section,
conform to the provisions of this section; and
(4) Include such other measures as the court deems
necessary to limit any disclosures not authorized by its order.
376.779. 1. All group health insurance policies providing
coverage on an expense-incurred basis, all group service or
indemnity contracts issued by a not for profit health service
corporation, all self-insured group health benefit plans, of any
type or description, and all such health plans or policies that
are individually underwritten or provide for such coverage for
specific individuals and the members of their families as
nongroup policies, which provide for hospital treatment, shall
provide coverage, while confined in a hospital or in a
residential or nonresidential facility certified by the
department of mental health, for treatment of alcoholism on the
same basis as coverage for any other illness, except that
coverage may be limited to thirty days in any policy or contract
benefit period. All Missouri group contracts issued or renewed,
and all Missouri individual contracts issued on or after December
31, 1980, shall be subject to this section. Coverage required by
this section shall be included in the policy or contract and
payment provided as for other coverage in the same policy or
contract notwithstanding any construction or relationship of
interdependent contracts or plans affecting coverage and payment
of reimbursement prerequisites under the policy or contract.
2. [Every insurance company and health services corporation
doing business in this state shall offer in all such policies or
contracts referred to in subsection 1, benefits for chemical
dependency and drug addiction which cover the following:
(1) Residential treatment programs as certified by the
department of mental health;
(2) Nonresidential treatment programs certified by the
department of mental health. The benefits in this subsection may
be limited to eighty percent of the reasonable and customary
charges for such services up to a maximum benefit of two thousand
dollars during each policy or contract benefit period. Said offer
may be accepted or rejected by the group or individual
policyholder or contract holder or at their election they may
take or purchase either or both of the benefits set out in
subdivision (1) or (2); provided, however, that nothing in this
section shall prohibit the insurance company and health services
corporation from including all or part of the coverage set forth
in this section as standard coverage in their policies or
contracts issued in this state.
3.] Insurers, corporations or groups providing coverage may
approve for payment or reimbursement vendors and programs
providing services or treatment required by this section. Any
vendor or person offering services or treatment subject to the
provisions of this section and seeking approval for payment or
reimbursement shall submit to the department of mental health a
detailed description of the services or treatment program to be
offered. The department of mental health shall make copies of
such descriptions available to insurers, corporations or groups
providing coverage under the provisions of this section. Each
insurer, corporation or group providing coverage shall notify the
vendor or person offering service or treatment as to its
acceptance or rejection for payment or reimbursement; provided,
however, payment or reimbursement shall be made for any service
or treatment program certified by the department of mental
health. Any notice of rejection shall contain a detailed
statement of the reasons for rejection and the steps and
procedures necessary for acceptance. Amended descriptions of
services or treatment programs to be offered may be filed with
the department of mental health. Any vendor or person rejected
for approval of payment or reimbursement may modify their
description and treatment program and submit copies of the
amended description to the department of mental health and to the
insurer, corporation or group which rejected the original
description.
[4.] 3. The department of mental health may issue rules
necessary to carry out the provisions of this section. No rule
or portion of a rule promulgated under the authority of this
section shall become effective unless it has been promulgated
pursuant to the provisions of section 536.024, RSMo.
[5.] 4. All substance abuse treatment programs in Missouri
receiving funding from the Missouri department of mental health
must be certified by the department.
376.810. As used in sections 376.810 to 376.814, the
following terms mean:
(1) "Chemical dependency", the psychological or
physiological dependence upon and abuse of drugs, including
alcohol, characterized by drug tolerance or withdrawal and
impairment of social or occupational role functioning or both;
(2) "Community mental health center", a legal entity
certified by the department of mental health or accredited by a
nationally recognized organization, through which a comprehensive
array of mental health services are provided to individuals;
(3) "Day program services", a structured, intensive day or
evening treatment or partial hospitalization program, certified
by the department of mental health or accredited by a nationally
recognized organization;
(4) "Episode", a distinct course of chemical dependency
treatment separated by at least thirty days without treatment;
(5) "Health insurance policy", all group health insurance
policies providing coverage on an expense-incurred basis, all
group service or indemnity contracts issued by a not for profit
health services corporation, all self-insured group health
benefit plans of any type or description to the extent that
regulation of such plans is not preempted by federal law, and all
such health insurance policies or contracts that are individually
underwritten or provide such coverage for specific individuals
and members of their families as nongroup policies, which provide
for hospital treatment. For the purposes of subsection 2 of
section 376.811, "health insurance policy" shall also include any
group or individual contract issued by a health maintenance
organization. The provisions of sections 376.810 to 376.814
shall not apply to policies which provide coverage for a
specified disease only, other than for mental illness or chemical
dependency;
(6) "Licensed professional", a licensed physician
specializing in the treatment of mental illness, a licensed
psychologist, a licensed clinical social worker or a licensed
professional counselor. Only prescription rights under this act
shall apply to medical physician's and doctors of osteopathy;
(7) "Managed care", the determination of availability of
coverage under a health insurance policy through the use of
clinical standards to determine the medical necessity of an
admission or treatment, and the level and type of treatment, and
appropriate setting for treatment, with required authorization on
a prospective, concurrent or retrospective basis, sometimes
involving case management;
(8) "Medical detoxification", hospital inpatient or
residential medical care to ameliorate acute medical conditions
associated with chemical dependency;
(9) "Nonresidential treatment program", program certified
by the department of mental health involving structured,
intensive treatment in a nonresidential setting;
(10) "Recognized mental illness", those conditions
classified as "mental disorders" in the American Psychiatric
Association Diagnostic and Statistical Manual of Mental
Disorders, but shall not include mental retardation;
(11) "Residential treatment program", program certified by
the department of mental health involving residential care and
structured, intensive treatment;
(12) "Social setting detoxification", a program in a
supportive nonhospital setting designed to achieve
detoxification, without the use of drugs or other medical
intervention, to establish a plan of treatment and provide for
medical referral when necessary.
376.811. 1. Every insurance company and health services
corporation doing business in this state shall offer in all
health insurance policies, benefits or coverage for chemical
dependency meeting the following minimum standards:
(1) Coverage for outpatient treatment through a
nonresidential treatment program, or through partial- or full-day
program services, of not less than twenty-six days per policy
benefit period;
(2) Coverage for residential treatment program of not less
than twenty-one days per policy benefit period;
(3) Coverage for medical or social setting detoxification
of not less than six days per policy benefit period;
(4) The coverages set forth in this subsection may be
subject to a separate lifetime frequency cap of not less than ten
episodes of treatment, except that such separate lifetime
frequency cap shall not apply to medical detoxification in a
life-threatening situation as determined by the treating
physician and subsequently documented within forty-eight hours of
treatment to the reasonable satisfaction of the insurance company
or health services corporation; and
(5) The coverages set forth in this subsection shall be:
(a) Subject to the same coinsurance, co-payment and
deductible factors as apply to physical illness;
(b) Administered pursuant to a managed care program
established by the insurance company or health services
corporation; and
(c) Covered services may be delivered through a system of
contractual arrangements with one or more providers, hospitals,
nonresidential or residential treatment programs, or other mental
health service delivery entities certified by the department of
mental health, or accredited by a nationally recognized
organization, or licensed by the state of Missouri.
2. In addition to the coverages set forth in subsection 1
of this section, every insurance company, health services
corporation and health maintenance organization doing business in
this state shall offer in all health insurance policies, benefits
or coverages for recognized mental illness, excluding chemical
dependency, meeting the following minimum standards:
(1) Coverage for outpatient treatment, including treatment
through partial- or full-day program services, for mental health
services for a recognized mental illness rendered by a licensed
professional to the same extent as any other illness;
(2) Coverage for residential treatment programs for the
therapeutic care and treatment of a recognized mental illness
when prescribed by a licensed professional and rendered in a
psychiatric residential treatment center licensed by the
department of mental health or accredited by the Joint Commission
on Accreditation of Hospitals to the same extent as any other
illness;
(3) Coverage for inpatient hospital treatment for a
recognized mental illness to the same extent as for any other
illness, not to exceed ninety days per year;
(4) The coverages set forth in this subsection shall be
subject to the same coinsurance, co-payment, deductible, annual
maximum and lifetime maximum factors as apply to physical
illness; and
(5) The coverages set forth in this subsection may be
administered pursuant to a managed care program established by
the insurance company, health services corporation or health
maintenance organization, and covered services may be delivered
through a system of contractual arrangements with one or more
providers, community mental health centers, hospitals,
nonresidential or residential treatment programs, or other mental
health service delivery entities certified by the department of
mental health, or accredited by a nationally recognized
organization, or licensed by the state of Missouri.
3. The offer required by sections 376.810 to 376.814 may be
accepted or rejected by the group or individual policyholder or
contract holder and, if accepted, shall fully and completely
satisfy and substitute for the coverage under section
376.779. Nothing in sections 376.810 to 376.814 shall prohibit
an insurance company, health services corporation or health
maintenance organization from including all or part of the
coverages set forth in sections 376.810 to 376.814 as standard
coverage in their policies or contracts issued in this state.
4. Every insurance company, health services corporation and
health maintenance organization doing business in this state
shall offer in all health insurance policies mental health
benefits or coverage as part of the policy or as a supplement to
the policy. Such mental health benefits or coverage shall
include at least two sessions per year to a licensed
psychiatrist, licensed psychologist, licensed professional
counselor, or licensed clinical social worker acting within the
scope of such license and under the following minimum standards:
(1) Coverage and benefits in this subsection shall be for
the purpose of diagnosis or assessment, but not dependent upon
findings; and
(2) Coverage and benefits in this subsection shall not be
subject to any conditions of preapproval, and shall be deemed
reimbursable as long as the provisions of this subsection are
satisfied; and
(3) Coverage and benefits in this subsection shall be
subject to the same coinsurance, co-payment and deductible
factors as apply to regular office visits under coverages and
benefits for physical illness.
5. If the group or individual policyholder or
contractholder rejects the offer required by this section, then
the coverage shall be governed by the mental health and chemical
dependency insurance act as provided in sections 376.825 to
376.835.
376.825. Sections 376.825 to 376.835 shall be known and may
be cited as the "Mental Health and Chemical Dependency Insurance
Act".
376.826. For the purposes of sections 376.825 to 376.835
the following terms shall mean:
(1) "Director", the director of the department of
insurance;
(2) "Health insurance policy" or "policy", all group health
insurance policies providing coverage on an expense-incurred
basis, all group service or indemnity contracts issued by a not
for profit health services corporation, all self-insured group
health benefit plans of any type or description to the extent
that regulation of such plans is not preempted by federal law,
and all such health insurance policies or contracts that are
individually underwritten or provide such coverage for specific
individuals and members of their families as nongroup policies,
which provide for hospital treatments. The term shall also
include any group or individual contract issued by a health
maintenance organization. The provisions of sections 376.825 to
376.835 shall not apply to policies which provide coverage for a
specified disease only, other than for mental illness or chemical
dependency;
(3) "Insurer", an entity licensed by the department of
insurance to offer a health insurance policy;
(4) "Mental illness", the following disorders contained in
the International Classification of Diseases (ICD-9-CM):
(a) Schizophrenic disorders and paranoid states (295 and
297, except 297.3);
(b) Major depression, bipolar disorder, and other affective
psychoses (296);
(c) Obsessive compulsive disorder, post-traumatic stress
disorder and other major anxiety disorders (300.0, 300.21,
300.22, 300.23, 300.3 and 309.81);
(d) Early childhood psychoses, and other disorders first
diagnosed in childhood or adolescence (299.8, 312.8, 313.81 and
314);
(e) Alcohol and drug abuse (291, 292, 303, 304, and 305,
except 305.1); and
(f) Anorexia nervosa, bulimia and other severe eating
disorders (307.1, 307.51, 307.52 and 307.53);
(g) Senile organic psychotic conditions (290);
(5) "Rate", "term", or "condition", any lifetime limits,
annual payment limits, episodic limits, inpatient or outpatient
service limits, and out-of-pocket limits. This definition does
not include deductibles, copayments, or coinsurance prior to
reaching any maximum out-of-pocket limit. Any out-of-pocket
limit under a policy shall be comprehensive for coverage of
mental illness and physical conditions.
376.827. 1. Nothing in this bill shall be construed as
requiring the coverage of mental illness.
2. Except for the coverage required pursuant to subsection
1 of section 376.779, and the offer of coverage required pursuant
to sections 376.810 through 376.814, if any of the mental illness
disorders enumerated in subdivision (4) of section 376.826 are
provided by the health insurance policy, the coverage provided
shall include all the disorders enumerated in subdivision (4) of
section 376.826 and shall not establish any rate, term, or
condition that places a greater financial burden on an insured
for access to evaluation and treatment for mental illness than
for access to evaluation and treatment for physical conditions,
generally, except that alcohol and other drug abuse services
shall have a minimum of thirty days total inpatient treatment and
a minimum of twenty total visits for outpatient treatment for
each year of coverage. A lifetime limit equal to four times such
annual limits may be imposed. The days allowed for inpatient
treatment can be converted for use for outpatient treatment on a
two-for-one basis.
3. Deductibles, copayment or coinsurance amounts for access
to evaluation and treatment for mental illness shall not be
unreasonable in relation to the cost of services provided.
4. A health insurance policy that is a federally qualified
plan of benefits shall be construed to be in compliance with
sections 376.825 to 376.833 if the policy is issued by a
federally qualified health maintenance organization and the
federally qualified health maintenance organization offered
mental health coverage as required by sections 376.825 to
376.833. If such coverage is rejected, the federally qualified
health maintenance organization shall, at a minimum, provide
coverage for mental health services as a basic health service as
required by the Federal Public Health Service Act, 42 U.S.C.
Section 300e., et seq.
5. Health insurance policies that provide mental illness
benefits pursuant to sections 376.825 to 376.835 shall be deemed
to be in compliance with the requirements of subsection 1 of
section 376.779.
6. The director may disapprove any policy that the director
determines to be inconsistent with the purposes of this section.
376.828. 1. The coverages set forth in sections 376.825 to
376.835 may be administered pursuant to a managed care program
established by the insurance company, health services corporation
or health maintenance organization, and covered services may be
delivered through a system of contractual arrangements with one
or more licensed providers, community mental health centers,
hospitals, nonresidential or residential treatment programs, or
other mental health service delivery entities certified by the
department of mental health, or accredited by a nationally
recognized organization, or licensed by the state of Missouri.
Nothing in this section shall authorize any unlicensed provider
to provide covered services.
2. An insurer may use a case management program for mental
illness benefits to evaluate and determine medically necessary
and clinically appropriate care and treatment for each patient.
3. Nothing in sections 376.825 to 376.835 shall be
construed to require a managed care plan as defined by section
354.600, RSMo, when providing coverage for benefits governed by
sections 376.825 to 376.835, to cover services rendered by a
provider other than a participating provider, except for the
coverage pursuant to subsection 4 of section 376.811, RSMo. An
insurer may contract for benefits provided in sections 376.825 to
376.835 with a managing entity or group of providers for the
management and delivery of services for benefits governed by
sections 376.825 to 376.835.
376.829. 1. The provisions of section 376.827 shall not be
violated if the insurer decides to apply different limits or
exclude entirely from coverage the following:
(1) Marital, family, educational, or training services
unless medically necessary and clinically appropriate;
(2) Services rendered or billed by a school or halfway
house;
(3) Care that is custodial in nature;
(4) Services and supplies that are not medically necessary
nor clinically appropriate; or
(5) Treatments that are considered experimental.
2. The director shall grant a policyholder a waiver from
the provisions of section 376.827 if the policyholder
demonstrates to the director by actual experience over any
consecutive twenty-four-month period that compliance with
sections 376.825 to 376.835 has increased the cost of the health
insurance policy by an amount that results in a two percent
increase in premium costs to the policyholder.
376.833. 1. The provisions of sections 376.825 to 376.835
apply to applications for coverage made on or after January 1,
2000, and to health insurance policies issued or renewed on or
after such date to residents of this state. Multi-year group
policies need not comply until the expiration of their current
multi-year term unless the policyholder elects to comply before
that time.
2. The director shall perform a study to assess the impact
of the mental health and substance abuse insurance act on
insurers, business interests, providers, and consumers of mental
health and substance abuse treatment services. The director
shall report the findings of this study to the general assembly
by January 1, 2004.
376.835. Notwithstanding the provision of subsection 1 of
section 376.827, all health insurance policies which cover state
employees including the Missouri consolidated health care plan
shall include coverage for mental illness. Multi-year group
policies need not comply until the expiration of their current
multi-year term unless the policyholder elects to comply before
that time.
630.003. 1. There is hereby created a department of mental
health to be headed by a mental health commission who shall
appoint a director, by and with the advice and consent of the
senate. The director shall be the administrative head of the
department and shall serve at the pleasure of the commission and
be compensated as provided by law for the director, division of
mental health.
2. The mental health commission may employ no more than
three additional persons to serve at the pleasure of the
commission.
3. All other employees of the department shall be selected
in accordance with chapter 36, RSMo.
[2.] 4. (1) The "State Mental Health Commission",
composed of seven members, is the successor to the former state
mental health commission and it has all the powers, duties and
responsibilities of the former commission. All members of the
commission shall be appointed by the governor, by and with the
advice and consent of the senate. None of the members shall
otherwise be employed by the state of Missouri.
(2) Three of the commission members first appointed shall
be appointed for terms of four years, and two shall be appointed
for terms of three years, and two shall be appointed for a term
of two years. The governor shall designate, at the time the
appointments are made, the length of the term of each member so
appointed. Thereafter all terms shall be for four years.
(3) At least two of the members of the commission shall be
physicians, one of whom shall be recognized as an expert in the
field of the treatment of nervous and mental diseases, and one of
whom shall be recognized as an expert in the field of mental
retardation or of other developmental disabilities. At least two
of the members of the commission shall be representative of
persons or groups who are consumers having substantial interest
in the services provided by the division, one of whom shall
represent the mentally retarded or developmentally disabled and
one of whom shall represent those persons being treated for
nervous and mental diseases. Of the other three members at least
one must be recognized for his expertise in general business
management procedures, and two shall be recognized for their
interest and expertise in dealing with alcohol/drug abuse
problems, or community mental health services.
[3.] 5. The provisions of sections 191.120, 191.125,
191.130, 191.140, 191.150, 191.160, 191.170, 191.180, 191.190,
191.200, 191.210, RSMo, and others as they relate to the division
of mental health not previously reassigned by executive
reorganization plan number 2 of 1973 as submitted by the governor
under chapter 26, RSMo, are transferred by specific type transfer
from the department of public health and welfare to the
department of mental health. The division of mental health,
department of health and welfare, chapter 202, RSMo, and others
are abolished and all powers, duties and functions now assigned
by law to the division, the director of the divisions of mental
health or any of the institutions or officials of the division
are transferred by type I transfer to the department of mental
health.
[4.] 6. The Missouri institute of psychiatry, which is
under the board of curators of the University of Missouri is
hereafter to be known as the "Missouri Institute of Mental
Health". The purpose of the institute will be that of conducting
research into improving services for persons served by the
department of mental health for fostering the training of
psychiatric residents in public psychiatry and for fostering
excellence in mental health services through employee training
and the study of mental health policy and ethics. To assist in
this training, hospitals operated by and providers contracting
with the department of mental health may be used for the same
purposes and under the same arrangements as the board of curators
of the University of Missouri utilizes with other hospitals in
the state in supervising residency training for medical doctors.
Appropriations requests for the Missouri institute of mental
health shall be jointly developed by the University of Missouri
and the department of mental health. All appropriations for the
Missouri institute of mental health shall be made to the curators
of the University of Missouri but shall be submitted separately
from the appropriations of the curators of the University of
Missouri.
[5.] 7. There is hereby established within the department
of mental health a division of mental retardation and
developmental disabilities. The director of the division shall
be appointed by the director of the department. The division
shall administer all state facilities under the direction and
authority of the department director. The Marshall Habilitation
Center, the Higginsville Habilitation Center, the Bellefontaine
Habilitation Center, the Nevada Habilitation Center, the St.
Louis Developmental Disabilities Treatment Centers, and the
regional centers located at Albany, Columbia, Hannibal, Joplin,
Kansas City, Kirksville, Poplar Bluff, Rolla, St. Louis, Sikeston
and Springfield and other similar facilities as may be
established, are transferred by type I transfer to the division
of mental retardation and developmental disabilities.
[6.] 8. All the duties, powers and functions of the
advisory council on mental retardation and community health
centers, sections 202.664 to 202.666, RSMo, are hereby
transferred by type I transfer to the division of mental
retardation and developmental disabilities of the department of
mental health. The advisory council on mental retardation and
community health centers shall be appointed by the division
director.
[7.] 9. The advisory council on mental retardation and
developmental disabilities heretofore established by executive
order and all of the duties, powers and functions of the advisory
council including the responsibilities of the provision of the
council in regard to the Federal Development Disabilities Law
(P.L. 91-517) and all amendments thereto are transferred by type
I transfer to the division of mental retardation and
developmental disabilities. The advisory council on mental
retardation and developmental disabilities shall be appointed by
the director of the division of mental retardation and
developmental disabilities.
[8.] 10. The advisory council on alcoholism and drug
abuse, chapter 202, RSMo, is transferred by type II transfer to
the department of mental health and the members of the advisory
council shall be appointed by the mental health director.
Section 1. 1. All individual and group health insurance
policies providing coverage on an expense incurred basis,
individual and group service or indemnity type contracts issued
by a nonprofit corporation, individual and group service
contracts issued by a health maintenance organization, all self-insured group arrangements to the extent not preempted by federal
law and all managed health care delivery entities of any type or
description, that are delivered, issued for delivery, continued
or renewed on or after August 28, 1999, and providing coverage to
any resident of this state shall provide benefits or coverage
for:
(1) A pelvic examination and pap smear for any
nonsymptomatic woman covered under such policy or contract, in
accordance with the current American Cancer Society guidelines;
(2) A prostate examination and laboratory tests for cancer
for any nonsymptomatic man covered under such policy or contract,
in accordance with the current American Cancer Society
guidelines; and
(3) A colorectal cancer examination and laboratory tests for
cancer for any nonsymptomatic person covered under such policy or
contract, in accordance with the current American Cancer Society
guidelines.
2. Coverage and benefits related to the examinations and
tests as required by this section shall be at least as favorable
and subject to the same dollar limits, deductible, and co-payments as other covered benefits or services.
3. Nothing in this act shall apply to accident-only,
hospital indemnity, Medicare supplement, long-term care, or other
limited benefit health insurance policies.
4. The provisions of this section shall not apply to short-term major medical policies of six months or less duration.
5. The attending physician shall make available to any
patient the advantages, disadvantages, and risks, including
cancer, associated with breast implantation prior to such
operation as provided by the department of health.
6. The department of health shall:
(1) Make available a standardized written summary that
would be clear to a prudent lay person that:
(a) Contains general information on breast implantation;
and
(b) Discloses potential dangers and side effects of a
breast implantation operation;
(2) Update the standardized written summary as deemed
necessary by the department of health; and
(3) By January 1, 2000, the department shall make available
the standardized written summary to all hospitals, clinics, and
physicians' offices that perform breast implantation.
7. The attending physician satisfies the requirements of
subsection 5 of this section if:
(1) The physician provides the breast implantation patient
with the standardized written summary described in subsection 2
of this section;
(2) The patient receives the standardized written summary
at least five days before the breast implantation operation; and
(3) The patient signs a statement, made available by the
department of health, acknowledging the patient's receipt of the
standardized written summary.
8. Failure of the department of health to make the summary
available, as described in subsection 6 of this section, shall be
an affirmative defense in an action alleging a violation of
subsection 5 of this section for the attending physician.
9. Nothing in this section shall alter, impair or otherwise
affect claims, rights or remedies available pursuant to law.
Section 2. The department of insurance shall create an
advisory committee to be known as the "Health Insurance Advisory
Committee". This committee shall be a voluntary committee
comprised of representatives of the insurance industry, provider
groups and the public. The committee shall consist of at least,
but not limited to, one member representing each of the following
areas: small group insurance, managed care, doctors of medicine,
doctors of osteopathy, pharmacists, dentists and public members
representing self-employed workers and the elderly. This
committee shall meet to discuss and advise the department on
issues relating to health care insurance.
Section B. The provisions of sections 376.825 to 376.835
shall expire on January 1, 2005.
Missouri House of Representatives