HCS#2 SCS SB 333 -- HEALTH AND SENIOR SERVICES

SPONSOR:  Stouffer (Cooper, 155)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Health
Care Policy by a vote of 8 to 0.

This substitute changes the laws regarding the Missouri Head
Injury Advisory Council, protections for vulnerable adults and
children, the Uniform Anatomical Gift Act, patient safety and
medical errors, the Chronic Kidney Disease Task Force, and the
Missouri Health Profession Shortage Planning Commission.

MISSOURI BRAIN INJURY ADVISORY COUNCIL

The substitute:

(1)  Renames the Missouri Head Injury Advisory Council to the
Missouri Brain Injury Advisory Council and transfers it to the
Department of Health and Senior Services from the Office of
Administration;

(2)  Decreases the number of members on the council from 25 to
18;

(3)  Requires the department director to appoint members to the
council;

(4)  Prohibits members of the council from receiving compensation
for their services;

(5)  Requires the department to plan and implement programs
promoting rehabilitation and community reintegration, apply for
and administer federal grants, and establish a means test to be
applied to all programs and services funded by the department for
determining eligibility;

(6)  Prohibits the department from denying services based on
race, sex, creed, marital status, national origin, handicap, or
age; and

(7)  Renames the Head Injury Fund to the Brain Injury Fund for
use by the department.

PROTECTIONS FOR VULNERABLE ADULTS AND CHILDREN

The substitute:

(1)  Transfers the Division of Aging from the Department of
Social Services to the Department of Health and Senior Services;

(2)  Adds financial exploitation of the elderly to the public
education and awareness program administered by the Department of
Health and Senior Services;

(3)  Transfers the powers, duties, and functions of the Board of
Nursing Home Administrators to the department;

(4)  Requires any health service provider or employee and allows
any other person having reasonable cause to believe that a
patient or consumer has been a victim of the misappropriation of
a patient's money to report the information to the department;

(5)  Requires the department, upon receipt of an imminent danger
report, to initiate an investigation promptly, but without a
24-hour time requirement.  If an investigation indicates a crime
has occurred, the appropriate law enforcement agency must be
notified.  The department must notify the resident's legal
representative of the report and investigation status when it
involves a resident who has been appointed a guardian and/or
conservator or is incapacitated and resides at a state-licensed
facility.  The department may also notify the resident's family
members or guardians;

(6)  Requires the department to keep the names of individuals
submitting abuse and misappropriation reports confidential unless
the complainant agrees to the disclosure of his or her name, the
name of the complainant is lawfully subpoenaed, the release of a
name is required by the Administrative Hearing Commission, or the
release of a name is requested by the Department of Social
Services for the purpose of licensure under Chapter 210, RSMo;

(7)  Protects a patient and the patient's family members from
eviction, harassment, or retaliation due to the filing of a
report of a violation or suspected violation of the provisions of
the substitute;

(8)  Requires patients and consumers whose services are funded by
the Missouri Medicaid Program to be checked against the sexual
offender registry and requires the Department of Health and
Senior Services to notify providers at the time of referral if a
patient or consumer is on that registry;

(9)  Makes any person failing to file a required report and any
person or provider who misuses or diverts the consumer's use of
any personal property or money or falsifies service delivery
documents guilty of a class A misdemeanor.  Any provider who
knowingly conceals abuse or neglect that results in the death or
serious injury of a patient will be guilty of a class D felony;

(10)  Authorizes the department to assess a $1,000 fine on any
provider who willfully and knowingly fails to report known abuse
by an employee;

(11)  Makes any person or entity that unlawfully discloses
information from the employee disqualification list guilty of an
infraction;

(12)  Extends the time a person can be listed on the employee
disqualification list by one year if he or she is employed in a
prohibited position while on the list;

(13)  Requires approved good cause waivers for employees to gain
or retain employment from a provider as of August 28, 2008;

(14)  Restates the department's rule-making authority to make any
rule effective only if it complies with and is subject to the
provisions of Chapter 536;

(15)  Prohibits state and federal financial assistance to be used
for the services of a personal care attendant who is listed on
the employee disqualification list, is registered as a sexual
offender, or has a disqualifying criminal history not excused by
a good cause waiver; and

(16)  Prohibits courts from suspending the imposition or
execution of a sentence, imposing a fine instead of a term of
imprisonment for first and second degree elder abuse cases and
sexual misconduct cases, and sentencing persons guilty of a crime
of violence against an elderly person to less than 30 consecutive
days or imposing a fine instead of imprisonment.

UNIFORM ANATOMICAL GIFT ACT

The substitute:

(1)  Requires coroners and medical examiners to cooperate with a
procurement organization to maximize the opportunity to recover
anatomical gifts;

(2)  Specifies additional requirements for coroners and medical
examiners to follow regarding anatomical gifts;

(3)  Requires that the Department of Health and Senior Services
establish or contract for the establishment of a first person
consent donor registry;

(4)  Specifies which documents are acceptable to make an
anatomical gift;

(5)  Specifies how an anatomical gift can be revoked;

(6)  Allows an individual to refuse to make an anatomical gift;

(7)  Specifies who is authorized to make an anatomical gift of a
deceased individual's body and to whom an anatomical gift can be
made;

(8)  Allows emergency personnel and hospital staff to search a
deceased or near death individual for documentation as a donor;

(9)  Specifies that upon referral of a potential donor, a
procurement organization will search an organ donor registry and
other applicable records to determine if the individual has made
an anatomical gift;

(10)  Allows a procurement organization to conduct a medical exam
to ensure medical suitability of the donation;

(11)  Specifies that neither the attending physician at death nor
the physician who determines time of death can participate in the
removal or transplantation of a body part of the deceased;

(12)  Specifies that a person who knowingly purchases or sells a
body part for transplantation will be guilty of a felony and
subject to a fine of not greater than $50,000, imprisonment not
exceeding seven years, or both; and

(13)  Requires the Department of Revenue to cooperate with a
state-established registry.

PATIENT SAFETY AND MEDICAL ERRORS

The substitute:

(1)  Requires hospitals to report certain patient safety
incidents to a patient safety organization no later than the
close of business on the next business day after the incident is
discovered;

(2)  Requires the hospital's initial report to include actions
taken to minimize the risk of harm to patients and prevent a
reoccurrence;

(3)  Requires the hospital to submit a completed root cause
analysis and reportable incident prevention plan to the patient
safety organization within 20 days;

(4)  Requires the patient safety organization to forward the
incident report, description of immediate actions taken, root
cause analysis, and reportable incident prevention plan to the
Department of Health and Senior Services;

(5)  Requires the department to investigate the incident,
determine if the hospital's response and plan are sufficient to
reduce the risk of future incidents, and ensure that the plan is
being followed and the results are reviewed.  The department must
also periodically review the patient safety organization
regarding report submissions and reviews;

(6)  Specifies that the department can charge a fee for
investigating and responding to incident reports;

(7)  Specifies that if a reportable incident is disclosed and an
incident prevention plan and root cause analysis are submitted
and approved by the department, the incident will not be
considered grounds for licensure deficiency;

(8)  Requires the department to consult with patient safety
organizations and hospital representatives to establish criteria
to identify cases in which reportable incidents have occurred in
a hospital with a frequency or possible pattern of negative
outcomes that require departmental intervention to protect the
public.  The department can impose license sanctions against
hospitals based on the reportable incidents as specified in the
substitute;

(9)  Requires the patient safety center to work with the
department to publish an annual report on reportable incidents;

(10)  Specifies that a hospital can report other adverse events
to a patient safety organization and the department and these
reports will be subject to the same protections and requirements
as reportable incidents;

(11)  Specifies that actions, decisions, proceedings,
discussions, or deliberations occurring at a patient safety
organization meeting will not be disclosed, except to carry out
the purposes of the organization;

(12)  Specifies that a patient safety work product is privileged
and confidential and will not be disclosed for any purpose
including any criminal, civil, or administrative proceeding;

(13)  Prohibits the discovery, disclosure, or admission into
evidence of a patient safety work product.  If the product is
admitted into evidence, it constitutes grounds for a mistrial or
similar termination of the proceeding;

(14)  Requires a patient safety organization to create
educational and evidence-based information that providers can use
to improve care; and

(15)  Specifies that a provider furnishing services to a patient
safety organization will not be liable for civil damages unless
the act, omission, decision, or other conduct is done with
malice, fraudulent intent, or in bad faith.

CHRONIC KIDNEY DISEASE TASK FORCE

The substitute:

(1)  Establishes the Chronic Kidney Disease Task Force and
requires the Department of Health and Senior Services to provide
the necessary staff, research, and meeting facilities; and

(2)  Requires the task force to:

(a)  Develop a plan to educate the public and health care
professionals about early screening, diagnosis, treatment, and
complications of chronic kidney disease;

(b)  Make recommendations regarding the implementation of the
plan;

(c)  Identify barriers to the adoption of best practices; and

(d)  Submit a report of its findings and recommendations to the
General Assembly within one year of the first task force meeting.

MISSOURI HEALTH PROFESSION SHORTAGE PLANNING COMMISSION

The Missouri Health Profession Shortage Planning Commission is
established within the Department of Economic Development.
Members appointed to the commission are to be recognized as
experts in the field of health, finance, economics, or health
facility management and must be appointed within 30 days of the
effective date of the substitute.  Non-legislative members will
serve a three-year term, while legislative members will serve
through their current legislative term.

The commission's duties include monitoring data and trends in the
health profession workforce, making recommendations on the
economic cluster for health care professions, identifying
recruitment and retention strategies for higher education health
care programs, promoting diversity, making recommendations on
financial and other assistance to students enrolled in health
care programs, and identifying recruitment and retention
strategies for health care employers.

The commission will annually submit a report on its findings and
recommendations to the appropriate standing committees of the
General Assembly.

The provisions regarding the Missouri Health Profession Shortage
Planning Commission will expire on August 30, 2012.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Greater
than $1,312,576 in FY 2008, Greater than $765,640 in FY 2009, and
Greater than $798,200 in FY 2010.  No impact on Other State Funds
in FY 2008, FY 2009, and FY 2010.

PROPONENTS:  Supporters say that the bill allows early treatment
in the first 18-month period after a brain injury when treatment
is most critical.  The change of the term "head injury" to "brain
injury" more accurately describes the nature of the injury.

Testifying for the bill were Senator Stouffer; and Department of
Health and Senior Services.

OPPONENTS:  There was no opposition voiced to the committee.

Missouri House of Representatives
94th General Assembly, 1st Regular Session
Last Updated July 25, 2007 at 11:22 am