Journal of the House

First Regular Session, 91st General Assembly

SEVENTY-SIXTH DAY, Thursday, May 17, 2001

Speaker Kreider in the Chair.

Prayer by Reverend Rudy Beard.

O Lord, as we pray for the members of this House, its officers and staff, we remember that You do not hurry, that You are the center of all peace.

But we are human. We grow tired. We feel the strain of meeting deadlines. We become irritated by frustrations. We need an inner calm, peace of mind; and only You can supply the needs of soul.

Give us Your peace, and refresh these men and women who labor for our state in this final week of their work. To You be glory and honor. Amen.

The Pledge of Allegiance to the flag was recited.

The Speaker appointed the following to act as Honorary Pages for the Day, to serve without compensation: Sam Kichline, Samantha Mack, Caitlin Davis, Jack Follis, Austin Sherrill, Emma Short, Dominque Falls, John E. Willett and Nathan Kelly.

The Journal of the seventy-fifth day was approved as corrected.

HOUSE COURTESY RESOLUTIONS OFFERED AND ISSUED

House Resolution No. 2183 - Representative Relford

House Resolution No. 2184

through

House Resolution No. 2187 - Representative Naeger

House Resolution No. 2188 - Representative Bearden

House Resolution No. 2189

through

House Resolution No. 2191 - Representative Townley

House Resolution No. 2192 - Representatives Treadway and Barry

House Resolution No. 2193 - Representative Scheve

House Resolution No. 2194 - Representative Mayer

House Resolution No. 2195 - Representative Cooper

House Resolution No. 2196

through

House Resolution No. 2199 - Representative Bartle

House Resolution No. 2200

and

House Resolution No. 2201 - Representative Hohulin

House Resolution No. 2202 - Representative Hunter

House Resolution No. 2203 - Representative Crump

House Resolution No. 2204

through

House Resolution No. 2206 - Representative Levin

House Resolution No. 2207 - Representative Relford

SECOND READING OF SENATE BILL

SCS SB 586 was read the second time.

MESSAGES FROM THE SENATE

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the President Pro Tem has appointed the following Conference Committee to act with a like Committee from the House on HS HCS SS SCS SB 48, as amended: Senators Sims, Bentley, Klarich, Johnson and Dougherty.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the President Pro Tem has appointed the following Conference Committee to act with a like Committee from the House on HS HCS SCS SB 266, as amended: Senators Bland, Stoll, Steelman, Westfall and Sims.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the President Pro Tem has appointed the following Conference Committee to act with a like Committee from the House on HS SCS SB 393, as amended: Senators Sims, Singleton, Bentley, Wiggins and Bland.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted the Conference Committee Report on HS HCS SS SCS SB 369, as amended, and has taken up and passed CCS HS HCS SS SCS SB 369.

HOUSE BILL WITH SENATE AMENDMENT

SCS HB 471, as amended, relating to drug trafficking, was taken up by Representative Jolly.

Representative Jolly moved that the House refuse to adopt SCS HB 471, as amended, and request the Senate to recede from its position or, failing to do so, grant the House a conference.

Which motion was adopted.

THIRD READING OF SENATE BILL - INFORMAL

SCS SB 387, with House Committee Amendment No. 1, relating to recovery of fuel costs, was taken up by Representative Mays (50).

On motion of Representative Mays (50), House Committee Amendment No. 1 was adopted.

On motion of Representative Mays (50), SCS SB 387, as amended, was read the third time and passed by the following vote:

Speaker Kreider declared the bill passed.

The emergency clause was adopted by the following vote:

HOUSE BILLS WITH SENATE AMENDMENTS

SCS HB 80, as amended, relating to antifraud enforcement, was taken up by Representative Ross.

Representative Ross moved that the House refuse to adopt SCS HB 80, as amended, and request the Senate to recede from its position or, failing to do so, grant the House a conference.

Which motion was adopted.

SCS HB 219, relating to fence law, was taken up by Representative Townley.

On motion of Representative Townley, SCS HB 219 was adopted by the following vote:

On motion of Representative Townley, SCS HB 219 was truly agreed to and finally passed by the following vote:

Speaker Kreider declared the bill passed.

SCS HS HCS HB 107, as amended, relating to tort victims' compensation fund, was taken up by Representative Clayton.

On motion of Representative Clayton, SCS HS HCS HB 107, as amended, was adopted by the following vote:

On motion of Representative Clayton, SCS HS HCS HB 107, as amended, was truly agreed to and finally passed by the following vote:

Speaker Kreider declared the bill passed.

BILLS IN CONFERENCE

CCR SS SCS HB 453, as amended, relating to environmental commissions and fees, was taken up by Representative Ransdall.

Representative Ransdall moved that the House refuse to adopt CCR SS SCS HB 453, as amended, and request the Senate to grant the House a further conference and the House conferees be bound to the last six lines of Section 1, Pages 80 and 81.

Representative Shields made a substitute motion that the House refuse to adopt CCR SS SCS HB 453, as amended, and request the Senate to grant the House a further conference and the House conferees be bound to the removal of the last six lines of Section 1 of the Conference Committee Substitute.

Which motion was adopted by the following vote:

CCR SCS HCS HB 241, as amended, relating to trusts, was taken up by Representative Smith.

On motion of Representative Smith, CCR SCS HCS HB 241, as amended, was adopted by the following vote:

On motion of Representative Smith, CCS SCS HCS HB 241 was read the third time and passed by the following vote:

Speaker Kreider declared the bill passed.

Speaker Pro Tem Abel assumed the Chair.

HOUSE BILL WITH SENATE AMENDMENT

SCS HB 157, relating to marriage licenses, was taken up by Representative Hosmer.

Representative Hosmer moved that the House refuse to adopt SCS HB 157 and request the Senate to recede from its position or, failing to do so, grant the House a conference and the conferees be allowed to exceed the differences concerning the licensing provisions.

Which motion was adopted.

MESSAGES FROM THE SENATE

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate refuses to recede from its position on SCS HB 80, as amended, and grants the House a conference thereon.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate refuses to recede from its position on SCS HB 471, as amended, and grants the House a conference thereon.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and passed SS SCS HS HCS HB 762, entitled:

An act to repeal sections 197.285, 208.151 and 376.1209, RSMo 2000, relating to women's health services, and to enact in lieu thereof four new sections relating to the same subjecct.

With Senate Amendment No. 1, Senate Substitute Amendment No. 1 for Senate Amendment No. 2, Senate Amendment No. 3, Senate Amendment No. 4, Senate Amendment No. 5, Senate Amendment No. 6 and Senate Amendment No. 7.

Senate Amendment No. 1

AMEND Senate Substitute for Senate Committee Substitute for House Substitute for House Committee Substitute for House Bill No. 762, Page 20, Section 376.1209, Line 27, by inserting immediately after said line the following:

"Section 1. 1. There is hereby created within the office of the governor a "Child Custody Abuse and Neglect Commission" which shall evaluate the laws and rules relating to child abuse, neglect, child custody and visitation and termination of parental rights and shall make recommendations on further action or legislative remedies, if any, to be taken as necessary. The commission shall review and recommend standardized guidelines for judicial review of what constitutes the best interest of the child.

2. The child abuse and neglect commission shall be composed of twelve members to be appointed by the governor, including a county prosecutor, a law enforcement officer, a juvenile officer, a member of the clergy, a psychologist, a pediatrician, and educator, the chairman of the children's services commission, a division of family services designee, and three citizens of the state of Missouri, chosen to reflect the racial composition of the state, to serve four-year terms and of the members first appointed, four shall serve for a term of two years, four shall serve for a term of three years, and four shall serve for a term of four years.

3. The commission shall make its first report to the governor and the general assembly by February 1, 2002, and any subsequent reports shall be made to the governor, the chief justice of the supreme court and the general assembly as necessary.

4. All members shall serve without compensation but shall be reimbursed for all actual and necessary expenses incurred in the performance of their official duties for the commission.

5. The office of the governor shall provide funding, administrative support, and staff for the effective operation of the commission.

6. This section shall expire on August 28, 2004."; and

Further amend the title and enacting clause accordingly.

Senate Substitute Amendment No. 1

for

Senate Amendment No. 2

AMEND Senate Substitute for Senate Committee Substitute for House Substitute for House Committee Substitute for House Bill No. 762, Pages 15-19, Section 354.900, by striking said section from the bill and inserting in lieu thereof the following:

"376.1199. 1. Each health carrier or health benefit plan that offers or issues health benefit plans providing obstetrical/gynecological benefits, which are delivered, issued for delivery, continued or renewed in this state on or after January 1, 2002, shall:

(1) Notwithstanding the provisions of subsection 4 of section 354.618, RSMo, provide enrollees with direct access to the services of a participating obstetrician, participating gynecologist or participating obstetrician/ gynecologist of her choice within the provider network for covered services. The services covered by this subdivision shall be limited to those services defined by the published recommendations of the accreditation council for graduate medical education for training an obstetrician, gynecologist or obstetrician/ gynecologist, including but not limited to diagnosis, treatment and referral for such services. A health carrier shall not impose additional copayments, coinsurance, or deductibles upon any enrollee who seeks or receives health care services pursuant to this subdivision, unless similar additional copayments, coinsurance, or deductibles are imposed for other types of health care services received within the provider network. Nothing in this subsection shall be construed to require a health carrier to perform, induce, pay for, reimburse, guarantee, arrange, provide any resources for or refer a patient for an abortion, as defined in section 188.015, RSMo, other than a spontaneous abortion or to prevent the death of the female upon whom the abortion is performed, or to supersede or conflict with section 376.805;

(2) Notify enrollees annually of cancer screenings covered by the enrollees' health benefit plan and the current American Cancer Society guidelines for all cancer screenings or notify enrollees at intervals consistent with current American Cancer Society guidelines of cancer screenings which are covered by the enrollees' health benefit plans. The notice shall be delivered by mail unless the enrollee and health carrier have agreed on another method of notification;

(3) Include coverage for services related to diagnosis, treatment and appropriate manage-ment of osteoporosis when such services are provided by a person licensed to practice medicine and surgery in this state, for individuals with a condition or medical history for which bone mass measurement is medically indicated for such individual. In determining whether testing or treatment is medically appropriate, due consideration shall be given to peer reviewed medical literature. A policy, provision, contract, plan or agreement may apply to such services the same deductibles, coinsurance and other limitations as apply to other covered services; and

(4) If a health benefit plan provides coverage for pharmaceutical benefits, provide coverage for contraceptives either at no charge or at the same level of deductible, coinsurance or copayment as any other covered drug. No such deductible, coinsurance or copayment shall be greater than any drug on the health benefit plan's formulary. As used in this section, "contraceptive" shall include all prescription drugs and devices approved by the federal Food and Drug Administration for use as a contraceptive, but shall exclude all drugs and devices that are intended to induce an abortion, as defined in section 188.015, RSMo, which shall be subject to the provisions of section 376.805. Nothing in this subdivision shall be construed to exclude coverage for prescription contraceptive drugs or devices ordered by a health care provider with prescriptive authority for reasons other than contraceptive or abortion purposes.

2. For the purposes of this section, "health carrier" and "health benefit plan" shall have the same meaning as defined in section 376.1350.

3. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months or less duration, or any other supplemental policy as determined by the director of the department of insurance.

4. Notwithstanding the provisions of subdivision (4) of subsection 1 of this section to the contrary:

(1) Any health carrier may issue to any person or entity purchasing a health benefit plan, a health benefit plan that excludes coverage for contraceptives if the use or provision of such contraceptives is contrary to the moral, ethical or religious beliefs or tenets of such person or entity;

(2) Upon request of an enrollee who is a member of a group health benefit plan and who states that the use or provision of contraceptives is contrary to his or her moral, ethical or religious beliefs, any health carrier shall issue to or on behalf of such enrollee a policy form that excludes coverage for contraceptives. Any administrative costs to a group health benefit plan associated with such exclusion of coverage not offset by the decreased costs of providing coverage shall be borne by the group policyholder or group plan holder;

(3) Any health carrier which is owned, operated or controlled in substantial part by an entity that is operated pursuant to moral, ethical or religious tenets that are contrary to the use or provision of contraceptives shall be exempt from the provisions of subdivision (4) of subsection 1 of this section.

For purposes of this subsection, if new premiums are charged for a contract, plan or policy, it shall be determined to be a new contract, plan or policy.

5. Except for a health carrier that is exempted from providing coverage for contraceptives pursuant to this section, a health carrier shall allow enrollees in a health benefit plan that excludes coverage for contraceptives pursuant to subsection 4 of this section to purchase a rider to the health benefit plan that includes coverage for contraceptives.

6. Any health benefit plan issued by a health carrier described in subdivision (3) of subsection 4 of this section and any group health benefit plan issued pursuant to subsection 1 of this section shall provide clear and conspicuous written notice on the enrollment form or any accompanying materials to the enrollment form and the group health benefit plan contract:

(1) Whether coverage for contraceptives is or is not included;

(2) That an enrollee who is a member of a group health benefit plan with coverage for contraceptives has the right to exclude coverage for contraceptives if such coverage is contrary to his or her moral, ethical or religious beliefs; and

(3) That an enrollee who is a member of a group health benefit plan without coverage for contraceptives has the right to purchase coverage which includes coverage for contraceptives.

7. Health carriers shall not disclose to the person or entity who purchased the health benefit plan the names of enrollees who exclude coverage for contraceptives in the health benefit plan or who purchase a rider to the health benefit plan that includes coverage for contraceptives. Health carriers and the person or entity who purchased the health benefit plan shall not discriminate against an enrollee because the enrollee excluded coverage for contraceptives in the health benefit plan or purchased a rider to the health benefit plan that includes coverage for contraceptives.

8. The department of insurance may promulgate rules necessary to implement the provisions of this section. No rule or portion of a rule promulgated pursuant to this section shall become effective unless it has been promulgated pursuant to chapter 536, RSMo."; and

Further amend the title and enacting clause accordingly.

Senate Amendment No. 3

AMEND Senate Substitute for Senate Committee Substitute for House Substitute for House Committee Substitute for House Bill No. 762, Page 20, Section 376.1209, Line 26, by inserting after all of said line the following:

"Section 1. 1. Notwithstanding any other provision of law, when the Department of Insurance intends to enter into any contract or other written agreement or approve any letter of intent for payment of money by the state in excess of one hundred thousand dollars, modification or potential reduction of a party's financial obligation to the state in excess of one hundred thousand dollars, the Department of Insurance shall forward a copy to the attorney general before entering into that contract, subcontract or other written agreement or approving the letter of intent.

2. Upon receiving the contract, other written agreement or letter of intent, the attorney general shall, within ten days, review and approve that contract, other written contract or letter of intent for its legal form and content as may be necessary to protect the legal interest of the state. If the attorney general does not approve, then the attorney general shall return the contract, other written agreement or letter of intent with additional proposed provisions as may be necessary to the proper enforcement of the contract as required to protect the state's legal interest. If the attorney general does not respond within ten days or, in the case of any contract that involves a payment of money by the state or a modification or potential reduction of a party's financial obligation to the state of one million dollars or more, within thirty days, the contract shall be deemed approved.

3. Communications related to the attorney general's review are attorney-client communications. The attorney general's written disposition shall be subject to chapter 610, RSMo."; and

Further amend the title and enacting clause accordingly.

Senate Amendment No. 4

AMEND Senate Substitute for Senate Committee Substitute for House Substitute for House Committee Substitute for House Bill No. 762, Page 20, Section 376.1209, Lines 16-17, by deleting all of said lines and inserting in lieu thereof the following:

"insurer, then the new policy shall provide coverage for prosthetic devices or reconstructive surgery and such coverage for prosthetic devices and reconstructive surgery shall be subject to the same deductible and coinsurance conditions applied to a mastectomy and all other terms and conditions applicable to other benefits under the new policy.".

Senate Amendment No. 5

AMEND Senate Substitute for Senate Committee Substitute for House Substitute for House Committee Substitute for House Bill No. 762, Page 20, Section 376.1209, Line 23, by inserting at the end of said line the following: "short-term major medical policies of six months or less duration,".

Senate Amendment No. 6

AMEND Senate Substitute for Senate Committee Substitute for House Substitute for House Committee Substitute for House Bill No. 762, Page 1, In the Title, Line 3 of said title, by striking "women's health services" and inserting in lieu thereof the following: "the department of health"; and

Further amend said bill, Page 1, Section A, Line 4, by inserting immediately after said line the following:

"192.1010. 1. There is hereby established within the department of health, the "Life Sciences Research Program". The program shall be administered by the director of the department of health based upon the recommendations of the "Life Sciences Research Board", which is hereby created. The program shall consist of grant awards from moneys appropriated from the "Life Sciences Research Fund", which is hereby created in the state treasury. The grant awards shall be designed to achieve the goals stated in subsection 4 of this section.

2. The life sciences research board shall consist of eight members who shall be appointed in the following manner:

(1) Each member shall be appointed by the governor with the advice and consent of the senate for a term of six years, except for the terms of the initial members. The board shall select its own chairperson from among its members;

(2) The members of the board shall be generally familiar with the life sciences and current research trends and developments, with either technical or scientific expertise in life sciences, and with an understanding of the application of the results of life sciences research;

(3) Two initial members of the life sciences research board shall be appointed to two-year terms. Three initial members shall be appointed to a four-year term. The remaining three initial members shall be appointed to six-year terms. All subsequent appointees shall be appointed to six-year terms;

(4) No member of the life sciences research board shall serve more than two consecutive full six-year terms on the board;

(5) The director of the department of health shall be a member of the board;

(6) The director of the office of minority health shall be a non-voting member of the board.

3. The life sciences research board shall solicit, collect and prioritize proposed research initiatives for consideration for funding by the board.

4. The life sciences research board shall take applications for grants-in-aid in order to increase the capacity and infrastructure for quality life sciences research in the state of Missouri and to improve the quantity and quality of life sciences research. Such research shall include: basic research, including the discovery of new knowledge; translational research, including translating knowledge into a usable form; and developmental research and clinical research, including but not limited to health research in human safety development and aging, cancer, endocrine, cardiovascular, neurological including nerve regeneration, pulmonary, diagnostic disease and infectious disease, and nutrition and food safety.

5. The applications shall be designed by the department of health in consultation with the board and shall contain information necessary to determine the potential benefits of grants-in-aid to be awarded, as well as other information deemed necessary for the administration of this program. The grant application shall describe in detail the proposed research project and how the research project shall be conducted in compliance with the requirements of 192.1010 to 192.1030. The department of health shall not approve a grant award unless the department makes specific written findings that such research project shall be conducted in compliance with sections 192.1010 to 192.1030. The grant application and the grant award shall be a public record within the meaning of chapter 610, RSMo. The department of health shall promulgate rules in accordance with chapter 536, RSMo, to implement the provisions of this subsection.

6. The department of health shall provide facilities, equipment, administrative and technical support services and administrative staff.

7. In determining projects to authorize, the life sciences research board shall consider the potential of any proposal to bring both health and economic benefit to the people of Missouri.

8. The life sciences research board shall have the authority to:

(1) Award research grants;

(2) Enter into contracts relating to research;

(3) Adopt research standards;

(4) Promulgate rules governing the administration of research programs, research grants, research contracts and licensing contracts, and the reimbursement of costs, utilization of intellectual property rights, conflict of interest guidelines, consistent with sections 192.1010 to 192.1035;

(5) Make provision for peer review panels to recommend and review research projects;

(6) Contract for administrative and technical support services;

(7) Lease or acquire facilities and equipment;

(8) Employ administrative staff; and

(9) Receive, disburse and administer any funds appropriated to it.

9. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in sections 192.1010 to 192.1035 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. The rulemaking authority granted in such sections and the provisions of 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, 2001, shall be invalid and void.

192.1015. The life sciences research board shall make provision for and secure from the state auditor or outside certified public accounting firm an annual audit of its financial affairs and the funds expended from the life sciences research account. The audit shall be performed on a fiscal year basis. Any audit shall be paid for by moneys expended from the life sciences research fund, whether performed by the state auditor or outside certified public accounting firm. The board will make copies of each audit publicly available. Every three years the board with assistance of its staff or independent contractors as determined by the board shall prepare a comprehensive report assessing the work and progress of the life sciences research program. Such assessment report shall analyze the impact of the board's programs and research performed, shall be provided to the governor and members of the general assembly and shall be publicly available.

192.1020. Grant awards made by the life sciences research board shall provide for the reimbursement of costs. Whether reimbursement of particular costs will be allowed depends on the application of a four-part test balancing, which shall include:

(1) The reasonableness of the cost;

(2) The connection to the grant;

(3) The consistency demonstrated in assigning costs to the grant; and

(4) Conformance with the particular terms and conditions of the award.

192.1025. Grant recipients have an obligation to preserve research freedom, to ensure timely disclosure of their research findings to the scientific community, including through publications and presentations at scientific meetings, and to promote utilization, commercialization and public availability of their inventions and other intellectual property developed in the performance of research funded by a grant award. Institutions or organizations receiving grant awards shall retain all right, title and interest, including all intellectual property rights, in and to any and all inventions, ideas, data, improvement, modifications, discoveries, know-how, creations, copyrightable material, trade secrets, methods, processes, discoveries and derivatives, whether patentable or not, which are made in the performance of work under a grant award. The life sciences research board may, however, adopt reasonable regulations to insure that any such intellectual property rights are utilized reasonably and in a manner which is in the public interest.

192.1030. 1. Notwithstanding the provisions of sections 192.1010 to 192.1025, no grant awards shall be paid, granted, or used, to subsidize in whole or in part:

(1) Abortion services; or

(2) Destructive human research; or

(3) Development of drugs or chemicals intended to be used to induce an abortion; or

(4) Human cloning.

2. For the purposes of this section:

(1) "Abortion services" shall mean performing or inducing, assisting in performing or inducing, or referring a woman for, an abortion, except when necessary to save the life of the mother;

(2) "Child" if in utero, shall mean the same as an unborn child, as defined in section 188.015, RSMo; and if ex utero, shall mean a human being at any of the stages of biological development of an unborn child from conception onward;

(3) "Destructive human research" shall mean research in which there is the taking or utilization of the organs, tissue or cellular material of a:

(a) Deceased child, unless consent was given the manner provided pursuant to sections 194.210 to 194.290, RSMo, relating to anatomical gifts, and neither parent caused the death of such child or consented to someone causing the death of such child; or

(b) Living child, when the intended or likely result of such taking or utilization is to kill or cause serious harm to the health, safety or welfare of such child, or when the purpose is to target such child for possible destruction in the future;

(4) "Facilities and administrative costs" shall mean those costs that are incurred for common or joint objectives and therefore cannot be identified readily and specifically with a particular research project or any other institutional activity;

(5) "Grant awards" shall mean awards of state funds pursuant to sections 192.1010 to 192.1030;

(6) "Human cloning" shall mean the replication of a human being genetically identical to another human being;

(7) "Research project" shall mean research specified in the grant award conducted under the auspices of the institution or institutions that applied for and received such grant award pursuant to sections 192.1010 to 192.1030, regardless of whether the research is funded in whole or part by such grant award. Such research shall include: basic research, including the discovery of new knowledge; translational research, including translating knowledge into a usable form; and developmental research and clinical research, including but not limited to research in human development and aging, cancer, endocrine, cardiovascular, neurological, pulmonary and infectious disease, and nutrition and food safety. Such research may also include research and development on product safety and preventative care technologies.

3. No grant awards shall be paid or granted pursuant to sections 192.1010 to 192.1030 to or on behalf of an existing or proposed research project that involves, as part of the project, abortion services, destructive human research, the development of drugs or chemicals intended to be used to induce an abortion or human cloning. A research project that receives a grant award shall not share costs with another research project, person or entity not qualified to receive a grant award pursuant to sections 192.1010 to 192.1030; provided, however, the research project that receives a grant award may pay facilities and administrative costs directly allocable to such research project. A research project that receives a grant award shall maintain financial records that demonstrate strict compliance with this section. The audit conducted pursuant to section 192.1015 shall also certify compliance with this section.

4. Any taxpayer of this state or its political subdivisions shall have standing to bring suit against the department of health, its officers or employees, in a circuit court of proper venue to enforce the provisions of this section.

5. Sections 192.1010 to 192.1030 shall not be construed to permit or make lawful any conduct that is otherwise unlawful under the laws of this state.

6. All of the provisions of sections 192.1010 to 192.1025 are severable; provided, however, the provisions of section 192.1030 are not severable from the provisions of sections 192.1010 to 192.1025. If any provision of sections 192.1010 to 192.1025 is found to be invalid, unenforceable or unconstitutional, the remaining provisions of sections 192.1010 to 192.1025 shall be and remain valid. However, if any provision of section 192.1030 shall be found to be invalid, unenforceable or unconstitutional, all the provisions of sections 192.1010 to 192.1025 shall be invalid and unenforceable."; and

Further amend the title and enacting clause accordingly.

Senate Amendment No. 7

AMEND Senate Substitute for Senate Committee Substitute for House Substitute for House Committee Substitute for House Bill No. 762, Page 15, Section 208.151, Line 6, by inserting after all of said line the following:

"354.400. As used in sections 354.400 to 354.535, the following terms shall mean:

(1) "Basic health care services", health care services which an enrolled population might reasonably require in order to be maintained in good health, including, as a minimum, emergency care, inpatient hospital and physician care and chiropractic care, as defined in chapter 331, RSMo, and outpatient medical and chiropractic services;

(2) "Community-based health maintenance organization", a health maintenance organization which:

(a) Is wholly owned and operated by hospitals, hospital systems, physicians, or other health care providers or a combination thereof who provide health care treatment services in the service area described in the application for a certificate of authority from the department of insurance;

(b) Is operated to provide a means for such health care providers to market their services directly to consumers in the service area of the health maintenance organization;

(c) Is governed by a board of directors that exercises fiduciary responsibility over the operations of the health maintenance organization and of which a majority of the directors consist of equal numbers of the following:

a. Physicians licensed pursuant to chapter 334, RSMo;

b. Purchasers of health care services who live in the health maintenance organization's service area;

c. Enrollees of the health maintenance organization elected by the enrollees of such organization; and

d. Hospital executives, if a hospital is involved in the corporate ownership of the health maintenance organization;

(d) Provides for utilization review, as defined in section 374.500, RSMo, under the auspices of a physician medical director who practices medicine in the service area of the health maintenance organization, using review standards developed in consultation with physicians who treat the health maintenance organization's enrollees;

(e) Is actively involved in attempting to improve performance on indicators of health status in the community or communities in which the health maintenance organization is operating, including the health status of those not enrolled in the health maintenance organization;

(f) Is accountable to the public for the cost, quality and access of health care treatment services and for the effect such services have on the health of the community or communities in which the health maintenance organization is operating on a whole;

(g) Establishes an advisory group or groups comprised of enrollees and representatives of community interests in the service area to make recommendations to the health maintenance organization regarding the policies and procedures of the health maintenance organization;

(h) Enrolls fewer than fifty thousand covered lives;

(3) "Covered benefit" or "benefit", a health care service to which an enrollee is entitled under the terms of a health benefit plan;

(4) "Director", the director of the department of insurance;

(5) "Emergency medical condition", the sudden and, at the time, unexpected onset of a health condition that manifests itself by symptoms of sufficient severity that would lead a prudent lay person, possessing an average knowledge of health and medicine, to believe that immediate medical care is required, which may include, but shall not be limited to:

(a) Placing the person's health in significant jeopardy;

(b) Serious impairment to a bodily function;

(c) Serious dysfunction of any bodily organ or part;

(d) Inadequately controlled pain; or

(e) With respect to a pregnant woman who is having contractions:

a. That there is inadequate time to effect a safe transfer to another hospital before delivery; or

b. That transfer to another hospital may pose a threat to the health or safety of the woman or unborn child;

(6) "Emergency services", health care items and services furnished or required to screen and stabilize an emergency medical condition, which may include, but shall not be limited to, health care services that are provided in a licensed hospital's emergency facility by an appropriate provider;

(7) "Enrollee", a policyholder, subscriber, covered person or other individual participating in a health benefit plan;

(8) "Evidence of coverage", any certificate, agreement, or contract issued to an enrollee setting out the coverage to which the enrollee is entitled;

(9) "Health care services", any services included in the furnishing to any individual of medical, chiropractic or dental care or hospitalization, or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability;

(10) "Health maintenance organization", any person which undertakes to provide or arrange for basic and supplemental health care services to enrollees on a prepaid basis, or which meets the requirements of section 1301 of the United States Public Health Service Act;

(11) "Health maintenance organization plan", any arrangement whereby any person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care services and at least part of such arrangement consists of providing and assuring the availability of basic health care services to enrollees, as distinguished from mere indemnification against the cost of such services, on a prepaid basis through insurance or otherwise, and as distinguished from the mere provision of service benefits under health service corporation programs;

(12) "Individual practice association", a partnership, corporation, association, or other legal entity which delivers or arranges for the delivery of health care services and which has entered into a services arrangement with persons who are licensed to practice medicine, osteopathy, dentistry, chiropractic, pharmacy, podiatry, optometry, or any other health profession and a majority of whom are licensed to practice medicine or osteopathy. Such an arrangement shall provide:

(a) That such persons shall provide their professional services in accordance with a compensation arrangement established by the entity; and

(b) To the extent feasible for the sharing by such persons of medical and other records, equipment, and professional, technical, and administrative staff;

(13) "Medical group/staff model", a partnership, association, or other group:

(a) Which is composed of health professionals licensed to practice medicine or osteopathy and of such other licensed health professionals (including dentists, chiropractors, pharmacists, optometrists, and podiatrists) as are necessary for the provisions of health services for which the group is responsible;

(b) A majority of the members of which are licensed to practice medicine or osteopathy; and

(c) The members of which (i) as their principal professional activity over fifty percent individually and as a group responsibility engaged in the coordinated practice of their profession for a health maintenance organization; (ii) pool their income from practice as members of the group and distribute it among themselves according to a prearranged salary or drawing account or other plan, or are salaried employees of the health maintenance organization; (iii) share medical and other records and substantial portions of major equipment and of professional, technical, and administrative staff; (iv) establish an arrangement whereby an enrollee's enrollment status is not known to the member of the group who provides health services to the enrollee;

(14) "Person", any partnership, association, or corporation;

(15) "Provider", any physician, hospital, or other person which is licensed or otherwise authorized in this state to furnish health care services;

(16) "Uncovered expenditures", the costs of health care services that are covered by a health maintenance organization, but that are not guaranteed, insured, or assumed by a person or organization other than the health maintenance organization, or those costs which a provider has not agreed to forgive enrollees if the provider is not paid by the health maintenance organization.

354.640. 1. All managed care organizations subject to the provisions of sections 354.400 to 354.636 shall provide chiropractic benefits to covered enrollees. A covered enrollee may utilize the services of a chiropractic physician as defined in chapter 331, RSMo, without discrimination relative to access, fees, deductibles, co-payments, benefit limits and practice parameters subject to the terms and conditions of the policy. The covered enrollee shall retain the right to choose chiropractic care on an elective, self-pay, fee-for-service basis. No entity regulated pursuant to this chapter shall prohibit a doctor of chiropractic from continuing care on such basis.

2. Nothing in this section shall be construed to limit the health plan's ability to credential providers or be deemed as an any willing provider provision."; and

Further amend said title, enacting clause and intersectional references accordingly.

In which the concurrence of the House is respectfully requested.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the President Pro Tem has appointed the following Conference Committee to act with a like Committee from the House on HCS SS SB 244, as amended: Senators Staples, Mathewson, Childers, Cauthorn and Klindt.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate refuses to concur in HS HCS SB 365, as amended, and requests that the House recede from its position and failing to do so, grant the Senate a conference thereon.

APPOINTMENT OF CONFERENCE COMMITTEES

The Speaker appointed the following Conference Committees to act with like Committees from the Senate on the following bills:

SCS HB 80: Representatives Gratz, Smith, Kelly (36) Ross and Reinhart

SCS HB 471: Representatives Jolly, Johnson (90), Clayton, Lograsso and Scott

THIRD READING OF SENATE BILLS

SB 470, with House Committee Amendment No. 1, relating to second state capitol commission, was taken up by Representative O'Toole.

On motion of Representative O'Toole, House Committee Amendment No. 1 was adopted.

Representative Farnen offered House Amendment No. 1.

House Amendment No. 1

AMEND Senate Bill No. 470, Page 3, Section 8.007, Line 6 of said page, by inserting after all of said line the following:

"(3) Evaluate and recommend courses of action to ensure accessibility to the capitol for physically disabled persons;"; and

Further amend said bill, Page 3, Section 8.007, Line 7 of said page, by striking the numeral "(3)" and inserting in lieu thereof the numeral "(4)"; and

Further amend said bill, Page 3, Section 8.007, Line 13 of said page, by striking the numeral "(4)" and inserting in lieu thereof the numeral "(5)"; and

Further amend said bill, Page 3, Section 8.007, Line 16 of said page, by striking the numeral "(5)" and inserting in lieu thereof the numeral "(6)"; and

Further amend said bill, Page 3, Section 8.007, Line 18 of said page, by striking the numeral "(6)" and inserting in lieu thereof the numeral "(7)"; and

Further amend said bill, Page 3, Section 8.007, Line 21 of said page, by inserting after all of said line the word "and"; and

Further amend said bill, Page 3, Section 8.007, Line 22 of said page, by striking the numeral "(7)" and inserting in lieu thereof the numeral "(8)"; and

Further amend said bill, Page 3, Section 8.007, Line 38 of said page, by striking the first occurrence of the word "and" and inserting in lieu thereof a comma ","; and

Further amend said bill, Page 3, Section 8.007, Line 38 of said page, by inserting after the word "restoration" the following: "and improved accessibility".

On motion of Representative Farnen, House Amendment No. 1 was adopted.

Representative O'Toole offered House Amendment No. 2.

House Amendment No. 2

AMEND Senate Bill No. 470, Page 3, Section 8.007, Line 37, by inserting after the word "stipulations," the word "and".

On motion of Representative O'Toole, House Amendment No. 2 was adopted.

On motion of Representative O'Toole, SB 470, as amended, was read the third time and passed by the following vote:

Speaker Pro Tem Abel declared the bill passed.

HCS SCS SB 591, relating to sewer districts, was taken up by Representative Hoppe.

Representative Hoppe offered HS HCS SCS SB 591.

Representative Ridgeway offered House Amendment No. 1.

House Amendment No. 1

AMEND House Substitute for House Committee Substitute for Senate Committee Substitute for Senate Bill No. 591, Page 8, Section 262.802, Line 17, by adding after the word "made" the following:

"However, if a political subdivision requires the property to be connected to the sewer system of the political subdivision pursuant to Section 644.027, RSMo, such connection shall not trigger the payment of the assessment.".

On motion of Representative Ridgeway, House Amendment No. 1 was adopted.

Representative Merideth offered House Amendment No. 2.

House Amendment No. 2

AMEND House Substitute for House Committee Substitute for Senate Committee Substitute for Senate Bill No. 591, by inserting in the appropriate place the following:

"277.212. 1. The attorney general shall enforce the provisions of sections 277.200 to 277.215. The department of agriculture shall refer violations of the provisions of sections 277.200 to 277.215 to the attorney general. The attorney general or any person injured by a violation of the provisions of sections 277.200 to 277.215 may bring an action pursuant to the provisions of chapter 407, RSMo, for any remedy allowed for unlawful merchandising practices.

2. A seller who receives a discriminatory price or who is offered only a discriminatory price in violation of the provisions of sections 277.200 to 277.215 may receive [treble] damages, costs and a reasonable attorney's fee.

277.215. 1. Each packer shall make available for publication and to the department of agriculture a daily report setting forth information regarding prices paid for livestock under each contract in force in Missouri in which the packer and a Missouri resident are parties for the purchase of livestock by the packer and which sets a date for delivery more than fourteen days after the making of the contract.

2. The report shall be completed on forms prepared by the department for comparison with cash market prices for livestock and livestock carcasses according to procedures required by the department. The report shall not include information regarding the identity of a seller.

3. Any packer who fails to report as required by this section is guilty of a class A misdemeanor.

4. The department shall adopt rules to implement the provisions of sections 277.200 to 277.215.

5. 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.

6. In the event a federal law regarding livestock price reporting becomes effective, the department of agriculture shall immediately adopt such rules as are necessary to permit Missouri producers and packers to remain economically competitive with producers and packers in other states.

[7. Sections 277.200 to 277.215 shall expire December 31, 2002.]"; and

Further amend said title, enacting clause and intersectional references accordingly.

On motion of Representative Merideth, House Amendment No. 2 was adopted.

On motion of Representative O'Toole, HS HCS SCS SB 591, as amended, was adopted.

On motion of Representative O'Toole, HS HCS SCS SB 591, as amended, was read the third time and passed by the following vote:

HOUSE BILL WITH SENATE AMENDMENTS

SS SCS HS HB 381, as amended, relating to the sale of tobacco products, was taken up by Representative Hoppe.

On motion of Representative Hoppe, SS SCS HS HB 381, as amended, was adopted by the following vote:

On motion of Representative Hoppe, SS SCS HS HB 381, as amended, was truly agreed to and finally passed by the following vote:

Speaker Pro Tem Abel declared the Bill Passed

Representative Britt assumed the Chair.

BILL IN CONFERENCE

CCR HCS SB 319, as amended, relating to assessment of students, was taken up by Representative Johnson (61).

On motion of Representative Johnson (61), CCR HCS SB 319, as amended, was adopted by the following vote:

On motion of Representative Johnson (61), CCS HCS SB 319 was truly agreed to and finally passed by the following vote:

Representative Britt declared the bill passed.

The emergency clause was adopted by the following vote:

MESSAGES FROM THE SENATE

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the President Pro Tem has appointed the following Conference Committee to act with a like Committee from the House on SCS HB 80, as amended: Senators Kenney, Klarich, DePasco, Mathewson and Loudon.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the President Pro Tem has appointed the following Conference Committee to act with a like Committee from the House on SCS HB 471, as amended: Senators Wiggins, Kenney, Westfall, Schneider and Yeckel.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate grants the House of Representatives further conference on SS SCS HB 453, as amended.

The President Pro Tem has reappointed the following Conference Committee to act with a like Committee from the House: Senators Steelman, Klarich, Gross, Mathewson and Quick.

Mr. Speaker: I am instructed by the Senate to inform the House of Representatives that the Senate has taken up and adopted HS HCS SB 288, as amended, and has taken up and passed HS HCS SB 288, as amended.

Emergency clause adopted.

APPOINTMENT OF CONFERENCE COMMITTEE

The Speaker appointed the following Conference Committee to act with a like Committee from the Senate on the following bill:

SS SCS HB 453: Representatives Smith, Ransdall, Merideth, Jetton and Hohulin

On motion of Representative Green (73), the House recessed until 2:07p.m.

AFTERNOON SESSION

The hour of recess having expired, the House was called to order by Speaker Kreider.

HOUSE COURTESY RESOLUTIONS OFFERED AND ISSUED

House Resolution No. 2208 - Representative Kreider

House Resolution No. 2209 - Representative Fares

House Resolution No. 2210

and

House Resolution No. 2211 - Representative Holt

House Resolution No. 2212 - Representative May (149)

House Resolution No. 2213 - Representative Abel

House Resolution No. 2214 - Representative Kreider

House Resolution No. 2215 - Representative Hanaway

COMMITTEE REPORT

Committee on Fiscal Review and Government Reform, Chairman Hollingsworth reporting:

Mr. Speaker: Your Committee on Fiscal Review and Government Reform, to which was referred SCS SB 578 (Fiscal Note), begs leave to report it has examined the same and recommends that it Do Pass.

BILLS CARRYING REQUEST MESSAGES

HS HCS SB 365, as amended, relating to tourism, was taken up by Representative Overschmidt.

Representative Overschmidt moved that the House refuse to recede from its position on HS HCS SB 365, as amended, and grant the Senate a conference.

Which motion was adopted.

SS SCS HS HCS HB 762, as amended, relating to women's health services, was taken up by Representative Barry.

Representative Barry moved that the House refuse to adopt SS SCS HS HCS HB 762, as amended, and request the Senate to recede from its position or, failing to do so, grant the House a conference.

Which motion was adopted.

CONFERENCE COMMITTEE REPORT

ON

HOUSE BILL NO. 621

Mr. Speaker: Your Conference Committee, appointed to confer with a like Committee of the Senate, on House Bill No. 621, with Senate Committee Amendment No. 1 and Senate Amendment No. 1, begs leave to report that we, after free and fair discussion of the differences between the House and the Senate, have agreed to recommend and do recommend to the respective bodies as follows:

1. That the Senate recede from its position on House Bill No. 621, as amended;

2. That the House recede from its position on House Bill No. 621;

3. That the attached Conference Committee Substitute for House Bill No. 621 be adopted.

FOR THE HOUSE: FOR THE SENATE:

/s/ Rep. William Gratz /s/ Sen. Larry Rohrbach

/s/ Rep. Mark Hampton /s/ Sen. Sarah Steelman

/s/ Rep. Carl Vogel /s/ Sen. John Russell

/s/ Rep. Randall Relford /s/ Sen. Wayne Goode

/s/ Rep. Rex Rector /s/ Sen. Ronnie DePasco

BILL IN CONFERENCE

CCR HB 621, as amended, relating to penitentiary redevelopment commission, was taken up by Representative Gratz.

On motion of Representative Gratz, CCR HB 621, as amended, was adopted by the following vote:

On motion of Representative Gratz, CCS HB 621 was read the third time and passed by the following vote: