SECOND REGULAR SESSION

SENATE COMMITTEE SUBSTITUTE FOR

HOUSE BILL NO. 1936

93RD GENERAL ASSEMBLY

     Reported from the Committee on Aging, Families, Mental and Public Health, April 27, 2006, with recommendation that the Senate Committee Substitute do pass.

TERRY L. SPIELER, Secretary.

5526S.02C

AN ACT

To repeal sections 192.935 and 197.291, RSMo, and to enact in lieu thereof three new sections relating to health care, with an expiration date.

Be it enacted by the General Assembly of the State of Missouri, as follows:

            Section A.  Sections 192.935 and 197.291, RSMo, are repealed and three new sections enacted in lieu thereof, to be known as sections 167.195, 192.935, and 197.291, to read as follows:

            167.195.  1.  Beginning July 1, 2007, every child enrolling in kindergarten or first grade in a public elementary school in this state shall receive one comprehensive vision examination performed by a state licensed optometrist, ophthalmologist, physician, or doctor of osteopathy.  The examination, or a copy of a prior examination under this section, shall be submitted to the school no later than January 1 of the first year in which the student is enrolled at the school.

            2.  The state board of education, in conjunction with the department of health and senior services, shall promulgate rules establishing the criteria for meeting the requirements of subsection 1 of this section, which may include, but are not limited to, forms or other proof of such examination, or other rules as are necessary for the enforcement of this section.  The form or other proof of such examination shall include but not be limited to identifying the result of the examinations performed under subsection 4 of this section, the cost for the examination, the examiner's qualifications, and method of payment through either:

            (1)  Insurance;

            (2)  The state Medicaid program;

            (3)  Personal injury;

            (4)  Complimentary; or

            (5)  Other form of payment.

            3.  The department of elementary and secondary education, in conjunction with the department of health and senior services, shall compile and maintain a list of sources to which children who may need vision examinations or children who have been found to need further examination or vision correction may be referred for treatment on a free or reduced cost basis.  The sources may include individuals, and federal, state, local government, and private programs.  The department of elementary and secondary education shall ensure that the superintendent of schools, the principal of each elementary school, the school nurse or other person responsible for school health services, and the parent organization for each district elementary school receives an updated copy of the list each year prior to school opening.  Professional and service organizations concerned with vision health may assist in gathering and disseminating the information, at the direction of the department of elementary and secondary education.

            4.  For purposes of this section, the following comprehensive vision examinations shall be performed:

            (1)  Complete case history;

            (2)  Visual acuity at distance:

            (a)  Unaided (mono plus binocular);

            (b)  Last prescription or habitual prescription (mono plus binocular);

            (3)  External examination, including pupil reactivity;

            (4)  Internal examination (ophthalmoscopic examination);

            (5)  Retinoscopy;

            (6)  Refractive status:

            (a)  Subjective refraction to best visual acuity at distance;

            (b)  Subjective refraction at near;

            (7)  Measurement of binocularity, including vergences, phoric, and accommodative ability;

            (8)  Color vision screening;

            (9)  Glaucoma screening, including tonometry.

            5.  Findings from the examination shall be kept by the optometrist, ophthalmologist, physician, or doctor of osteopathy for a period of six years.

            6.  For purposes of this section, the office of any optometrist, ophthalmologist, physician, or doctor of osteopathy conducting a comprehensive vision examination shall contain, in good working condition, the following minimum equipment:

            (1)  Ophthalmoscope;

            (2)  Retinoscope or its equivalent;

            (3)  Tonometer;

            (4)  Visual Field Testing Device;

            (5)  Color Vision Testing Device;

            (6)  Keratometer or its equivalent;

            (7)  Biomicroscope;

            (8)  Lenses for subjective testing;

            (9)  Blood pressure measuring device.

            7.  In the event that a parent or legal guardian of a child subject to this section shall submit to the appropriate school administrator a written request that the child be excused from taking a vision examination as provided in this section on the grounds of religious beliefs, that child shall be so excused.

            8.  Pursuant to section 23.253, RSMo, of the Missouri sunset act:

            (1)  The provisions of the new program authorized under this section shall automatically sunset four years after the effective date of this section unless reauthorized by an act of the general assembly; and

            (2)  If such program is reauthorized, the program authorized under this section automatically sunset eight years after the effective date of the reauthorization of this section; and

            (3)  This section shall terminate on September first of the calendar year immediately following the calendar year in which the program authorized under this section is sunset.

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

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

            3.  The program shall provide for:

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

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

            (3)  Treatment procedures necessary to prevent blindness;

            (4)  Any additional costs for vision examinations under section 167.195, RSMo, that are not covered by existing public health insurance.  Subject to appropriations, moneys from the fund shall be used to pay for those additional costs, provided that the costs do not exceed ninety-nine thousand dollars per year.  Payment from the fund for vision examinations under section 167.195, RSMo, shall not exceed the allowable state Medicaid reimbursement amount for vision examinations.  

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

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

            6.  No rule or portion of a rule promulgated pursuant to the authority of this section shall become effective unless it has been promulgated pursuant to the provisions of chapter 536, RSMo.

            197.291.  1.  There is hereby established a "Technical Advisory Committee on the Quality of Patient Care and Nursing Practices" within the department of health and senior services.  The committee shall be comprised of nine members appointed by the director of the department of health and senior services [on or before December 1, 2000], one of whom shall be a representative of the department of health and senior services and one of whom shall be a representative of the general public.  In addition, the director shall appoint three members representing licensed registered nurses from a list of recommended appointees provided by the Missouri Nurses Association, one member representing licensed practical nurses from a list of recommended appointees provided by the Missouri Licensed Practical Nurses Association, two members from a list of recommended appointees provided by the Missouri Hospital Association, and one member representing licensed physicians from a list of recommended appointees provided by the Missouri State Medical Association.  

            2.  The committee shall work with hospitals, nurses, physicians, state agencies, community groups and academic researchers to develop specific recommendations related to staffing, improving the quality of patient care, and insuring the safe and appropriate employment of licensed nurses within hospitals and ambulatory surgical centers.  The committee shall develop recommendations and submit an annual report based on such recommendations to the governor, chairpersons of standing health and appropriations committees of the general assembly and the department of health and senior services no later than December thirty-first of each year[, beginning in 2001].  

            3.  The department of health and senior services shall provide such support as the committee members require to aid it in the performance of its duties.  

            4.  Committee members shall not be compensated for their services but shall be reimbursed for their actual and necessary expenses incurred in the performance of their duties.  

            5.  The provisions of this section shall expire on December 31, [2006] 2011.

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