HB 1707 -- CERTAIN PROCESSING FEES EXCLUDED FROM SALES TAX (Coleman)

COMMITTEE OF ORIGIN: Standing Committee on Commerce

This bill modifies the definition of "gross receipts" for the purposes of sales tax, to provide that charges incident to the extension of credit must include credit card and debit card processing fees.

HB 1847 -- DENTAL PROFESSIONS (Hewkin)

COMMITTEE OF ORIGIN: Standing Committee on Economic Development

Currently, a corporation cannot practice dentistry unless the corporation is a nonprofit corporation or a professional corporation. Exemptions exist for hospital nonprofit corporations that provide dental services at facilities owned by a city, county, or other political subdivision of the State. This bill exempts entities contracted with the State to provide care in correctional centers.

The bill repeals outdated license reciprocity language and replaces it with new language in accordance with Statute 324.009, RSMo.

This bill also creates the "Dentist and Dental Hygienist Compact". Dentists and dental hygienists licensed in a state that participate in the Interstate Compact can practice in other participating states without additional requirements. The bill also enhances the ability of participating states to protect the public health and safety and cooperate in regulating the practice of dentistry and dental hygiene.

The bill specifies the conditions for a state to join and continue as a participating state, such as enacting a compact that is not materially different from the model compact, implementing a criminal background check requirement, accepting certain examinations and accreditations, and paying a participation fee to the Dentist and Dental Hygienist Compact Commission. The bill also defines the qualifications and obligations of a licensee who seeks to obtain and exercise a compact privilege in a remote state, such as having a qualifying license, meeting any jurisprudence requirement, reporting any adverse action, and complying with the scope of practice of the remote state.

The bill establishes the "Dentist and Dental Hygienist Compact Commission", composed of one commissioner from each participating state, to administer and enforce the Compact. The Commission will have the power to adopt rules and bylaws, maintain a data system, charge fees, conduct investigations, take disciplinary actions, issue subpoenas, and initiate legal proceedings. The bill also outlines the procedures and standards for the Commission's meetings, financial review, executive board, and annual report. This bill is similar to HB 56 (2025) and HB 2075 (2024).

HB 1961 -- DIETITIANS (Peters)

COMMITTEE OF ORIGIN: Standing Committee on Economic Development

This bill establishes the "Dietitian Licensure Compact", which is an interstate agreement that allows the practice of dietetics across state lines within other states that are a part of the Compact. The bill outlines the licensing requirements, education requirements for the dietitians, and the duties of the member states.

The bill further proposes to establish a joint government agency known as the "Dietitian Licensure Compact Commission", which will administer and enforce the Compact, adopt rules and bylaws, maintain a data system, investigate complaints, report complaints to home states of dietitians, and perform other functions necessary or appropriate to achieve the purposes of the Compact.

Provisions of the bill ensure the Compact will not affect Missouri's license reciprocity laws.

This bill specifies that, a first time applicant who has not previously taken or passed an examination may obtain without examination a nonrenewable temporary license by paying a temporary license fee and submitting an agreement-to-supervise form that is signed by a licensed dietitian who has agreed to supervise the applicant. Such temporary licensee may practice dietetics, but any such practice must be under the supervision of a dietitian licensed in this State.

The supervising dietitian must have an unencumbered license to practice and he or she cannot be an immediate family member of the temporary licensee.

The temporary license obtained by an applicant will expire the date the licensee's employment with the supervising dietitian has ceased or within 180 days of its issuance, whichever occurs first.

This bill is similar to HB 397 (2025) and HB 1666 (2024).

HCS HBs 2642, 2296, 1966 & 1680 -- INSURANCE COVERAGE OF ALTERNATIVES TO OPIOID DRUGS (Stinnett)

COMMITTEE OF ORIGIN: Standing Committee on Health and Mental Health

This bill requires that when a licensed health care professional acting within the scope of his or her license prescribes a nonopioid medication for the treatment of acute or chronic pain to an enrollee, it will be unlawful for a health benefit plan to:

(1) Deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug;

(2) Require the enrollee to try an opioid prescription drug before providing coverage of the nonopioid prescription drug; or

(3) Require a higher level of cost-sharing for the nonopioid prescription drug than for an opioid prescription drug.

This will apply to health benefit plans delivered, issued for delivery, continued, or renewed on or after January 1, 2027.

This bill is similar to HB 1680 and SB 902 (2026).

HCS HB 3010 -- PRIOR AUTHORIZATION OF HEALTH CARE SERVICES (Stinnett)

COMMITTEE OF ORIGIN: Standing Committee on Health and Mental Health

Currently, provided a patient is an enrollee of a health benefit plan, a utilization review entity is prohibited from revoking, limiting, conditioning, or otherwise restricting a prior authorization for a health care service within 45 working days of the date the health care provider receives the prior authorization. This bill changes the time frame to be the lesser of six months after the date the health care provider receives the prior authorization approval or the length of treatment as determined by the patient's health care provider.

Additionally, if a health carrier requires a prior authorization for a recurring health care service or maintenance medication for the treatment of a chronic or long-term condition, the approval will remain valid for the lesser of 12 months from the date the health care provider receives the prior authorization approval or the length of treatment as determined by the patient's health care provider.

Failure of a health carrier to comply with these provisions will result in any health care services subject to prior authorization to be automatically deemed authorized by the health carrier for a duration of time of at least the time frames described above.

Currently, any utilization review entity performing prior authorization review must provide a unique confirmation number to a provider upon receipt from that provider of a request for prior authorization. This bill requires a timestamp to be provided to a provider as well.

Prior to January 1, 2021, health carriers utilizing prior authorization review were required to develop a single secure electronic prior authorization cover page for all of its health benefit plans utilizing prior authorization review, which would be used by the carrier or its utilization review entity to accept and respond to, and which providers would use to submit, requests for prior authorization. This bill repeals that provision and instead provides that for plan years beginning on or after January 1, 2027, health carriers or utilization review entities are required to implement and maintain a prior authorization application programming interface (API) to respond to requests for prior authorization for health care services, excluding prescription drugs. If the API cannot be implemented in time, the carrier must notify the Department of Commerce and Insurance requesting an extension. Health care providers must use the API to submit requests for prior authorization for health care services, excluding prescription drugs.

The bill requires contracts between health carriers and participating health care providers entered into or renewed on or after January 1, 2027, to include a provision requiring health care providers to submit prior authorization requests via the API; failure to do so will result in the enrollee not being subject to cost sharing in excess of the in-network cost-sharing amount.

Additionally, the bill requires that health carriers utilizing prior authorization make available statistics regarding prior authorization approvals and denials for health care services in a readily available format. Carriers must submit the URL to the Department, which must publish the website locations in a central location on the Department's website. The bill specifies what information must be included.

This bill requires that health carriers offering health benefit plans with a managed care component report to the Department a complete list of the health care services for which prior authorization is required. The bill requires health carriers to reduce the scope of claims subject to prior authorizations. To promote consistency among carriers, the Department is required to review the submitted reports and compile an annual report to be published on the Department?s website. The bill also requires the reporting by health carriers to the Department of aggregated data related to certain practices, including, but not limited to, the number of prior authorization requests, the number of requests approved or denied, and the number of requests for mental health services, behavioral health benefits, and substance use disorders. The bill lists the data required to be reported.

The bill requires that contracts between health carriers and health care providers include a provision for the continuation of prior authorization approvals for enrollees from a previous health carrier for at least 180 days from the effective date of the enrollee?s coverage under the new health benefit plan, subject to the terms of the certificate of coverage. At any time during this 180-day period, the new health carrier can perform its own review to grant a prior authorization approval subject to the terms of the certificate of coverage. Additionally, if there is a change in coverage of or approval criteria for a previously authorized health care service, the change in coverage or approval criteria must not affect an enrollee who received prior authorization approval before the effective date of the change through the remainder of the enrollee?s plan year.

Beginning January 1, 2027, prior authorization is not required unless a determination is made that less than 90% of prior authorization requests submitted by the health care provider in the previous evaluation period, as defined in the bill, were or would have been approved.

Entities exempt from these prior authorization requirements may be audited, up to a maximum of two times per year, and exemption may be revoked under specific conditions, such as approval rates dropping below 90%. Additionally, exemptions are void if providers are found guilty of fraud or abuse.

Online portals may be required for prior authorization submissions, and no adverse determinations are to be finalized unless reviewed by a clinical peer.

The bill specifies requirements for notifying the provider of determinations in the bill, requires carriers and utilization review entities to maintain an online portal giving providers access to certain information, and provides that a health carrier or utilization review entity must notify the health care provider no later than 25 days after a determination has been made.

Lastly, no health carrier or utilization review entity can deny or reduce payments to a health care provider who had a prior authorization, unless the provider made a knowing and material misrepresentation with the intent to deceive the carrier or utilization review entity, or unless the health care service was not substantially performed.

This bill does not apply to MO HealthNet, except with regard to a Medicaid managed care organization as defined by law. The bill also does not apply to providers who have not participated in a health benefit plan offered by the carrier for at least one full evaluation period.

This bill should not be construed to authorize providers to provide services outside the scope of their licenses, nor to require health carriers or utilization review entities to pay for care provided outside the scope of a provider's license.

SCS/SB 841 - This act modifies several provisions relating to health care, including: (1) awareness days; (2) hospital investments and service areas; (3) epinephrine products; (4) community paramedic services; (5) doula services; (6) telehealth; (7) Department of Health and Senior Services contracts for public health; (8) limits on the sale of over-the-counter drugs; (9) administration of medications; (10) hospital workplace violence; (11) inspections of long-term care facilities; (12) MO HealthNet coverage of certain clinical pathology services; (13) food-borne allergies; (14) the practice of dentistry in correctional centers; (15) the administration of certain vaccines; (16) licensure of wholesale drug distributors; (18) the "RX Cares for Missouri Program"; (19) insurance coverage of anesthesia services; and (20) insurance coverage of alternatives to opioid drugs.

AWARENESS DAYS (Sections 9.412 and 9.418)

This act designates each September as "Brain Aneurysm Awareness Month" in Missouri and the last full week of April each year as "Infertility Awareness Week" in Missouri.

HOSPITAL INVESTMENTS AND SERVICE AREAS (Sections 96.192, 96.196, 206.110, and 206.158)

This act modifies the investment authority of boards of trustees of municipal hospitals in third class cities and hospital district hospitals. Current law permits investment of up to 25% of funds not required for operations of the hospital or other obligations. This act permits investment of up to 50% of funds not required for operations or other obligations in a manner described in the act, with the remaining portion to be invested into any investment in which the state Treasurer is allowed to invest. These provisions shall only apply if the hospital receives less than three percent of its annual revenues from municipal, county, hospital district, or state taxes or appropriated funds from the municipality in which such hospital is located.

Under this act, municipal hospitals in third class cities may operate in areas where hospital district hospitals and county hospitals operate. Hospital district hospitals may operate in areas where municipal hospitals in third class cities and county hospitals operate.

These provisions are identical to provisions in SCS/HCS/HB 943 (2025) and SCS/SB 317 (2025) and substantially similar to SB 244 (2025).

EPINEPHRINE PRODUCTS (Sections 167.627, 167.630, 190.246, 196.990, and 321.621)

This act changes "epinephrine auto-injector" to "epinephrine delivery device" throughout statute.

These provisions are similar to provisions in HB 165 (2025) and HB 553 (2025).

COMMUNITY PARAMEDIC SERVICES (Sections 190.098)

This act modifies provisions relating to certification of community paramedics and the provision of community paramedic services. Community paramedic services shall mean those services provided by an entity that employs licensed paramedics certified by the Department of Health and Senior Services as community paramedics for services that are provided in a nonemergent setting, consistent with the education and training of a community paramedic and the supervisory standard approved by the medical director, and documented in the entity's patient care plans or protocols.

Any ambulance service that seeks to provide community paramedic services outside of its service area shall have a memorandum of understanding (MOU) with the ambulance service of that area if that ambulance service is already providing those services or shall notify the ambulance services of that area if that ambulance service is not providing community paramedic services. Emergency medical response agencies (EMRAs) may provide community paramedic services in a ground ambulance service's service area. If the ground ambulance service is already providing those services, then the EMRA and ground ambulance service may enter into a MOU for the coordination of services. If the ground ambulance service provides those services after the EMRA begins to provide them, then the ground ambulance service and EMRA shall enter into a MOU for the coordination of services.

The Department shall establish regulations for the purpose of recognizing community paramedic services entities that have met the standards necessary to provide such services. The Department shall endorse such entities to provide community paramedic services for a period of 5 years.

These provisions are similar to a provision in SCS/HCS/HB 943 (2025) and SCS/SB 317 (2025), SB 548 (2025), SB 206 (2025), and SCS/SB 1382 (2024).

DOULA SERVICES (Sections 191.708, 208.152, 208.662, and 208.1400-1425)

This act creates the "Missouri Doula Reimbursement Act". Under this act, the chief medical officer or chief medical director of the Department of Health and Senior Services, the Department of Mental Health, or the MO HealthNet Division of the Department of Social Services may issue nonspecific recommendations for doula services, a medical standing order for prenatal vitamins, or a medical standing order for a purpose promulgated in rule, to terminate as specified in the act.

Additionally, this act adds doula services and childbirth education classes for pregnant women and a support person to the list of covered MO Healthnet and "Show-Me Healthy Babies Program" services, to be reimbursed as described in the act. The Department of Social Services shall study the impact of the childbirth education classes on infant and maternal mortality and shall submit a report to the General Assembly prior to January 1, 2028.

These provisions are identical to provisions in HCS/SB 94 (2025) and HCS/HB 1095 (2025).

TELEHEALTH (Sections 191.1146, and 334.108)

Currently, the establishment of a physician-patient relationship for purposes of telehealth shall include an interview and a physical examination. Under this act, an evaluation is required, but a physical examination shall be required only if needed to meet the standard of care.

Current law prohibits the use of an internet or telephone questionnaire completed by a patient from constituting an acceptable medical interview for the provision of treatment by telehealth. This act permits such questionnaires if the information provided is sufficient as though the medical evaluation was performed in person, with a report to be provided to the patient's primary health care provider within fourteen days of evaluation, as described in the act.

Additionally, current law requires a physician-patient relationship for purposes of telehealth to include a sufficient dialogue with the patient regarding treatment. This act changes "dialogue" to "exchange" with the patient regarding treatment.

Finally, current law prohibits a health care provider from prescribing any drug, controlled substance, or other treatment to a patient based solely on an internet request or questionnaire. Under this act, a health care provider shall not prescribe any drug, controlled substance, or other treatment to a patient in the absence of a proper provider-patient relationship.

These provision are substantially similar to SB 108 (2025) and SB 851 (2024) and similar to SCS/SB 418 (2023) and HB 710 (2023).

DEPARTMENT OF HEALTH AND SENIOR SERVICES CONTRACTS FOR PUBLIC HEALTH (Section 192.021)

This act authorizes the Department of Health and Senior Services to contract with an entity on a qualified vendor list comprised of Missouri affiliates of national public health associations or public health institutes in order to assist in carrying out its duties to promote the health and well-being of Missouri residents. Such contracts may include efforts to assist in the delivery of health services throughout the state and the administration of grant funds and related programs. The Department and the designated affiliate shall provide a report to the General Assembly as specified in the act.

This provision is substantially similar to a provision in HCS/SB 94 (2025) and SB 549 (2025).

LIMITS ON SALE OF OVER-THE-COUNTER DRUGS (Sections 195.417 and 579.060)

Current law prohibits the sale, purchase, or dispensation of ephedrine, phenylpropanolamine, or pseudoephedrine to the same individual in a twelve-month period in any total amount greater than 43.2 grams without a valid prescription. This act changes the total amount to 61.2 grams.

These provisions are identical to provisions in SB 548 (2025), SB 143 (2025), SCS/HCS/HB 943 (2025), SCS/SB 317 (2025), SS/SCS/HCS/HB 1659 (2024), and SCS/SB 1485 (2024) and similar to HB 2824 (2024).

Beginning October 1, 2026, any manufacturer of any drug product containing any detectable amount of ephedrine, phenylpropanolamine, or pseudoephedrine sold in this state shall fees to the administrator of the real-time electronic pseudoephedrine tracking system, as specified in the act. A manufacturer who fails to knowingly pay such fee shall have committed the offense of unlawful sale, distribution, or purchase of over-the-counter methamphetamine precursor drugs, which is a Class A misdemeanor.

These provisions are identical to a provision in SB 725 (2025) and HB 1036 (2025).

ADMINISTRATION OF MEDICATIONS (Sections 196.990 and 335.081)

This act adds licensed long-term care facilities and child care facilities to the definition of "authorized entity" in current law permitting such entities to stock a supply of epinephrine delivery devices for use in an emergency. Additionally, the administration by technicians, nurses' aides, or their equivalent in long-term care facilities of epinephrine delivery devices and subcutaneous injectable medications to treat diabetes shall not be prohibited by nurse licensing laws.

These provisions are similar to provisions in SCS/HCS/HB 943 (2025), SB 548 (2025), SCS/SB 317 (2025), and HCS/HB 2824 (2024).

HOSPITAL WORKPLACE VIOLENCE (Section 197.708)

Under this act, each hospital shall prominently display a printed sign, in all capital letters, warning that assaulting a health care professional is a serious crime which may be punishable as a class A misdemeanor.

This provision is identical to a provision HCS/SB 94 (2025) and HCS/HB 1213 (2025) and substantially similar to SB 791 (2025).

INSPECTIONS OF LONG-TERM CARE FACILITIES (Sections 198.022 and 198.070)

Under this act, the Department of Health and Senior Services may accept, in lieu of an inspection conducted by the Department, a written report of a survey or inspection conducted by any state or federal agency, provided the survey or inspection is comparable in scope or method to the Department's inspections and conducted in accordance with Title XVIII of the Social Security Act. A residential care or assisted living facility shall be subject to an inspection by the Department if the facility fails to maintain an accredited status by a recognized accreditation entity. Finally, if a facility exempt from an annual inspection under this act has one or more violations of any class I standards, then the facility shall be subject to a full inspection by the Department.

This provision is substantially similar to a provision in SCS/HCS/HB 943 (2025) and similar to SB 689 (2025).

MO HEALTHNET COVERAGE OF CERTAIN CLINICAL PATHOLOGY SERVICES (Section 208.149)

This act requires that the fee for the professional component of clinical pathology services shall be paid by MO HealthNet for professional services provided by a hospital-based pathologist for inpatient clinical pathology services rendered to MO HealthNet patients. The reimbursement shall be set at thirty percent of the approved outpatient simplified fee schedule based on Medicare's clinical laboratory fee schedule, as described in the act.

This provision is identical to a provision in HCS/SB 94 (2025) and SCS/HCS/HB 943 (2025).

FOOD-BORNE ALLERGIES (Section 210.225)

This act establishes "Elijah's Law". Before July 1, 2028, each licensed child care provider shall adopt a policy on allergy prevention and response with a focus on potentially deadly food-borne allergies, as specified in the act. The Department of Elementary and Secondary Education shall develop a model policy or policies before July 1, 2027.

This provision is substantially similar to SB 783 (2025) and HB 580 (2025).

PRACTICE OF DENTISTRY IN CORRECTIONAL CENTERS (Section 332.081)

Current law provides that no corporation shall practice dentistry unless that corporation is a nonprofit corporation or a professional corporation under Missouri law. This act provides that such provision shall not apply to entities contracted with the state to provide care in correctional centers.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), SB 143 (2025), SB 548 (2025), SCS/SB 317 (2025), SS/SCS/HCS/HB 1659 (2024), SB 1287 (2024), and HB 2280 (2024).

ADMINISTRATION OF CERTAIN VACCINES (Section 338.010)

This act provides that the practice of pharmacy shall include the ordering and administering of vaccines, except for the vaccine for chikungunya and those vaccines approved by the U.S. Food and Drug Administration after January 1, 2026, instead those after January 1, 2023.

This provision is substantially similar to a provision in SCS/HCS/HB 943 (2025), SB 548 (2025), SCS/SB 317 (2025), SB 1455 (2024), SCS/HB 2280 (2024), and HB 2879 (2024).

LICENSURE OF WHOLESALE DRUG DISTRIBUTORS (Section 338.333)

Under this act, the Board of Pharmacy may permit an out-of-state wholesale drug distributor or third-party logistics provider to be licensed in this state despite not having a license issued by the distributor's or provider's resident state if the distributor or provider has a current and valid drug distributor accreditation from the National Association of Boards of Pharmacy.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), HCS/SB 94 (2025), and HB 1465 (2025).

RX CARES FOR MISSOURI PROGRAM (Section 338.710)

This act removes the expiration date of August 28, 2026, from the "RX Cares for Missouri Program".

This provision is identical to HB 1445 (2025).

INSURANCE COVERAGE OF ANESTHESIA SERVICES (Section 376.1245)

Under this act, no health carrier or health benefit plan shall establish, implement, or enforce any policy that imposes a time limit for the payment of anesthesia services provided during a medical or surgical procedure, as described in the act.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), HCS/SB 94 (2025), and HCS/HBs 1126 & 932 (2025).

INSURANCE COVERAGE OF ALTERNATIVES TO OPIOID DRUGS (Section 376.1280)

This act provides that if an enrollee has an elevated risk of opioid misuse, as defined in the act, the enrollee's health benefit plan shall not deny coverage of a non-opioid prescription drug in favor of an opioid drug, require the enrollee to try an opioid drug before covering the non-opioid prescription drug, or require a higher level of cost-sharing for a non-opioid prescription drug than for an opioid drug.

This act shall apply to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027.

This provision is substantially similar to SB 902 (2026) and substantially similar to SB 158 (2025).

SARAH HASKINS

SB 895 - Under this act, any person who has at least 3 years of work experience in an occupation or profession in another state or the District of Columbia that does not use a license to regulate that occupation or profession may submit an application for a license in Missouri, with proof of experience and U.S. citizenship, to the relevant oversight body. Within 45 days of receiving the application, the oversight body shall make a determination of qualification. The oversight body shall require an applicant to take and pass a profession-specific examination and may require an examination specific to Missouri laws.

A license issued under this act shall be a one-time, non-renewable, two-year temporary license. If the applicant is not residing in Missouri, the oversight body shall conditionally approve the application. If an applicant fails to provide proof of domicile in Missouri within 90 days of receipt of temporary license, the oversight body may terminate the temporary license and the applicant may reapply for the temporary license.

Upon expiration of the temporary license, individuals shall be required to apply for a permanent license, consistent with the licensure and application requirements of that license as set forth in statute and rule. A license issued under this act shall not be qualified for reciprocity with another state or as part of an interstate compact. The provisions of this act shall not apply to certain specified professions.

This act is identical to a provision in SS/SB 61 (2025) and in the perfected HB 478 (2025) and is similar to a provision in SB 817 (2024), in HCS/SS#2/SCS/SB 88 (2023) and HB 1900 (2022).

KATIE O'BRIEN

Additionally, health care providers shall not be required to obtain prior authorization for any health care services unless the health carrier or utilization review entity has approved or would have approved less than 90% of all prior authorization requests submitted by that provider for health care services.

Health carriers and utilization review entities shall notify providers within 25 days after a determination is made under the act, shall include in the notification certain information used in making the determination, shall establish an appeals process for the providers, and shall maintain an online prior authorization portal as described in the act.

No health carrier or utilization review entity shall deny or reduce payment to a health care provider for a health care service for which the provider has prior authorization, except as described in the act.

This act shall not apply to MO HealthNet services not provided through a managed care organization, or to providers who have not participated in a health benefit plan offered by the health carrier for at least one full evaluation period.

This act is substantially similar to HB 618 (2025) and to provisions in HCS/SB 94 (2025), and is similar to SB 230 (2025), SB 983 (2024), HB 1976 (2024), SB 576 (2023), and HB 1045 (2023).

TAYLOR MIDDLETON

This act shall apply to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027.

This act is similar to SB 158 (2025), HB 804 (2025), and provisions in HCS/SS/SB 7 (2025).

TAYLOR MIDDLETON

Under current law, collaborative practice arrangements between physicians and registered professional nurses may delegate to an APRN the authority to administer, dispense, or prescribe certain controlled substances. This act provides that the section of law providing for such agreements shall not apply to APRNs, excluding certified registered nurse anesthetists ("CRNAs"), who have been in a collaborative practice arrangement for a cumulative 2000 documented hours with a collaborating physician and whose license is in good standing. APRNs applying for licensure by endorsement may demonstrate to the Missouri State Board of Nursing completion of such hours. Additionally, any such APRN shall not be required to enter into or remain in such arrangement to practice in this state.

This act also provides that an APRN's prescriptive authority shall include authority to prescribe, dispense, and administer controlled substances as provided in current law. Furthermore, the provision on prescriptive authority shall also apply to good-standing APRNs who have been in collaborative practice arrangements for a cumulative 2000 documented hours with collaborating physicians and who are no longer required to hold collaborative practice arrangements.

This act is identical to SB 1016 (2026), provisions in SB 1719 (2026), HB 3040 (2026), SCS/SBs 144 & 179 (2025) and contains provisions identical to provisions in SB 809 (2024) and is substantially similar to HB 1875 (2024).

KATIE O'BRIEN

The Compact further provides that a dentist or dental hygienist with compact privilege shall function within the scope of practice authorized by the participating state in which they seek to practice and shall be subject to that state's regulatory authority. A dentist or dental hygienist whose privilege in a participating state is encumbered or removed is not eligible for compact privilege in other participating states until the encumbrance or removal has passed and all requirements are met.

Additionally, the Compact creates the Dentist and Dental Hygienist Compact Commission ("Commission"), which is a joint government agency of the participating states tasked with administering and implementing the Compact. Each participating state shall have one Commissioner, who shall be selected within sixty days by the licensing authority of the participating state. Additionally, there shall be an Executive Board of the Commission, composed of seven Commissioners, to act on behalf of the Commission.

The act provides for the powers and duties of the Commission, including the development and maintenance of a coordinated database and reporting system containing licensure, adverse actions, and investigative information on all licensees and applicants. The Commission may levy on and collect an annual assessment from each participating state and impose fees on licensees for the compact privilege in order to cover the cost of the operations and activities of the Commission and its staff.

Upon enactment, the Compact shall be reviewed by the Commission to determine if it is materially different from the Model Compact and whether the state qualifies for participation in the Compact. Any state that adopts the Compact subsequent to the Commission’s initial adoption of the rules and bylaws shall be subject to the rules and bylaws existing on the date on which the Compact becomes law.

Any participating state may withdraw from the Compact by repealing the Compact, but such withdrawal shall not take effect until 180 days after the enactment of the repeal. Finally, the Compact shall be binding upon participating states and shall supersede any conflict with state law.

This act is similar to HB 1847 (2026), HCS/SS/SB 7 (2025), a provision in HB 56 (2025), in HCS/SS/SB 61 (2025), SB 327 (2025), in HB 1031 (2025), in SCS/HCS/HB 943 (2025), in SS/SB 778 (2024), and HB 2075 (2024).

KATIE O'BRIEN

Under current law, collaborative practice arrangements between physicians and registered professional nurses may delegate to an APRN the authority to administer, dispense, or prescribe certain controlled substances. This act provides that the section of law providing for such agreements shall not apply to APRNs, excluding certified registered nurse anesthetists ("CRNAs"), who have been in a collaborative practice arrangement for a cumulative 2000 documented hours with a collaborating physician and whose license is in good standing. APRNs applying for licensure by endorsement may demonstrate to the Missouri State Board of Nursing completion of such hours. Additionally, any such APRN shall not be required to enter into or remain in such arrangement to practice in this state.

This act also provides that an APRN's prescriptive authority shall include authority to prescribe, dispense, and administer controlled substances as provided in current law. Furthermore, the provision on prescriptive authority shall also apply to good-standing APRNs who have been in collaborative practice arrangements for a cumulative 2000 documented hours with collaborating physicians and who are no longer required to hold collaborative practice arrangements.

This act is identical to SB 979 (2026), provisions in SB 1719 (2026), HB 3040 (2026), SCS/SBs 144 & 179 (2025), contains provisions identical to SB 809 (2025), and is substantially similar to HB 1875 (2024).

KATIE O'BRIEN

This act is identical to SB 17 (2025), SB 943 (2024), and SB 673 (2023) and substantially similar to a provision in SS/SB 830 (2024).

SARAH HASKINS

A defendant who receives notice of an alleged website accessibility violation and in good faith takes substantial steps to correct the violation within 90 days shall have a rebuttable presumption that any subsequent litigation is not abusive. The presumption may be overcome by a showing that the defendant failed to complete reasonable corrective measures within 90 days or acted in bad faith.

The Attorney General may intervene or bring an action on behalf of Missouri residents that are targets of abusive website access litigation. The Attorney General may also issue guidance as to when litigation practices are deemed abusive, but such guidance shall not preclude legitimate accessibility enforcement actions.

The court may award attorney's fees to the party defending against the abusive litigation. The court may also award punitive damages or sanctions not to exceed three times the amount of attorney's fees awarded by the court.

If the U.S. Department of Justice issues standards concerning website accessibility under the federal Americans with Disabilities Act, the provisions of this act shall expire.

This act is substantially similar to HB 1694 (2026) and is similar to SB 907 (2026), SB 1272 (2026), HB 1674 (2026), HB 1755 (2026), HB 1780 (2026), HB 1842 (2026), HB 2056 (2026), HB 2150 (2026), and HB 2312 (2026).

KATIE O'BRIEN

This act is identical to SB 522 (2025) and SB 545 (2025), is substantially similar to a provision in HB 1981 (2026), in HB 831 (2025), and is similar to a provision in SB 910 (2024), HB 1561 (2024), and HB 1881 (2024).

KATIE O'BRIEN

If the defendant in a website access violation case attempts to correct the alleged violation within 30 days of being provided notice, there shall be a rebuttable presumption that the subsequent initiation or continuance of litigation constitutes abusive litigation. Such presumption shall not exist if the alleged violation is not corrected within 90 days under circumstances described in the act. If the Attorney General determines that the website access litigation is not abusive, then there shall be a rebuttable presumption that the litigation is not abusive.

The court may award attorney's fees to the party defending against the abusive litigation. The court may also award punitive damages or sanctions not to exceed three times the amount of attorney's fees awarded by the court.

If the U.S. Department of Justice issues standards concerning website accessibility under the federal Americans with Disabilities Act, the provisions of this act shall expire.

This act is identical to HB 2056 (2026), is substantially similar to SB 907 (2026), HB 1674 (2026), HB 1755 (2026), HB 1780 (2026), HB 1842 (2026), HB 2150 (2026), and HB 2312 (2026), and is similar to SB 1154 (2026) and HB 1694 (2026).

KATIE O'BRIEN

Additionally, current law provides a sales tax exemption for the sales or rental of manual and powered wheelchairs, including parts. This act applies the exemption to accessories for such wheelchairs. (Section 144.030)

This provision is identical to SB 173 (2023) and to a provision in SB 573 (2025), SB 1180 (2024), HCS/HB 1427 (2024), HB 1817 (2024), HCS/SS/SB 143 (2023), and SCS/HCS/HB 154 (2023), and is similar to SB 943 (2022), HB 1864 (2022), and SB 483 (2021), and to a provision in SS/SCS/SB 649 (2022), SB 743 (2022), CCS/HCS/SB 226 (2021).

This act also provides a sales tax exemption for sales of class III medical devices that use electric fields for the purposes of treatment of cancer, including components and repair parts and disposable or single patient use supplies required for the use of such supplies. (Section 144.813)

This provision is identical to a provision in SB 573 (2025), SB 1180 (2024), HCS/HB 1427 (2024), HB 1817 (2024), SS/SCS/SB 131 (2023), and SCS/HCS/HB 154 (2023), and is substantially similar to SB 943 (2022), HB 1864 (2022), and SB 483 (2021), and to a provision in SS/SCS/SB 649 (2022), SB 743 (2022), CCS/HCS/SB 226 (2021).

JOSH NORBERG

This act is identical to SB 1247 (2026), SB 545 (2025), and SB 522 (2025), is substantially similar to a provision in HB 1981 (2026), in HB 831 (2025), and is similar to a provision in SB 910 (2024), HB 1561 (2024), and HB 1881 (2024).

KATIE O'BRIEN

CLINICIAN-ADMINISTERED DRUGS (Section 376.411)

This act provides that a health carrier or pharmacy benefits manager (PBM) shall not impose any penalty, impediment, differentiation, or limitation on participating providers for providing medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to refusing to approve or pay, or reimbursing less than the contracted payment amount.

Carriers and PBMs shall not impose any penalty, impediment, differentiation, or limitation on a covered person who is administered medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to: limiting coverage or benefits; requiring an additional fee, higher co-payment, or higher coinsurance amount; or interfering with a patient's ability to obtain a clinician-administered drug from the patient's provider or pharmacy of choice by any means, including but not limited to inducing, steering, or offering financial or other incentives.

Carriers and PBMs shall not impose any penalty, impediment, differentiation, or limitation on any pharmacy that is dispensing medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to requiring a pharmacy to dispense the drugs to a patient with the intention that the patient will transport the medication to a health care provider for administration.

These provisions shall not apply if the clinician-administered drug is not otherwise covered by the carrier or PBM.

These provisions are identical to provisions in SB 13 (2025), the introduced SB 751 (2024), HCS/HB 2267 (2024), SB 26 (2023), HCS/HB 198 (2023), SB 1129 (2022), and HB 2305 (2022), and similar to provisions in SB 921 (2022), SB 1129 (2022), and HB 2305 (2022).

REFERENCE PRODUCTS AND BIOSIMILARS (Section 376.415)

A health carrier or PBM providing coverage for a reference product or a biological product that is biosimilar to the reference product shall provide coverage for the reference product and all biological products that have been deemed biosimilar to the reference product. The scope, extent, and amount of the required coverage shall be the same, including but not limited to any payment limitations or cost-sharing obligations.

These provisions are identical to provisions in SB 13 (2025), the introduced SB 751 (2024), HCS/HB 2267 (2024), SB 26 (2023), HCS/HB 198 (2023), SB 1129 (2022), and HB 2305 (2022), and similar to provisions in SB 921 (2022), SB 1129 (2022), and HB 2305 (2022).

340B DRUG PRICING PROGRAM (Section 376.416)

Under this act, no health carrier or pharmacy benefits manager (PBM) shall discriminate against a covered entity or a pharmacy, as such terms are defined in the act, by:

• Reimbursing a covered entity or pharmacy for a quantity of a 340B drug, as defined in the act, in an amount less than the carrier, PBM, or affiliate would pay to any other similarly situated pharmacy for such quantity of the drug on the basis that the entity or pharmacy is a covered entity or a pharmacy, or that the entity or pharmacy dispenses 340B drugs. (Section 376.416.2(1));

• Imposing any terms or conditions on covered entities or pharmacies which differ from the terms or conditions applicable to other similarly situated pharmacies or entities on the basis that the entity or pharmacy is a covered entity or dispenses 340B drugs, including but not limited to certain terms and conditions described in the act. (Section 376.416.2(2));

• Interfering with an individual's choice to receive a 340B drug from a covered entity or pharmacy. (Section 376.416.2(3));

• Discriminating in reimbursement to a covered entity or pharmacy based on the determination or indication a drug is a 340B drug. (Section 376.416.2(4));

• Requiring a covered entity or pharmacy to identify a 340B drug sooner than 45 days after the point of sale of the drug. (Section 376.416.2(5));

• Refusing to contract with a covered entity or pharmacy for reasons other than those that apply equally to entities or pharmacies that are not covered entities or similarly situated pharmacies, or on the basis that the entity or pharmacy is a covered entity as described under federal law, or on the basis that the entity or pharmacy is described as a covered entity under provisions of federal law. (Section 376.416.2(6));

• Denying the covered entity the ability to purchase drugs at 340B program pricing by substituting a rebate discount. (Section 376.416.2(7));

• Refusing to cover drugs purchased under the 340B drug pricing program. (Section 376.416.2(8)); or

• Requiring a covered entity or pharmacy to reverse, resubmit, or clarify a 340B-drug pricing claim after the initial adjudication unless these actions are in the normal course of pharmacy business and not related to the 340B drug pricing, except as required by federal law. (Section 376.416.2(9)).

The Director of the Department of Commerce and Insurance shall impose a civil penalty on any health carrier or PBM violating certain provisions of the act, not to exceed $5,000 per violation per day. (Section 376.416.3).

These provisions are identical to provisions in SB 13 (2025), and similar to provisions in SB 372 (2025), HB 784 (2025), HB 785 (2025), HB 943 (2025), the introduced SB 751 (2024), SCS/SBs 978 & 1035 (2024), SB 1213 (2024), HCS/HB 2267 (2024), HB 1977 (2024), SB 26 (2023), HCS/HB 198 (2023), SB 426 (2023), HB 197 (2023), SB 921 (2022), HCS/HB 1677 (2022), SB 1129 (2022), and HB 2305 (2022).

PRIOR AUTHORIZATION OF HEALTH CARE SERVICES (Sections 376.2100, 376.2102, 376.2104, 376.2106, and 376.2108)

This act enacts provisions relating to prior authorization of health care services.

Beginning January 1, 2027, health care providers shall not be required to obtain prior authorization for a health care service unless the health carrier or utilization review entity determines that in the most recent evaluation period, as defined in the act, less than 90% of the prior authorization requests submitted by that provider for that health care service were approved or would have been approved.

Also beginning January 1, 2027, health care providers shall not be required to obtain prior authorization for any health care services unless the health carrier or utilization review entity has approved or would have approved less than 90% of all prior authorization requests submitted by that provider for health care services.

Health carriers or utilization review entities may elect to have certain hospitals determine which of certain conditions, laid out in the act, the hospital will comply with in order to obtain a prior authorization exemption under the act.

Exemptions from prior authorization under the act shall not apply to: pharmacy services, not to exceed the amount of $100,000; imaging services, not to exceed $100,000; cosmetic procedures that are not medically necessary; or investigative or experimental treatments. Maximum dollar amounts for these exceptions shall be adjusted annually for inflation as described in the act.

The act further specifies certain prior authorization requests that shall not be included in making determinations under the act, specifies identification methods for the providers, includes provisions for the auditing and retraction of determinations under the act, allows for health carriers and utilization review entities to require providers to use an online portal to submit prior authorization requests, requires adverse determinations under the act to be reviewed by a clinical peer of the provider, and requires a grace period for patients who have received prior authorization for a 90-day supply of medication.

Health carriers and utilization review entities shall notify providers within 25 days after a determination is made under the act, shall include in the notification certain information used in making the determination, shall establish an appeals process for the providers, and shall maintain an online prior authorization portal as described in the act.

No health carrier or utilization review entity shall deny or reduce payment to a health care provider for a health care service for which the provider has prior authorization, except as described in the act.

These provisions shall not apply to MO HealthNet services not provided through a managed care organization, or to providers who have not participated in a health benefit plan offered by the health carrier for at least one full evaluation period.

These provisions are identical to HCS/SS#2/SB 79 (2025), HB 618 (2025), and similar to SB 230 (2025), SB 983 (2024), HB 1976 (2024), SB 576 (2023), and HB 1045 (2023).

TAYLOR MIDDLETON

This provision is identical to provisions in HCS/SB 94 (2025), HCS/HBs 1126 & 932 (2025), and SCS/HCS/HB 94 (2025).

TAYLOR MIDDLETON

MINIMUM WAGE (Section 290.502)

The act reinstates an annual cost of living index for the minimum wage rate.

EARNED PAID TIME (Sections 290.601 through 290.643)

The act reinstates the provisions of law establishing a system of earned paid sick time.

The act provides that all applicable employees accrue a minimum of one hour of earned paid sick time for every 30 hours worked. Employees of an employer with 15 or more employees can use up to 56 hours of time in any given year but employees of an employer with fewer than 15 employees can only use 40 hours of time in any given year. Accrual begins January 1, 2027, or upon the commencement of employment, whichever is later. Employees may used earned paid sick time following 90 days of continuous employment, unless an employer's written policy allows the use of such leave prior to such time.

The act limits the reasons for which an employee may use earned paid sick time to the following reasons:

• An employee's mental or physical illness, injury, or health condition; an employee's need for medical diagnosis, care, or treatment of a mental or physical illness, injury, or health condition; an employee's need for preventative medical care;

• Care of a family member with a mental or physical illness, injury, or health condition; care of a family member who needs medical diagnosis, care, or treatment of a mental or physical illness, injury, or health condition; care of a family member who needs preventative medical care;

• Closure of the employee's place of business by order of a public official due to a public health emergency, or an employee's need to care for a child whose school or place of care has been closed by order of a public official due to a public health emergency, or care for oneself or a family member when it has been determined by the health authorities having jurisdiction or by a health care provider that the employee's or family member's presence in the community may jeopardize the health of others because of his or her exposure to a communicable disease, whether or not the employee or family member has actually contracted the communicable disease; or

• Absence necessary due to domestic violence, sexual assault, or stalking, provided the leave is to allow the employee to obtain for the employee or the employee's family member one of several listed services, described in the act.

Earned paid sick time shall be provided upon the request of an employee. Such request may be made orally, in writing, by electronic means, or by any other means acceptable to the employer. When possible, the request shall include the expected duration of the absence. Employees shall provide notice of the need for using earned paid sick time when the use is foreseeable.

The act additionally allows certain private employees to earn paid bereavement time in the same manner as earned paid sick time is accrued. Earned paid bereavement time can be used within 90 days of the death of a family member, as defined under current law, or in connection with an event resulting in reproductive loss. Earned paid bereavement time shall begin to accrue at the commencement of employment or January 1, 2027, whichever is later. All provisions applicable to the accrual and use of earned paid sick time are applicable to the accrual and use of earned paid bereavement time under this act.

Employers may request, but not require, employees to search for or find a replacement worker to cover hours during which the employee is using earned paid sick time. Additionally, an employer may require reasonable documentation, as described in the act, for time used on three or more consecutive work days.

Any employer who willfully violates or fails to comply with any of the provisions and requirements of this act shall be guilty of a class C misdemeanor. Each day of violation or failure to comply and each employee affected shall constitute a separate offense.

Furthermore, any individual who claims to have been aggrieved by a failure of an employer to comply with any portion of this act, including but not limited to the failure to provide earned paid sick time or to allow employees to use such time, or who claims to have suffered a retaliatory personnel action prohibited by this act, shall have a right of action and may commence a civil action in the appropriate court of jurisdiction within three years of the accrual of the cause of action, to obtain appropriate relief with respect to such unlawful violation. Such action may be brought without first filing an administrative complaint. If the court finds a violation has occurred, the court may grant as relief, as it deems appropriate and to the extent permitted by law, any permanent or temporary injunction, the full amount of any unpaid earned sick time plus any actual damages suffered as the result of the employer's violation of this act, an additional amount equal to twice any unpaid earned sick time as liquidated damages, costs, and reasonable attorney's fees as may be allowed by the court, and other legal or equitable relief as may be appropriate to remedy the violation, including, without limitation, reinstatement to employment and back pay.

SCOTT SVAGERA

This act shall apply to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027.

This act is similar to SB 158 (2025), HB 804 (2025), and provisions in HCS/SS/SB 7 (2025).

TAYLOR MIDDLETON

If the defendant in a website access violation case attempts to correct the alleged violation within 30 days of being provided notice, there shall be a rebuttable presumption that the subsequent initiation or continuance of litigation constitutes abusive litigation. Such presumption shall not exist if the alleged violation is not corrected within 90 days under circumstances described in the act. If the Attorney General determines that the website access litigation is not abusive, then there shall be a rebuttable presumption that the litigation is not abusive.

The court may award attorney's fees to the party defending against the abusive litigation. The court may also award punitive damages or sanctions not to exceed three times the amount of attorney's fees awarded by the court.

If the U.S. Department of Justice issues standards concerning website accessibility under the federal Americans with Disabilities Act, the provisions of this act shall expire.

This act is substantially similar to SB 907 (2026), SB 1272 (2026), HB 1674 (2026), HB 1755 (2026), HB 1780 (2026), HB 1842 (2026), HB 2056 (2026), HB 2150 (2026), and HB 2312 (2026), and is similar to SB 1154 (2026) and HB 1694 (2026).

KATIE O'BRIEN

This act also modifies provisions relating to abuse and neglect of elderly and disabled persons by adding financial exploitation to the definition of "abuse"; adding persons to the list of mandated reporters in current law for in-home services clients, long-term care facilities, and personal care assistance services; requiring certain investigative reports to be confidential; and permitting hearings for persons placed on employee disqualification lists to take place by telephone or electronic means.

This act establishes procedures for reporting misappropriation of property or funds for patients of certain medical facilities and entities, including hospitals and home health agencies.

Finally, this act makes several technical changes to the current elderly and disabled persons abuse and neglect statutes.

SARAH HASKINS

The Compact creates a joint government agency ("Commission") and provides for its powers and duties, including overseeing the administration of the Compact, issuing advisory opinions and training on the Compact, and enforce compliance with the Compact. Additionally, each state's dental board shall have two voting members on the Commission, with one member required to be a member of the Missouri Dental Board. States shall submit all actions and documents determined by the Commission to the Clearinghouse, which is described in the act as the clearinghouse and databank administered by the American Association of Dental Boards that houses adverse actions and denials of licensure from the state dental boards. Insurance companies and entities verifying documents for the purposes of licenses to dentists or dental hygienists may seek information from the Clearinghouse for public record documents.

The Compact sets forth the requirements for a dentist or dental hygienist to obtain and exercise the ability to practice in other participating states with the home state's dental board determining the eligibility of an application for a compact license privilege. The Compact further provides that a dentist or dental hygienist with compact privilege shall be subject to and comply with the laws and regulations of the participating state in which they seek to practice and shall be subject to that state's dental board. Appeals of a denial of a compact privilege application shall be filed with the home state within thirty days of the denial.

Additionally, a licensee shall notify the Commission within ten days of any adverse action taken against his or her license in a state that is not a member of the Compact. Home states may take adverse actions against a holder of a compact license privilege regardless of where the actions occurred and any participating state where the compact licensee holds a compact license privilege may investigate an allegation of a violation of the laws and rules of the practice of dentistry or dental hygiene in any other state where the licensee holds a compact license privilege. Participating states may also participate together in joint investigations of compact licensees.

Dental boards issuing a compact license privilege may also impose a fee for such privilege, except no fee shall be required for any active-duty military member or their spouse for up to one year after separation from the service.

Furthermore, the Compact shall become active and binding upon the fifth state's enactment of the Compact. Any participating state may withdraw from the Compact by repealing the Compact, but the Compact shall remain in effect until six months after the date of withdrawal.

This act is identical to SB 109 (2025) and HB 1290 (2025).

KATIE O'BRIEN

Any individual may report violations of the act to the Department of Natural Resources. If the Department finds that a violation occurred, the Department shall ask the Attorney General to commence a civil action. If the court finds that a violation occurred, the court may grant relief as described in the act.

JULIA SHEVELEVA

This act also repeals a provision of law prohibiting the Administrative Hearing Commission from granting a stay order when the claim arises under certain programs funded, in whole or in part, by federal funds.

This act is identical to HB 2538 (2026).

SARAH HASKINS

The numerator of the dental loss ratio shall be the amount expended for clinical dental services provided to dental plan enrollees, including payments under capitation contracts with dental providers. Costs and payment amounts not included in the numerator are defined in the act.

The denominator of the dental loss ratio shall be the amount of all earned premiums received by the dental plan for dental services, excluding federal and state taxes, licensing fees, regulatory fees, payments or receipts for risk adjustments, risk corridors, reinsurance, community benefit expenditures, and other payments required by federal law.

The dental plan shall provide an annual rebate to each enrollee, on a pro rata basis, to the extent the dental loss ratio is less than eighty-five percent before August first of the year following the year for which the dental loss ration report was issued.

Any failure to rebate the amount prescribed in this act by a dental plan not required to be licensed by the Department of Commerce and Insurance, shall be deemed an unlawful practice under current law.

This act is identical to HB 2471 (2026).

TAYLOR MIDDLETON

This act is identical to HCS/HB 2974 (2026).

KATIE O'BRIEN

KATIE O'BRIEN