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MissouriHB23722026 Regular SessionHouseWALLET
Modifies provisions relating to health care
Sponsored By: Tara Peters (Republican)
Signed by Governor
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Bill Overview
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59 provisions identified: 41 benefits, 6 costs, 12 mixed.
State health plan covers Lyme care
The Missouri Consolidated Health Care Plan must cover testing, treatment, and management of Lyme disease and posttreatment Lyme disease syndrome. Coverage includes necessary office visits and ongoing tests. It includes experimental long-term antibiotic therapy when the drug has FDA approval for an indication. FDA-approved drugs used off-label for tick-borne disease are also covered. A licensed provider must diagnose the participant after evaluating symptoms, test results, or treatment response.
Broader breast exams without cost sharing
Plans subject to the breast-exam coverage rule must cover contrast-enhanced mammograms and expanded supplemental exams. Supplemental exams include those based on added cancer risk, including heterogeneously or extremely dense breasts. Covered exams carry no cost-sharing under this section. For health savings account-qualified high-deductible plans, that protection starts after the federal minimum deductible is met. Federally defined preventive care remains covered without cost-sharing before that deductible is met.
Children entering custody get health deadlines
Children entering custody must receive a physical exam within 72 hours. They must receive a referral for developmental, behavioral, and emotional screening within 30 days after that exam. The exam provider must request past medical records, which must arrive within 30 days of placement and be accessible to foster families. Vaccines cannot be given during the physical without a parent or legal guardian's consent. If screening finds a concern, a full assessment may be completed within 60 days after entry into custody.
Drug approvals move online for patients
Beginning July 1, 2028, health carriers must maintain online prescription-drug approval systems linked to qualifying prescribing and health-record systems. They must show real-time patient costs and support approvals needing no extra information or clinical review when approval criteria are met. Carriers cannot charge for access or access provider data beyond the enrollee's data without provider consent. Carriers without the required system generally cannot require drug prior approval, except as department rules allow.
Health plans must ease care approvals
By January 1, 2028, health carriers and review entities must maintain a federally compliant digital approval system for non-drug care. Carriers must accept requests through it; carriers needing more time must submit a written extension request and compliance plan. Carriers must also reduce which claims need prior approval, and the insurance department must publish findings by October 1 yearly. MO HealthNet managed-care groups and the division face phased compliance deadlines of July 1, 2027, and July 1, 2028. Those deadlines cover referenced requirements whose full details are not included in this provision.
Hospital billing violations block debt collection
Beginning August 28, 2026, hospitals cannot start or continue collecting certain debts from patients or their guarantors. The debt must cover care received during material violations of federal hospital price-transparency rules. A federal penalty or official notice of material deficiencies left uncorrected after warnings or corrective plans must document the violation. Only care provided during that violation period qualifies.
Maternity plans cover home pressure monitors
Beginning January 1, 2027, Missouri plans with maternity benefits must cover prescribed home blood pressure monitors and related education and training. This applies to plans delivered, issued, continued, or renewed on or after that date. Coverage applies during pregnancy and up to 12 months postpartum when medically appropriate under American College of Obstetricians and Gynecologists guidelines. A repeat prescription is covered only for a condition that worsens enough to require it or for a later pregnancy.
Medicaid nutrition program needs federal approval
The Department of Social Services can seek a federal waiver for a MO HealthNet Food is Medicine program. It targets participants with nutrition-related chronic diseases. Services may include case management, nutrition counseling, medically tailored meals or groceries, and produce prescriptions. Starting the program depends on federal waiver approval.
Medical assistance rules continue past expiration
The law removes the August 28, 2025, expiration date from a medical assistance provision. That provision continues instead of ending on that date. The supplied provision does not identify the specific benefits involved.
More facilities can stock emergency epinephrine
Authorized entities, including child care and licensed care facilities, can stock prescribed epinephrine delivery systems, not just auto-injectors. They must follow storage, training, oversight, and emergency-response requirements; public schools and public charter schools use separate rules. Emergency use without parental or guardian consent is allowed when that person is absent and imminent danger is reasonably believed. Liability protections extend to administering or self-administering these systems. Those protections exclude reckless disregard and willful or wanton misconduct.
More group coverage options for workers
The law expands who can establish or maintain a multiple-employer self-insured plan. Plans can cover employees of at least two employers and their dependents. They can also cover at least two self-employed people, each with at least one common-law employee, and their dependents. Benefits can include health, dental, or short-term disability coverage. The arrangement cannot be fully insured.
Patients gain health coverage approval protections
For state-submitted claims covered by a MO HealthNet plan or waiver, covered entities must accept the state's coverage approval as prior approval. They cannot deny payment solely because their own prior approval was missing. The rule excludes the specified original Medicare, Medicare Advantage, cost-reimbursement, health care prepayment, and Part D programs. For provider contracts started or renewed beginning January 1, 2028, carriers can require electronic approval requests through the specified digital system. A provider's failure to use that system cannot change the patient's otherwise applicable cost-sharing.
Pharmacists gain device and drug authority
Pharmacists can prescribe medical devices authorized by joint rules from the state medical and pharmacy boards. Those rules must take effect within six months after the act's effective date. Pharmacists can also dispense ivermectin and hydroxychloroquine without a prescriber's order under Board of Pharmacy procedures and approved warning labels. The drugs must remain securely stored and unavailable for self-service; technicians need pharmacist supervision. Pharmacists must give use instructions when board procedures require them.
Pharmacists provide more treatment and vaccines
Pharmacists with medication therapeutic plan authority can provide medication services for flu, group A strep, and COVID-19 under joint board rules. This replaces the prior statewide-standing-order framework. Pharmacists can also order and give eligible FDA-approved or authorized vaccines, subject to statutory exclusions. Recipients must be at least seven or the CDC-recommended age, whichever is older; vaccines approved after January 1, 2026, need joint board inclusion. Vaccinations follow joint pharmacy and medical board rules, except when emergency rules apply.
Plans cannot cap anesthesia payment time
For contracts entered, renewed, or materially changed beginning January 1, 2027, covered plans cannot set anesthesia payment time limits. They also cannot exclude all anesthesia time when calculating payment for medical or surgical procedures. The rule includes MO HealthNet and the other specified state health programs. It excludes anesthesia connected with dental procedures and services performed under a dental license. It does not require payment for anesthesia given by an unlicensed or otherwise unqualified person.
Plans cover yearlong birth control supplies
Beginning January 1, 2027, plans covering self-administered hormonal birth control must reimburse dispensing a supply intended to last up to one year. This includes covered generic and brand-name products. The rule applies when plans are delivered, issued, continued, or renewed on or after that date. Deductibles and copayments cannot exceed those for similar health services. The 2026 requirements for up to 90 days, or 180 days for generics, end after December 31, 2026.
Pregnant Medicaid patients get doula coverage
Pregnant MO HealthNet participants who request doula care get at least six support sessions, plus up to ten more when needed. Coverage includes one birth, including a scheduled cesarean, and up to two lactation support visits. Community navigation is covered, with services outside those sessions limited to ten billings during pregnancy and the postpartum period. Enrolled doulas can enroll with affiliated fee-for-service and managed-care payers. Doula services must be paid on a fee-for-service schedule; payment rates are not stated.
Students gain more epinephrine device options
Students can carry and self-administer prescribed epinephrine delivery systems through the school authorization process. A physician must teach proper use, approve a written plan, and confirm skill with the required school-nurse involvement when available. Parents or guardians must submit the required documents and sign a liability statement. School boards can also authorize nurses to stock systems prescribed by a physician, physician assistant, or nurse practitioner. Nurses, properly trained employees, and trained contracted agents can give them for suspected life-threatening allergic reactions; trained contracted agents receive civil-liability protection.
Childbirth classes covered; doulas face standards
Show-Me Healthy Babies covers childbirth education classes when the unborn child is enrolled in the program. Doulas providing MO HealthNet-covered services must enroll as providers and be at least 18. They must have liability insurance, individually or through a supervising organization. They must also meet the applicable training or certification requirement.
Alpha-gal test results gain privacy protection
Laboratories and the Missouri health department cannot disclose identifiable alpha-gal test results or related protected health information to others. They may share that information only with the person tested and the provider who ordered the blood test.
Disabled parking permits require fewer renewals
Removable disabled windshield placards renew every eight years instead of four. During the transition, valid placards can renew automatically for eight years or until the current physician's statement expires. Missouri-licensed occupational therapists can certify plate or placard applications for conditions they may legally diagnose and treat. Applicants can use a Veterans Affairs statement verifying permanent disability instead of a physician's statement. People 75 or older who supplied a physician's statement with their original application do not need another when renewing.
Annual cold medicine purchase limit rises
The 12-month limit for covered ephedrine, phenylpropanolamine, and pseudoephedrine products rises from 43 grams to 61.2 grams per person. The matching quantity threshold for the specified unlawful sale, distribution, or purchase offense also rises to 61.2 grams. Valid-prescription exceptions remain in place.
Care staff can give more injections
Trained technicians, nurses' aides, and equivalent staff in licensed long-term care facilities can give specified injectable medicines. These include insulin and prescribed diabetes medicines injected under the skin. Diabetes medicines must be ordered by an authorized prescriber. Staff can also give epinephrine delivery systems ordered for stock supply or prescribed for an individual resident. Expected epinephrine users must receive the required training.
Lyme treatment providers gain licensing protection
Missouri providers cannot face discipline or lose license renewal solely for prescribing, administering, or dispensing Lyme disease treatment. Protection also covers posttreatment Lyme disease syndrome and medically necessary extended antibiotics or similar treatment. Care must stay within the provider's professional scope. This licensing protection does not require insurance to pay for treatment.
Mental health support for first responders
A qualifying department mental health program can satisfy peace officers' and first responders' required check-in every three to five years. Providers must notify the officer's commander or responder's supervisor when the check-in is complete. The law also creates the 988 Public Safety Fund for state public safety services addressing responder stress and trauma. The fund relies on legislative appropriations; no amount is set. Unspent money and investment earnings stay in the fund.
Telemedicine treatment records follow privacy rules
Providers must collect, store, and maintain records for telemedicine-prescribed drugs and other treatment under federal HIPAA privacy rules. Those rules also allow health information sharing to support continued care.
Social work supervisors need less experience
Qualified clinical, advanced macro, and baccalaureate social work supervisors need three years of relevant field experience, down from five. They must still meet supervisory training and other legal requirements.
Local growers get nutrition purchasing priority
When feasible, MO HealthNet must prioritize including community groups and local growers in purchases of locally grown food for nutrition prescriptions. This priority does not guarantee any group or grower a contract, purchase, or payment.
Hospitals must post worker assault warnings
Hospitals must prominently post warning signs in emergency department and labor and delivery waiting rooms. Signs must state that assaulting health care workers on duty is a serious crime prosecuted to the fullest extent of law. This is a posting requirement, not a new criminal penalty.
Community paramedic services gain care standards
The state health department must set standards for community paramedic services covering medical oversight, training, records, and quality improvement. Standards also cover formal links with primary care when needed. Entities meeting the standards and employing certified community paramedics receive five-year endorsements. Services must be nonemergency care under approved medical-director supervision and documented care plans or protocols.
Emergency responders carry broader epinephrine devices
Missouri basic life support ambulances and stretcher vans must carry epinephrine delivery systems and at least one trained user. The requirement covers delivery systems beyond auto-injectors. The fire personnel fund uses appropriated money solely to supply adult-patient epinephrine systems to qualified first responder agencies. Spending depends on legislative appropriation, and no dollar amount is set. Unspent money stays in the fund after each two-year budget period.
Lyme research grants prioritize rural areas
The health department must use the Lyme Research and Eradication Fund for grants to public four-year schools, research institutions, and nonprofits. Grants support diagnostics, therapies, treatments, and eradication strategies; at least 20% of fund money must support rural-county eradication work. No total funding amount is stated. A Lyme Disease Task Force advises on prevention, surveillance, education, and diagnostic guidance and monitors the law's implementation. It must meet at least twice yearly and include two Missouri residents who have or have had Lyme disease.
Medication safety program continues without expiration
The law removes the RX Cares for Missouri Program's August 28, 2026, expiration date. The program can continue medication-safety and prescription-drug-abuse prevention activities and education. Spending uses money appropriated to the Board of Pharmacy, with no amount set here. The money cannot fund a state prescription drug monitoring program.
Mental health detention filings need no notary
Specified peace officers, health professionals, and hospital employees no longer need notarization for mental health detention applications and supporting documents. They can instead sign declarations under penalty of perjury. The legal criteria for detention do not change.
Missouri removes state insurance exchange ban
The law removes Missouri's ban on creating or operating a state health insurance exchange. It does not create an exchange or change anyone's coverage or premiums by itself.
Prison contractors can provide dental care
Entities contracted by the state to provide care in correctional centers gain an exception to the stated corporate dental-practice limit. Dental services must be delivered by a person regulated under Missouri dental law. That person must work within their license or registration.
Rural fire districts gain epinephrine access
Authorized state health department physicians can issue a statewide standing order for adult epinephrine systems to qualifying nonmetropolitan fire districts. District eligibility follows the law's five-year American Community Survey test, using qualifying estimates ending in zero or five. Users must complete director-approved training. Exceptions cover specified licensed health professionals and people acting under a lawful prescription.
Qualifying hospitals gain more investment options
Certain hospitals and hospital districts can invest up to 50% of available funds in specified mutual funds, bonds, or money-market investments. Remaining funds must use investments allowed for the state treasurer. Eligible hospitals must receive under 3% of annual revenue from government taxes and separately under 3% from their municipality's appropriations. Eligible districts must receive under 3% from district or state taxes; available funds exclude immediate disbursements and operating needs. Bonds must mature within ten years; district bonds need a top-five long-term rating or the highest short-term rating.
Discount drug providers gain payment protections
Health plans and pharmacy benefit managers cannot discriminate against providers because they participate in the federal 340B drug discount program. Banned practices include lower payments, different terms, drug-identification demands, coverage refusals, and certain demands after claims are processed. Routine claim changes unrelated to 340B pricing, and changes required by federal law, remain allowed. The state insurance director must impose civil penalties of up to $5,000 per violation per day.
Hospital districts gain room to operate
Hospital districts gain authority to act in certain third- and fourth-class counties. The restriction based on an existing hospital applies when that hospital was organized under the hospital district law. It does not apply when the existing hospital was organized under chapter 96 or 205. The change does not guarantee new services or lower household costs.
Medicaid sets minimum pathology payments
MO HealthNet must reimburse hospital-based pathologists for the professional part of qualifying clinical pathology services in high-complexity labs. Payment must equal at least 30% of the approved Independent Lab–Technical Component fee schedule. Services must be provided to MO HealthNet participants. Payments go to physicians or entities assigned the right to receive them, not to households.
Out-of-state drug suppliers gain licensing route
Certain out-of-state wholesale drug distributors and logistics providers can qualify for Missouri licensing through reciprocity. This route applies when their home state does not issue the relevant license. They must hold current drug distributor accreditation from the National Association of Boards of Pharmacy or its successor. The state they ship from must offer reciprocal treatment to Missouri entities. Missouri Board of Pharmacy rules also apply.
Speech therapy fellows need direct supervision
Speech-language pathology license applicants must complete their clinical fellowship under direct supervision. The supervisor must be a speech-language pathologist in good standing. Applicants with an audiology clinical doctoral degree remain exempt from this supervision requirement.
Public birth and death listings narrowed
The law removes the health department's specific authority to provide requested lists of people born or dying on a particular date. That exception previously allowed names and birth or death dates. Other vital-record access rules and disclosure exceptions are unchanged by this provision.
City hospitals face new expansion limits
Hospitals organized under Missouri's city hospital law cannot expand into another third- or fourth-class county with such a hospital. The ban covers buying, operating, or leasing related facilities and conducting health care activities. City approval is required for a hospital's first related facility or health care activity outside city limits if it received city funds in the previous 12 months.
Certification rules for community paramedics
Applicants for Missouri community paramedic certification must hold a current paramedic license and complete an approved training program. The program must have department approval or accreditation from a national organization approved by the department. Applicants must also submit the department-approved application.
Health claim handlers face response deadline
Health plans, third-party administrators, administrative service organizations, and pharmacy benefit managers must answer state inquiries about health care payment claims. They must respond within 60 days after receiving the inquiry. This deadline does not require households to file reports or require claim payment within 60 days.
Drug manufacturers pay new tracking fees
Beginning October 1, 2026, covered drug manufacturers must pay monthly fees for Missouri's real-time pseudoephedrine tracking system. The system administrator sets the amounts, charging manufacturers only for transactions involving their own products sold in or into Missouri. Knowing failure to pay the required fees is a class A misdemeanor.
Adult protection agencies can share records
The Department of Social Services can examine and copy specified adult-protection reports. Adult-protection team members can share records needed for team activities benefiting an eligible adult. Confidentiality and official-duty limits still apply. The Department of Mental Health can receive a reporter's identity for specified investigations of abuse or neglect of vulnerable people.
Remote prescriptions balance access and safeguards
Physicians prescribing through telemedicine or the internet must obtain a reliable medical history. A physical exam is required only when needed to meet the standard of care. Providers cannot prescribe drugs, controlled substances, or other treatment without a proper provider-patient relationship. Prescriptions generally cannot rely solely on a telemedicine evaluation. The exception covers physicians, authorized designees, advanced practice nurses, physician assistants, and assistant physicians in collaborative arrangements, acting within scope with an established, ongoing physician-patient relationship.
Accreditation can replace care facility inspections
The health department can accept comparable accreditation surveys instead of required residential care or assisted living inspections. Surveys must match state scope and methods and follow federal Medicare law. Facilities must supply accreditation reports for public posting and promptly forward suspected abuse or neglect reports. Losing recognized accreditation triggers an inspection. A facility exempt from annual inspection must receive a full state survey after one or more class I violations.
Child care providers need allergy policies
Licensed child care providers must adopt allergy prevention and response policies before July 1, 2028. The policies must give priority to potentially deadly food allergies. Having a policy is a condition of licensure.
Emergency care duties expand with oversight
Ambulance services must contract with another provider for community paramedic services; contracts can run indefinitely with at least 60 days' cancellation notice. Emergency medical technicians must work within their training, experience, and the national scope model, using physician orders or approved protocols. State advisers can add advanced technician duties; local medical directors can add paramedic duties for agencies or individual clinicians. The health department can deny or refuse renewal of credentials, including endorsements, or file disciplinary complaints on listed grounds.
Labs must report alpha-gal test results
Alpha-gal syndrome joins Missouri's reportable disease list. Labs must electronically report qualifying alpha-gal blood test results within seven days; patients have no reporting duty. Results must meet laboratory standards and the current national case definition for sensitization. With appropriated funding, the health department can sample reports to determine case status and must report findings annually to the CDC. Reporting must begin no later than six months after August 28, 2026.
Lyme reporting adds patient privacy choices
Providers, labs, and local health departments must report confirmed or suspected Lyme cases within seven days using CDC surveillance definitions. Patients must be offered an opt-in choice before identifiable information is shared with listed public health agencies. The health department must publish a yearly report by December 31 covering disease patterns, treatment outcomes, and barriers to care. Reports go to the CDC and legislature, with public-university collaboration to integrate data into existing tick-borne disease monitoring.
Doctor licensing sets documents and screening
Physician applicants must provide a criminal background check, qualifying education credentials, and proof of required postgraduate training. Applicants using a valid Educational Commission for Foreign Medical Graduates certificate must show two years of postgraduate training. Except where law allows otherwise, the board cannot demand application information beyond the listed materials. The board can require other-jurisdiction license histories and past or pending investigations, discipline, or sanctions. It can also obtain National Practitioner Data Bank or Federation of State Medical Boards reports.
Employer health plans must hold reserves
Covered multiple-employer self-insured health plans must maintain a surplus account. It must hold the greater of $600,000 or twice the plan's authorized control level risk-based capital. This financial requirement applies to plans, not directly to participating households.
False facts trigger health project review
The certificate-of-need committee must act when it obtains evidence of hidden or misstated material facts within 30 days after approval. At its next regular meeting, it must vote on rescinding the certificate and requiring a new application. This also covers certificates granted after an appeal of a denial.
Malpractice insurance association can suspend operations
The medical malpractice joint underwriting association can suspend operations under its operating plan when voluntary-market insurance is reasonably available. It must also have insured no more than two individual physicians annually for at least two consecutive years. During suspension, it cannot collect member dues or fees unless the director authorizes an assessment or resumed operations.
Sponsors & Cosponsors
Sponsor
Tara Peters
Republican • House
Cosponsors
Connie Steinmetz
Democratic • House
Donna Barnes
Democratic • House
LaDonna Appelbaum
Democratic • House
Terri Violet
Republican • House
Roll Call Votes
House vote • 5/14/2026
House Adopts - SS SCS, as amended
Yes: 115 • No: 23
House vote • 5/14/2026
Truly Agreed To and Finally Passed
Yes: 116 • No: 21
House vote • 5/14/2026
Reported Do Pass
Yes: 8 • No: 0
Senate vote • 5/13/2026
Third Read and Passed with Amendments - SA 1, SA2, SA 3, SA 1 to SA 4, SA 4, as amended, SA 1 to SA 5, SA 5, as amended, & SA 6, adopted
Yes: 26 • No: 5
House vote • 4/2/2026
Third Read and Passed
Yes: 129 • No: 20 • Other: 1
House vote • 3/31/2026
Reported Do Pass
Yes: 7 • No: 0
House vote • 3/5/2026
Reported Do Pass
Yes: 11 • No: 0
House vote • 2/5/2026
HCS Reported Do Pass
Yes: 17 • No: 1
Actions Timeline
Delivered to Secretary of State (G)
7/13/2026HouseApproved by Governor (G)
7/13/2026HouseDelivered to Governor
5/28/2026HouseSigned by President Pro Tem
5/28/2026SenateSigned by House Speaker
5/28/2026HouseHouse Message
5/14/2026HouseTruly Agreed To and Finally Passed - AYES: 116 NOES: 21 PRESENT: 0
5/14/2026HouseHouse Adopts - SS SCS, as amended AYES: 115 NOES: 23 PRESENT: 0
5/14/2026HouseTaken Up
5/14/2026HouseReported Do Pass - AYES: 8 NOES: 0 PRESENT: 0
5/14/2026HouseVoted Do Pass
5/14/2026HouseExecutive Session Completed
5/14/2026HouseReferred: Fiscal Review
5/13/2026HouseReported to the House with... - SS SCS, as amended
5/13/2026HouseThird Read and Passed with Amendments - SA 1, SA2, SA 3, SA 1 to SA 4, SA 4, as amended, SA 1 to SA 5, SA 5, as amended, & SA 6, adopted AYES: 26 NOES: 5 PRESENT: 0
5/13/2026SenateTaken Up
5/13/2026SenateReported Do Pass
5/13/2026SenateVoted Do Pass
5/13/2026SenateExecutive Session Held
5/13/2026SenateReferred: Fiscal Oversight
5/12/2026SenateSS Adopted - SA 1, SA2, SA 3, SA 1 to SA 4, SA 4, as amended, SA 1 to SA 5, SA 5, as amended, & SA 6, adopted
5/12/2026SenateSS Offered
5/12/2026SenateTaken Up for Third Reading
5/12/2026SenatePlaced on Informal Calendar
5/7/2026SenateReported Do Pass
5/7/2026Senate
Bill Text
Truly Agreed
5/14/2026
Perfected
3/25/2026
Committee Substitute
2/5/2026
Senate Substitute
2/5/2026
Introduced
1/7/2026
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