MissouriSB10192026 Regular SessionSenateWALLET

Modifies several provisions relating to health care

Sponsored By: Sandy Crawford (Republican)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

15 provisions identified: 9 benefits, 0 costs, 6 mixed.

Court treatment brings oversight and hospitalization

Courts must assign each outpatient treatment participant a case manager from a certified community behavioral health clinic. Both must report to court at least every 90 days; case managers must immediately report substantial participant or program noncompliance. Treatment providers must immediately notify the court when a participant does not follow the order. Without a hearing, courts can order an evaluation or psychiatric hospitalization for up to 10 days. A community mental health center recommendation permits a longer stay, capped at 90 days or the order's remaining term, whichever is shorter. A person who objects gets a hearing and must be discharged unless a court or jury finds hospitalization necessary by clear and convincing evidence. Annual reports to the General Assembly from the state courts administrator begin December 1, 2028.

Courts can order outpatient mental treatment

Courts can order assisted outpatient mental health treatment for adults age 18 or older, for up to two years. The person must have mental illness, refuse voluntary treatment, and be unable to make an informed treatment decision. Treatment must prevent decline likely to cause serious harm, or the person must have a qualifying noncompliance history within 36 months. That history includes at least two civil detentions or specified correctional mental health services, or noncompliance leading to serious violence, threats, or attempts. The court needs clear and convincing evidence, and an appropriate treatment program must agree to accept the person. An order expires unless an authorized petitioner requests continued treatment before it ends. Extensions use the original process, but the 36-month history window does not determine whether continued treatment is appropriate.

Patients get nonopioid pain coverage protections

These protections apply to health plans delivered, issued for delivery, continued, or renewed on or after January 1, 2027. Plans cannot deny prescribed nonopioid pain medicine in favor of an opioid or require patients to try an opioid first. They also cannot charge higher cost-sharing for the nonopioid than for an opioid. A licensed health professional must prescribe the medicine for acute or chronic pain within their licensed scope.

Telehealth expands with patient care safeguards

Providers licensed through Missouri's out-of-state pathway can offer telehealth on the same terms as other fully licensed providers. Physicians can establish patient relationships remotely when care standards allow, after reviewing medical history and performing an adequate examination. Providers cannot prescribe without a proper patient relationship; telemedicine-only prescribing requires an ongoing relationship and compliance with professional practice rules. A treating professional must review questionnaires, which must provide information equivalent to an in-person evaluation. Questionnaire providers must work for or contract with a Missouri-licensed health care business. Providers must keep prescription and treatment records under federal health privacy rules. For online or phone questionnaires, providers must send an evaluation report within 14 days to the primary provider identified by the patient. Reports must include the patient's identity, evaluation date, diagnosis, treatment, and further instructions.

Shared employer health plans gain safeguards

The law broadens qualifying shared, self-insured health plans for multiple employers and self-employed people and their dependents. Participating self-employed people must each have at least one common-law employee, and the arrangement cannot be fully insured. Plans must keep a surplus equal to the greater of $600,000 or twice their authorized control level risk-based capital. Each trustee must carry a bond of at least $150,000. Plans must follow insurer investment limits, use Missouri-licensed investment managers, and file annual financial and risk-based capital reports.

Artificial intelligence cannot claim therapist status

People and businesses developing or deploying artificial intelligence in Missouri cannot publicly claim it is or acts as a mental health professional. They also cannot claim it provides therapy or psychotherapy, or makes mental health diagnoses. Civil penalties are $10,000 for a first violation and $20,000 for each later violation. The restriction targets public claims about the technology.

Speech license applicants gain supervisor choices

Missouri speech-language pathology applicants seeking licensure by examination can use clinical fellowship supervisors licensed in any state. The supervisor must be a speech-language pathologist whose license is in good standing. Applicants with an audiology clinical doctoral degree remain exempt from the fellowship requirement.

Hospitals must post worker assault warnings

Hospitals must prominently post printed warnings in emergency department and labor-and-delivery waiting rooms. Signs must state that assaulting a health professional performing official duties is a serious crime. The warning includes striking workers with bodily fluid and says assaults will be prosecuted to the fullest extent of law.

Hospitals gain more room to invest

Eligible chapter 96 hospitals can invest up to 50% of money not needed immediately in listed investments, up from 25%. Eligible hospital districts also gain a 50% investment limit. Choices include specified mutual funds, money-market investments, and top-rated bonds with maturities no longer than 10 years. Remaining money must use investments allowed for Missouri's state treasurer. Hospitals qualify only when tax revenue is below 3% of annual revenue and municipal appropriations are separately below 3%. Districts qualify only when hospital district or state tax revenue is below 3% of annual revenue.

Drug discount providers gain payment protections

Health carriers, pharmacy benefit managers, and their agents or affiliates cannot discriminate against providers because they participate in 340B drug discounts. Protection also covers pharmacies contracted to dispense those drugs. Banned practices include lower payments, unequal fees, discriminatory network or audit rules, coverage denials, and demands to identify 340B drugs. Limits also cover forced claim reversals or resubmissions, with exceptions for normal business practices or federal law. Violations carry civil penalties up to $5,000 per violation per day, and the state insurance director must adopt rules.

Health department gains direct contracting options

Missouri's Department of Health and Senior Services can contract directly with qualifying Missouri affiliates of national public health associations or institutes. Similar or successor entities also qualify. Contracts can help deliver statewide health services and manage grant funds and related programs. This authority does not set aside a specific amount of money or create an individual benefit.

Hospitals can serve more nearby counties

Chapter 96 hospitals can buy, operate, or lease related facilities and provide health services in more third- or fourth-class counties. The county must have a chapter 205 or 206 hospital and no chapter 96 hospital. Hospital districts gain similar authority outside their boundaries where a county has a chapter 96 or 205 hospital, but none under chapter 206. Hospitals expanding outside their city need city approval if they received city funds in the previous 12 months. These powers do not require hospitals or districts to open facilities or offer services.

Medicaid sets minimum payments for pathologists

MO HealthNet must recognize and pay for the professional part of clinical pathology services provided by hospital-based pathologists. Payment must equal at least 30% of the approved MO HealthNet Independent Laboratory–Technical Component fee schedule. The money goes directly to the physician or an assigned payee, not the patient. The Department of Social Services must pursue any federal state plan changes needed to carry out the payment rule.

State gains secure mental health placements

The Department of Mental Health chooses secure placements for people in sexually violent predator proceedings or committed for treatment. It can use Corrections facilities when space and services are available and the Corrections director agrees. It can also contract with Missouri county jails and licensed health or mental health providers. People in prisons or jails must stay separate from offenders, except for occasional supervised incidental contact. Committed people must remain secure and separate from other mental health patients. Existing bans on offender violence also cover facilities run by entities designated by the department to confine or care for offenders.

Mental health detention filings need fewer formalities

Peace officers, specified facility health professionals, and hospital employees acting for a hospital can file detention materials without notarization. This covers mental health detention applications and supporting affidavits, declarations, or other documents. They can use statements under penalty of perjury instead. The exemption does not cover every applicant.

Sponsors & Cosponsors

Sponsor

Sandy Crawford
Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 28 • No: 1

House vote • 5/14/2026

Reported Do Pass

Yes: 8 • No: 0

House vote • 4/28/2026