Missouri Revised Statutes
Chapter 191 - Health and Welfare
Section 191.1150 - Citation of law — definitions — designation of caregiver, when — requirements.

Effective - 28 Aug 2018
191.1150. Citation of law — definitions — designation of caregiver, when — requirements. — 1. This section shall be known as the "Caregiver, Advise, Record, and Enable (CARE) Act".
2. As used in this section, the following terms shall mean:
(1) "Admission", a patient's admission into a hospital as an in-patient;
(2) "After-care", assistance that is provided by a caregiver to a patient after the patient's discharge from a hospital that is related to the condition of the patient at the time of discharge, including assisting with activities of daily living, as defined in section 198.006; instrumental activities of daily living, as defined in section 198.006; or carrying out medical or nursing tasks as permitted by law;
(3) "Ambulatory surgical center", the same as defined in section 197.200;
(4) "Caregiver", an individual who is eighteen years of age or older, is duly designated as a caregiver by a patient under this section, and who provides after-care assistance to such patient in the patient's residence;
(5) "Discharge", a patient's release from a hospital or an ambulatory surgical center to the patient's residence following an admission;
(6) "Hospital", the same as defined in section 197.020;
(7) "Residence", a dwelling that the patient considers to be his or her home. Residence shall not include:
(a) A facility, the same as defined in section 198.006;
(b) A hospital, the same as defined in section 197.020;
(c) A prison, jail, or other detention or correctional facility operated by the state or a political subdivision;
(d) A residential facility, the same as defined in section 630.005;
(e) A group home or developmental disability facility, the same as defined in section 633.005; or
(f) Any other place of habitation provided by a public or private entity which bears legal or contractual responsibility for the care, control, or custody of the patient and which is compensated for doing so.
3. A hospital or ambulatory surgical center shall provide each patient or, if applicable, the patient's legal guardian with an opportunity to designate a caregiver following the patient's admission into a hospital or entry into an ambulatory surgical center and prior to the patient's discharge. Such designation shall include a written consent of the patient or the patient's legal guardian to release otherwise confidential medical information to the designated caregiver if such medical record would be needed to enable the completion of after-care tasks. The written consent shall be in compliance with federal and state laws concerning the release of personal health information. Prior to discharge, a patient may elect to change his or her caregiver in the event that the original designated caregiver becomes unavailable, unwilling, or unable to care for the patient. Designation of a caregiver by a patient or a patient's legal guardian does not obligate any person to arrange or perform any after-care tasks for the patient.
4. The hospital or ambulatory surgical center shall document the patient's or the patient's legal guardian's designation of caregiver, the relationship of the caregiver to the patient, and the caregiver's available contact information.
5. If the patient or the patient's legal guardian declines to designate a caregiver, the hospital or ambulatory surgical center shall document such information.
6. The hospital or ambulatory surgical center shall notify a patient's caregiver of the patient's discharge or transfer to another facility as soon as practicable, which may be after the patient's physician issues a discharge order. In the event that the hospital or ambulatory surgical center is unable to contact the designated caregiver, the lack of contact shall not interfere with, delay, or otherwise affect the medical care provided to the patient or an appropriate discharge of the patient. The hospital or ambulatory surgical center shall document the attempt to contact the caregiver.
7. Prior to being discharged, if the hospital or ambulatory surgical center is able to contact the caregiver and the caregiver is willing to assist, the hospital or ambulatory surgical center shall provide the caregiver with the patient's discharge plan, if such plan exists, or instructions for the after-care needs of the patient and give the caregiver the opportunity to ask questions about the after-care needs of the patient.
8. A hospital or ambulatory surgical center is not required nor obligated to determine the ability of a caregiver to understand or perform any of the after-care tasks outlined in this section.
9. Nothing in this section shall authorize or require compensation of a caregiver by a state agency or a health carrier, as defined in section 376.1350.
10. Nothing in this section shall require a hospital or ambulatory surgical center to take actions that are inconsistent with or duplicative of the standards of the federal Medicare program under Title XVIII of the Social Security Act and its conditions of participation in the Code of Federal Regulations or the standards of a national accrediting organization with deeming authority under Section 1865(a)(1) of the Social Security Act.
11. Nothing in this section shall create a private right of action against a hospital, ambulatory surgical center, a hospital or ambulatory surgical center employee, or an individual with whom a hospital or ambulatory surgical center has a contractual relationship.
12. A hospital, ambulatory surgical center, hospital or ambulatory surgical center employee, or an individual with whom a hospital or ambulatory surgical center has a contractual relationship shall not be liable in any way for an act or omission of the caregiver.
13. No act or omission under this section by a hospital, ambulatory surgical center, hospital or ambulatory surgical center employee, or an individual with whom a hospital or ambulatory surgical center has a contractual relationship shall give rise to a citation, sanction, or any other adverse action by any licensing authority to whom such individual or entity is subject.
14. Nothing in this section shall be construed to interfere with the rights of an attorney-in-fact under a durable power of health care under sections 404.800 to 404.872.
15. The department of health and senior services shall provide ambulatory surgical centers and hospitals a standard form that may be used to satisfy the requirements of this section. Nothing in this section shall prohibit a hospital or ambulatory surgical center from continuing the use of a current patient communication or disclosure form to satisfy the requirements of this section, provided that the facility's current form is compliant with Centers for Medicare and Medicaid Services (CMS) standards and regulations.
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(L. 2018 S.B. 718)

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Structure Missouri Revised Statutes

Missouri Revised Statutes

Title XII - Public Health and Welfare

Chapter 191 - Health and Welfare

Section 191.005 - Information exchange between departments, rulemaking authority.

Section 191.025 - Health care compact.

Section 191.116 - Alzheimer's state plan task force established — members, appointment, duties — report — expiration date.

Section 191.127 - Land may be leased for farming or grazing — procedure.

Section 191.150 - Purchase of food limited to use of institution inmates.

Section 191.160 - Board and living quarters for employees of institutions.

Section 191.170 - Mistreatment of inmates — penalty.

Section 191.180 - Furnishing unfit food to institution — penalty.

Section 191.190 - Accessory to mistreatment of inmates or furnishing of unwholesome food — penalty.

Section 191.210 - Attendance of patient by private physician.

Section 191.211 - Funding of certain programs.

Section 191.213 - Additional funding sources for certain programs.

Section 191.226 - Costs of HIV testing for certain crime victims payable by department of health and senior services, when, conditions.

Section 191.227 - Medical records to be released to patient, when, exception — fee permitted, amount — liability of provider limited — annual handling fee adjustment — disclosure of deceased patient records, when.

Section 191.228 - Physician and pharmacist not subject to discipline for cooperation.

Section 191.229 - Accreditation of not-for-profit human services organizations deemed equivalent to licensure.

Section 191.231 - Community-based integrated delivery system, qualification, powers — organization, board of directors, powers — plans.

Section 191.235 - Mercury contained in immunizations, not to be administered to certain persons — insurance reimbursement for nonmercury immunizations — exemptions, when.

Section 191.237 - Failure to participate in health information organization, no fine or penalty may be imposed — no exchange of data, when — definitions.

Section 191.250 - Citation of law — definitions — DNR orders, requirements — revocation of consent — appointment of guardian, when — continuation of treatment not required, when.

Section 191.300 - Definitions.

Section 191.305 - Missouri genetic advisory committee created — purpose — appointment, terms — qualifications — expenses.

Section 191.310 - Duties of committee — liaison officers with mental health and education, appointment.

Section 191.315 - Genetics program to be established by department — rules authorized — procedure.

Section 191.317 - Confidentiality of all tests and personal information — exceptions — retention of specimens, procedure.

Section 191.320 - Genetic diagnostic and counseling services to be established — outreach centers, duties — referral for abortion, procedure, requirements.

Section 191.323 - Powers and duties of department of health and senior services in prevention and treatment of genetic diseases and birth defects.

Section 191.325 - Cost of services, how paid — free to persons financially unable to pay — residency requirement.

Section 191.331 - Infants to be tested for metabolic and genetic diseases — reports — exceptions — refusal to test — fee for screening test, department may impose by rule, use of fees — formula provided by department, when — assistance available, whe...

Section 191.332 - Supplemental newborn screening requirements — additional screenings — rulemaking authority.

Section 191.333 - Citation of law — screening for lysosomal storage diseases — rulemaking authority — fee increase authorized.

Section 191.334 - Chloe's Law — critical congenital heart disease screening, requirements — rulemaking authority.

Section 191.335 - Hemophilia program established — state assistance, when.

Section 191.340 - Hemophilia program — care and treatment — financial assistance — education — duties of department.

Section 191.360 - Trained employee of end-stage renal disease facility may initiate dialysis — not unlawful practice of medicine.

Section 191.362 - Appropriately trained employees to have completed course in dialysis techniques.

Section 191.365 - Sickle cell anemia — purposes of program — financial assistance, when.

Section 191.370 - Sickle cell anemia, development of program for care and treatment — duties of department.

Section 191.375 - Cystic fibrosis, program for care and treatment — financial assistance, when.

Section 191.380 - Cystic fibrosis, duties of department.

Section 191.400 - State board of health and senior services — appointment — terms — qualifications — limitation on other employment, exception — vacancies — compensation — meetings.

Section 191.411 - System of coordinated health care services — health access incentive fund created, purpose — enhanced Medicaid payments — rules — annual report.

Section 191.425 - Program established, eligibility — contracting authority — conditional on receipt of federal funding — sunset provision.

Section 191.480 - Manufacturers may make investigational drugs and devices available to eligible patients, when — definitions — requirements.

Section 191.500 - Definitions.

Section 191.505 - Department of health and senior services to administer — may make rules and regulations.

Section 191.510 - Contracts for loans to include terms.

Section 191.515 - Requirements for application.

Section 191.520 - Maximum amount of loans — source of funds.

Section 191.525 - Number of loans available — to whom — length of loans.

Section 191.530 - Interest on loans — repayment terms — temporary deferral.

Section 191.535 - Termination of course of study, effect.

Section 191.540 - Repayment schedules — breach of contract.

Section 191.545 - Recovery — actions for.

Section 191.550 - Approval of contracts.

Section 191.594 - Citation of law — prevalence of depression and suicide study — prohibited acts — definitions.

Section 191.596 - Research project authorized — committee established, members, duties — center study, contents — annual report.

Section 191.600 - Loan repayment program established — health professional student loan repayment program fund established — use.

Section 191.603 - Definitions.

Section 191.605 - Department to designate as areas of need — factors to be considered.

Section 191.607 - Qualifications for eligibility established by department.

Section 191.609 - Contract for repayment of loans, contents.

Section 191.611 - Loan repayment program to cover certain loans — amount paid per year of obligated service — schedule of payments — communities sharing costs to be given first consideration.

Section 191.614 - Termination of medical studies or failure to become licensed doctor, liability — breach of contract for service obligation, penalties — recovery of amount paid by contributing community.

Section 191.615 - Application for federal funds — insufficient funds, effect.

Section 191.630 - Definitions.

Section 191.631 - Testing for disease, consent deemed given, when — hospital to conduct testing, written policies and procedures required — notification for confirmed exposure, by whom — limitations on testing and duties of hospitals, coroners, and m...

Section 191.640 - Blood-borne pathogen standard required for occupational exposure of public employees to blood and other infectious materials — definitions — requirements of needleless system and sharps — violations, penalty.

Section 191.645 - Risk of exposure to Hepatitis C, information to be made available — website to be maintained, content.

Section 191.648 - Expedited partner therapy permitted, requirements for physicians utilizing — rulemaking authority.

Section 191.650 - Definitions.

Section 191.653 - HIV testing performed by whom, how — consultation with subject required, when.

Section 191.656 - Confidentiality of reports and records, exceptions — violation, civil action for injunction, damages, costs and attorney fees — health care provider participating in judicial proceeding, immune from civil liability.

Section 191.657 - Disclosure of confidential HIV information, by court order, only to certain persons, procedure, when.

Section 191.658 - HIV infection status disclosure by department of health and senior services to exposed health workers or law enforcement officers, when, violation, penalty.

Section 191.659 - Department of corrections, HIV and infectious diseases testing without right of refusal — exception — minors victim of sexual assault, testing, notice to parents or custodians required.

Section 191.662 - Department of mental health, permissive HIV testing without right of refusal, when — results of testing not to be reported to department of health and senior services, when.

Section 191.663 - HIV testing, defined — court order to test certain sexual offenders — costs — bond — disclosure of results of test — parents of unemancipated minor informed, when.

Section 191.665 - Discrimination prohibited, exceptions.

Section 191.668 - Department of health and senior services and department of elementary and secondary education to prepare education programs, contents.

Section 191.671 - Insurance companies, HMOs or health service corporations, HIV testing by, regulation by department — disclosure of test results, confidentiality.

Section 191.674 - Court-ordered HIV testing without right of refusal, department of health and senior services may seek, when — court record closed, proceeding to be in camera, when.

Section 191.677 - Serious infectious or communicable diseases, prohibited acts, criminal penalties — affirmative defense — use of pseudonym, when.

Section 191.680 - Maintaining a nuisance, abatement to be ordered, when.

Section 191.683 - Reports to general assembly by department of health and senior services.

Section 191.686 - Anonymous testing sites in central Missouri, Kansas City, Springfield and St. Louis — reports of results, use of coded system — contact notification required, when.

Section 191.689 - Schools to be given notice of identity of child with HIV infection, when, by whom — identity of infected child may be released to whom by school.

Section 191.692 - Premarital HIV testing, rulemaking authorized, when.

Section 191.694 - Infection control procedures — requirements and training for health care facilities and professionals.

Section 191.695 - Rulemaking authority, department of health and senior services — procedure.

Section 191.699 - Disciplinary action for health care professionals who discriminate or require HIV testing before treatment.

Section 191.700 - Testing of all health care professionals not justified — voluntary and confidential evaluation of infected professional, procedure — expert review panel qualifications, powers and duties, practice restrictions, when — health care fa...

Section 191.703 - Death of patient with infectious or contagious disease, notification to funeral director or coroner.

Section 191.710 - MO HealthNet program and SCHIPS to focus on premature infant health care.

Section 191.711 - Education publications to be prepared, contents — distribution.

Section 191.724 - Discrimination based on religious beliefs or moral convictions prohibited, health plan coverage of abortion — no mandatory employee coverage of certain procedures — attorney general to enforce — sterilization defined.

Section 191.725 - Physician to counsel pregnant patients on effects of cigarettes, alcohol and controlled substances — certifying form to be signed by patient on counseling — educational materials to be furnished to physicians.

Section 191.729 - School districts to be furnished information on prenatal and postnatal effects of substances, when.

Section 191.731 - Pregnant woman referred for substance abuse to have priority for treatment — confidentiality of records.

Section 191.737 - Children exposed to substance abuse, referral by physician to children's division — physician making referral immune from civil liability — confidentiality of report.

Section 191.739 - Protective and preventive services to be provided by department of social services, duties.

Section 191.748 - Shaken baby syndrome video, required viewing, when.

Section 191.755 - Department to post resources on website, content.

Section 191.756 - Grants awarded by board of health and senior services — eligibility criteria.

Section 191.758 - Information to be made available by physician to pregnant women, when.

Section 191.761 - Umbilical cord blood samples, department to provide courier service to nonprofit umbilical cord blood bank — rulemaking authority.

Section 191.765 - Definitions.

Section 191.767 - Persons not to smoke in public places or meetings, except in designated smoking areas — designation of space for smoking area, requirements.

Section 191.769 - Areas not considered public places.

Section 191.771 - Person in control of public places or public meetings, duties.

Section 191.773 - Violators, guilty of infraction.

Section 191.775 - Public schools and school buses — smoking, or tobacco or vapor product use prohibited — permissible use of tobacco, where.

Section 191.776 - Child day care facilities, smoking or tobacco use when children are present, prohibited, penalty.

Section 191.777 - More stringent ordinances or rules may be adopted by governing bodies or school boards.

Section 191.800 - Definitions.

Section 191.803 - Boards of education to establish breakfast program — rules — waiver, procedure.

Section 191.805 - Hardship grant program, distribution of, rules.

Section 191.807 - Supplemental funding, women, infants and children supplemental food program — funding of certain county health offices, use, maximum amount of grants — rules and regulations.

Section 191.810 - Department of health and senior services to establish standards for summer food service program — where established — order of priority — waiver, filing required.

Section 191.813 - Agencies to coordinate outreach programs — specific programs — public service announcements to be designed.

Section 191.815 - Administrative rules, procedure.

Section 191.828 - Evaluations, effect of initiatives.

Section 191.831 - Health initiatives fund established, use — Alt-care pilot program, components — participation may be required.

Section 191.835 - Community 2000 grants program — local commissions, members — goals, objectives — evaluations, funding.

Section 191.839 - Education programs for persons with no or inadequate health insurance.

Section 191.843 - Authorizes grants for regional research consortia in a distressed community.

Section 191.875 - Citation--definitions--estimate of cost provided, when--statement--disclosure of costs without discounts.

Section 191.900 - Definitions.

Section 191.905 - False statement to receive health care payment prohibited — kickback, bribe, purpose, prohibited, exceptions — abuse prohibited — penalty — prosecution, procedure — Medicaid fraud reimbursement fund created — restitution — civil pen...

Section 191.907 - Original source of information to receive a portion of any recovery.

Section 191.908 - Whistleblower protections — violations, penalty.

Section 191.910 - Attorney general may investigate violations, powers — service authorized — prosecuting attorney, report, prosecution — provision of records — no limitation of other actions.

Section 191.914 - False report or claim, penalty.

Section 191.915 - Breast-feeding information provided, when, by whom.

Section 191.918 - Breast-feeding in public permitted — not sexual conduct, public indecency, or obscenity — no municipal ordinances to prohibit or restrict.

Section 191.923 - Prenatally diagnosed conditions, patient to be provided information — definitions — clearinghouse of information to be established.

Section 191.925 - Screening for hearing loss, infants, when — procedures used — exemptions — information provided, by whom — no liability, when.

Section 191.928 - Surveillance and monitoring system for certain newborns — standards and follow-up procedure — confidentiality of information.

Section 191.931 - Early intervention services available — report, content.

Section 191.937 - Rulemaking authority, procedure.

Section 191.940 - Citation of law — definitions — hospitals and ambulatory surgical centers to provide information about postpartum depression.

Section 191.950 - Prostate cancer pilot programs — definitions — eligibility — services provided — grants — rulemaking authority — sunset provision.

Section 191.975 - Adoption awareness, department duties — advertising campaign authorized — rulemaking authority.

Section 191.980 - Missouri area health education centers program established — authority of director — duties.

Section 191.990 - Diabetes goals and benchmarks — report, contents.

Section 191.1050 - Definitions.

Section 191.1053 - Designation of areas — re-evaluation of designations, when — rulemaking authority.

Section 191.1056 - Fund created, use of moneys.

Section 191.1075 - Definitions.

Section 191.1080 - Council created, purpose, members, terms, duties — report — expiration date.

Section 191.1085 - Program established, purpose — website information — rulemaking authority.

Section 191.1100 - Citation of law — definitions.

Section 191.1102 - Additional licensure not required, when — inapplicability.

Section 191.1104 - Display of license or certificate, how satisfied.

Section 191.1106 - Registration with department required, fee, contents — quarterly reports — list of providers — recordkeeping requirements — rulemaking authority.

Section 191.1110 - Immunity from liability, when — no compensation to be received — certain military personnel deemed licensed.

Section 191.1112 - Volunteer crisis response teams — definitions — immunity from liability, inapplicability of.

Section 191.1140 - Treatment of chronic, common, and complex diseases, program authorized, purpose.

Section 191.1145 - Definitions — telehealth services authorized, when.

Section 191.1146 - Physician-patient relationship required, how established.

Section 191.1150 - Citation of law — definitions — designation of caregiver, when — requirements.

Section 191.1164 - Citation of law — definitions.

Section 191.1165 - Medication-assisted treatment — formulary medications and requirements — disclosure of MAT services provided — incarcerated persons and diversion program participants, assessment for substance use disorders.

Section 191.1167 - Contracts, policies, or procedures in violation of act deemed null and void.

Section 191.1168 - Severability clause.

Section 191.1400 - Citation of law — definitions — compassionate care visits to be permitted, policy — limitations — informational materials — violations may be reported — immunity from liability, when.

Section 191.1601 - Citation of law.

Section 191.1603 - Definitions.

Section 191.1604 - Long-term dignity savings account, use, requirements.

Section 191.1605 - Accounts, use of moneys — withdrawals, recapture — death of account holder, effect of.

Section 191.1606 - Reporting, forms — rulemaking authority.

Section 191.1607 - Financial institutions, requirements — no responsibility or liability, when.

Section 191.2290 - Citation of law — definitions — state of emergency, designated essential caregiver designation — requirements.