Text of MO HB 2065 (2026)

SECOND REGULAR SESSION HOUSE BILL NO. 2065 103RD GENERAL ASSEMBLY INTRODUCED BY REPRESENTATIVE THOMAS. 4882H.01I JOSEPH ENGLER, Chief Clerk AN ACT To repeal sections 191.1720, 208.152, 217.230, and 221.120, RSMo, and to enact in lieu thereof three new sections relating to gender transition procedures. Be it enacted by the General Assembly of the state of Missouri, as follows: Section A. Sections 191.1720, 208.152, 217.230, and 221.120, RSMo, are repealed 2 and three new sections enacted in lieu thereof, to be known as sections 208.152, 217.230, and 3 221.120, to read as follows: 208.152. 1. MO HealthNet payments shall be made on behalf of those eligible needy 2 persons as described in section 208.151 who are unable to provide for it in whole or in part, 3 with any payments to be made on the basis of the reasonable cost of the care or reasonable 4 charge for the services as defined and determined by the MO HealthNet division, unless 5 otherwise hereinafter provided, for the following: 6 (1) Inpatient hospital services, except to persons in an institution for mental diseases 7 who are under the age of sixty-five years and over the age of twenty-one years; provided that 8 the MO HealthNet division shall provide through rule and regulation an exception process for 9 coverage of inpatient costs in those cases requiring treatment beyond the seventy-fifth 10 percentile professional activities study (PAS) or the MO HealthNet children's diagnosis 11 length-of-stay schedule; and provided further that the MO HealthNet division shall take into 12 account through its payment system for hospital services the situation of hospitals which 13 serve a disproportionate number of low-income patients; 14 (2) All outpatient hospital services, payments therefor to be in amounts which 15 represent no more than eighty percent of the lesser of reasonable costs or customary charges 16 for such services, determined in accordance with the principles set forth in Title XVIII A and EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. 17 B, Public Law 89-97, 1965 amendments to the federal Social Security Act (42 U.S.C. Section 18 301, et seq.), but the MO HealthNet division may evaluate outpatient hospital services 19 rendered under this section and deny payment for services which are determined by the MO 20 HealthNet division not to be medically necessary, in accordance with federal law and 21 regulations; 22 (3) Laboratory and X-ray services; 23 (4) Nursing home services for participants, except to persons with more than five 24 hundred thousand dollars equity in their home or except for persons in an institution for 25 mental diseases who are under the age of sixty-five years, when residing in a hospital licensed 26 by the department of health and senior services or a nursing home licensed by the department 27 of health and senior services or appropriate licensing authority of other states or government- 28 owned and -operated institutions which are determined to conform to standards equivalent to 29 licensing requirements in Title XIX of the federal Social Security Act (42 U.S.C. Section 30 1396, et seq.), as amended, for nursing facilities. The MO HealthNet division may recognize 31 through its payment methodology for nursing facilities those nursing facilities which serve a 32 high volume of MO HealthNet patients. The MO HealthNet division when determining the 33 amount of the benefit payments to be made on behalf of persons under the age of twenty-one 34 in a nursing facility may consider nursing facilities furnishing care to persons under the age of 35 twenty-one as a classification separate from other nursing facilities; 36 (5) Nursing home costs for participants receiving benefit payments under subdivision 37 (4) of this subsection for those days, which shall not exceed twelve per any period of six 38 consecutive months, during which the participant is on a temporary leave of absence from the 39 hospital or nursing home, provided that no such participant shall be allowed a temporary 40 leave of absence unless it is specifically provided for in his Added text start: or her : end added text plan of care. As used in 41 this subdivision, the term "temporary leave of absence" shall include all periods of time 42 during which a participant is away from the hospital or nursing home overnight because he Added text start: or she : end added text 43 Added text start: or she : end added text is visiting a friend or relative; 44 (6) Physicians' services, whether furnished in the office, home, hospital, nursing 45 home, or elsewhere, provided, that no funds shall be expended to any abortion facility, as 46 defined in section 188.015, or to any affiliate, as defined in section 188.015, of such abortion 47 facility; 48 (7) Subject to appropriation, up to twenty visits per year for services limited to 49 examinations, diagnoses, adjustments, and manipulations and treatments of malpositioned 50 articulations and structures of the body provided by licensed chiropractic physicians 51 practicing within their scope of practice. Nothing in this subdivision shall be interpreted to 52 otherwise expand MO HealthNet services; HB 2065 2 53 (8) Drugs and medicines when prescribed by a licensed physician, dentist, podiatrist, 54 or an advanced practice registered nurse; except that no payment for drugs and medicines 55 prescribed on and after January 1, 2006, by a licensed physician, dentist, podiatrist, or an 56 advanced practice registered nurse may be made on behalf of any person who qualifies for 57 prescription drug coverage under the provisions of P.L. 108-173; 58 (9) Emergency ambulance services and, effective January 1, 1990, medically 59 necessary transportation to scheduled, physician-prescribed nonelective treatments; 60 (10) Early and periodic screening and diagnosis of individuals who are under the age 61 of twenty-one to ascertain their physical or mental defects, and health care, treatment, and 62 other measures to correct or ameliorate defects and chronic conditions discovered thereby. 63 Such services shall be provided in accordance with the provisions of Section 6403 of P.L. 64 101-239 and federal regulations promulgated thereunder; 65 (11) Home health care services; 66 (12) Family planning as defined by federal rules and regulations; provided, that no 67 funds shall be expended to any abortion facility, as defined in section 188.015, or to any 68 affiliate, as defined in section 188.015, of such abortion facility; and further provided, 69 however, that such family planning services shall not include abortions or any abortifacient 70 drug or device that is used for the purpose of inducing an abortion unless such abortions are 71 certified in writing by a physician to the MO HealthNet agency that, in the physician's 72 professional judgment, the life of the mother would be endangered if the fetus were carried to 73 term; 74 (13) Inpatient psychiatric hospital services for individuals under age twenty-one as 75 defined in Title XIX of the federal Social Security Act (42 U.S.C. Section 1396d, et seq.); 76 (14) Outpatient surgical procedures, including presurgical diagnostic services 77 performed in ambulatory surgical facilities which are licensed by the department of health 78 and senior services of the state of Missouri; except, that such outpatient surgical services shall 79 not include persons who are eligible for coverage under Part B of Title XVIII, Public Law 89- 80 97, 1965 amendments to the federal Social Security Act, as amended, if exclusion of such 81 persons is permitted under Title XIX, Public Law 89-97, 1965 amendments to the federal 82 Social Security Act, as amended; 83 (15) Personal care services which are medically oriented tasks having to do with a 84 person's physical requirements, as opposed to housekeeping requirements, which enable a 85 person to be treated by his or her physician on an outpatient rather than on an inpatient or 86 residential basis in a hospital, intermediate care facility, or skilled nursing facility. Personal 87 care services shall be rendered by an individual not a member of the participant's family who 88 is qualified to provide such services where the services are prescribed by a physician in 89 accordance with a plan of treatment and are supervised by a licensed nurse. Persons eligible HB 2065 3 90 to receive personal care services shall be those persons who would otherwise require 91 placement in a hospital, intermediate care facility, or skilled nursing facility. Benefits payable 92 for personal care services shall not exceed for any one participant one hundred percent of the 93 average statewide charge for care and treatment in an intermediate care facility for a 94 comparable period of time. Such services, when delivered in a residential care facility or 95 assisted living facility licensed under chapter 198Added text start: , : end added text shall be authorized on a tier level based on 96 the services the resident requires and the frequency of the services. A resident of such facility 97 who qualifies for assistance under section 208.030 shall, at a minimum, if prescribed by a 98 physician, qualify for the tier level with the fewest services. The rate paid to providers for 99 each tier of service shall be set subject to appropriations. Subject to appropriations, each 100 resident of such facility who qualifies for assistance under section 208.030 and meets the 101 level of care required in this section shall, at a minimum, if prescribed by a physician, be 102 authorized up to one hour of personal care services per day. Authorized units of personal care 103 services shall not be reduced or tier level lowered unless an order approving such reduction or 104 lowering is obtained from the resident's personal physician. Such authorized units of personal 105 care services or tier level shall be transferred with such resident if he or she transfers to 106 another such facility. Such provision shall terminate upon receipt of relevant waivers from 107 the federal Department of Health and Human Services. If the Centers for Medicare and 108 Medicaid Services determines that such provision does not comply with the state plan, this 109 provision shall be null and void. The MO HealthNet division shall notify the revisor of 110 statutes as to whether the relevant waivers are approved or a determination of noncompliance 111 is made; 112 (16) Mental health services. The state plan for providing medical assistance under 113 Title XIX of the Social Security Act, 42 U.S.C. Section 1396, et seq., as amended, shall 114 include the following mental health services when such services are provided by community 115 mental health facilities operated by the department of mental health or designated by the 116 department of mental health as a community mental health facility or as an alcohol and drug 117 abuse facility or as a child-serving agency within the comprehensive children's mental health 118 service system established in section 630.097. The department of mental health shall 119 establish by administrative rule the definition and criteria for designation as a community 120 mental health facility and for designation as an alcohol and drug abuse facility. Such mental 121 health services shall include: 122 (a) Outpatient mental health services including preventive, diagnostic, therapeutic, 123 rehabilitative, and palliative interventions rendered to individuals in an individual or group 124 setting by a mental health professional in accordance with a plan of treatment appropriately 125 established, implemented, monitored, and revised under the auspices of a therapeutic team as 126 a part of client services management; HB 2065 4 127 (b) Clinic mental health services including preventive, diagnostic, therapeutic, 128 rehabilitative, and palliative interventions rendered to individuals in an individual or group 129 setting by a mental health professional in accordance with a plan of treatment appropriately 130 established, implemented, monitored, and revised under the auspices of a therapeutic team as 131 a part of client services management; 132 (c) Rehabilitative mental health and alcohol and drug abuse services including home 133 and community-based preventive, diagnostic, therapeutic, rehabilitative, and palliative 134 interventions rendered to individuals in an individual or group setting by a mental health 135 or alcohol and drug abuse professional in accordance with a plan of treatment appropriately 136 established, implemented, monitored, and revised under the auspices of a therapeutic team as 137 a part of client services management. As used in this section, mental health professional and 138 alcohol and drug abuse professional shall be defined by the department of mental health 139 pursuant to duly promulgated rules. With respect to services established by this subdivision, 140 the department of social services, MO HealthNet division, shall enter into an agreement with 141 the department of mental health. Matching funds for outpatient mental health services, clinic 142 mental health services, and rehabilitation services for mental health and alcohol and drug 143 abuse shall be certified by the department of mental health to the MO HealthNet division. 144 The agreement shall establish a mechanism for the joint implementation of the provisions of 145 this subdivision. In addition, the agreement shall establish a mechanism by which rates for 146 services may be jointly developed; 147 (17) Such additional services as defined by the MO HealthNet division to be 148 furnished under waivers of federal statutory requirements as provided for and authorized by 149 the federal Social Security Act (42 U.S.C. Section 301, et seq.) subject to appropriation by the 150 general assembly; 151 (18) The services of an advanced practice registered nurse with a collaborative 152 practice agreement to the extent that such services are provided in accordance with chapters 153 334 and 335, and regulations promulgated thereunder; 154 (19) Nursing home costs for participants receiving benefit payments under 155 subdivision (4) of this subsection to reserve a bed for the participant in the nursing home 156 during the time that the participant is absent due to admission to a hospital for services which 157 cannot be performed on an outpatient basis, subject to the provisions of this subdivision: 158 (a) The provisions of this subdivision shall apply only if: 159 a. The occupancy rate of the nursing home is at or above ninety-seven percent of MO 160 HealthNet certified licensed beds, according to the most recent quarterly census provided to 161 the department of health and senior services which was taken prior to when the participant is 162 admitted to the hospital; and HB 2065 5 163 b. The patient is admitted to a hospital for a medical condition with an anticipated 164 stay of three days or less; 165 (b) The payment to be made under this subdivision shall be provided for a maximum 166 of three days per hospital stay; 167 (c) For each day that nursing home costs are paid on behalf of a participant under this 168 subdivision during any period of six consecutive months such participant shall, during the 169 same period of six consecutive months, be ineligible for payment of nursing home costs of 170 two otherwise available temporary leave of absence days provided under subdivision (5) of 171 this subsection; and 172 (d) The provisions of this subdivision shall not apply unless the nursing home 173 receives notice from the participant or the participant's responsible party that the participant 174 intends to return to the nursing home following the hospital stay. If the nursing home receives 175 such notification and all other provisions of this subsection have been satisfied, the nursing 176 home shall provide notice to the participant or the participant's responsible party prior to 177 release of the reserved bed; 178 (20) Prescribed medically necessary durable medical equipment. An electronic web- 179 based prior authorization system using best medical evidence and care and treatment 180 guidelines consistent with national standards shall be used to verify medical need; 181 (21) Hospice care. As used in this subdivision, the term "hospice care" means a 182 coordinated program of active professional medical attention within a home, outpatient and 183 inpatient care which treats the terminally ill patient and family as a unit, employing a 184 medically directed interdisciplinary team. The program provides relief of severe pain or other 185 physical symptoms and supportive care to meet the special needs arising out of physical, 186 psychological, spiritual, social, and economic stresses which are experienced during the final 187 stages of illness, and during dying and bereavement and meets the Medicare requirements for 188 participation as a hospice as are provided in 42 CFR Part 418. The rate of reimbursement 189 paid by the MO HealthNet division to the hospice provider for room and board furnished by a 190 nursing home to an eligible hospice patient shall not be less than ninety-five percent of the 191 rate of reimbursement which would have been paid for facility services in that nursing home 192 facility for that patient, in accordance with subsection (c) of Section 6408 of P.L. 101-239 193 (Omnibus Budget Reconciliation Act of 1989); 194 (22) Prescribed medically necessary dental services. Such services shall be subject to 195 appropriations. An electronic web-based prior authorization system using best medical 196 evidence and care and treatment guidelines consistent with national standards shall be used to 197 verify medical need; 198 (23) Prescribed medically necessary optometric services. Such services shall be 199 subject to appropriations. An electronic web-based prior authorization system using best HB 2065 6 200 medical evidence and care and treatment guidelines consistent with national standards shall 201 be used to verify medical need; 202 (24) Blood clotting products-related services. For persons diagnosed with a bleeding 203 disorder, as defined in section 338.400, reliant on blood clotting products, as defined in 204 section 338.400, such services include: 205 (a) Home delivery of blood clotting products and ancillary infusion equipment and 206 supplies, including the emergency deliveries of the product when medically necessary; 207 (b) Medically necessary ancillary infusion equipment and supplies required to 208 administer the blood clotting products; and 209 (c) Assessments conducted in the participant's home by a pharmacist, nurse, or local 210 home health care agency trained in bleeding disorders when deemed necessary by the 211 participant's treating physician; 212 (25) Medically necessary cochlear implants and hearing instruments, as defined in 213 section 345.015, that are: 214 (a) Prescribed by an audiologist, as defined in section 345.015; or 215 (b) Dispensed by a hearing instrument specialist, as defined in section 346.010; 216 (26) The MO HealthNet division shall, by January 1, 2008, and annually thereafter, 217 report the status of MO HealthNet provider reimbursement rates as compared to one hundred 218 percent of the Medicare reimbursement rates and compared to the average dental 219 reimbursement rates paid by third-party payors licensed by the state. The MO HealthNet 220 division shall, by July 1, 2008, provide to the general assembly a four-year plan to achieve 221 parity with Medicare reimbursement rates and for third-party payor average dental 222 reimbursement rates. Such plan shall be subject to appropriation and the division shall 223 include in its annual budget request to the governor the necessary funding needed to complete 224 the four-year plan developed under this subdivision. 225 2. Additional benefit payments for medical assistance shall be made on behalf of 226 those eligible needy children, pregnant women and blind persons with any payments to be 227 made on the basis of the reasonable cost of the care or reasonable charge for the services as 228 defined and determined by the MO HealthNet division, unless otherwise hereinafter provided, 229 for the following: 230 (1) Dental services; 231 (2) Services of podiatrists as defined in section 330.010; 232 (3) Optometric services as described in section 336.010; 233 (4) Orthopedic devices or other prosthetics, including eye glasses, dentures, and 234 wheelchairs; 235 (5) Hospice care. As used in this subdivision, the term "hospice care" means a 236 coordinated program of active professional medical attention within a home, outpatient and HB 2065 7 237 inpatient care which treats the terminally ill patient and family as a unit, employing a 238 medically directed interdisciplinary team. The program provides relief of severe pain or other 239 physical symptoms and supportive care to meet the special needs arising out of physical, 240 psychological, spiritual, social, and economic stresses which are experienced during the final 241 stages of illness, and during dying and bereavement and meets the Medicare requirements for 242 participation as a hospice as are provided in 42 CFR Part 418. The rate of reimbursement 243 paid by the MO HealthNet division to the hospice provider for room and board furnished by a 244 nursing home to an eligible hospice patient shall not be less than ninety-five percent of the 245 rate of reimbursement which would have been paid for facility services in that nursing home 246 facility for that patient, in accordance with subsection (c) of Section 6408 of P.L. 101-239 247 (Omnibus Budget Reconciliation Act of 1989); 248 (6) Comprehensive day rehabilitation services beginning early posttrauma as part of a 249 coordinated system of care for individuals with disabling impairments. Rehabilitation 250 services must be based on an individualized, goal-oriented, comprehensive and coordinated 251 treatment plan developed, implemented, and monitored through an interdisciplinary 252 assessment designed to restore an individual to Added text start: an : end added text optimal level of physical, cognitive, and 253 behavioral function. The MO HealthNet division shall establish by administrative rule the 254 definition and criteria for designation of a comprehensive day rehabilitation service facility, 255 benefit limitations and payment mechanism. Any rule or portion of a rule, as that term is 256 defined in section 536.010, that is created under the authority delegated in this subdivision 257 shall become effective only if it complies with and is subject to all of the provisions of 258 chapter 536 and, if applicable, section 536.028. This section and chapter 536 are 259 nonseverable and if any of the powers vested with the general assembly pursuant to chapter 260 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently 261 held unconstitutional, then the grant of rulemaking authority and any rule proposed or 262 adopted after August 28, 2005, shall be invalid and void. 263 3. The MO HealthNet division may require any participant receiving MO HealthNet 264 benefits to pay part of the charge or cost until July 1, 2008, and an additional payment after 265 July 1, 2008, as defined by rule duly promulgated by the MO HealthNet division, for all 266 covered services except for those services covered under subdivisions (15) and (16) of 267 subsection 1 of this section and sections 208.631 to 208.657 to the extent and in the manner 268 authorized by Title XIX of the federal Social Security Act (42 U.S.C. Section 1396, et seq.) 269 and regulations thereunder. When substitution of a generic drug is permitted by the prescriber 270 according to section 338.056, and a generic drug is substituted for a name-brand drug, the 271 MO HealthNet division may not lower or delete the requirement to make a co-payment 272 pursuant to regulations of Title XIX of the federal Social Security Act. A provider of goods 273 or services described under this section must collect from all participants the additional HB 2065 8 274 payment that may be required by the MO HealthNet division under authority granted herein, 275 if the division exercises that authority, to remain eligible as a provider. Any payments made 276 by participants under this section shall be in addition to and not in lieu of payments made by 277 the state for goods or services described herein except the participant portion of the pharmacy 278 professional dispensing fee shall be in addition to and not in lieu of payments to pharmacists. 279 A provider may collect the co-payment at the time a service is provided or at a later date. A 280 provider shall not refuse to provide a service if a participant is unable to pay a required 281 payment. If it is the routine business practice of a provider to terminate future services to an 282 individual with an unclaimed debt, the provider may include uncollected co-payments under 283 this practice. Providers who elect not to undertake the provision of services based on a 284 history of bad debt shall give participants advance notice and a reasonable opportunity for 285 payment. A provider, representative, employee, independent contractor, or agent of a 286 pharmaceutical manufacturer shall not make co-payment for a participant. This subsection 287 shall not apply to other qualified children, pregnant women, or blind persons. If the Centers 288 for Medicare and Medicaid Services does not approve the MO HealthNet state plan 289 amendment submitted by the department of social services that would allow a provider to 290 deny future services to an individual with uncollected co-payments, the denial of services 291 shall not be allowed. The department of social services shall inform providers regarding the 292 acceptability of denying services as the result of unpaid co-payments. 293 4. The MO HealthNet division shall have the right to collect medication samples from 294 participants in order to maintain program integrity. 295 5. Reimbursement for obstetrical and pediatric services under subdivision (6) of 296 subsection 1 of this section shall be timely and sufficient to enlist enough health care 297 providers so that care and services are available under the state plan for MO HealthNet 298 benefits at least to the extent that such care and services are available to the general 299 population in the geographic area, as required under subparagraph (a)(30)(A) of 42 U.S.C. 300 Section 1396a and federal regulations promulgated thereunder. 301 6. Beginning July 1, 1990, reimbursement for services rendered in federally funded 302 health centers shall be in accordance with the provisions of subsection 6402(c) and Section 303 6404 of P.L. 101-239 (Omnibus Budget Reconciliation Act of 1989) and federal regulations 304 promulgated thereunder. 305 7. Beginning July 1, 1990, the department of social services shall provide notification 306 and referral of children below age five, and pregnant, breast-feeding, or postpartum women 307 who are determined to be eligible for MO HealthNet benefits under section 208.151 to the 308 special supplemental food programs for women, infants and children administered by the 309 department of health and senior services. Such notification and referral shall conform to the 310 requirements of Section 6406 of P.L. 101-239 and regulations promulgated thereunder. HB 2065 9 311 8. Providers of long-term care services shall be reimbursed for their costs in 312 accordance with the provisions of Section 1902 (a)(13)(A) of the Social Security Act, 42 313 U.S.C. Section 1396a, as amended, and regulations promulgated thereunder. 314 9. Reimbursement rates to long-term care providers with respect to a total change in 315 ownership, at arm's length, for any facility previously licensed and certified for participation 316 in the MO HealthNet program shall not increase payments in excess of the increase that 317 would result from the application of Section 1902 (a)(13)(C) of the Social Security Act, 42 318 U.S.C. Section 1396a (a)(13)(C). 319 10. The MO HealthNet division may enroll qualified residential care facilities and 320 assisted living facilities, as defined in chapter 198, as MO HealthNet personal care providers. 321 11. Any income earned by individuals eligible for certified extended employment at a 322 sheltered workshop under chapter 178 shall not be considered as income for purposes of 323 determining eligibility under this section. 324 12. If the Missouri Medicaid audit and compliance unit changes any interpretation or 325 application of the requirements for reimbursement for MO HealthNet services from the 326 interpretation or application that has been applied previously by the state in any audit of a MO 327 HealthNet provider, the Missouri Medicaid audit and compliance unit shall notify all affected 328 MO HealthNet providers five business days before such change shall take effect. Failure of 329 the Missouri Medicaid audit and compliance unit to notify a provider of such change shall 330 entitle the provider to continue to receive and retain reimbursement until such notification is 331 provided and shall waive any liability of such provider for recoupment or other loss of any 332 payments previously made prior to the five business days after such notice has been sent. 333 Each provider shall provide the Missouri Medicaid audit and compliance unit a valid email 334 address and shall agree to receive communications electronically. The notification required 335 under this section shall be delivered in writing by the United States Postal Service or 336 electronic mail to each provider. 337 13. Nothing in this section shall be construed to abrogate or limit the department's 338 statutory requirement to promulgate rules under chapter 536. 339 14. Beginning July 1, 2016, and subject to appropriations, providers of behavioral, 340 social, and psychophysiological services for the prevention, treatment, or management of 341 physical health problems shall be reimbursed utilizing the behavior assessment and 342 intervention reimbursement codes 96150 to 96154 or their successor codes under the 343 Current Procedural Terminology (CPT) coding system. Providers eligible for such 344 reimbursement shall include psychologists. 345 15. There shall be no payments made under this section for gender transition 346 surgeries, cross-sex hormones, or puberty-blocking drugs[De let ed te xt sta rt: , as suc h terms are defined in section 191.1720: end deleted text 347 Deleted text start: , as such terms are defined in section 191.1720: end deleted textDeleted text start: ,: end deleted text] for the purpose of a gender transition. HB 2065 10 217.230. The director shall arrange for necessary health care services for offenders 2 confined in correctional centers, which shall not include any gender transition surgery[Deleted text start: , as defined in section 191.1720: end deleted text 3 Deleted text start: , as defined in section 191.1720: end deleted text]. 221.120. 1. If any prisoner confined in the county jail is sick and in the judgment of 2 the jailer, requires the attention of a physician, dental care, or medicine, the jailer shall 3 procure the necessary medicine, dental care or medical attention necessary or proper to 4 maintain the health of the prisoner; provided, that this shall not include any gender transition 5 surgery[Deleted text start: , as defined in section 191.1720: end deleted text]. The costs of such medicine, dental care, or medical 6 attention shall be paid by the prisoner through any health insurance policy as defined in 7 subsection 3 of this section, from which the prisoner is eligible to receive benefits. If the 8 prisoner is not eligible for such health insurance benefits then the prisoner shall be liable for 9 the payment of such medical attention, dental care, or medicine, and the assets of such 10 prisoner may be subject to levy and execution under court order to satisfy such expenses in 11 accordance with the provisions of section 221.070, and any other applicable law. The county 12 commission of the county may at times authorize payment of certain medical costs that the 13 county commission determines to be necessary and reasonable. As used in this section, the 14 term "medical costs" includes the actual costs of medicine, dental care or other medical 15 attention and necessary costs associated with such medical care such as transportation, guards 16 and inpatient care. 17 2. The county commission may, in [Deleted text start: their: end deleted text] Added text start: its : end added text discretion, employ a physician by the 18 year, to attend such prisoners, and make such reasonable charge for his Added text start: or her : end added text service and 19 medicine, when required, to be taxed and collected as provided by law. 20 3. As used in this section, the following terms mean: 21 (1) "Assets", property, tangible or intangible, real or personal, belonging to or due a 22 prisoner or a former prisoner, including income or payments to such prisoner from Social 23 Security, workers' compensation, veterans' compensation, pension benefits, previously earned 24 salary or wages, bonuses, annuities, retirement benefits, compensation paid to the prisoner per 25 work or services performed while a prisoner or from any other source whatsoever, including 26 any of the following: 27 (a) Money or other tangible assets received by the prisoner as a result of a settlement 28 of a claim against the state, any agency thereof, or any claim against an employee or 29 independent contractor arising from and in the scope of the employee's or contractor's official 30 duties on behalf of the state or any agency thereof; 31 (b) A money judgment received by the prisoner from the state as a result of a civil 32 action in which the state, an agency thereof or any state employee or independent contractor 33 where such judgment arose from a claim arising from the conduct of official duties on behalf 34 of the state by the employee or subcontractor or for any agency of the state; HB 2065 11 35 (c) A current stream of income from any source whatsoever, including a salary, 36 wages, disability benefits, retirement benefits, pension benefits, insurance or annuity benefits, 37 or similar payments; [Deleted text start: and: end deleted text] 38 (2) "Health insurance policy", any group insurance policy providing coverage on an 39 expense-incurred basis, any group service or indemnity contract issued by a not-for-profit 40 health services corporation or any self-insured group health benefit plan of any type or 41 description. [Repealed Section 191.1720 Repealed Section 191.1720: 1 This section shall be known and may be cited as the 2 "Missouri Save Adolescents from Experimentation (SAFE) Act". 3 2. For purposes of this section, the following terms mean: 4 (1) "Biological sex", the biological indication of male or female in the 5 context of reproductive potential or capacity, such as sex chromosomes, 6 naturally occurring sex hormones, gonads, and nonambiguous internal and 7 external genitalia present at birth, without regard to an individual's 8 psychological, chosen, or subjective experience of gender; 9 (2) "Cross-sex hormones", testosterone, estrogen, or other androgens 10 given to an individual in amounts that are greater or more potent than would 11 normally occur naturally in a healthy individual of the same age and sex; 12 (3) "Gender", the psychological, behavioral, social, and cultural 13 aspects of being male or female; 14 (4) "Gender transition", the process in which an individual transitions 15 from identifying with and living as a gender that corresponds to his or her 16 biological sex to identifying with and living as a gender different from his or 17 her biological sex, and may involve social, legal, or physical changes; 18 (5) "Gender transition surgery", a surgical procedure performed for the 19 purpose of assisting an individual with a gender transition, including, but not 20 limited to: 21 (a) Surgical procedures that sterilize, including, but not limited to, 22 castration, vasectomy, hysterectomy, oophorectomy, orchiectomy, or 23 penectomy; 24 (b) Surgical procedures that artificially construct tissue with the 25 appearance of genitalia that differs from the individual's biological sex, 26 including, but not limited to, metoidioplasty, phalloplasty, or vaginoplasty; or 27 (c) Augmentation mammoplasty or subcutaneous mastectomy; 28 (6) "Health care provider", an individual who is licensed, certified, or 29 otherwise authorized by the laws of this state to administer health care in the 30 ordinary course of the practice of his or her profession; 31 (7) "Puberty-blocking drugs", gonadotropin-releasing hormone 32 analogues or other synthetic drugs used to stop luteinizing hormone 33 secretion and follicle stimulating hormone secretion, synthetic antiandrogen 34 drugs to block the androgen receptor, or any other drug used to delay or 35 suppress pubertal development in children for the purpose of assisting an 36 individual with a gender transition. 37 3. A health care provider shall not knowingly perform a gender 38 transition surgery on any individual under eighteen years of age. HB 2065 12 39 4. (1) A health care provider shall not knowingly prescribe or 40 administer cross-sex hormones or puberty-blocking drugs for the purpose of a 41 gender transition for any individual under eighteen years of age. 42 (2) The provisions of this subsection shall not apply to the prescription 43 or administration of cross-sex hormones or puberty-blocking drugs for any 44 individual under eighteen years of age who was prescribed or administered 45 such hormones or drugs prior to August 28, 2023, for the purpose of assisting 46 the individual with a gender transition. 47 (3) The provisions of this subsection shall expire on August 28, 2027. 48 5. The performance of a gender transition surgery or the prescription 49 or administration of cross-sex hormones or puberty-blocking drugs to an 50 individual under eighteen years of age in violation of this section shall be 51 considered unprofessional conduct and any health care provider doing so shall 52 have his or her license to practice revoked by the appropriate licensing entity 53 or disciplinary review board with competent jurisdiction in this state. 54 6. (1) The prescription or administration of cross-sex hormones or 55 puberty-blocking drugs to an individual under eighteen years of age for the 56 purpose of a gender transition shall be considered grounds for a cause of action 57 against the health care provider. The provisions of chapter 538 shall not apply 58 to any action brought under this subsection. 59 (2) An action brought pursuant to this subsection shall be brought 60 within fifteen years of the individual injured attaining the age of twenty-one or 61 of the date the treatment of the injury at issue in the action by the defendant 62 has ceased, whichever is later. 63 (3) An individual bringing an action under this subsection shall be 64 entitled to a rebuttable presumption that the individual was harmed if the 65 individual is infertile following the prescription or administration of cross-sex 66 hormones or puberty-blocking drugs and that the harm was a direct result of 67 the hormones or drugs prescribed or administered by the health care provider. 68 Such presumption may be rebutted only by clear and convincing evidence. 69 (4) In any action brought pursuant to this subsection, a plaintiff may 70 recover economic and noneconomic damages and punitive damages, without 71 limitation to the amount and no less than five hundred thousand dollars in the 72 aggregate. The judgment against a defendant in an action brought pursuant to 73 this subsection shall be in an amount of three times the amount of any 74 economic and noneconomic damages or punitive damages assessed. Any 75 award of damages in an action brought pursuant to this subsection to a 76 prevailing plaintiff shall include attorney's fees and court costs. 77 (5) An action brought pursuant to this subsection may be brought in 78 any circuit court of this state. 79 (6) No health care provider shall require a waiver of the right to bring 80 an action pursuant to this subsection as a condition of services. The right to 81 bring an action by or through an individual under the age of eighteen shall not 82 be waived by a parent or legal guardian. 83 (7) A plaintiff to an action brought under this subsection may enter 84 into a voluntary agreement of settlement or compromise of the action, but no 85 agreement shall be valid until approved by the court. No agreement allowed 86 by the court shall include a provision regarding the nondisclosure or HB 2065 13 87 confidentiality of the terms of such agreement unless such provision was 88 specifically requested and agreed to by the plaintiff. 89 (8) If requested by the plaintiff, any pleadings, attachments, or exhibits 90 filed with the court in any action brought pursuant to this subsection, as well as 91 any judgments issued by the court in such actions, shall not include the 92 personal identifying information of the plaintiff. Such information shall be 93 provided in a confidential information filing sheet contemporaneously filed 94 with the court or entered by the court, which shall not be subject to public 95 inspection or availability. 96 7. The provisions of this section shall not apply to any speech 97 protected by the First Amendment of the United States Constitution. 98 8. The provisions of this section shall not apply to the following: 99 (1) Services to individuals born with a medically-verifiable disorder of 100 sex development, including, but not limited to, an individual with external 101 biological sex characteristics that are irresolvably ambiguous, such as those 102 born with 46,XX chromosomes with virilization, 46,XY chromosomes with 103 undervirilization, or having both ovarian and testicular tissue; 104 (2) Services provided when a physician has otherwise diagnosed an 105 individual with a disorder of sex development and determined through genetic 106 or biochemical testing that the individual does not have normal sex 107 chromosome structure, sex steroid hormone production, or sex steroid 108 hormone action; 109 (3) The treatment of any infection, injury, disease, or disorder that has 110 been caused by or exacerbated by the performance of gender transition surgery 111 or the prescription or administration of cross-sex hormones or puberty- 112 blocking drugs regardless of whether the surgery was performed or the 113 hormones or drugs were prescribed or administered in accordance with state 114 and federal law; or 115 (4) Any procedure undertaken because the individual suffers from a 116 physical disorder, physical injury, or physical illness that would, as certified by 117 a physician, place the individual in imminent danger of death or impairment of 118 a major bodily function unless surgery is performed.] Bill Body End HB 2065 14