2023 Missouri Legislative Outlook: Health & Mental Health

By: Dr. Ramon Martinez III

As the emergency phase of the COVID-19 pandemic has waned, upcoming health & mental health legislation in 2023 looks to address several themes left outstanding in the previous session and re-focus on other underlying issues in health.

Professional Registration and Licensure

Healthcare workforce shortages have been on the rise since the start of the COVID-19 pandemic, and lawmakers have offered several legislative solutions to help ease training, recruitment, or retention of these understaffed fields. Some pre-filed bills would allow reciprocal recognition of licenses from other states (HB 270), changes the licensing requirements or scope of practice for advanced practice registered nursing (HB 271 | HB 330 | SB 208 | HB 284), nurse anesthetists (HB 329 | SB 27), or naturopathic medical practitioners (SB 322).

Relevant Science Notes: Medical Licensure Reciprocity in Missouri, Advanced Practice Registered Nurse Scope of Practice, COVID-19 and the Missouri Workforce.

Given workforce shortages in the health field, an alternative to recognizing licenses from other states is to enter into an interstate compact that guarantees reciprocal recognition of licenses from any state for any medical field. Bills that include this are entry into the interstate compact for medicine (HB 285| HB 348), and mental health counseling (SB 70).

Another method to address healthcare workforce shortages has been to allow the currently available fields of care to perform additional services above what they are typically licensed to do. These expanded scopes of practice can include professionals in physical therapy (HB 99 | HB115 | HB 144), dentistry (HB 100 | HB 249 | SB 270), and pharmacy (HB 198).

Relevant Science Notes: Interstate Medical Licensure Compact, Counseling Interstate Compact.

Insurance Coverage

At the federal level, recent focus has been placed on expanding the range of services that private or subsidized insurances (like Medicare and Medicaid) cover. Similarly, several bills have been introduced for the 2023 session that would require state-regulated insurance plans to do the same. These include services like:

• breast cancer screenings (HB 147),
• lower cost or ‘biosimilar’ pharmaceuticals (HB 198 | SB 26),
• emergency care and contraceptives for rape victims (HB161),
• overall contraceptive coverage (HB 287),
• fertility treatments (HB 323),
• lower-cost insulin and epinephrine (HB 342 | SB 283),
• drugs for sexually transmitted diseases between partners (HB 291), or
• coverage of drugs that achieve the same therapeutic benefit outside of the health plan (HB 324).

Given that medical devices and prescriptions are not always covered or can be cost-prohibitive to patients, several bills have been introduced to provide tax credits for these items. These include credits for devices used to treat cancer (HB 154), contraception (HB 321), and wheelchairs (SB 173).

Relevant Science Notes: Expanded Prescription Contraceptive Supply, Expedited Partner Therapies, Pricing & Transparency in Prescription Drug Costs.

Opioid Treatments

Missouri and the rest of the United States has experienced negative health outcomes (addiction, fatalities, economic downturn) from the opioid epidemic, both from prescription and illicit opioid drugs. Various bills have been filed that attempt to address or pass penalties to the proliferation of opioid use, including penalties for fentanyl trafficking (HB 250), allows the sale of the overdose rescue drug naloxone (HB 117 | HB 343), requires the state to follow federal guidelines for opioid prescriptions (HB 320), or allows pharmacists to prescribe medication-assisted therapies used to treat opioid addiction (SB 41).

Relevant Science Notes: Opioids in Missouri, Substance Abuse & Naltrexone Hydrochloride, Fentanyl Testing Kits, Pharmacist Scope of Practice, Behavioral Healthcare Deficits & Interventions.

Patient Examinations

Several bills have been introduced that increase the protection of patients from examinations by a doctor without consent. These include restricting examinations under anesthesia without express prior consent (HB 283 | SB 106).

Relevant Science Note: Pelvic Exams & Informed Consent

Questions? Contact Dr. Ramon Martinez III, Health & Mental Health Policy Fellow, ramon@mostpolicyinitiative.org.