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SECOND REGULAR SESSION
[TRULY AGREED TO AND FINALLY PASSED]
HOUSE COMMITTEE SUBSTITUTE FOR
SENATE BILL NO. 1019
103RD GENERAL ASSEMBLY
2026
4774H.04T
AN ACT
To repeal sections 96.192, 96.196, and 206.110, RSMo, and section 192.026 as truly agreed to and
finally passed by senate substitute for senate committee substitute for house committee
substitute for house bill no. 2372, one hundred third general assembly, second regular
session, and to enact in lieu thereof five new sections relating to health care.
Be it enacted by the General Assembly of the State of Missouri, as follows:
1 Section A. Sections 96.192, 96.196, and 206.110, RSMo,
2 and section 192.026 as truly agreed to and finally passed by
3 senate substitute for senate committee substitute for house
4 committee substitute for house bill no. 2372, one hundred third
5 general assembly, second regular session, are repealed and five
6 new sections enacted in lieu thereof, to be known as sections
7 96.192, 96.196, 192.026, 206.110, and 206.158, to read as
8 follows:
1 96.192. 1. The board of trustees of any hospital
2 authorized under subsection 2 of this section, and
3 established and organized under the provisions of sections
4 96.150 to 96.229[,]:
5 (1) May invest up to [twenty-five] fifty percent of
6 the hospital's "available funds", defined in this section as
7 funds not required for immediate disbursement in obligations
8 or for the operation of the hospital [in any United States
EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
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9 investment grade fixed income funds or any diversified stock
10 funds, or both.], into:
11 (a) Any mutual funds that invest in stocks, bonds, or
12 real estate, or any combination thereof;
13 (b) Bonds that have:
14 a. One of the five highest long-term ratings or the
15 highest short-term rating issued by a nationally recognized
16 rating agency; and
17 b. A final maturity of ten years or less;
18 (c) Money market investments; or
19 (d) Any combination of investments described in
20 paragraphs (a) to (c) of this subdivision; and
21 (2) Shall invest the remaining percentage of any
22 available funds not invested as allowed under subdivision
23 (1) of this subsection into any investment in which the
24 state treasurer is allowed to invest.
25 2. The provisions of this section shall only apply if
26 the hospital:
27 (1) Receives less than [one] three percent of its
28 annual revenues from municipal, county, or state taxes; and
29 (2) Receives less than [one] three percent of its
30 annual revenue from appropriated funds from the municipality
31 in which such hospital is located.
1 96.196. 1. A hospital organized under this chapter
2 may purchase, operate or lease, as lessor or lessee, related
3 facilities or engage in health care activities, except in
4 counties of the third or fourth classification (other than
5 the county in which the hospital is located) where there
6 already exists a hospital organized pursuant to this chapter
7 [and chapter 205 or 206]; provided, however, that this
8 exception shall not prohibit the continuation of existing
9 activities otherwise allowed by law.
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10 2. If a hospital organized pursuant to this chapter
11 accepts appropriated funds from the city during the twelve
12 months immediately preceding the date that the hospital
13 purchases, operates or leases its first related facility
14 outside the city boundaries or engages in its first health
15 care activity outside the city boundaries, the governing
16 body of the city shall approve the hospital's plan for such
17 purchase, operation or lease prior to implementation of the
18 plan.
1 [192.026. 1. Sections 103.190 and 192.026
2 to 192.029 shall be known and may be cited as
3 the "Missouri Lyme Disease Eradication Act".
4 2. As used in sections 103.190 and 192.026
5 to 192.029, the following terms shall mean:
6 (1) "Department", the department of health
7 and senior services;
8 (2) "Lyme disease", a condition caused by
9 an infection of the bacterium Borrelia
10 burgdorferi, Borrelia mayonii, Borrelia afzelii,
11 Borrelia garinii, Borrelia valaisiana, Borrelia
12 lusitaniae, Bartonella, Babesia, Ehrlichia, or
13 related species, transmitted to humans through
14 the bite of infected blacklegged ticks (Ixodes
15 scapularis) or other ticks, as diagnosed by the
16 two-tier serologic testing recommended by the
17 federal Centers for Disease Control and
18 Prevention (CDC) or by a similar blood test
19 ordered by a treating health care provider or by
20 clinical evaluation;
21 (3) "Medically necessary", health care
22 services or products that a treating health care
23 provider exercising prudent clinical judgment
24 would provide to a patient for the purpose of
25 preventing, evaluating, diagnosing, or treating
26 an illness, injury, disease, or symptoms of
27 such, and that are:
28 (a) Clinically appropriate in terms of
29 type, frequency, extent, site, and duration for
30 the specific circumstances; and
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31 (b) Not primarily for the mere convenience
32 of the patient, health care provider, or as
33 determined by the provider based on the
34 patient's specific circumstances;
35 (4) "Posttreatment Lyme disease syndrome",
36 a condition characterized by persistent
37 symptoms, including, but not limited to,
38 fatigue, pain, respiratory impairment,
39 neurological impairment, or other cognitive
40 impairment following standard antibiotic or
41 other treatment for Lyme disease.
42 3. Health care providers, laboratories,
43 and local health departments shall report to the
44 department all confirmed or suspected cases of
45 Lyme disease within seven days of diagnosis
46 using standardized surveillance case definitions
47 developed by the CDC. Any patient who receives
48 a positive or suspected diagnosis of Lyme
49 disease shall be given the option to opt in to
50 having their identifiable information shared
51 with the department, local public health
52 officials, or the CDC.
53 4. The department shall compile an annual
54 report on the incidence and prevalence of Lyme
55 disease in Missouri, including, but not limited
56 to, demographic data, geographic distribution,
57 treatment outcomes, and barriers to care. The
58 department shall submit the report to the CDC
59 and the general assembly and make such report
60 available to the public on the department's
61 website by no later than December thirty-first
62 of each year.
63 5. The department shall collaborate with
64 the University of Missouri or any public four-
65 year institution of higher education to
66 integrate Lyme disease surveillance data into
67 existing tick-borne disease monitoring programs.
68 6. Any information collected or reported
69 under this section shall be done in a manner
70 that protects individually identifiable or
71 potentially identifiable information and that is
72 consistent with state and federal privacy laws.
73 7. The department may promulgate any rules
74 and regulations necessary to implement the
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75 provisions of sections 192.026 to 192.028. Any
76 rule or portion of a rule, as that term is
77 defined in section 536.010, that is created
78 under the authority delegated in this section
79 shall become effective only if it complies with
80 and is subject to all of the provisions of
81 chapter 536 and, if applicable, section
82 536.028. This section and chapter 536 are
83 nonseverable and if any of the powers vested
84 with the general assembly pursuant to chapter
85 536 to review, to delay the effective date, or
86 to disapprove and annul a rule are subsequently
87 held unconstitutional, then the grant of
88 rulemaking authority and any rule proposed or
89 adopted after August 28, 2026, shall be invalid
90 and void.]
1 192.026. 1. Sections 103.190 and 192.026 to 192.029
2 shall be known and may be cited as the "Missouri Lyme
3 Disease Eradication Act".
4 2. As used in sections 103.190 and 192.026 to 192.029,
5 the following terms shall mean:
6 (1) "Department", the department of health and senior
7 services;
8 (2) "Lyme disease", a condition caused by an infection
9 of the bacterium Borrelia burgdorferi, Borrelia mayonii,
10 Borrelia afzelii, Borrelia garinii, Borrelia valaisiana, or
11 Borrelia lusitaniae, transmitted to humans through the bite
12 of infected blacklegged ticks (Ixodes scapularis) or other
13 ticks, as defined by the national reporting case definition
14 and posted by the Centers for Disease Control and Prevention
15 National Notifiable Diseases Surveillance System;
16 (3) "Medically necessary", health care services or
17 products that a treating health care provider exercising
18 prudent clinical judgment would provide to a patient for the
19 purpose of preventing, evaluating, diagnosing, or treating
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20 an illness, injury, disease, or symptoms of such, and that
21 are:
22 (a) Clinically appropriate in terms of type,
23 frequency, extent, site, and duration for the specific
24 circumstances; and
25 (b) Not primarily for the mere convenience of the
26 patient, health care provider, or as determined by the
27 provider based on the patient's specific circumstances;
28 (4) "Posttreatment Lyme disease syndrome", a condition
29 characterized by persistent symptoms, including, but not
30 limited to, fatigue, pain, respiratory impairment,
31 neurological impairment, or other cognitive impairment
32 following standard antibiotic or other treatment for Lyme
33 disease.
34 3. Health care providers, laboratories, and local
35 health departments shall report to the department all
36 confirmed or suspected cases of Lyme disease within three
37 days of diagnosis using standardized surveillance case
38 definitions developed by the CDC. Any patient who receives
39 a positive or suspected diagnosis of Lyme disease shall be
40 given the option to opt in to having their identifiable
41 information shared with the department, local public health
42 officials, or the CDC.
43 4. The department shall compile an annual report on
44 the incidence and prevalence of Lyme disease in Missouri,
45 including, but not limited to, demographic data, geographic
46 distribution, treatment outcomes, and barriers to care. The
47 department shall submit the report to the CDC and the
48 general assembly and make such report available to the
49 public on the department's website by no later than December
50 thirty-first of each year.
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51 5. The department shall collaborate with the
52 University of Missouri or any public four-year institution
53 of higher education to integrate Lyme disease surveillance
54 data into existing tick-borne disease monitoring programs.
55 6. Any information collected or reported under this
56 section shall be done in a manner that protects individually
57 identifiable or potentially identifiable information and
58 that is consistent with state and federal privacy laws.
59 7. The department may promulgate any rules and
60 regulations necessary to implement the provisions of
61 sections 192.026 to 192.028. Any rule or portion of a rule,
62 as that term is defined in section 536.010, that is created
63 under the authority delegated in this section shall become
64 effective only if it complies with and is subject to all of
65 the provisions of chapter 536 and, if applicable, section
66 536.028. This section and chapter 536 are nonseverable and
67 if any of the powers vested with the general assembly
68 pursuant to chapter 536 to review, to delay the effective
69 date, or to disapprove and annul a rule are subsequently
70 held unconstitutional, then the grant of rulemaking
71 authority and any rule proposed or adopted after August 28,
72 2026, shall be invalid and void.
1 206.110. 1. A hospital district, both within and
2 outside such district, except in counties of the third or
3 fourth classification (other than within the district
4 boundaries) where there already exists a hospital organized
5 pursuant to [chapters 96, 205 or] this chapter; provided,
6 however, that this exception shall not prohibit the
7 continuation or expansion of existing activities otherwise
8 allowed by law, shall have and exercise the following
9 governmental powers, and all other powers incidental,
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10 necessary, convenient or desirable to carry out and
11 effectuate the express powers:
12 (1) To establish and maintain a hospital or hospitals
13 and hospital facilities, and to construct, acquire, develop,
14 expand, extend and improve any such hospital or hospital
15 facility including medical office buildings to provide
16 offices for rental to physicians and dentists on the
17 district hospital's medical or dental staff, and the
18 providing of sites therefor, including offstreet parking
19 space for motor vehicles;
20 (2) To acquire land in fee simple, rights in land and
21 easements upon, over or across land and leasehold interest
22 in land and tangible and intangible personal property used
23 or useful for the location, establishment, maintenance,
24 development, expansion, extension or improvement of any
25 hospital or hospital facility. The acquisition may be by
26 dedication, purchase, gift, agreement, lease, use or adverse
27 possession or by condemnation;
28 (3) To operate, maintain and manage a hospital and
29 hospital facilities, and to make and enter into contracts,
30 for the use, operation or management of a hospital or
31 hospital facilities; to engage in health care activities;
32 and to make and enter into leases of equipment and real
33 property, a hospital or hospital facilities, as lessor or
34 lessee, regardless of the duration of such lease; and to
35 provide rules and regulations for the operation, management
36 or use of a hospital or hospital facilities. Any agreement
37 entered into pursuant to this subsection pertaining to the
38 lease of the hospital shall have a definite termination date
39 as negotiated by the parties, but this shall not preclude
40 the trustees from entering into a renewal of the agreement
41 with the same or other parties pertaining to the same or
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42 other subjects upon such terms and conditions as the parties
43 may agree;
44 (4) To fix, charge and collect reasonable fees and
45 compensation for the use or occupancy of the hospital or any
46 part thereof, or any hospital facility, and for nursing
47 care, medicine, attendance, or other services furnished by
48 the hospital or hospital facilities, according to the rules
49 and regulations prescribed by the board from time to time;
50 (5) To borrow money and to issue bonds, notes,
51 certificates, or other evidences of indebtedness for the
52 purpose of accomplishing any of its corporate purposes,
53 subject to compliance with any condition or limitation set
54 forth in this chapter or otherwise provided by the
55 Constitution of the state of Missouri;
56 (6) To employ or enter into contracts for the
57 employment of any person, firm, or corporation, and for
58 professional services, necessary or desirable for the
59 accomplishment of the corporate objects of the district or
60 the proper administration, management, protection or control
61 of its property;
62 (7) To maintain the hospital for the benefit of the
63 inhabitants of the area comprising the district who are
64 sick, injured, or maimed regardless of race, creed or color,
65 and to adopt such reasonable rules and regulations as may be
66 necessary to render the use of the hospital of the greatest
67 benefit to the greatest number; to exclude from the use of
68 the hospital all persons who willfully disregard any of the
69 rules and regulations so established; to extend the
70 privileges and use of the hospital to persons residing
71 outside the area of the district upon such terms and
72 conditions as the board of directors prescribes by its rules
73 and regulations;
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74 (8) To police its property and to exercise police
75 powers in respect thereto or in respect to the enforcement
76 of any rule or regulation provided by the ordinances of the
77 district and to employ and commission police officers and
78 other qualified persons to enforce the same;
79 (9) To lease to or allow for any institution of higher
80 education to use or occupy the hospital, any real estate or
81 facility owned or leased by the district or any part thereof
82 for the purpose of health care-related and general education
83 or training.
84 2. The use of any hospital or hospital facility of a
85 district shall be subject to the reasonable regulation and
86 control of the district and upon such reasonable terms and
87 conditions as shall be established by its board of directors.
88 3. A regulatory ordinance of a district adopted under
89 any provision of this section may provide for a suspension
90 or revocation of any rights or privileges within the control
91 of the district for a violation of any such regulatory
92 ordinance.
93 4. Nothing in this section or in other provisions of
94 this chapter shall be construed to authorize the district or
95 board to establish or enforce any regulation or rule in
96 respect to hospitalization or the operation or maintenance
97 of such hospital or any hospital facilities within its
98 jurisdiction which is in conflict with any federal or state
99 law or regulation applicable to the same subject matter.
1 206.158. 1. The board of directors of any hospital
2 district authorized under subsection 2 of this section, and
3 established and organized under the provisions of this
4 chapter:
5 (1) May invest up to fifty percent of its "available
6 funds", defined in this section as funds not required for
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7 immediate disbursement in obligations or for the operation
8 of the hospital district, into:
9 (a) Any mutual funds that invest in stocks, bonds, or
10 real estate, or any combination thereof;
11 (b) Bonds that have:
12 a. One of the five highest long-term ratings or the
13 highest short-term rating issued by a nationally recognized
14 rating agency; and
15 b. A final maturity of ten years or less;
16 (c) Money market investments; or
17 (d) Any combination of investments described in
18 paragraphs (a) to (c) of this subdivision; and
19 (2) Shall invest the remaining percentage of any
20 available funds not invested as allowed under subdivision
21 (1) of this subsection into any investment in which the
22 state treasurer is allowed to invest.
23 2. The provisions of this section shall apply only if
24 the hospital district receives less than three percent of
25 its annual revenues from hospital district or state taxes.
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