Chapter 199 Rehabilitation Center - Head Injury - Tuberculosis Testing and Commitment
199.003 - Injury prevention, brain injury rehabilitation and local health services, department responsible — powers — duties.
1.The department shall have the responsibility, subject to appropriations, of ensuring that injury prevention and brain injury rehabilitation evaluation, service coordination, treatment, rehabilitation, and community support services are accessible, wherever possible.
2.The powers, functions and duties of the department shall include the following:
(1)Planning and implementing, in cooperation with the Missouri brain injury advisory council, accessible programs to promote rehabilitation and community reintegration of persons with brain injuries;
(2)Provision of technical assistance and training to community-based programs assisting persons with brain injuries;
(3)Assurance of quality for brain injury services funded by the department;
(4)Sponsorship and encouragement of research into the causes, effects, prevention, treatment and rehabilitation of injuries and appropriateness and cost and benefit effectiveness of brain injury rehabilitation, residential programs and specialized services;
(5)Provision of public information relating to injury prevention and brain injury treatment and rehabilitation;
(6)Cooperation with nonstate governmental agencies and private sector programs and projects relating to injury prevention and brain injury treatment and rehabilitation;
(7)Receiving federal grants and aids for injury prevention and for persons with brain injuries and brain injury rehabilitation under the terms of the grants and aids and administering or paying them out.The director shall approve such applications for federal assistance administered through the department as may be considered advisable in consultation with the Missouri brain injury advisory council;
(8)Promulgating rules under the provisions of this section, as necessary to prescribe policies or standards which affect charging and funding of adult brain injury rehabilitation services.The rules applicable to each program or service operated or funded by the department shall be available for public inspection and review at such program or service.The rules and policies shall be compatible with and appropriate to the program mission, population served, size, type of service, and other reasonable classifications;
(9)Promulgating reasonable rules relative to the implementation of participant rights described in sections 199.001 to 199.051;
(10)Promulgating rules setting forth a reasonable standard means test which shall be applied to all programs and services funded by the department in determining eligibility for such services.
3.Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028.This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2011, shall be invalid and void.
199.007 - Brain injury advisory council, advisory body to department.
The Missouri brain injury advisory council, created by section 192.745, shall act as the advisory body to the department and department director.Any power or function of the department requiring planning activities shall be undertaken with the direct input and cooperation of the advisory council.The department shall not undertake or duplicate any activity or function of the council under the provisions of section 192.745.
199.033 - Records to be confidential — disclosure upon request, certain persons, when — disclosure to be documented.
1.Information and records compiled, obtained, prepared or maintained by the rehabilitation facilities, residential facility or specialized program operated or funded by the department or otherwise in the course of providing services to patients shall be confidential.
2.The facilities or programs shall disclose information and records to the following upon their request:
(1)The parent of a minor patient;
(2)The guardian or other person having legal custody of the patient;
(3)The attorney of a patient who is a ward of the juvenile court, an alleged incompetent, an incompetent ward or a person detained under chapter 632, as evidenced by court orders of the attorney's appointment;
(4)An attorney or personal physician as authorized by the patient.
3.The facilities or services may disclose information and records under any of the following:
(1)As authorized by the patient;
(2)To persons or agencies responsible for providing health care services to such patients;
(3)To the extent necessary for a recipient to make a claim or for a claim to be made on behalf of a recipient for aid or insurance;
(4)To qualified personnel for the purpose of conducting scientific research, management audits, financial audits, program evaluations or similar studies; provided, that such personnel shall not identify, directly or indirectly, any individual patient in any report of such research, audit or evaluation, or otherwise disclose patient identities in any manner;
(5)To the courts as necessary for the administration of the provisions of sections 199.001 to 199.055;
(6)To law enforcement officers or public health officers, but only to the extent necessary to carry out the responsibilities of their office, and all such law enforcement and public health officers shall be obligated to keep such information confidential;
(7)Pursuant to an order of a court or administrative agency of competent jurisdiction;
(8)To the department of social services as necessary to report or have investigated abuse, neglect, or rights violations of patients.
4.The facility or program shall document the dates, nature, purposes and recipients of any records disclosed under this section.
5.Nothing contained in this section shall limit the rights of discovery in judicial or administrative procedures as otherwise provided for by statute or rule.
199.037 - Patient rights, rules and regulations, director to promulgate — exception.
The director of the department shall promulgate reasonable rules relative to the implementation of patient rights described in sections 199.001 to 199.051.These rules shall not apply to facilities, programs or services operated or provided by the curators of the University of Missouri.
199.180 - Local health agency may institute proceedings for commitment — emergency temporary commitment permitted, when.
1.A person found to have tuberculosis shall follow the instructions of the local public health authority or the department, shall obtain the required treatment, and shall minimize the risk of infecting others with tuberculosis.
2.When a person with active tuberculosis, or a person who is a potential transmitter, violates the rules, regulations, instructions, or orders promulgated by the department of health and senior services or the local public health authority, and is thereby conducting himself or herself so as to expose other persons to danger of tuberculosis, after having been directed by the local public health authority to comply with such rules, regulations, instructions, or orders, the local public health authority may institute proceedings by petition for DOT or commitment, returnable to the circuit court of the county in which such person resides, or if the person be a nonresident or has no fixed place of abode, then in the county in which the person is found.Strictness of pleading shall not be required and a general allegation that the public health requires DOT or commitment of the person named therein shall be sufficient.
3.If the public health authority determines that a person with active tuberculosis, or a person who is a potential transmitter, poses an immediate threat by conducting himself or herself so as to expose other persons to an immediate danger of tuberculosis, the public health authority may file an ex parte petition for emergency temporary commitment pursuant to subsection 5 of section 199.200.
199.280 - Department authority in response to outbreaks.
The department retains all powers granted under section 192.020 in responding to tuberculosis cases, outbreaks, and tuberculosis disease investigations.
199.190 - Patients not to be committed, when.
No potential transmitter who in his or her home or other place obeys the rules and regulations of the public health authority or the department of health and senior services, and the policies of the treating facility, for the control of tuberculosis or who voluntarily accepts care in a tuberculosis institution, hospital, home, or other place and obeys the rules and regulations of the public health authority or the department of health and senior services for the control of contagious tuberculosis shall be committed under the provisions of sections 199.170 to 199.350.
199.290 - Mandatory testing of health care facility workers — higher education, students and faculty, testing program required — rulemaking authority.
1.All employees and volunteers of a health care facility shall receive a tuberculin skin test or interferon gamma release assay (IGRA) test upon employment as recommended in the most recent version of the Centers for Disease Control and Prevention (CDC) Guidelines for Preventing Transmission of Mycobacterium Tuberculosis in Health Care Settings.If the screening test is positive, appropriate evaluation and follow-up shall be done in accordance with such CDC guidelines.This provision shall not be construed to prohibit any institution from establishing requirements for employees or volunteers that exceed those stated in the CDC guidelines.
2.All institutions of higher education in Missouri shall implement a targeted testing program on their campuses for all on-campus students and faculty upon matriculation.If an institution does not have a student health center or similar facility, such person identified by the targeted testing program to be at high risk for latent tuberculosis infection or for developing tuberculosis disease shall be referred to a local public health agency for a course of action consistent with sections 199.170 to 199.350.
3.Any entering student of an institution of higher education in Missouri who does not comply with the targeted testing program shall not be permitted to maintain enrollment in the subsequent semester at such institution.
4.Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028.This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2013, shall be invalid and void.
199.043 - Discrimination prohibited.
In accordance with state and federal law, no residential facility, day program or specialized service operated or funded by the department shall deny admission or other services to any person because of his race, sex, creed, marital status, national origin, handicap or age.
199.200 - Procedure in circuit court — duties of local prosecuting officers — costs — emergency temporary commitment, procedures.
1.Upon filing of the petition, the court shall set the matter down for a hearing either during term time or in vacation, which time shall be not less than five days nor more than fifteen days subsequent to filing.A copy of the petition together with summons stating the time and place of hearing shall be served upon the person three days or more prior to the time set for the hearing.Any X-ray picture and report of any written report relating to sputum examinations certified by the department of health and senior services or local public health authority shall be admissible in evidence without the necessity of the personal testimony of the person or persons making the examination and report.
2.The prosecuting attorney or the city attorney shall act as legal counsel for their respective local public health authorities in this proceeding and such authority is hereby granted.The court shall appoint legal counsel for the individual named in the petition if requested to do so if such individual is unable to employ counsel.
3.All court costs incurred in proceedings under sections 199.170 to 199.350, including examinations required by order of the court but excluding examinations procured by the person named in the petition, shall be borne by the county in which the proceedings are brought.
4.Summons shall be served by the sheriff of the county in which proceedings under sections 199.170 to 199.350 are initiated and return thereof shall be made as in other civil cases.
5.Upon the filing of an ex parte petition for emergency temporary commitment pursuant to subsection 3 of section 199.180, the court shall hear the matter within ninety-six hours of such filing.The local public health authority shall have the authority to detain the individual named in the petition pending the court's ruling on the ex parte petition for emergency temporary commitment.If the petition is granted, the individual named in the petition shall be confined in a facility designated by the department of health and senior services in accordance with section 199.230 until a full hearing pursuant to subsections 1 to 4 of this section is held.
199.051 - Inspections, department may conduct, when.
The department may inspect any facility or program at any time if a contract has been issued or an application for a contract has been filed.
199.041 - Probate court to notify department, when — estate subject to means test, when, procedure — appeal of decision of director.
1.Any probate division of the circuit court having knowledge of the existence of an estate of a patient receiving services from residential facilities or other programs operated or funded by the department shall promptly notify the director of the nature and extent of the estate and the identity of the attorney of record and conservator.The director shall then apply the standard means test contained in the rules of the department to determine if the estate shall be charged for services rendered by the department.
2.If the director determines that the estate should be charged for the evaluation, care, treatment, rehabilitation or room and board provided or funded by the department, and notifies the conservator, the conservator shall pay the charges.If the conservator fails to pay for the charges, after reasonable delay, the head of the department, residential facility or day program may discharge the patient.
3.The decision of the director shall be final, and appeal may be made to the circuit court of Cole County or the county where the person responsible for payment resides in the manner provided by chapter 536.The director shall notify the conservator and the supervising court of such failure to pay for services rendered by a facility or program operated or funded by the department at least thirty days before the patient is discharged.If the conservator appeals the decision of the director, the patient shall remain in the facility or program pending final disposition of the appeal.
199.010 - Missouri rehabilitation center, University of Missouri to operate, duties for brain injury — department to provide rehabilitation and tuberculosis treatment.
The curators of the University of Missouri shall provide for the care of persons needing brain injury and other rehabilitation subject to appropriation by the general assembly.The department of health and senior services shall provide for the treatment and commitment of persons having tuberculosis subject to appropriation by the general assembly.
199.210 - Rights of patient, witnesses — order of court — transportation costs — department may contract for care.
1.Upon the hearing set in the order, the individual named in the order shall have a right to be represented by counsel, to confront and cross-examine witnesses against him or her, and to have compulsory process for the securing of witnesses and evidence in his or her own behalf.The court may in its discretion call and examine witnesses and secure the production of evidence in addition to that adduced by the parties; such additional witnesses being subject to cross-examination by either or both parties.
2.Upon a consideration of the petition and evidence, if the court finds that the person named in the petition is a potential transmitter and conducts himself or herself so as to be a danger to the public health, an order shall be issued committing the individual named in the petition to a facility designated by the department of health and senior services and directing the sheriff to take such individual into custody and deliver him or her to the facility or designated pickup location.If the court does not so find, the petition shall be dismissed.The cost of transporting the person to the facility or pickup location designated by the department of health and senior services shall be paid out of general county funds.
3.The department may contract for the care of any tuberculosis patient.Such contracts shall provide that state payment shall be available for the treatment and care of such patients only after benefits from all third-party payers have been exhausted.
199.230 - Confinement on order, duration.
Upon commitment, the patient shall be confined in a facility designated by the department of health and senior services until such time as the patient's discharge will not endanger public health.
199.220 - Order appealable.
The order shall be subject to review at the instance of either party, as in other civil cases.
199.020 - Residence of officers — rent, how established — expiration thirty days after transfer of Missouri rehabilitation center to University of Missouri.
1.The following officers and their families shall, with the permission of the department of health and senior services, reside on the premises or other property of the center:center director, assistant director, physicians, and other personnel required for the center's operation as recommended by the center's director.Personnel residing at the center shall pay a monthly rental determined annually at the lower of cost or fair market value; except that the center director, with the approval of the director of the department of health and senior services, may establish a lower rate as required to fill the center's personnel needs.
*2.This section shall terminate thirty days following the date notice is provided to the revisor of statutes that an agreement has been executed which transfers the Missouri rehabilitation center from the department of health and senior services to the board of curators of the University of Missouri.
199.275 - Active tuberculosis, infected persons, unlawful acts — violation, penalty.
1.It shall be unlawful for any person knowingly infected with active pulmonary or laryngeal tuberculosis to:
(1)Act in a reckless manner by exposing another person to tuberculosis without the knowledge and consent of such person to be exposed to tuberculosis; or
(2)Report to work with active contagious tuberculosis.The person may report to work if adhering to his or her prescribed treatment regimen and is deemed noninfectious by the attending physician in conjunction with the department or the local public health authority; or
(3)Violate the requirements of a commitment order.
2.Any person who violates subdivision* (1), (2), or (3) of subsection 1 of this section is guilty of a class B misdemeanor unless the victim contracts tuberculosis from such contact, in which case it is a class A misdemeanor.
199.029 - Rules and regulations, general operating rules, department to promulgate — procedure — exception.
1.The department shall promulgate rules under the provisions of this section and chapter 536 as necessary to prescribe policies or standards which affect charging and funding of residential care rehabilitation programs and specialized services for persons with brain injuries available to the public.The rules applicable to each facility, program or service operated or funded by the department shall be available for public inspection and review at such facility, program or service.These rules shall not apply to facilities, programs or services operated or provided by curators of the University of Missouri.
2.The rules, operating regulations and facility policies shall be compatible with and appropriate to the facility or program mission, population served, size, type of service and other reasonable classifications.No rule or portion of a rule promulgated under the authority of this chapter shall become effective unless it has been promulgated pursuant to the provisions of section 536.024.
199.270 - Proceedings for release of patient.
Any time after commitment, the patient or, if incapacitated, the patient's legal guardian, or if a minor, a parent or next of kin having reason to believe that such patient no longer has contagious tuberculosis or that his or her discharge will not endanger public health, may institute proceedings by petition, in the circuit court of the county that originally issued the order for commitment, whereupon the court shall set the matter down for a hearing before the court within fifteen days requiring the local public health authority to show cause on a day certain why the patient should not be released.The court shall also require that the patient be allowed the right to be examined prior to the hearing by a licensed physician of the patient's own choice, if so desired, and at the patient's own personal expense.Thereafter all proceedings shall be conducted the same as on the proceedings for commitment with the right of appeal by either party as herein provided; provided, however, such petition for discharge shall not be brought or renewed more than once every six months.
199.170 - Definitions.
The following terms, as used in sections 199.170 to 199.350, mean:
(1)"Active tuberculosis", tuberculosis disease caused by the mycobacterium tuberculosis complex that is demonstrated to be contagious by clinical, bacteriological, or radiological evidence.Tuberculosis is considered active until cured;
(2)"Cure" or "treatment to cure", the completion of a recommended course of therapy as defined in subdivision (11) of this section and as determined by the attending physician in conjunction with the local public health authority or the department of health and senior services;
(3)"Department", the department of health and senior services;
(4)"Directly observed therapy" or "DOT", a strategy in which a health care provider or other trained person watches a patient swallow each dose of prescribed antituberculosis medication;
(5)"Facility", any hospital licensed under chapter 197, any public nonlicensed hospital, any long-term care facility licensed under chapter 198, any health care institution, any correctional or detention facility, or any mental health facility approved by the local public health authority or the department;
(6)"Immediate threat", a rebuttable presumption that a person has active tuberculosis and:
(a)Is not taking medications as prescribed;
(b)Is not following the recommendations of the treating physician, local public health authority, or the department;
(c)Is not seeking treatment for signs and symptoms compatible with tuberculosis; or
(d)Evidences a disregard for the health of the public;
(7)"Isolation", the physical separation in a single-occupancy room to isolate persons with suspected or confirmed infectious tuberculosis disease.An isolation should provide negative pressure in the room, an airflow rate of six to twelve air changes per hour, and direct exhaust of air from the room to the outside of the building or recirculation of the air through a high efficiency particulate air (HEPA) filter;
(8)"Latent tuberculosis infection", infection with mycobacterium tuberculosis without symptoms or signs of disease.Patients with such infection do not have tuberculosis disease, are not infectious and cannot spread tuberculosis infection to others;
(9)"Local public health authority", any legally constituted local city or county board of health or health center board of trustees or the director of health of the city of Kansas City, the director of the Springfield-Greene County health department, the director of health of St.Louis County or the commissioner of health of the City of St. Louis, or in the absence of such board, the county commission or the county board of tuberculosis hospital commissioners of any county;
(10)"Potential transmitter", any person who has the diagnosis of pulmonary or laryngeal tuberculosis but has not begun a recommended course of therapy, or who has the diagnosis of pulmonary tuberculosis and has started a recommended course of therapy but has not completed the therapy.This status applies to any individual with tuberculosis, regardless of his or her current bacteriologic status;
(11)"Recommended course of therapy", a regimen of antituberculosis chemotherapy in accordance with medical standards of the American Thoracic Society, the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, or the American Academy of Pediatrics;
(12)"Targeted testing program", a program that screens all faculty and students to identify those at high risk for latent tuberculosis infection and persons at high risk for developing tuberculosis disease, and includes testing of identified high-risk populations to determine those that would benefit from treatment.Screening shall require the completion of a tuberculosis risk assessment questionnaire form recommended by the American College of Health Association or the Centers for Disease Control and Prevention.High-risk populations include students from countries where tuberculosis is endemic or students with other risk factors for tuberculosis as identified by the Centers for Disease Control and Prevention.
199.039 - Means test, determination of amount to charge for services, director to promulgate rules and regulations.
The director of the department shall promulgate rules setting forth a reasonable standard means test which shall be applied to all facilities, programs and services operated or funded by the department in determining the amount to be charged to persons receiving services.Notwithstanding other provisions of sections 199.001 to 199.051, the department shall accept funds from federal reimbursement, third-party reimbursement, private pay or other funding sources.
199.260 - Apprehension and return of patient leaving rehabilitation center without discharge.
Any person committed under the provisions of sections 199.170 to 199.350 who leaves the facility designated by the department of health and senior services without having been discharged by the director of the facility or other officer in charge or by order of court shall be taken into custody and returned thereto by the sheriff of any county where such person may be found, upon an affidavit being filed with the sheriff by the director of the facility, or duly authorized officer in charge thereof, to which the person had been committed.The action may be prosecuted under section 199.275, if appropriate.
199.031 - Federal grants, department may receive, purposes — application.
1.The department may receive federal grants and aids for injury prevention and for persons with brain injuries and brain injury rehabilitation under the terms of the grants and aids and administer or pay them out subject to the provisions attached.
2.The director shall approve such applications for federal assistance administered through the department as may be considered advisable after consultation with the Missouri brain injury advisory council.
199.240 - Consent required for medical or surgical treatment.
No person committed to a facility designated by the department of health and senior services under sections 199.170 to 199.350 shall be required to submit to medical or surgical treatment without such person's consent, or, if incapacitated, without the consent of his or her legal guardian, or, if a minor, without the consent of a parent or next of kin, unless authorized by a written order of the circuit court under section 199.200 or as otherwise permitted by law.
199.001 - Definitions.
As used in sections 199.001 to 199.055*, the following terms mean:
(1)"Brain injury", includes brain injury and traumatic brain injury as defined in section 192.735;
(2)"Department", the department of health and senior services' adult brain injury program;
(3)"Injury or trauma", any unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen;
(4)"Rehabilitation", a comprehensive series of interventions for physical, medical, cognitive and psychological disabilities designed to restore a person to his maximum functional potential.
199.009 - Contracts with public or private vendors, allowed — brain injury, department to secure comprehensive program, contents.
1.The department may provide injury prevention, and brain injury evaluation, care, treatment, rehabilitation and such related services directly or through contracts from private and public vendors in this state, the quality of the services being equal, appropriate and consistent with professional advice in the least restrictive environment and as close to an individual's home community as possible, with funds appropriated for this purpose.
2.If it is determined through a comprehensive evaluation that a person has a traumatic brain injury so as to require the coordination of provision of services, including other state governmental agencies, nongovernmental and the private sector, and if such person, such person's parent, if the person is a minor, or legal guardian, so requests, the department shall, within the limits of available resources and subject to relevant federal and state laws, secure a comprehensive program of any necessary services for such person.Such services may include, but need not be limited to, the following:
(1)Assessment and evaluation;
(11)Day activity programs;
(13)Referral to appropriate services;
(15)Supported work, if provided by the department, shall be directed toward preparation for education or vocational achievement, independent living, and community participation.Long-term needs shall be identified and efforts made to link participants with appropriate resources.
3.In securing the comprehensive program of services, the department shall involve the participant, his or her family or his or her legal guardian in decisions affecting his or her care, rehabilitation, services or referral.The quality of the services being equal, appropriate and consistent with professional advice, services shall be offered in the least restrictive environment and as close to an individual's home community as possible.
4.In accordance with state and federal law, no service or program operated or funded by the department shall deny admission or other services to any person because of the person's race, sex, creed, marital status, national origin, handicap, or age.
199.350 - Nursing homes and correctional centers, authority to promulgate rules for testing.
The department shall have the authority to promulgate rules and regulations which require the preadmission testing for tuberculosis of all residents in nursing homes in the state and the annual testing of all health care workers and volunteers in nursing homes in the state, and residents and staff of state correctional centers.The department shall annually issue screening guidelines on other groups determined by the department to be at high risk for tuberculosis.
199.250 - Facilities, contracts with, costs, how paid.
1.The department of health and senior services may contract for such facilities as are necessary to carry out the functions of sections 199.010 to 199.350.Such contracts shall be exempt from the competitive bidding requirements of chapter 34.
2.State payment shall be available for the treatment and care of individuals committed under section 199.210 only after benefits from all third-party payers have been exhausted.