HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/STATE/MISSOURI.ASC

Text File | 1993-01-14 | 38KB | 845 lines

/* MISSOURI has passed law dealing with testing, education and
discrimination, as well as notifying schools of infected
students. */



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

1.   No person shall perform or conduct HIV testing except
physicians, hospitals, and those persons authorized by the
department of health. No person shall be authorized by the
department of health to perform or conduct HIV testing unless
such person provides suitable verification to the department that
such testing shall be performed in accordance with departmental
regulations governing the types of tests performed and the manner
in which they are administered. The department may monitor the
continued compliance of such persons with departmental
regulations. Hospitals licensed pursuant to chapter 197, RSMo,
shall be deemed to be in compliance with departmental regulations
governing HIV testing.

2.   All HIV testing shall be performed in accordance with the
department rules governing HIV testing procedures.

3.   Except as provided in sections 191.671 and 191.686, all
physicians, hospitals, or other persons authorized by the
department of health who perform or conduct HIV blood sampling
shall provide consultation with the subject prior to taking the
sample and during the reporting of the test results and shall
report to the department of health the identity of any individual
confirmed to be infected with HIV.



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

1.   (1) All information known to and records containing any
information held or maintained by any person, or by any agency,
department, or political subdivision of the state concerning an
individual's HIV infection status or the results of any
individual's HIV testing shall be strictly confidential and shall
not be disclosed except to:

(a) Public employees within the agency, department, or political
subdivision who need to know to perform their public duties;

(b) Public employees of other agencies, departments, or political
subdivisions who need to know to perform their public duties;

(c)  Persons other than public employees who are entrusted with
the regular care of those under the care and custody of a state
agency, including but not limited to operators of day care
facilities, group homes, residential care facilities and adoptive
or foster parents;

(d)  As authorized by subsection 2 of this section;

(2)  Further disclosure by public employees shall be governed by
subsections 2 and 3 of this section;

(3)  Disclosure by a public employee or any other person in
violation of this section may be subject to civil actions brought
under subsection 6 of this section.

2.   (1) Unless the person acted in bad faith or with conscious
disregard, no person shall be liable for violating any duty or
right of confidentiality established by law for disclosing the
results of an individual's HIV testing:

(a)  To the department of health;

(b)  To health care personnel working directly with the infected
individual who have a reasonable need to know the results for the
purpose of providing direct patient health care;

(c)  Pursuant to the written authorization of the subject of the
test result or results;

(d)  To the spouse of the subject of the test result or results;

(e)  To the subject of the test result or results;

(f)  To the parent or legal guardian or custodian of the subject
of the testing, if he is an unemancipated minor;

(g)  To the victim of any sexual offense defined in chapter 566,
RSMo, which includes sexual intercourse as an element of the
crime;

(2)  Paragraphs (b) and (d) of subdivision (1) of this subsection
shall not be construed in any court to impose any duty on a
person to disclose the results of an individual's HIV testing to
a spouse or health care professional or other potentially exposed
person, parent or guardian;

(3)  No person to whom the results of an individual's HIV testing
has been disclosed pursuant to paragraphs (b) and (c) of
subdivision (1) of this subsection shall further disclose such
results;

(4)  When the results of HIV testing, disclosed pursuant to
paragraph (b) of subdivision (1) of this subsection, are included
in the medical record of the patient who is subject to the test,
the inclusion is not a disclosure for purposes of such paragraph
so long as such medical record is afforded the same
confidentiality protection afforded other medical records.

3.   All communications between the subject of HIV testing and a
physician, hospital, or other person authorized by the department
of health who performs or conducts HIV blood sampling shall be
privileged communications.

4.   The identity of any individual participating in a research
project approved by an institutional review board shall not be
reported to the department of health by the physician conducting
the research project.

5.   The subject of HIV testing who is found to have HIV
infection shall disclose such information to any health care
professional from whom such person receives health care services.
Said notification shall be made prior to receiving services from
such health care professional.

6.   Any individual aggrieved by a violation of this section or
regulations promulgated by the department of health may bring a
civil action for damages. If it is found in a civil action that:

(1)  A person has negligently violated this section, the person
is liable for, each violation, for:

(a) The greater of actual damages or liquidated damages of one
thousand dollars; and

(b)  Court costs and reasonable attorney's fees incurred by the
person bringing the action; and

(c)  Such other relief, including injunctive relief, as the court
may deem appropriate; or

(2)  A person has willfully or intentionally or recklessly
violated this section, the person is liable, for each violation,
for:

(a)  The greater of actual damages or liquidated damages of five
thousand dollars; and

(b)  Exemplary damages; and

(c)  Court costs and reasonable attorney's fees incurred by the
person bringing the action; and

(d)  Such other relief, including injunctive relief, as the court
may deem appropriate.

7.   No civil liability shall accrue to any health care provider
as a result of making good faith report to the department of
health about a person reasonably believed to b infected with HIV,
or cooperating in good faith with the department in an
investigation determining whether a court order directing an
individual to undergo HIV testing will b(' sought, or in
participating in good faith in any judicial proceeding resulting
from such report or investigations and any person making such a
report, or cooperating with such a~ investigation or
participating in such a judicial proceeding shall be immune from
civil liability as a result of such actions so long as taken in
good faith.



191.659.  Department of corrections, HIV testing without right of
refusal-exception

1.   Except as provided in subsection 2 of this section, all
individuals who are delivered to the department of corrections
and a" individuals who are released or discharged from any
correctional facility operated by the department of corrections,
before such individuals are released or discharged, shall undergo
HIV testing without the right of refusal. In addition, the
department of corrections may perform or conduct HIV testing on
all individuals required to undergo annual or biannual physical
examinations by the department of corrections at the time of such
examinations.

2.   The department of corrections shall not perform HIV testing
on an individual delivered to the department if similar HIV
testing has been performed on the individual subsequent to trial
and if the department is able to obtain the results of the prior
HIV test

3.   The department shall inform the victim of any sexual offense
defined in chapter 566, RSMo, which includes sexual intercourse
as an element of the crime, of any confirmed positive results of
HIV testing on an offender within the custody of the department.



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

1.   The department of mental health may perform or conduct HIV
testing or HIV sampling without the right of refusal on:

(1)  Any individual participating in a methadone treatment
program for the treatment of intravenous drug abuse and who has
refused to undergo such testing whenever there are reasonable
grounds to believe that the individual is infected with HIV and
is a reasonable health threat to others;

(2)  Any individual under the care and custody of the department
of mental health who has refused to undergo testing whenever
there are reasonable grounds to believe that the individual is
infected with HIV and is a reasonable health threat to others,
unless such testing is otherwise prohibited by law.

2.   The department of mental health shall not report to the
department of health the identity of any individual for whom HIV
testing pursuant to this section confirms HIV infection if such
reporting is prohibited by federal law or regulation.



191.663.  HIV testing, defined--court order to test certain
sexual offenders-costs-bond-<liscI~osure of results of test

1.   As used in this section and section 191.659, the term "HIV
testing" means serological tests upon a sample of venous blood to
determine the presence of the human immunodeficiency virus that
causes acquired immunodeficiency syndrome.

2.   Any person who is convicted or who pleads guilty or nolo
contendere to any sexual offense defined in chapter 566, RSMo,
which includes sexual intercourse as an element of the crime,
shall be ordered by the court to undergo HIV testing prior to
incarceration without the right of refusal.

3.   Costs of such HIV testing shall be taxed to the defendant as
costs in the criminal proceeding. Such testing costs may be
retained by the court from the bond filed by the defendant under
subsection 4 of this section.

4.   Any defendant charged with a sexual offense defined in
chapter 566, RSMo, which includes sexual intercourse as an
element of the crime, shall be required to post a minimum bond
amount for his release prior to trial. The minimum bond amount
shall be sufficient to cover the cost of any post-trial HIV
testing ordered by the court.

5.   Notwithstanding any provision of section 191.656, or any
other law to the contrary, the victim of any crime defined in
chapter 566, RSMo, which includes sexual intercourse as an
element, shall have a right to access to the results of any HIV
testing performed pursuant to the provisions of this section, and
the victim shall be informed of any confirmed positive results of
the HIV testing. The administrator of the jail or correctional
facility in which the defendant is confined shall also have
access to the test results.



191.665.  Discrimination prohibited, exceptions

1.   Provisions of chapter 213, RSMo, shall apply to individuals
with HIV infection, acquired immunodeficiency syndrome and
acquired immunodeficiency syndrome-related complex; provided that
such protection shall not include an individual who has a
currently contagious disease or infection and who, by reason of
such disease or infection, would constitute a direct threat to
the health or safety of other individuals or who, by reason of
the currently contagious disease or infection, is unable to
perform the duties of their employment.

2.   Subsection 1 of this section shall not be construed to mean
that any action taken I y the Missouri commission on human rights
prior to June 1,1988, concerning discrimination against any
individual on the basis that such individual has HIV infection or
is perceived to have HIV infection to be an improper exercise of
authority by the commission.



191.668.  Department of health and department of elementary and
secondary education to prepare education programs, contents

1.   The department of health shall prepare public education and
awareness plans an programs for the general public, and the
department of elementary and secondary education shall prepare
educational programs for public schools, regarding means c
transmission and prevention and treatment of the HIV virus. The
plans and program shall include, but not be limited to:

(1)  Medically correct, age specific, transmission and prevention
programs for use at the discretion of the public schools
beginning with students at the sixth grade level.  The
educational programs shall stress moral responsibility in and
restraint from sexual activity and avoidance of controlled
substance use whereby HIV can be transmitted

(2)  Risk reduction programs for specific populations at high
risk of HIV infection

(3)  Educational programs on transmission and prevention of HIV
infection in the workplace for use by employers;

(4)  Personal protection procedures for use by health care
providers and others in close contact with potentially infected
individuals;

(5)  General public information programs and circulars containing
factual information that will allow the public at large to assess
its risk and develop informed individual judgment and behavior.
The department shall prepare for free distribution among the
residents of the state printed information concerning the means
of transmission of the HIV virus, the dangers from HIV infection,
means of prevention, and the necessity for testing; and

(6)  Develop presentations for community service and school
organizations describing the medical and psychosocial aspects of
HIV infection, including information on how infection is
transmitted and can be prevented.

2.   None of the plans, programs or printed information prepared
or provided under this section shall promote behavior that is an
offense in violation of chapter 566, RSMo, concerning sexual
offenses; is an offense involving the use of a controlled
substance as defined in chapter 195, RSMo; is an offense in
violation of section 568.020, RSMo, concerning incest; or is an
offense in violation of any city, county or state law prohibiting
prostitution or patronizing prostitution.



191.671.  Insurance companies, HMO's or health service
corporations, HIV testing by, regulation by division of insurance-
disclosure of test results, confidentiality

1.   No other section of this act 'shall apply to any insurer,
health services corporation, or health maintenance organization
licensed by the division of insurance which conducts HIV testing
only for the purposes of assessing a person's fitness for
insurance coverage offered by such insurer, health services
corporation, or health maintenance corporation, except that
nothing in this section shall be construed to exempt any insurer,
health services corporation or health maintenance organization in
their capacity as employers from the provisions of section
191.665 relating to employment practices.

2.   Upon renewal of any individual or group insurance policy,
subscriber contractor health maintenance organization contract
covering medical expenses, no insurer, health services
corporation or health maintenance organization shall deny or
alter coverage to any previously covered individual who has been
diagnosed as having HIV infection or any HIV-related condition
during the previous policy or contract period only because of
such diagnosis, nor shall any such insurer, health services
corporation or health maintenance organization exclude coverage
for treatment of such infection or condition with respect to any
such individual.

3.   The director of the division of insurance shall establish by
regulation standards for the use of HIV testing by insurers,
health services corporations and health maintenance
organizations.

4.   A laboratory certified by the U.S. Department of Health and
Human Services under the Clinical Laboratory Improvement Act of
1967, permitting testing of specimens obtained in interstate
commerce, and which subjects itself to ongoing proficiency
testing by the College of American Pathologists, the American
Association of Bio Analysts, or an equivalent program approved by
the Centers for Disease Control shall be authorized to perform or
conduct HIV testing for an insurer, health services corporation
or health maintenance organization pursuant to this section.

5.   The result or results of HIV testing of an applicant for
insurance coverage shall not be disclosed by an insurer, health
services corporation or health maintenance organization, except
as specifically authorized by such applicant in writing. Such
result or results shall however, be disclosed to a physician
designated by the subject of the test. If there is no physician
designated, the insurer, health services corporation, or health
maintenance organization shall disclose the identity of
individuals residing in Missouri having a confirmed positive HIV
test result to the department of health. Provided, further, that
no such insurer, health services corporation or health
maintenance organization shall be liable for violating any duty
or right of confidentiality established by law for disclosing
such identity of individuals having a confirmed positive HIV test
result to the department of health. Such disclosure shall be in a
manner that ensures confidentiality. Disclosure of test results
in violation of this section shall constitute a violation of
sections 375.930 to 375.948, RSMo, regulating trade practices in
the business of insurance. Nothing in this subsection shall be
construed to foreclose any remedies existing on June 1, 1988.



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

1.   The department of health may seek in its own name in a court
of competent jurisdiction a court order directing an individual
to undergo HIV testing without the right of refusal after
reasonable efforts have been made by the department to obtain
informed consent to HIV testing. The court shall grant such order
whenever there are reasonable grounds to believe that an
individual is infected with HIV and there is clear and convincing
evidence of a serious and present health threat to others posed
by the individual if infected.

2.   The record of any suit filed pursuant to this section shall
be closed to the public and, at the request of the individual,
any hearing shall be held in camera.



191.677.  Prohibited acts, criminal penalties

1.   It shall be unlawful for any individual knowingly infected
with HIV to:

(1)  Be or attempt to be a blood, organ, sperm or tissue donor
except as deemed necessary for medical research; or

(2)  Deliberately create a grave and unjustifiable risk of
infecting another with HIV through sexual or other contact when
an individual knows that he is creating that risk

2.   Violation of the provisions of subsection 1 of this section
is a class D felony.

3.   The department of health may file a complaint with the
prosecuting attorney of a court of competent jurisdiction
alleging that an individual has violated a provision of
subsection 1 of this section.  The department of health shall
assist the prosecutor in preparing such case.



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

1.   Any person who shall erect, establish, continue, maintain,
use, own, or lease any building, structure, or place used for the
purpose of lewdness, assignation, or illegal purpose involving
sexual or other contact through which transmission of HIV
infection can occur is guilty of maintaining a nuisance.

2.   The building, structure, or place, or the ground itself, in
or upon which any such lewdness, assignation, or illegal purpose
is conducted, permitted, carried on, continued, or exists, and
the furniture, fixtures, musical instruments, and movable
property used in conducting or maintaining such nuisance, are
hereby declared to be a nuisance and shall be enjoined and abated
as provided in subsection 3 of this section.

3.   If the existence of a nuisance is admitted or established in
an action pursuant to this section or in a criminal proceeding in
any court, an order of abatement shall be entered as part of the
judgment in the case. The order shall direct the effectual
closing of the business for any purpose, and so keeping it closed
for a period of one year.

4.   The department of health shall file suit in its own name in
any court of competent jurisdiction to enforce the provisions of
this section.



191.683.  Reports to general assembly by department of health

The department of health shall regularly report to the
appropriate committees of both houses of the general assembly:

(1)  The number of individuals with HIV infection for whom a
health care plan has been developed detailing the form and impact
of such health care plans in a manner that does not identify or
provide identifying characteristics of an individual infected
with HIV;

(2)  The nature and extent to which the department has utilized
judicial proceedings in a manner that does not identify or
provide identifying characteristics of any individual subject to
such proceedings;

(3)  The form and extent of the handling of federal funds
available to the department of health for disbursement;

(4)  The form and extent of programs and efforts funded by state
funds; and

(5)  Any other information such committees shall seek.



191.686.  Department testing sites in Kansas City, Springfield
and St. Louis, anonymous testing-reports of results, use of coded
system-contact notification required, when

1.   The department of health shall designate one HIV testing
site in the St. Louis area, one in the Kansas City area, and one
in the Springfield area where those persons not required to
undergo HIV testing without the right of refusal may be tested
anonymously.

2.   All physicians, hospitals, or other persons authorized by
the department of health who perform or conduct HIV blood
sampling may refuse to perform or conduct anonymous HIV blood
sampling for an individual and may refer such person to the
designated HIV testing sites.

3.   A coded system that does not link individual identity with
the request or result shall be used to report the results of such
testing to the department of health.

4.   All designated HIV testing sites shall be required to
initiate contact notification when submitting test results to
individuals who request anonymous testing and who test positive
for HIV infection.



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

1.   Only after a school has adopted a policy consistent with
recommendations of the Centers for Disease Control on school
children who test positive for HIV shall the department of health
give prompt and confidential notice of the identity of any child
reported to the department to have HI"" infection and the parent
or guardian of any child confirmed by the department of health
standards to have HI"" infection shall also give prompt and
confidential notice of the identity of such child to the
superintendent of the school district in which the child resides,
and if the child attends a nonpublic elementary or secondary
school, to the chief administrative officer of such school.

2.   The superintendent or chief administrative officer may
disclose the identity of an infected child to those persons:

(1)  Who are designated by the school district to determine the
fitness of an individual to attend school; and

(2)  Who have a reasonable need to know the identity of the child
in order to provide proper health care.



191.692.  Premarital HIV testing, rulemaking authorized, when

The department of health may promulgate rules providing for
mandatory premarital HI"" testing if the Centers for Disease
Control so indicates.



191.694.  Infection control procedure"- requirements and training
for health care facilities and professionals

1.   All health care professionals and health care facilities
shall adhere to universal precautions, as defined by the Centers
for Disease Control of the United States Public Health Service,
including the appropriate use of hand washing, protective
barriers, and care in the use and disposal of needles and other
sharp instruments, to minimize the risk of transmission of HIV,
HBV and other blood-borne infections to patients.  Health care
professionals and health care facilities shall comply with
current guidelines, established by the Centers for Disease
Control, for disinfection and sterilization of reusable devices
used in invasive procedures.

2.   Health care professionals who have exudative lesions or
weeping dermatitis of the hands, forearms, or other locations
that may contact patients, particularly on exposed areas such as
hands or forearms, shall refrain from performing all invasive
procedures, and from handling patient-care equipment and devices
used in performing invasive procedures until the condition
resolves.

3.   As a condition for renewal of a certificate of registration
or authority, permit, or license, all health care facilities
shall provide satisfactory evidence that periodic training n
infection control procedures, including universal precautions, is
provided to all personnel who perform patient care services at or
from such facilities.  Regulations for such training shall be
promulgated by the state regulatory authorities or bodies
responsible for licensing the respective health care facilities.

4.   All health care professionals who perform invasive
procedures shall receive training on infection control procedures
relevant to HIV and related diseases, including universal
precautions and prevention of percutaneous injuries, appropriate
for their specialty and approved by the department of health.
The department of health, in cooperation with appropriate state
regulatory authorities responsible for licensing the respective
health care professionals and in cooperation with professional
societies, shall develop regulations for such training. The
requirements set forth in this subsection shall be deemed
satisfied if the health care professional completes the training
provided in accordance with the provisions of subsection 3 of
this section.



191.695.  Rulemaking authority, department of health

1.   No rule or portion of a rule promulgated under the authority
of sections 191.650 to 191.698 shall become effective until it
has been approved by the joint committee or administrative rules.
Upon filing any proposed rule with the secretary of state, the
department of health shall concurrently submit such proposed rule
to the committee which may hold hearings upon any proposed rule
and may disapprove any proposed rule or portion thereof at any
time. In the event the committee disapproves any proposed rule or
portion thereof, the committee shall notify the department of
health and the secretary of state. If any proposed rule or
portion thereof is disapproved by the committee, the secretary of
state shall publish in the Missouri register, as soon as
practicable, an order that such rule or portion thereof has been
disapproved.

2.   The department of health shall not file any final order of
rulemaking with the secretary of state until twenty days after
such final order of rulemaking has beer received by the
committee. The committee may hold one or more hearings upon such
final order of rulemaking during the twenty day period.  If the
committee neither approves or disapproves any order of rulemaking
within the twenty day period, the department of health may file
such order of rulemaking with the secretary of state and the
order of rule making shall be deemed approved, subject to
subsequent suspension b~ the committee.  In the event the
committee disapproves any order of rulemaking 0] portion thereof,
the committee shall notify the department of health and the
secretary of state.  If any final order of rulemaking or portion
thereof is disapproved by the committee, the department of health
shall not file any disapproved provision in an order of
rulemaking and the secretary of state shall not publish any
disapproved provision in the Missouri register.

3.   Any rule or portion of a rule promulgated under this
authority of sections 191.65( to 191.698 may be suspended by the
committee at any time after a hearing conducted thereon. If any
rule is suspended by the committee, the secretary of state shall
publish in the Missouri register, as soon as practicable, an
order withdrawing the rule.

4.   No other provision of chapter 536, RSMo, regarding notice,
publication or nonjudicial review of any rule promulgated by the
department of health shall be applicable to such rules. Any
person seeking judicial review of any such rule shall be deemed
to have exhausted all administrative review procedures.
Notwithstanding the provisions of section 1.140, RSMo, the
provisions of this section are nonseverable and the grant of
rulemaking authority is essentially dependent on the review power
vested with the committee. If the review power is held
unconstitutional or invalid, the grant of rulemaking authority
and any rule promulgated under such rulemaking authority shall
also be invalid or void.



191.698.  Repealed



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

Any health care professional who, after disclosure has been made
by a patient of HI"" infection, discriminates against the patient
on the basis of that HI"" infection or who, prior to such
disclosure, makes HI"" testing a condition of treatment shall be
subject to administrative disciplinary action for violation of a
professional trust or confidence or the commission of an act of
unprofessional conduct as those terms are used in sections
330.160, RSMo, 332.321, RSMo, 334.100, PSMo, and 335.066, RSMo.



191.700.  Testing of cell health care professionals not justified
-- voluntary and confidential evaluation of infected
professional, procedure -- expert review panel qualifications,
powers and duties, practice restrictions, when-health care
facilities informed only of restrictions-violations, complaints
made to appropriate boards

1.   The current assessment by the Centers for Disease Control of
the risk that infected health care professionals will transmit
HIV or HBV to patients during invasive procedures does not
justify mandatory testing to detect infection with those viruses.
Health care professionals who perform invasive procedures are
advised, however, to know their HIV antibody status and their
hepatitis B antigen status.

2.   (1) The department of health shall establish and oversee a
voluntary evaluation process for health care professionals
infected with HIV or HBV who perform invasive procedures. This
evaluation process may be accessed directly by an infected health
care professional, or by the director of a health care facility
with the consent of the infected health care professional and
after consultation with his private physician.

(2)  The confidential and individualized evaluation shall be
conducted by an expert review panel appointed by the department
of health.  Each panel shall include at least such individuals
as:

(a)  The health care professional's private physician;

(b)  An infectious disease specialist with expertise in the
epidemiology of HI"" and HBV transmission who is not involved in
the care of the health care professional;

(c)  A health care professional with expertise in the procedures
performed by the infected health care professional; and

(d)  A state or local public health official.

(3)  The department of health, in cooperation with appropriate
state regulatory authorities or bodies responsible for licensing
the respective health care professionals and with professional
societies, shall develop uniform evaluation criteria which shall
be used in determining whether, and under what circumstances, any
restrictions or limitations should be placed on an individual
health care professional's medical practice.  These criteria
shall, consistent with guidelines from the Centers for Disease
Control, include at least the following inquiries:

(a)  Whether the health care professional performs procedures in
which injury could result in that individual's blood
contamination of a patient's body cavity, subcutaneous tissues,
or mucous membranes;

(b)  The nature of the invasive procedures performed by the
health care professional and the techniques used, skill and
experience, and compliance with infection control practices
demonstrated by that individual; and

(c)  Whether the presence of physical or mental impairments may
interfere with the health care professional's ability to perform
such invasive procedures safely.

(4)(a) The individualized evaluation and the recommendations of
the panel shall be based on the premise that HI"" or HBV
infection alone does not justify limiting the health care
professional's duties.

(b)  The panel may determine which procedures the health care
professional may or may not perform, or perform with
modifications.  If the panel is uncertain about whether a
procedure may pose some risk of HI"" or HBV transmission, it may
recommend that such procedures be performed only after the
patients have been informed of the health care professional's
infection status.

(5)(a) Information obtained during the evaluation process shall
be confidential and shall not be disclosed except to health care
facilities where the health care professional provides patient
care.  The department of health may only notify or disclose to
such facilities the practice restrictions and limitations imposed
on the health care professional. Such restrictions and
limitations shall be disclosed only to those employed by such
health care facilities who have a reasonable need to know the
information.

(b)  Practice restrictions or limitations recommended by the
department of health shall be monitored by the health care
facilities in which the infected health care professional is
employed.  If practice restrictions or limitations are placed on
community based health care professionals, periodic monitoring to
ensure compliance shall be performed by the department of health.

(c)  Health care professionals whose practices are restricted or
limited because of their HI"" or HBV infection status shall,
whenever possible, be provided opportunities to continue
appropriate patient care activities.

(d)  Health care facilities regulated under sections 197.010 to
197.120, RSMo, may maintain or establish peer review panels that
operate under the regulations developed by the department of
health and the recommendations of the Centers for Disease Control
of the United States Public Health Service.

(e)  Any violation of practice restrictions or limitations by a
health care professional shall constitute either an act violative
of professional trust and confidence, or failure or refusal to
properly guard against contagious infections or communicable
diseases or the spread thereof, or both, as these terms are used
in sections 330.160, RSMo, 332.321, RSMo, 334.100, RSMo, and
335.066, RSMo.  Complaints of possible violations of practice
restrictions or limitations may be made to the appropriate state
board, as provided under chapter 330, RSMo, 332, RSMo, 334, RSMo,
or 335, RSMo.

3.   The department of health shall, from time to time, review
established standards for preventing the transmission of HI"" or
HBV from health care professionals to patients and, consistent
with current medical knowledge and revised or updated guidelines
from the Centers for Disease Control, modify existing standards
and require additional minimum standards, as appropriate.

4.   Notwithstanding the provisions of sections 191.650 to
191.698, the department of health may exercise the general
authority and power under section 192.020, RSMo, to intervene in
instances where there is reason to believe that a health care
professional is practicing in a manner that creates a grave and
unjustifiable risk of injury to others.



376.817.  Adopted children, coverage, exception to requirement,
children with AIDS

1.   No individual or group insurance policy providing coverage
on an expense-incurred basis, no individual or group service or
indemnity contract issued by a not for profit health services
corporation nor any self-insured group health benefit plan of any
type or description shall be offered, issued or renewed in this
state on or after August 28, 1991, unless the policy, plan or
contract covers adopted children of the insured, subscriber or
enrollee on the same basis as other dependents.

2.   The coverage required by this section is effective from the
date of placement for the purpose of adoption and continues
unless the placement is disrupted prior to legal adoption and the
child is removed from placement. Coverage shall include the
necessary care and treatment of medical conditions existing prior
to the date of placement provided that no coverage shall be
required for any child placed for adoption, if the prospective
adoptive parents knew or should have known that the child had an
HIV- or AIDS-related illness at the time of placement.

3.   As used in this section, "placement" means in the physical
custody of the adoptive parent.