Missouri Revised Statutes













Chapter 191

Health and Welfare

←191.005

Section 191.025.1

191.115→

August 28, 2015

Health care compact.

191.025. The Health Care Compact is enacted into law and entered into

by the state as a party, and is of full force and effect between the state

and any other states joining therein in accordance with the terms of the

Compact, which such Compact is as follows:



Section 1. Definitions. As used in this Compact, unless the context

clearly indicates otherwise:



"Member State" shall refer to a state that is signatory to this

Compact and has adopted it under the laws of that state.



"Effective date" shall refer to the date upon which this Compact shall

become effective for purposes of the operation of state and federal law in

a Member State, which shall be the later of:



(a) the date upon which this Compact shall be adopted under the laws

of the Member State, and;



(b) the date upon which this Compact receives the consent of Congress

pursuant to Article I, Section 10, of the United States Constitution, after

at least two Member States adopt this Compact.



"Health Care" means care, services, supplies, or plans related to the

health of an individual and includes but is not limited to:



(a) preventive, diagnostic, therapeutic, rehabilitative, maintenance,

or palliative care and counseling, service, assessment, or procedure with

respect to the physical or mental condition or functional status of an

individual or that affects the structure or function of the body; and



(b) sale or dispensing of a drug, device, equipment, or other item in

accordance with a prescription; and



(c) an individual or group plan that provides, or pays the cost of,

care, services, or supplies related to the health of an individual; except

any care, services, supplies, or plans provided by the United States

Department of Defense, the United States Department of Veteran Affairs, or

provided to Native Americans.



"Commission" shall refer to the Interstate Advisory Health Care

Commission.



"Member State" means a state that is signatory to this Compact and has

adopted it under the laws of that state.



"Member State Base Funding Level" means a number equal to the total

federal spending on Health Care in the Member State during federal fiscal

year 2010 as determined. On or before the effective date, each Member

State shall determine the Member State Base Funding Level for its state,

and that number shall be binding upon that Member State. (The preliminary

estimate of Member State Base Funding Level for the State of Missouri is

$18,669,000,000.)



"Member State Current Year Funding Level" means the Member State Base

Funding Level multiplied by the Member State Current Year Population

Adjustment Factor multiplied by the Current Year Inflation Adjustment

Factor.



"Member State Current Year Population Adjustment Factor" means the

average population of the Member State in the current year less the average

population of the Member State in federal fiscal year 2010, divided by the

average population of the Member State in federal fiscal year 2010, plus 1.

Average population in a Member State shall be determined by the United

States Census Bureau.



"Current Year Inflation Adjustment Factor" means the Total Gross

Domestic Product Deflator in the current year divided by the Total Gross

Domestic Product Deflator in federal fiscal year 2010. Total Gross

Domestic Product Deflator shall be determined by the Bureau of Economic

Analysis of the United States Department of Commerce.



Section 2. Pledge. The Member States shall take joint and separate

action to secure the consent of the United States Congress to this Compact

in order to return the authority to regulate health care to the Member

States, consistent with the goals and principles articulated in this

Compact. The Member States shall improve health care policy within their

respective jurisdictions and according to the judgment and discretion of

each Member States.



Section 3. Legislative Power. The legislatures of the Member States

have the primary responsibility to regulate health care in their respective

states.



Section 4. State Control. Each Member State, within its state, may

suspend by legislation the operation of all federal laws, rules,

regulations, and orders regarding Health Care that are inconsistent with

the laws and regulations adopted by the Member State pursuant to this

Compact. Federal laws, rules, regulations, and orders regarding health

care will remain in effect unless a Member State expressly suspends them

pursuant to its authority under this Compact. For any federal law, rule,

regulation, or order that remains in effect in a Member State after the

effective date, that Member State shall be responsible for the associated

funding obligations in its state.



Section 5. Funding.



(a) Each federal fiscal year, each Member State shall have the right

to federal monies up to an amount equal to its Member State Current Year

Funding Level for that federal fiscal year, funded by Congress as mandatory

spending and not subject to annual appropriation, to support the exercise

of Member State authority under this Compact. This funding shall not be

conditional on any action of or regulation, policy, law, or rule being

adopted by the Member State.



(b) By the start of each federal fiscal year, Congress shall

establish an initial Member State Current Year Funding Level for each

Member State, based upon reasonable estimates. The final Member State

Current Year Funding Level shall be calculated, and funding shall be

reconciled by the United States Congress, based upon information provided

by each Member State and audited by the United States Government

Accountability Office.



Section 6. Interstate Advisory Health Care Commission.



(a) The Commission may study the issues of health care regulation of

particular concern to the Member States. The Commission may make

nonbinding recommendations to the Member States. The legislatures of the

Member States may consider these recommendations in determining the

appropriate health care policy in their respective states.



(b) The Commission shall collect information and data to assist the

Member States in their regulation of health care, including assessing the

performance of various state health care programs and compiling information

on the prices health care. The Commission shall then make this information

and data available to the legislatures of the Member States.

Notwithstanding any other provision in this Compact, no Member State shall

disclose to the Commission the health information of any individual, nor

shall the Commission disclose the health information of any individual.



(c) The Commission consists of members appointed by each Member State

through a process to be determined by the laws of each Member State. A

Member State may not appoint more than two members to the Commission, and

at any time a Member State may withdraw membership from the Commission at

any time. Each Commission member is entitled to one vote. The Commission

shall not act unless a majority of the members are present, and no action

shall be binding unless approved by a majority of the commission's total

membership.



(d) The Commission may elect from among its membership a chairperson.

The Commission may adopt and publish bylaws and policies that are not

inconsistent with this Compact. The Commission shall meet at least once a

year, and may meet more frequently, as its bylaws direct.



(e) The Commission shall be funded by the Member States as agreed to

by the Member States. The Commission shall have the responsibilities and

duties as may be conferred upon it by subsequent action of the respective

legislatures of the Member States in accordance with the terms of this

Compact.



(f) The Commission shall not take any action within a Member State

that contravenes any state law of that Member State.



Section 7. Congressional Consent. This Compact shall be effective on

its adoption by at least two Member States and consent of the United States

Congress. This Compact shall be effective unless the United States

Congress, in consenting to this Compact, alters the fundamental purposes of

this Compact, which are:



(a) To secure the right of the Member States to regulate Health Care

in their respective states pursuant to this Compact and to suspend the

operation of any conflicting federal laws, rules, regulations, and orders

within their states; and



(b) To secure federal funding for Member States that choose to invoke

their authority under this Compact, as prescribed by Section 5 above.



Section 8. Amendments. The Member States, by unanimous agreement,

may amend this Compact from time to time without the prior consent or

approval of Congress and any amendment shall be effective unless, within

one year, the Congress disapproves that amendment. Any state may join this

Compact after the date on which Congress consents to the Compact by

adoption into law under its state Constitution.



Section 9. Withdrawal; Dissolution. Any Member State may withdraw

from this Compact by adopting a law to that effect, but no such withdrawal

shall take effect until six months after the Governor of the withdrawing

Member State has given notice of the withdrawal to the other Member States.

This Compact shall be dissolved upon the withdrawal of all but one of the

Member States.



(L. 2011 H.B. 423)







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