The Deadline to Comment is August 31!
IHCM ACTION ALERT
Please write a letter commenting on Dept of Health & Senior Services Regulations
August 8, 2023
Have you ever wondered how Missouri schools, churches, and places of public assembly were able to be closed during the Covid crisis? It’s because the Department of Health and Senior Services (DHSS) instituted unconstitutional regulations that allowed them to violate our rights.
Missourians had a chance to challenge these rules in 2018 during Missouri’s 5-Year Periodic Rule Review, but no one did. The agency received zero comments. Two years later, these regulations cost schools, businesses, and individuals billions in lost revenue, not to mention the social, educational, and spiritual consequences.
This year, however, DHSS is under review again. The 60-day comment period ends soon, however, Aug 31, 2023. In order to make your voice heard, you need to act quickly!
The article below details what to review, what feedback is desired, and where to send/submit comments. Your letters must be received by the respective agency (not legislators) no later than August 31, 2023.
Please take a few minutes to read, then submit your letter to DHSS. We need to let them know that we are informed and we are watching them!
Sincerely,
Informed Health Choice Missouri
IHCM.info
Periodic Rule Review — Background
Rules (or regulations) interpret, implement, and prescribe Missouri’s laws. They are not laws, but if correctly created, they can have the force of law. All of Missouri’s regulations are catalogued in an online document called The Missouri Code of State Regulations, or CSR.
Our Missouri Representatives and Senators do not vote on rules. As a whole, they are not part of the rulemaking process. However, a select committee of Reps and Senators called the Joint Committee on Administrative Rules (JCAR) does have some say in rulemaking.
Rules are created through a process called promulgation. First the rule is filed with the Sec. of State. Next is a period of public comment. After that, JCAR reviews it before it becomes part of the Code of State Regulations. Once a proposed rule is promulgated and becomes part of the CSR, it is hard to challenge. However, once every five years, the public gets a chance to comment on all of the current regulations. This is called Missouri’s Periodic Rule Review.
Missouri’s Periodic Rule Review
By law in RSMo 536.175, all 22 Titles of the CSR (which represent each of Missouri’s agencies) must undergo a complete review of their regulations every five years. The agencies take turns according to the law. A few are reviewed each year until all have been analyzed.
In a periodic review, agencies must do 3 things:
1) Analyze all of their rules per the criteria in RSMo 536.175 (see above).
2) Notify the public and let them comment on all existing rules, either good or bad.
3) Write a report summarizing their internal review and the public comments. This must be submitted to JCAR by June 30 of the following year.
This year, the rules are up for review:
Title 15 – Elected Officials
Title 16 – Retirement Systems
Title 17 – Boards of Police Commissioners
Title 18 – Public Defender Commission
Title 19 – Dept. of Health and Senior Services
The comment period for these periodic reviews is always July 1 and ends August 31st. Any Missourian can write a letter to the agency to voice their approval or challenge existing rules.
Rules IHCM Members are Challenging
IHCM is focusing on Title 19, especially division 20 (Public Health), chapters 20 (Communicable Disease) and 28 (Immunizations). If you are a healthcare worker it’s likely that many other chapters in this healthcare title will interest you, also.
For instance, this rule 19 CSR 20-20.030 (scroll down to the rule number at the bottom left of pg. 8 of the CSR), “Exclusion from School and Readmission”. This rule and the statute that supports it says that those “liable to transmit” a disease, even a healthy child, cannot attend school during a disease outbreak. This could mean a healthy child who shows no symptoms, whose parents make choices for vaccination that are different from the ACIP vaccine schedule and have submitted a religious exemption, cannot attend school like other healthy children in that instance. Excluding a healthy child from school can be a violation of Constitutional rights.
As you can see in the “authorization” section, this rule is based on RSMo (Missouri Revisor of Statutes) 167.191. However, the rule by itself, we believe, still violates the Constitution.
Other rules that are problematic in Chapter 20
19 CSR 20-20.010 Definitions of quarantine, modified quarantine, and infectious waste
19 CSR 20-20.020 Novel InfluenzaA on the immediately reportable list
19 CSR 20-20.030 (see above)
19 CSR 20-20.040 Examining healthy people during an outbreak
19 CSR 20-20.050 Inspecting property during an outbreak
19 CSR 20-28.040 Daycare immunizations must comply with ACIP
How Can You Comment?
We will walk you though the process of submitting a comment below:
Step 1: Read Rules
Read any rules that concern you. You can also read the “authorization” part below the rule, then look up the statute that authorizes it. The rule can’t go beyond the parameters of the statute.
Step 2: Write a Letter to the Agency that Promulgated the Rule (scroll for addresses)
Tell them…
– the specific rule you are commenting on
– your comment about the rule and whether you think it should be appealed (changed) or rescinded (removed)
– include your name and identifying information
Please write a separate letter for each title (or division — see below). You can review multiple rules, but keep the letter specific to one title. Keep your comments focused on each specific rule, not about other concerns.
Step 3: Email Your Letter. Send Us a Copy
Send your letter to the person at the agency listed in the section below. Remember, the letters must be received by the Aug. 31st deadline. We prefer email instead of snail mail.
Please send a copy to us at 2023rulesreview@gmail.com. We will not share your address. Our only reason for this is to have a record of what the public wants so we can keep the agency accountable in their summary.
Reasons to Challenge a Rule
Per RSMO 536.014, rules are invalid if:
1) There is an absence of statutory authority for the rule or any portion thereof; or
2) The rule is in conflict with state law; or
3) The rule is so arbitrary and capricious as to create such substantial inequity as to be unreasonably burdensome on persons affected.
Per this law, RSMO 536.175, agencies must review their rules according to this criteria:
1) Is the rule obsolete?
2) Does the rule overlap, duplicate, or conflict with other rules?
3) Are the reference materials incorporated into it proper (fiscal notes, charts, etc)?
4) Are the rules affecting small businesses still relevant?
5) What action should be taken in regard to that specific rule? Should it be rescinded (removed) or amended (changed)?
Another thing to consider are court decisions regarding rules, such as the Shannon Robinson vs. DHSS case. In 2020, Ms. Robinson and other plaintiffs sued DHSS for closing churches, businesses, and schools during the Covid pandemic. As a result of that lawsuit, Judge Daniel Green ordered DHSS to remove four unconstitutional regulations in Title 19 (19 CSR 20-20.040(2)(G) through (I), 19 CSR 20-20.040(6)).
In this landmark decision, Judge Green said DHSS can’t “abolish representative government in the creation of public health laws” or “authorize closure of a school or assembly based on the unfettered opinion of an unelected official.”
We urge you to read Judge Green’s decision to learn more about his critique of DHSS’ public health regulations.
These rules Judge Green threw out were in the CSR during the last periodic review, but no one challenged them. DHSS received zero comments on the entire title. Two years later, those rules cost indviduals and businesses millions of dollars in lost revenue due to lockdowns.
It took an expensive lawsuit by Shannon Robinson and her fellow plaintiffs to get a judge to remove them. This year, we have a chance to challenge any unconstitutional DHSS rules that remain at the cost of a letter, not a lawsuit.
Please take a few minutes to read these rules and write your letter.
Where to Send
Address your letter according to the title in which it appears. If you are commenting on rules in multiple titles, please send separate letters, addressed accordingly. Thank you!
DHSS is first, since it is our first priority. Scroll down for the remaining addresses.
Title 19—Department of Health and Senior Services
Stephen Witte
PO Box 570
Jefferson City, MO 65102
Or email: Stephen.Witte@health.mo.gov
Here is an example of how to format your letter.
Sample Letter – For Reference Only, Don’t Copy
Stephen Witte
PO Box 570
Jefferson City, MO 65102
Or email: Stephen.Witte@health.mo.gov
Re: 19 CSR 30-1.064 Partial Filling of Controlled Substance Prescriptions
Dear Mr. Witte:
The rule referenced above makes it difficult for pain patients like me, who deal with medication shortages on a regular basis, to get the prescriptions we need.
What you need to know is pain patients sign contracts with our doctors that we will only use one pharmacy for these scripts. If the pharmacy only has part of your script, they can do partial fills in all meds BUT controlled substances. The patients waiting for these scripts are in pain. For example, if you are able to get 75 pills of 120 script and you take those 75, you can NOT get the rest. That’s it. What this statute says is you can get a partial (and I was told 7 days). Then the pharmacist must write on the script the partial fill.
Then everyone hopes the pharmacy gets the rest of the meds in stock in 72 hours. If not, the pharmacist must contact the doctor and get a new script. Imagine weekends or holidays and the doctor is unavailable. Imagine the patient being disabled and paid an Uber to travel. This can potentially send a patient into a serious medical crisis.
This rule should be rescinded. Pharmacists should be given the autonomy to make the decisions that are best for the individuals who are dependent on these medications for their quality of life.
Sincerely,
Mr. or Ms. Missourian
Addresses for other titles:
Secretary of State (Division 20)
Frank Jung and Trish Vincent
PO Box 1767
Jefferson City, MO 65102-1767
Or email: comments@sos.mo.gov
State Auditor (Division 30)
Leslie Korte
PO Box 869
Jefferson City, MO 65102
Or email: leslie.korte@auditor.mo.gov
Treasurer (Division 40)
C. Douglas Shull
Harry S. Truman State Office Building
Room 78
Jefferson City, MO 65102
Or email: doug.shull@treasurer.mo.gov
Attorney General (Division 50)
Todd Scott
PO Box 899
Jefferson City, MO 65102
Or email: rules@ago.mo.gov
Title 16—Retirement Systems
Public School Retirement System of Missouri (Division 10)
Mike Moorefield
3210 W. Truman Blvd.
Jefferson City, MO 65109
Or email: MMoorefield@psrsmo.org
Missouri Local Government Employees’ Retirement System (LAGERS) (Division 20)
Sheila Reinsch
PO Box 1665
Jefferson City, MO 65102-1665
Or email: sreinsch@molagers.org
The County Employees Retirement Fund (Division 50)
Michael Ruff
2121 Schotthill Woods Road
Jefferson City, MO 65101
Or email: mruff@mocerf.org
* Divisions 30 and 40 are not included in the review
Title 17—Board of Police Commissioners
Kansas City Board of Police Commissioners (Division 10)
Bethany Ruoff
1125 Locust Street
Kansas City, MO 64106
Or email: ogc@kcpd.or
* Division 20 is not included in this review.
Title 18—Public Defender Commission
Greg Mermelstein
1000 W. Nifong, Bldg. 7, Ste. 100
Columbia, MO 65203
Or email: Greg.Mermelstein@mspd.mo.gov
Final Thoughts
Thank you for taking the time to write a letter. These rules affect your life, your school, your business, your church, and most importantly your family’s health. Remember, after you submit your letter, please drop us a copy (a pic from your phone or a scan — anything will help) to 2023RulesReview@gmail.com. If you have questions, please contact us there. We will do our best to help!
Informed Health Choice Missouri
ihcm.info
