SSHCSHBs115&99--HEALTHCAREPROFESSIONALS
ThisbillrelatedtoHealthCareProfessionals.
ADVANCEDPRACTICEREGISTEREDNURSES(Section195.070,334.104,
335.016,335.019,335.036,335.046,335.051,335.056,335.076,
335.086,and335.175)
Thisbillmodifieslicensingandcollaborativepractice
arrangementsforadvancedpracticeregisterednurses(APRNs). The
billallowsanAPRNtoprescribeScheduleIIcontrolledsubstances
forhospicepatientsandcollaborativepracticearrangements
betweentheAPRNandthecollaboratingphysicianmaywaive
geographicproximityrequirements,asspecifiedinthebill,
includingwhenthearrangementoutlinestheuseoftelehealthand
whentheAPRNisprovidingservicesinacorrectionalcenter.
Collaboratingphysiciansordesignatedphysiciansshallbepresent
withtheAPRNforsufficientperiodsoftime,atleastonceevery2
weeks,toparticipateinchartreviewsandsupervision.
Currently,anAPRNisrequiredtopracticewiththecollaborating
physiciancontinuouslypresentforaone-monthperiodwhenentering
intoanarrangementwiththephysician. Thisbillwaivesthat
requirementwhenaprimarycareorbehavioralhealthphysician
entersintoanarrangementwithaprimarycareorbehavioralhealth
APRN,thephysicianisnewtothepatientpopulation,andtheAPRN
isfamiliarwiththepatientpopulation.
Currently,anursemaybelicensedtopracticeprofessionalor
practicalnursing. Thisbilladdsalicensetopracticeadvanced
practicenursingandmodifiesthedefinitionsofAPRNandthe
practiceofprofessionalnursing. Thebillspecifiesthe
requirementsfortheadvancedpracticenursinglicense,including
therequirementthatanapplicantfirstholdacurrentregistered
professionalnurselicense,andhavecompletedcertaingraduate-
levelprogramsandcertifications, orholdadocumentof
recognitiontopracticeasanAPRNthatiscurrentasofAugust28,
2023.LicenserenewalsforAPRNlicensesandregistered
professionalnurselicensesmustoccuratthesametimeandfailure
torenewandmaintaintheregisteredprofessionalnurselicenseor
failuretoprovideevidenceofanactiverequiredcertification
shallresultintheexpirationoftheAPRNlicense. Thisbill
Modifiesthenamesofthespecificcertifyingorganizationsfor
nursingspecialtiesandspecifiesthattheStateBoardof
RegistrationfortheHealingArts,withintheDepartmentof
InsuranceandCommerce,shallmakeinformationpubliclyavailable
aboutwhichphysiciansandotherhealthcareprovidershaveentered
intocollaborativepracticearrangements ASSISTANTPHYSICIANS(Section334.036)
Currently,arequirementforlicensureasanassistantphysicianis
thattheapplicantmustbeagraduateofanymedicalschool.This
billprovidesthattheapplicantmustbeagraduateofamedical
schoolaccreditedbyorganizationsspecifiedinthebill.Thebill
repealsaprovisionoflawthatauthorizesanassistantphysician
collaborativepracticearrangementinanypilotprojectareas
establishedinwhichassistantphysiciansmaypractice.
PHYSICALTHERAPISTS(Sections334.100,334.506,and334.613)
Thisbillchangesthelawsregardingphysicaltherapistssothat
physicaltherapistsnolongerneedaprescriptionorreferralfrom
adoctorinordertoevaluateandinitiatetreatmentonapatient,
aslongasthephysicaltherapisthasadoctorateofphysical
therapydegreeorhasfiveyearsofclinicalpracticeasaphysical
therapist. Thebillrequiresaphysicaltherapisttorefertoan
approvedhealthcareprovideranypatientwhoseconditionisbeyond
thephysicaltherapist'sscopeofpractice,oranypatientwhodoes
notdemonstratemeasurableorfunctionalimprovementafter10
visitsor30days,whicheveroccursfirst.
Thephysicaltherapistmustalsoconsultwithanapprovedhealth
careproviderbeforecontinuingtherapyifafter10visitsor30
days,whicheveroccursfirst,thepatienthasdemonstrated
measurableorfunctionalimprovementfromthephysicaltherapyand
thephysicaltherapistbelievesthatcontinuationofphysical
therapyisnecessary. Continuedphysicaltherapymustbein
accordancewithanydirectionofthehealthcareprovider. The
physicaltherapistmustnotifythehealthcareproviderof
continuingphysicaltherapyevery30days.Physicaltherapy
servicesperformedwithinaprimaryorsecondaryschoolfor
individualswithinagesnotinexcessof21yearsareexemptfrom
thisrequirement. Thisbillremovesaprovisionthatallowsthe
StateBoardofRegistrationfortheHealingArtstofilea
complaintagainstaphysicaltherapistwhoprovidesphysical
therapywithoutaprescription.
PROFESSIONALCOUNSELORS (Sections337.510and337.550)
Thisbillmodifiesprovisionsrelatingtolicensereciprocityfor
professionalcounselors. Thisbillrepealsthecurrentprovision
allowinganapplicantlicensedinanotherstateorterritoryto
receivealicenseinthisstateiftheyareapprovedoringood
standingwithcertainprofessionalorganizationsandimplementsa
provisionpermittinganypersonwho,foratleastoneyear,has
heldavalid,currentlicenseissuedbyanotherstate,abranchor
unitofthemilitary,aU.S.territory,ortheDistrictof Columbia,toapplyforanequivalentMissourilicensethroughthe
Board,subjecttoproceduresandlimitationsasspecifiedinthe
bill.
Thisbillestablishesalicensedprofessionalcounselorsinterstate
compact. Thepurposeofthecompactistofacilitatethe
interstatepracticeoflicensedprofessionalcounselorswiththe
goalofimprovingpublicaccesstoprofessionalcounseling
services. Thecompactsetsforththerequirementstobemetin
orderforastatetojointhecompact. Eachmemberstatemust
requireanapplicantforaprofessionalcounselorlicensetoobtain
orretainalicenseinthehomestateandmeetthehomestate's
qualifications forlicensureorrenewaloflicensureaswellasall
otherapplicablestatelaws.
Thecompactcreatesajointpublicagencyknownasthe"Counseling
CompactCommission". ThepowersanddutiesoftheCommissionare
specifedintheCompactandenforcetheprovisionsandrulesofthe
compact. TheCommissionshallprovideforthedevelopment,
maintenance,andutilizationofacoordinateddatabaseand
reportingsystemcontaininglicenses,adverseactions,and
investigativeinformationonalllicensedindividualsinmember
states.
ThecompactwillcomeintoeffectonthedateonwhichtheCompact
isenactedintolawinthe10thmemberstate.Anymemberstatemay
withdrawfromtheCompactbyenactingastatuterepealingthe
provisions. TheCompactisbindinguponmemberstatesandshall
supersedeanyconflictwithstatelaw.
ADMINISTRATION OFMEDICATIONSBYPHARMACISTS(Sections338.010and
338.012)
Thisbillmodifiesseveralprovisionsrelatingtothe
administration ofmedicationsbypharmacists. Initsmain
provisions,thisbill:
(1)Modifiesthedefinitionofamedicationtherapeuticplanby
repealinglanguagedefiningitbytheprescriptionordersolongas
theprescriptionorderisspecifictoeachpatientforcarebya
pharmacist.
(2)Repealslanguagefromcurrentlawdefiningthepracticeof
pharmacyasincludingtheadministration ofspecificvaccinesby
writtenphysicianprotocolforspecificpatientsandaddslanguage
definingthepracticeofpharmacyasincludingtheorderingand
administeringofcertainFDA-approvedorauthorizedvaccinesto
personsatleast7yearsofageortheCDC-approvedage,whichever
isolder,pursuanttorulespromulgatedbytheBoardofPharmacy andtheBoardofRegistrationfortheHealingArtsorrules
promulgatedunderastateofemergency.
(3)Repealstheprovisionsrequiringanypharmacistwhoacceptsa
prescriptionorderforamedicationtherapeuticplantohavea
writtenprotocolfromthereferringphysician.
(4)Permitsapharmacistwithacertificateofmedication
therapeuticplanauthoritytoprovidemedicationtherapyservices
pursuanttoawrittenphysicianprotocoltopatientswithan
establishedphysician-patientrelationshipwiththeprotocol
physician.
(5)Allowsalicensedpharmacisttoorderandadministervaccines
approvedorauthorizedbytheFDAtoaddressapublichealthneed,
asauthorizedbythestateorfederalgovernment,duringastateor
federally-declaredpublichealthemergency.
(6)Allowsapharmacistwithacertificateofmedication
therapeuticplanauthoritymayprovideinfluenza,groupA
streptococcus, andCOVID-19medicationtherapyservicespursuantto
astatewidestandingorderissuedbytheDirectoroftheDepartment
ofHealthandSeniorServicesoraphysicianlicensedbythe
Department.