HCSHB271--NURSES
SPONSOR: Riley
COMMITTEEACTION:Voted"DoPasswithHCS"bytheStanding
CommitteeonHealthcareReformbyavoteof12to1.
ThefollowingisasummaryoftheHouseCommitteeSubstituteforHB
271.
Thisbillmodifieslicensingandcollaborativepractice
arrangementsforadvancedpracticeregisterednurses(APRNs).
Underthisbill,anAPRNmayprescribeScheduleIIcontrolled
substancesforhospicepatients,asspecifiedinthebill.
Additionally,collaborativepracticearrangementsbetweentheAPRN
andthecollaboratingphysicianmaywaivegeographicproximity
requirementswhenthearrangementoutlinestheuseof
telecommunications.
Currently,anAPRNshallpracticewiththecollaboratingphysician
continuouslypresentforaone-monthperiodwhenenteringintoan
arrangementwiththephysician. Thisbillwaivesthatrequirement
whenaprimarycarephysicianentersintoanarrangementwitha
primarycareAPRN,thephysicianisnewtothepatientpopulation,
andtheAPRNisfamiliarwiththepatientpopulation.
Currently,anursemaybelicensedtopracticeprofessionalor
practicalnursing. Thisbilladdsalicensetopracticeadvanced
practicenursingandmodifiesthedefinitionsofAPRNandthe
practiceofprofessionalnursing. Additionally,thisbill
specifiestherequirementsfortheadvancedpracticenursing
license,includingtherequirementthatanapplicantfirstholda
currentregisteredprofessionalnurselicense,andhavecompleted
certaingraduate-levelprogramsandcertifications, orholda
documentofrecognitiontopracticeasanAPRNthatiscurrentas
ofAugust28,2023.LicenserenewalsforAPRNlicensesand
registeredprofessionalnurselicensesshalloccuratthesametime
andfailuretorenewandmaintaintheregisteredprofessionalnurse
licenseorfailuretoprovideevidenceofanactiverequired
certificationshallresultintheexpirationoftheAPRNlicense.
ThisbillfurtherspecifiesrequirementsforanAPRN'spatient
recordretention,aswellasmodifiesthenamesofthespecific
certifyingorganizationsfornursingspecialties.
Underthebill,theStateBoardofRegistrationfortheHealing
Arts,withintheDepartmentofCommerceandInsurance,shallmake
informationpubliclyavailableaboutwhichphysiciansandother healthcareprovidershaveenteredintocollaborativepractice
arrangements.
ThebillissimilartoSCSSB79(2023);HB1578(2022)andHB693
(2019).
Thefollowingisasummaryofthepublictestimonyfromthe
committeehearing. Thetestimonywasbasedontheintroduced
versionofthebill.
PROPONENTS: Supporterssaythattheseregulatoryreductionsmay
increasehealthcareworkeraccessinruralandunderservedareas
withinthestate,particularlywithinnursinghomes;thatefforts
tofillworkershortageshavenotalwaysincludedexpandingthe
scopeofpracticeforAPRNs,thoughotherstateshavedoneasmuch;
statesthatrankevenlowerthanMissouriinseveralhealth-related
outcomeshavejustasmany,ifnotmore,restrictionsfortheir
APRNs;currentregulationscanblockcompetitionfortheprovision
ofhealthcareinruralareas;therequirementforcollaborating
physicianscanmakeitdifficulttoestablishoversightanda
workingrelationship;existingprovidersinnetworkshavehadto
reducehoursatcertainsitesorclosethemaltogether;
collaboratingphysiciansarehardtofind,prohibitivelyexpensive
tokeep,andthereareadditionalbarrierstosustainablysecure
thoserelationships; andinstatesthathavepermittednursesto
practicetothefullextentoftheireducationandtraining,
malpracticeratesdidnotspikeasaresultofthesechanges.
TestifyinginpersonforthebillwereRepresentative Riley;
ChristianDaleTanner;MissouriBehavioralHealthCouncil;Theresa
Spakowski;MissouriFarmBureau;MissouriHealthCareAssociation;
KarenWhite,MissouriHighlandsHealthCare;MissouriFamilyHealth
Council;MissouriNursesAssociation;AssociationofMissouriNurse
Practitioners; AmericansForProsperity;MissouriHospital
Association,UniversityofMOHealthcareSystem;ChestnutHealth
Systems;UnitedWe;Delilah(Lila)Pennington,MissouriNurses
Association,MissouriAPRNsForFullPracticeAuthority;RoyHoland
MD;MissouriChamberofCommerce&Industry;NationalCouncilof
StateBoardsofNursing;andBJCHealthcare.
OPPONENTS: Thosewhoopposethebillsaythatanyproposed
legislationshouldbejudgedonthebasisofitsdeliveryofhigh-
qualitycaretoresidentsandpatients,whichthisbilldoesnot
offer;negativeimpactsonallprofessionsfromvirtuallearnings
areasofyetundetermined;surveydataindicatesasmuchas95%of
patientswantphysiciansinvolvedintheircareteams,upto75%
wouldwaitlongerandpaymoretoensureasmuch,and91%saythe
educationandformaltrainingofphysiciansisavitalaspectof
theprofession;competitionkeepsAPRNsinurbanandsuburban areas,wheretheywanttoliveandpractice;thisbilldoesnot
addressthe"pipelineproblem,"whereinruralstudentsneedgreater
resourcesandopportunitiesintheircommunitiesupongraduation
frommedicalschool;thisbillcontainstoofewguardrails;and
thatthereareseveralotherwaysthatpatientcaremaybeimproved
upon.
TestifyinginpersonagainstthebillwereJeffreyD.Davis,DO;
MissouriCollegeofEmergencyPhysicians;AmericanCollegeofOB
GYNs;MissouriDermatological Society;MissouriSocietyof
Anesthesiologists; MistyTodd,MissouriAcademyofFamily
Physicians;MatthewCasey;GeorgeJ.Hruza,MissouriStateMedical
Association;ArnieC.Dienoff;MissouriStateOrthopaedic
Association;andMissouriAssociationofOsteopathicPhysiciansand
Surgeons.
OTHERS:Otherstestifyingonthebillsaytherewillalwaysbe
nuanceinanissueascomplexasAPRNsandcollaborativepractice
arrangements;thereareavarietyoffactorsthataffectAPRN
supplyintheworkforce;thatregardingaccess,APRNsmaybeable
toimproveserviceinruralareasandforthoseonMedicare,at
similarcostsandqualitiesofcare;andthatAPRNstendtowork
morehoursandareoftenself-employed.
TestifyinginpersononthebillwasRamonMartinez,MostPolicy
Initiative.
Writtentestimonyhasbeensubmittedforthisbill.Thefull
writtentestimonyandwitnessestestifyingonlinecanbefound
underTestimonyonthebillpageontheHousewebsite.