FIRSTREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
HOUSEBILLNO.271
102NDGENERALASSEMBLY
0512H.02C DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsections195.070,334.104,335.016,335.019,335.036,335.046,335.051,335.056,
335.076,335.086,and335.175,RSMo,andtoenactinlieuthereoftwelvenew
sectionsrelatingtonurses.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections195.070,334.104,335.016,335.019,335.036,335.046,335.051,
2335.056,335.076,335.086,and335.175,RSMo,arerepealedandtwelvenewsections
3enactedinlieuthereof,tobeknownassections195.070,334.104,335.016,335.019,335.036,
4335.046,335.049,335.051,335.056,335.076,335.086,and335.175,toreadasfollows:
195.070.1.Aphysician,podiatrist,dentist,aregisteredoptometristcertifiedto
2administerpharmaceuticalagentsasprovidedinsection336.220,oranassistantphysicianin
3accordancewithsection334.037oraphysicianassistantinaccordancewithsection334.747
4ingoodfaithandinthecourseofhisorherprofessionalpracticeonly,mayprescribe,
5administer,anddispensecontrolledsubstancesorheorshemaycausethesametobe
6administeredordispensedbyanindividualasauthorizedbystatute.
7 2.Anadvancedpracticeregisterednurse,asdefinedinsection335.016,butnota
8certifiedregisterednurseanesthetistasdefinedinsubdivision(8)ofsection335.016,who
9holdsacertificateofcontrolledsubstanceprescriptiveauthorityfromtheboardofnursing
10undersection335.019andwhoisdelegatedtheauthoritytoprescribecontrolledsubstances
11underacollaborativepracticearrangementundersection334.104mayprescribeany
12controlledsubstanceslistedinSchedulesIII,IV,andVofsection195.017,andmayhave
13restrictedauthorityinScheduleII.PrescriptionsforScheduleIImedicationsprescribedbyan
14advancedpracticeregisterednursewhohasacertificateofcontrolledsubstanceprescriptive
15authorityarerestrictedtoonlythosemedicationscontaininghydrocodoneandScheduleII
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 16controlledsubstancesforhospicepatientspursuanttotheprovisionsofsection334.104.
17However,nosuchcertifiedadvancedpracticeregisterednurseshallprescribecontrolled
18substanceforhisorherownselforfamily.ScheduleIIInarcoticcontrolledsubstanceand
19ScheduleII-hydrocodoneprescriptionsshallbelimitedtoaonehundredtwenty-hoursupply
20withoutrefill.
21 3.Aveterinarian,ingoodfaithandinthecourseoftheveterinarian'sprofessional
22practiceonly,andnotforusebyahumanbeing,mayprescribe,administer,anddispense
23controlledsubstancesandtheveterinarianmaycausethemtobeadministeredbyanassistant
24ororderlyunderhisorherdirectionandsupervision.
25 4.Apractitionershallnotacceptanyportionofacontrolledsubstanceunusedbya
26patient,foranyreason,ifsuchpractitionerdidnotoriginallydispensethedrug,except:
27 (1)Whenthecontrolledsubstanceisdeliveredtothepractitionertoadministertothe
28patientforwhomthemedicationisprescribedasauthorizedbyfederallaw.Practitioners
29shallmaintainrecordsandsecurethemedicationasrequiredbythischapterandregulations
30promulgatedpursuanttothischapter;or
31 (2)Asprovidedinsection195.265.
32 5.Anindividualpractitionershallnotprescribeordispenseacontrolledsubstancefor
33suchpractitioner'spersonaluseexceptinamedicalemergency.
334.104.1.Aphysicianmayenterintocollaborativepracticearrangementswith
2registeredprofessionalnurses.Collaborativepracticearrangementsshallbeintheformof
3writtenagreements,jointlyagreed-uponprotocols,orstandingordersforthedeliveryof
4healthcareservices.Collaborativepracticearrangements,whichshallbeinwriting,may
5delegatetoaregisteredprofessionalnursetheauthoritytoadministerordispensedrugsand
6providetreatmentaslongasthedeliveryofsuchhealthcareservicesiswithinthescopeof
7practiceoftheregisteredprofessionalnurseandisconsistentwiththatnurse'sskill,training
8andcompetence.
9 2.(1)Collaborativepracticearrangements,whichshallbeinwriting,maydelegateto
10aregisteredprofessionalnursetheauthoritytoadminister,dispenseorprescribedrugsand
11providetreatmentiftheregisteredprofessionalnurseisanadvancedpracticeregisterednurse
12asdefinedinsubdivision(2)ofsection335.016.Collaborativepracticearrangementsmay
13delegatetoanadvancedpracticeregisterednurse,asdefinedinsection335.016,theauthority
14toadminister,dispense,orprescribecontrolledsubstanceslistedinSchedulesIII,IV,andVof
15section195.017,andScheduleII-hydrocodone;exceptthat,thecollaborativepractice
16arrangementshallnotdelegatetheauthoritytoadministeranycontrolledsubstanceslistedin
17SchedulesIII,IV,andVofsection195.017,orScheduleII-hydrocodoneforthepurposeof
18inducingsedationorgeneralanesthesiafortherapeutic,diagnostic,orsurgicalprocedures.
HCSHB271 2 19ScheduleIIInarcoticcontrolledsubstanceandScheduleII-hydrocodoneprescriptionsshall
20belimitedtoaonehundredtwenty-hoursupplywithoutrefill.
21 (2)Notwithstandinganyotherprovisionofthissectiontothecontrary,a
22collaborativepracticearrangementmaydelegatetoanadvancedpracticeregistered
23nursetheauthoritytoadminister,dispense,orprescribeScheduleIIcontrolled
24substancesforhospicepatients;provided,thattheadvancedpracticeregisterednurseis
25employedbyahospiceprovidercertifiedpursuanttochapter197andtheadvanced
26practiceregisterednurseisprovidingcaretohospicepatientspursuanttoa
27collaborativepracticearrangementthatdesignatesthecertifiedhospiceasalocation
28wheretheadvancedpracticeregisterednurseisauthorizedtopracticeandprescribe.
29 (3)Suchcollaborativepracticearrangementsshallbeintheformofwritten
30agreements,jointlyagreed-uponprotocolsorstandingordersforthedeliveryofhealthcare
31services.
32 (4)Anadvancedpracticeregisterednursemayprescribebuprenorphineforuptoa
33thirty-daysupplywithoutrefillforpatientsreceivingmedication-assistedtreatmentfor
34substanceusedisordersunderthedirectionofthecollaboratingphysician.
35 3.Thewrittencollaborativepracticearrangementshallcontainatleastthefollowing
36provisions:
37 (1)Completenames,homeandbusinessaddresses,zipcodes,andtelephonenumbers
38ofthecollaboratingphysicianandtheadvancedpracticeregisterednurse;
39 (2)Alistofallotherofficesorlocationsbesidesthoselistedinsubdivision(1)ofthis
40subsectionwherethecollaboratingphysicianauthorizedtheadvancedpracticeregistered
41nursetoprescribe;
42 (3)Arequirementthatthereshallbepostedateveryofficewheretheadvanced
43practiceregisterednurseisauthorizedtoprescribe,incollaborationwithaphysician,a
44prominentlydisplayeddisclosurestatementinformingpatientsthattheymaybeseenbyan
45advancedpracticeregisterednurseandhavetherighttoseethecollaboratingphysician;
46 (4)Allspecialtyorboardcertificationsofthecollaboratingphysicianandall
47certificationsoftheadvancedpracticeregisterednurse;
48 (5)Themannerofcollaborationbetweenthecollaboratingphysicianandthe
49advancedpracticeregisterednurse,includinghowthecollaboratingphysicianandthe
50advancedpracticeregisterednursewill:
51 (a)Engageincollaborativepracticeconsistentwitheachprofessional'sskill,training,
52education,andcompetence;
53 (b)Maintaingeographicproximity,exceptthecollaborativepracticearrangement
54mayallowforgeographicproximitytobewaivedforamaximumoftwenty-eightdaysper
55calendaryearforruralhealthclinicsasdefinedbyP.L.95-210,aslongasthecollaborative
HCSHB271 3 56practicearrangementincludesalternativeplansasrequiredinparagraph(c)ofthis
57subdivision.Thisexceptiontogeographicproximityshallapplyonlytoindependentrural
58healthclinics,provider-basedruralhealthclinicswheretheproviderisacriticalaccess
59hospitalasprovidedin42U.S.C.Section1395i-4,andprovider-basedruralhealthclinics
60wherethemainlocationofthehospitalsponsorisgreaterthanfiftymilesfromtheclinic.
61Thecollaborativepracticearrangementmayallowforgeographicproximitytobe
62waivedwhenthearrangementoutlinestheuseoftelecommunications,asdescribedin
63section191.1145.Thecollaboratingphysicianisrequiredtomaintaindocumentationrelated
64tothisrequirementandtopresentittothestateboardofregistrationforthehealingartswhen
65requested;and
66 (c)Providecoverageduringabsence,incapacity,infirmity,oremergencybythe
67collaboratingphysician;
68 (6)Adescriptionoftheadvancedpracticeregisterednurse'scontrolledsubstance
69prescriptiveauthorityincollaborationwiththephysician,includingalistofthecontrolled
70substancesthephysicianauthorizesthenursetoprescribeanddocumentationthatitis
71consistentwitheachprofessional'seducation,knowledge,skill,andcompetence;
72 (7)Alistofallotherwrittenpracticeagreementsofthecollaboratingphysicianand
73theadvancedpracticeregisterednurse;
74 (8)Thedurationofthewrittenpracticeagreementbetweenthecollaborating
75physicianandtheadvancedpracticeregisterednurse;
76 (9)Adescriptionofthetimeandmannerofthecollaboratingphysician'sreviewof
77theadvancedpracticeregisterednurse'sdeliveryofhealthcareservices.Thedescriptionshall
78includeprovisionsthattheadvancedpracticeregisterednurseshallsubmitaminimumoften
79percentofthechartsdocumentingtheadvancedpracticeregisterednurse'sdeliveryofhealth
80careservicestothecollaboratingphysicianforreviewbythecollaboratingphysician,orany
81otherphysiciandesignatedinthecollaborativepracticearrangement,everyfourteendays;and
82 (10)Thecollaboratingphysician,oranyotherphysiciandesignatedinthe
83collaborativepracticearrangement,shallrevieweveryfourteendaysaminimumoftwenty
84percentofthechartsinwhichtheadvancedpracticeregisterednurseprescribescontrolled
85substances.Thechartsreviewedunderthissubdivisionmaybecountedinthenumberof
86chartsrequiredtobereviewedundersubdivision(9)ofthissubsection.
87 4.Thestateboardofregistrationforthehealingartspursuanttosection334.125and
88theboardofnursingpursuanttosection335.036mayjointlypromulgaterulesregulatingthe
89useofcollaborativepracticearrangements.Suchrulesshallbelimitedtospecifying
90geographicareastobecovered,themethodsoftreatmentthatmaybecoveredby
91collaborativepracticearrangementsandtherequirementsforreviewofservicesprovided
92pursuanttocollaborativepracticearrangementsincludingdelegatingauthoritytoprescribe
HCSHB271 4 93controlledsubstances.Anyrulesrelatingtodispensingordistributionofmedicationsor
94devicesbyprescriptionorprescriptiondrugordersunderthissectionshallbesubjecttothe
95approvalofthestateboardofpharmacy.Anyrulesrelatingtodispensingordistributionof
96controlledsubstancesbyprescriptionorprescriptiondrugordersunderthissectionshallbe
97subjecttotheapprovalofthedepartmentofhealthandseniorservicesandthestateboardof
98pharmacy.Inordertotakeeffect,suchrulesshallbeapprovedbyamajorityvoteofa
99quorumofeachboard.Neitherthestateboardofregistrationforthehealingartsnorthe
100boardofnursingmayseparatelypromulgaterulesrelatingtocollaborativepractice
101arrangements.Suchjointlypromulgatedrulesshallbeconsistentwithguidelinesfor
102federallyfundedclinics.Therulemakingauthoritygrantedinthissubsectionshallnotextend
103tocollaborativepracticearrangementsofhospitalemployeesprovidinginpatientcarewithin
104hospitalsasdefinedpursuanttochapter197orpopulation-basedpublichealthservicesas
105definedby20CSR2150-5.100asofApril30,2008.
106 5.Thestateboardofregistrationforthehealingartsshallnotdeny,revoke,suspend
107orotherwisetakedisciplinaryactionagainstaphysicianforhealthcareservicesdelegatedtoa
108registeredprofessionalnurseprovidedtheprovisionsofthissectionandtherules
109promulgatedthereunderaresatisfied.Uponthewrittenrequestofaphysiciansubjecttoa
110disciplinaryactionimposedasaresultofanagreementbetweenaphysicianandaregistered
111professionalnurseorregisteredphysicianassistant,whetherwrittenornot,priortoAugust
11228,1993,allrecordsofsuchdisciplinarylicensureactionandallrecordspertainingtothe
113filing,investigationorreviewofanallegedviolationofthischapterincurredasaresultof
114suchanagreementshallberemovedfromtherecordsofthestateboardofregistrationforthe
115healingartsandthedivisionofprofessionalregistrationandshallnotbedisclosedtoany
116publicorprivateentityseekingsuchinformationfromtheboardorthedivision.Thestate
117boardofregistrationforthehealingartsshalltakeactiontocorrectreportsofalleged
118violationsanddisciplinaryactionsasdescribedinthissectionwhichhavebeensubmittedto
119theNationalPractitionerDataBank.Insubsequentapplicationsorrepresentationsrelatingto
120hisorhermedicalpractice,aphysiciancompletingformsordocumentsshallnotberequired
121toreportanyactionsofthestateboardofregistrationforthehealingartsforwhichthe
122recordsaresubjecttoremovalunderthissection.
123 6.Withinthirtydaysofanychangeandoneachrenewal,thestateboardof
124registrationforthehealingartsshallrequireeveryphysiciantoidentifywhetherthephysician
125isengagedinanycollaborativepractice[agreement] arrangement, includingcollaborative
126practice[agreements] arrangementsdelegatingtheauthoritytoprescribecontrolled
127substances,orphysicianassistant[agreement] collaborativepracticearrangementand
128alsoreporttotheboardthenameofeachlicensedprofessionalwithwhomthephysicianhas
129enteredintosuch[agreement] arrangement. Theboard[may] shallmakethisinformation
HCSHB271 5 130availabletothepublic.Theboardshalltrackthereportedinformationandmayroutinely
131conductrandomreviewsofsuch[agreements] arrangementstoensurethat[agreements]
132arrangementsarecarriedoutforcomplianceunderthischapter.
133 7.Notwithstandinganylawtothecontrary,acertifiedregisterednurseanesthetistas
134definedinsubdivision(8)ofsection335.016shallbepermittedtoprovideanesthesiaservices
135withoutacollaborativepracticearrangementprovidedthatheorsheisunderthesupervision
136ofananesthesiologistorotherphysician,dentist,orpodiatristwhoisimmediatelyavailableif
137needed.Nothinginthissubsectionshallbeconstruedtoprohibitorpreventacertified
138registerednurseanesthetistasdefinedinsubdivision(8)ofsection335.016fromenteringinto
139acollaborativepracticearrangementunderthissection,exceptthatthecollaborativepractice
140arrangementmaynotdelegatetheauthoritytoprescribeanycontrolledsubstanceslistedin
141SchedulesIII,IV,andVofsection195.017,orScheduleII-hydrocodone.
142 8.Acollaboratingphysicianshallnotenterintoacollaborativepracticearrangement
143withmorethansixfull-timeequivalentadvancedpracticeregisterednurses,full-time
144equivalentlicensedphysicianassistants,orfull-timeequivalentassistantphysicians,orany
145combinationthereof.Thislimitationshallnotapplytocollaborativearrangementsofhospital
146employeesprovidinginpatientcareserviceinhospitalsasdefinedinchapter197or
147population-basedpublichealthservicesasdefinedby20CSR2150-5.100asofApril30,
1482008,ortoacertifiedregisterednurseanesthetistprovidinganesthesiaservicesunderthe
149supervisionofananesthesiologistorotherphysician,dentist,orpodiatristwhoisimmediately
150availableifneededassetoutinsubsection7ofthissection.
151 9.Itistheresponsibilityofthecollaboratingphysiciantodetermineanddocument
152thecompletionofatleastaone-monthperiodoftimeduringwhichtheadvancedpractice
153registerednurseshallpracticewiththecollaboratingphysiciancontinuouslypresentbefore
154practicinginasettingwherethecollaboratingphysicianisnotcontinuouslypresent.This
155limitationshallnotapplytocollaborativearrangementsofprovidersofpopulation-based
156publichealthservicesasdefinedby20CSR2150-5.100asofApril30,2008, orto
157collaborativepracticearrangementsbetweenaprimarycarephysicianandaprimary
158careadvancedpracticeregisterednurse,wherethecollaboratingphysicianisnewtoa
159patientpopulationtowhichtheadvancedpracticeregisterednurseisfamiliar.
160 10.Noagreementmadeunderthissectionshallsupersedecurrenthospitallicensing
161regulationsgoverninghospitalmedicationordersunderprotocolsorstandingordersforthe
162purposeofdeliveringinpatientoremergencycarewithinahospitalasdefinedinsection
163197.020ifsuchprotocolsorstandingordershavebeenapprovedbythehospital'smedical
164staffandpharmaceuticaltherapeuticscommittee.
165 11.Nocontractorother[agreement] arrangementshallrequireaphysiciantoactas
166acollaboratingphysicianforanadvancedpracticeregisterednurseagainstthephysician's
HCSHB271 6 167will.Aphysicianshallhavetherighttorefusetoactasacollaboratingphysician,without
168penalty,foraparticularadvancedpracticeregisterednurse.Nocontractorotheragreement
169shalllimitthecollaboratingphysician'sultimateauthorityoveranyprotocolsorstanding
170ordersorinthedelegationofthephysician'sauthoritytoanyadvancedpracticeregistered
171nurse,butthisrequirementshallnotauthorizeaphysicianinimplementingsuchprotocols,
172standingorders,ordelegationtoviolateapplicablestandardsforsafemedicalpractice
173establishedbyhospital'smedicalstaff.
174 12.Nocontractorother[agreement] arrangementshallrequireany[advanced
175practice] registerednursetoserveasacollaborating[advancedpractice] registerednursefor
176anycollaboratingphysicianagainstthe[advancedpractice] registerednurse'swill.[An
177advancedpractice] Aregisterednurseshallhavetherighttorefusetocollaborate,without
178penalty,withaparticularphysician.
335.016.Asusedinthischapter,unlessthecontextclearlyrequiresotherwise,the
2followingwordsandtermsmean:
3 (1)"Accredited",theofficialauthorizationorstatusgrantedbyanagencyfora
4programthroughavoluntaryprocess;
5 (2)"Advancedpracticeregisterednurse"or"APRN", a[nursewhohaseducation
6beyondthebasicnursingeducationandiscertifiedbyanationallyrecognizedprofessional
7organizationasacertifiednursepractitioner,certifiednursemidwife,certifiedregistered
8nurseanesthetist,oracertifiedclinicalnursespecialist.Theboardshallpromulgaterules
9specifyingwhichnationallyrecognizedprofessionalorganizationcertificationsaretobe
10recognizedforthepurposesofthissection.Advancedpracticenursesandonlysuch
11individualsmayusethetitle"AdvancedPracticeRegisteredNurse"andtheabbreviation
12"APRN"] personwhoislicensedundertheprovisionsofthischaptertoengageinthe
13practiceofadvancedpracticenursingasacertifiedclinicalnursespecialist,certified
14nursemidwife,certifiednursepractitioner,orcertifiedregisterednurseanesthetist;
15 (3)"Approval",officialrecognitionofnursingeducationprogramswhichmeet
16standardsestablishedbytheboardofnursing;
17 (4)"Board"or"stateboard",thestateboardofnursing;
18 (5)"Certifiedclinicalnursespecialist",aregisterednursewhoiscurrentlycertifiedas
19aclinicalnursespecialistbyanationallyrecognizedcertifyingboardapprovedbytheboard
20ofnursing;
21 (6)"Certifiednursemidwife",aregisterednursewhoiscurrentlycertifiedasanurse
22midwifebytheAmerican[CollegeofNurseMidwives] MidwiferyCertificationBoard, or
23othernationallyrecognizedcertifyingbodyapprovedbytheboardofnursing;
HCSHB271 7 24 (7)"Certifiednursepractitioner",aregisterednursewhoiscurrentlycertifiedasa
25nursepractitionerbyanationallyrecognizedcertifyingbodyapprovedbytheboardof
26nursing;
27 (8)"Certifiedregisterednurseanesthetist",aregisterednursewhoiscurrently
28certifiedasanurseanesthetistbytheCouncilonCertificationofNurseAnesthetists,the
29[CouncilonRecertificationofNurseAnesthetists] NationalBoardofCertificationand
30RecertificationforNurseAnesthetists, orothernationallyrecognizedcertifyingbody
31approvedbytheboardofnursing;
32 (9)"Executivedirector",aqualifiedindividualemployedbytheboardasexecutive
33secretaryorotherwisetoadministertheprovisionsofthischapterundertheboard'sdirection.
34Suchpersonemployedasexecutivedirectorshallnotbeamemberoftheboard;
35 (10)"Inactive[nurse] licensestatus", asdefinedbyrulepursuanttosection335.061;
36 (11)"Lapsedlicensestatus",asdefinedbyruleundersection335.061;
37 (12)"Licensedpracticalnurse"or"practicalnurse",apersonlicensedpursuanttothe
38provisionsofthischaptertoengageinthepracticeofpracticalnursing;
39 (13)"Licensure",theissuingofalicense[topracticeprofessionalorpractical
40nursing] tocandidateswhohavemetthe[specified] requirementsspecifiedunderthis
41chapter,authorizingthepersontoengageinthepracticeofadvancedpractice,
42professional,orpracticalnursing,andtherecordingofthenamesofthosepersonsas
43holdersofalicensetopracticeadvancedpractice,professional, orpracticalnursing;
44 (14)"Practiceofadvancedpracticenursing",theperformanceforcompensation
45ofactivitiesandservicesconsistentwiththerequirededucation,training,certification,
46demonstratedcompetencies,andexperiencesofanadvancedpracticeregisterednurse;
47 (15)"Practiceofpracticalnursing",theperformanceforcompensationofselected
48actsforthepromotionofhealthandinthecareofpersonswhoareill,injured,orexperiencing
49alterationsinnormalhealthprocesses.Suchperformancerequiressubstantialspecialized
50skill,judgmentandknowledge.Allsuchnursingcareshallbegivenunderthedirectionofa
51personlicensedbyastateregulatoryboardtoprescribemedicationsandtreatmentsorunder
52thedirectionofaregisteredprofessionalnurse.Forthepurposesofthischapter,theterm
53"direction"shallmeanguidanceorsupervisionprovidedbyapersonlicensedbyastate
54regulatoryboardtoprescribemedicationsandtreatmentsoraregisteredprofessionalnurse,
55including,butnotlimitedto,oral,written,orotherwisecommunicatedordersordirectivesfor
56patientcare.Whenpracticalnursingcareisdeliveredpursuanttothedirectionofaperson
57licensedbyastateregulatoryboardtoprescribemedicationsandtreatmentsorunderthe
58directionofaregisteredprofessionalnurse,suchcaremaybedeliveredbyalicensedpractical
59nursewithoutdirectphysicaloversight;
HCSHB271 8 60 [(15)] (16)"Practiceofprofessionalnursing",theperformanceforcompensationof
61anyactoractionwhichrequiressubstantialspecializededucation,judgmentandskillbased
62onknowledgeandapplicationofprinciplesderivedfromthebiological,physical,social,
63behavioral,andnursingsciences,including,butnotlimitedto:
64 (a)Responsibilityforthepromotionandteachingofhealthcareandtheprevention
65ofillnesstothepatientandhisorherfamily;
66 (b)Assessment,datacollection,nursingdiagnosis,nursingcare,evaluation,and
67counselofpersonswhoareill,injured, orexperiencingalterationsinnormalhealthprocesses;
68 (c)Theadministrationofmedicationsandtreatmentsasprescribedbyaperson
69licensedbyastateregulatoryboardtoprescribemedicationsandtreatments;
70 (d)Thecoordinationandassistanceinthedeterminationanddeliveryofaplanof
71healthcarewithallmembersofahealthteam;
72 (e)Theteachingandsupervisionofotherpersonsintheperformanceofanyofthe
73foregoing;
74 [(16)A](17)"Registeredprofessionalnurse"or"registerednurse",apersonlicensed
75pursuanttotheprovisionsofthischaptertoengageinthepracticeofprofessionalnursing;
76 [(17)] (18)"Retiredlicensestatus",anypersonlicensedinthisstateunderthischapter
77whoretiresfromsuchpractice.Suchpersonshallfilewiththeboardanaffidavit,onaform
78tobefurnishedbytheboard,whichstatesthedateonwhichthelicenseeretiredfromsuch
79practice,anintenttoretirefromthepracticeforatleasttwoyears,andsuchotherfactsastend
80toverifytheretirementastheboardmaydeemnecessary;butifthelicenseethereafter
81reengagesinthepractice,thelicenseeshallrenewhisorherlicensewiththeboardas
82providedbythischapterandbyruleandregulation.
335.019.1.Anadvancedpracticeregisterednurse'sprescriptiveauthorityshall
2includeauthorityto:
3 (1)Prescribe,dispense,andadministermedicationsandnonscheduledlegend
4drugs,asdefinedinsection338.330,withinsuchAPRN'spracticeandspecialty;and
5 (2)Notwithstandinganyotherprovisionofthischaptertothecontrary,receive,
6prescribe,administer,andprovidenonscheduledlegenddrugsamplesfrom
7pharmaceuticalmanufacturerstopatientsatnochargetothepatientoranyotherparty.
8 2.Theboardofnursingmaygrantacertificateofcontrolledsubstanceprescriptive
9authoritytoanadvancedpracticeregisterednursewho:
10 (1)Submitsproofofsuccessfulcompletionofanadvancedpharmacologycoursethat
11shallincludepreceptorialexperienceintheprescriptionofdrugs,medicines, andtherapeutic
12devices;and
HCSHB271 9 13 (2)Providesdocumentationofaminimumofthreehundredclockhourspreceptorial
14experienceintheprescriptionofdrugs,medicines,andtherapeuticdeviceswithaqualified
15preceptor;and
16 (3)Providesevidenceofaminimumofonethousandhoursofpracticeinanadvanced
17practicenursingcategorypriortoapplicationforacertificateofprescriptiveauthority.The
18onethousandhoursshallnotincludeclinicalhoursobtainedintheadvancedpracticenursing
19educationprogram.Theonethousandhoursofpracticeinanadvancedpracticenursing
20categorymayincludetransmittingaprescriptionorderorallyortelephonicallyortoan
21inpatientmedicalrecordfromprotocolsdevelopedincollaborationwithandsignedbya
22licensedphysician;and
23 (4)Hasacontrolledsubstanceprescribingauthoritydelegatedinthecollaborative
24practicearrangementundersection334.104withaphysicianwhohasanunrestrictedfederal
25DrugEnforcementAdministrationregistrationnumberandwhoisactivelyengagedina
26practicecomparableinscope,specialty,orexpertisetothatoftheadvancedpractice
27registerednurse.
335.036.1.Theboardshall:
2 (1)Electforaone-yeartermapresidentandasecretary,whoshallalsobetreasurer,
3andtheboardmayappoint,employandfixthecompensationofalegalcounselandsuch
4boardpersonnelasdefinedinsubdivision(4)ofsubsection11ofsection324.001asare
5necessarytoadministertheprovisionsofsections335.011to[335.096] 335.099;
6 (2)Adoptandrevisesuchrulesandregulationsasmaybenecessarytoenableitto
7carryintoeffecttheprovisionsofsections335.011to[335.096] 335.099;
8 (3)Prescribeminimumstandardsforeducationalprogramspreparingpersonsfor
9licensureasaregisterednurseorlicensedpracticalnursepursuanttotheprovisionsof
10sections335.011to[335.096] 335.099;
11 (4)Provideforsurveysofsuchprogramseveryfiveyearsandinadditionatsuch
12timesasitmaydeemnecessary;
13 (5)Designateas"approved"suchprogramsasmeettherequirementsofsections
14335.011to[335.096] 335.099andtherulesandregulationsenactedpursuanttosuchsections;
15andtheboardshallannuallypublishalistofsuchprograms;
16 (6)Denyorwithdrawapprovalfromeducationalprogramsforfailuretomeet
17prescribedminimumstandards;
18 (7)Examine,license,andcausetoberenewedthelicensesofdulyqualified
19applicants;
20 (8)Causetheprosecutionofallpersonsviolatingprovisionsofsections335.011to
21[335.096] 335.099, andmayincursuchnecessaryexpensestherefor;
HCSHB271 10 22 (9)Keeparecordofalltheproceedings;andmakeanannualreporttothegovernor
23andtothedirectorofthedepartmentofcommerceandinsurance.
24 2.Theboardshallsettheamountofthefeeswhichthischapterauthorizesand
25requiresbyrulesandregulations.Thefeesshallbesetataleveltoproducerevenuewhich
26shallnotsubstantiallyexceedthecostandexpenseofadministeringthischapter.
27 3.Allfeesreceivedbytheboardpursuanttotheprovisionsofsections335.011to
28[335.096] 335.099shallbedepositedinthestatetreasuryandbeplacedtothecreditofthe
29stateboardofnursingfund.Alladministrativecostsandexpensesoftheboardshallbepaid
30fromappropriationsmadeforthosepurposes.Theboardisauthorizedtoprovidefundingfor
31thenursingeducationincentiveprogramestablishedinsections335.200to335.203.
32 4.Theprovisionsofsection33.080tothecontrarynotwithstanding,moneyinthis
33fundshallnotbetransferredandplacedtothecreditofgeneralrevenueuntiltheamountin
34thefundattheendofthebienniumexceedstwotimestheamountoftheappropriationfrom
35theboard'sfundsfortheprecedingfiscalyearor,iftheboardrequiresbyrule,permitrenewal
36lessfrequentlythanyearly,thenthreetimestheappropriationfromtheboard'sfundsforthe
37precedingfiscalyear.Theamount,ifany,inthefundwhichshalllapseisthatamountinthe
38fundwhichexceedstheappropriatemultipleoftheappropriationsfromtheboard'sfundsfor
39theprecedingfiscalyear.
40 5.Anyruleorportionofarule,asthattermisdefinedinsection536.010,thatis
41createdundertheauthoritydelegatedinthischaptershallbecomeeffectiveonlyifitcomplies
42withandissubjecttoalloftheprovisionsofchapter536and,ifapplicable,section536.028.
43AllrulemakingauthoritydelegatedpriortoAugust28,1999,isofnoforceandeffectand
44repealed.Nothinginthissectionshallbeinterpretedtorepealoraffectthevalidityofany
45rulefiledoradoptedpriortoAugust28,1999,ifitfullycompliedwithallapplicable
46provisionsoflaw.Thissectionandchapter536arenonseverableandifanyofthepowers
47vestedwiththegeneralassemblypursuanttochapter536toreview,todelaytheeffectivedate
48ortodisapproveandannularulearesubsequentlyheldunconstitutional,thenthegrantof
49rulemakingauthorityandanyruleproposedoradoptedafterAugust28,1999,shallbeinvalid
50andvoid.
335.046.1.Anapplicantforalicensetopracticeasaregisteredprofessionalnurse
2shallsubmittotheboardawrittenapplicationonformsfurnishedtotheapplicant.The
3originalapplicationshallcontaintheapplicant'sstatementsshowingtheapplicant'seducation
4andothersuchpertinentinformationastheboardmayrequire.Theapplicantshallbeofgood
5moralcharacterandhavecompletedatleastthehighschoolcourseofstudy,ortheequivalent
6thereofasdeterminedbythestateboardofeducation,andhavesuccessfullycompletedthe
7basicprofessionalcurriculuminanaccreditedorapprovedschoolofnursingandearneda
8professionalnursingdegreeordiploma.Eachapplicationshallcontainastatementthatitis
HCSHB271 11 9madeunderoathoraffirmationandthatitsrepresentationsaretrueandcorrecttothebest
10knowledgeandbeliefofthepersonsigningsame,subjecttothepenaltiesofmakingafalse
11affidavitordeclaration.Applicantsfromnon-English-speakinglandsshallberequiredto
12submitevidenceofproficiencyintheEnglishlanguage.Theapplicantmustbeapprovedby
13theboardandshallpassanexaminationasrequiredbytheboard.Theboardmayrequireby
14ruleasarequirementforlicensurethateachapplicantshallpassanoralorpractical
15examination.Uponsuccessfullypassingtheexamination,theboardmayissuetothe
16applicantalicensetopracticenursingasaregisteredprofessionalnurse.Theapplicantfora
17licensetopracticeregisteredprofessionalnursingshallpayalicensefeeinsuchamountasset
18bytheboard.Thefeeshallbeuniformforallapplicants.Applicantsfromforeigncountries
19shallbelicensedasprescribedbyrule.
20 2.Anapplicantforlicensetopracticeasalicensedpracticalnurseshallsubmittothe
21boardawrittenapplicationonformsfurnishedtotheapplicant.Theoriginalapplicationshall
22containtheapplicant'sstatementsshowingtheapplicant'seducationandothersuchpertinent
23informationastheboardmayrequire.Suchapplicantshallbeofgoodmoralcharacter,and
24havecompletedatleasttwoyearsofhighschool,oritsequivalentasestablishedbythestate
25boardofeducation,andhavesuccessfullycompletedabasicprescribedcurriculuminastate-
26accreditedorapprovedschoolofnursing,earnedanursingdegree,certificateordiplomaand
27completedacourseapprovedbytheboardontheroleofthepracticalnurse.Eachapplication
28shallcontainastatementthatitismadeunderoathoraffirmationandthatitsrepresentations
29aretrueandcorrecttothebestknowledgeandbeliefofthepersonsigningsame,subjecttothe
30penaltiesofmakingafalseaffidavitordeclaration.Applicantsfromnon-English-speaking
31countriesshallberequiredtosubmitevidenceoftheirproficiencyintheEnglishlanguage.
32Theapplicantmustbeapprovedbytheboardandshallpassanexaminationasrequiredbythe
33board.Theboardmayrequirebyruleasarequirementforlicensurethateachapplicantshall
34passanoralorpracticalexamination.Uponsuccessfullypassingtheexamination,theboard
35mayissuetotheapplicantalicensetopracticeasalicensedpracticalnurse.Theapplicantfor
36alicensetopracticelicensedpracticalnursingshallpayafeeinsuchamountasmaybesetby
37theboard.Thefeeshallbeuniformforallapplicants.Applicantsfromforeigncountriesshall
38belicensedasprescribedbyrule.
39 3.(1)Anapplicantforalicensetopracticeasanadvancedpracticeregistered
40nurseshallsubmittotheboardawrittenapplicationonformsfurnishedtothe
41applicant.Theoriginalapplicationshallcontain:
42 (a)Statementsshowingtheapplicant'seducationandothersuchpertinent
43informationastheboardmayrequire;and
HCSHB271 12 44 (b)Astatementthatitismadeunderoathoraffirmationandthatits
45representationsaretrueandcorrecttothebestknowledgeandbeliefoftheperson
46signingsame,subjecttothepenaltiesofmakingafalseaffidavitordeclaration.
47 (2)Theapplicantforalicensetopracticeasanadvancedpracticeregistered
48nurseshallpayafeeinsuchamountasmaybesetbytheboard.Thefeeshallbe
49uniformforallapplicants.
50 (3)Anapplicantshall:
51 (a)Holdacurrentregisteredprofessionalnurselicenseorprivilegetopractice,
52shallnotbecurrentlysubjecttodisciplineoranyrestrictions,andshallnotholdan
53encumberedlicenseorprivilegetopracticeasaregisteredprofessionalnurseor
54advancedpracticeregisterednurseinanystateorterritory;
55 (b)Havecompletedanaccreditedgraduate-leveladvancedpracticeregistered
56nurseprogramandachievedatleastonecertificationasaclinicalnursespecialist,nurse
57midwife,nursepractitioner,orregisterednurseanesthetist,withatleastonepopulation
58focusprescribedbyruleoftheboard;
59 (c)Becurrentlycertifiedbyanationalcertifyingbodyrecognizedbythe
60Missouristateboardofnursingintheadvancedpracticeregisterednurserole;and
61 (d)Haveapopulationfocusonhisorhercertification,correspondingwithhisor
62hereducationaladvancedpracticeregisterednurseprogram.
63 (4)Anypersonholdingadocumentofrecognitiontopracticenursingasan
64advancedpracticeregisterednurseinthisstatethatiscurrentonAugust28,2023,shall
65bedeemedtobelicensedasanadvancedpracticeregisterednurseundertheprovisions
66ofthissectionandshallbeeligibleforrenewalofsuchlicenseundertheconditionsand
67standardsprescribedinthischapterandasprescribedbyrule.
68 4.Uponrefusaloftheboardtoallowanyapplicantto[sitfor]takeeitherthe
69registeredprofessionalnurses'examinationorthelicensedpracticalnurses'examination,[as
70thecasemaybe,]oruponrefusaltoissueanadvancedpracticeregisterednurselicense,
71theboardshallcomplywiththeprovisionsofsection621.120andadvisetheapplicantofhis
72orherrighttohaveahearingbeforetheadministrativehearingcommission.The
73administrativehearingcommissionshallhearcomplaintstakenpursuanttosection621.120.
74 [4.]5.Theboardshallnotdenyalicensebecauseofsex,religion,race,ethnicorigin,
75ageorpoliticalaffiliation.
335.049.1.Anyadvancedpracticeregisterednurseactivelypracticingina
2directorindirectpatientcaresettingshall:
3 (1)Reporttotheboardthemailingaddressoraddressesofhisorhercurrent
4practicelocationorlocations;
5 (2)Notifytheboardwithinthirtydaysofanychangeinpracticesetting;and
HCSHB271 13 6 (3)Notifytheboardwithinthirtydaysofanychangeinamailingaddressofany
7ofhisorherpracticelocations.
8 2.Advancedpracticeregisterednursesshallmaintainanadequateandcomplete
9patientrecordforeachpatientthatisretainedonpaper,microfilm,electronicmedia,or
10othermediathatiscapableofbeingprintedforreviewbytheboard.Anadequateand
11completepatientrecordshallincludedocumentationofthefollowinginformation:
12 (1)Identificationofthepatient,includingname,birthdate,address,and
13telephonenumber;
14 (2)Thedateordatesthepatientwasseen;
15 (3)Thecurrentstatusofthepatient,includingthereasonforthevisit;
16 (4)Observationofpertinentphysicalfindings;
17 (5)Assessmentandclinicalimpressionofdiagnosis;
18 (6)Planforcareandtreatmentoradditionalconsultationsordiagnostictesting,
19ifnecessary.Iftreatmentincludesmedication,theadvancedpracticeregisterednurse
20shallincludeinthepatientrecordthemedicationanddosageofanymedication
21prescribed,dispensed,oradministered;and
22 (7)Anyinformedconsentforofficeprocedures.
23 3.Patientrecordsremainingunderthecare,custody,andcontrolofthe
24advancedpracticeregisterednurseshallbemaintainedbytheadvancedpractice
25registerednurseorhisorherdesigneeforaminimumofsevenyearsfromthedateon
26whichthelastprofessionalservicewasprovided.
27 4.Anycorrection,addition,orchangeinanypatientrecordmademorethan
28forty-eighthoursafterthefinalentryisenteredintherecordandsignedbythe
29advancedpracticeregisterednurseshallbeclearlymarkedandidentifiedassuch.The
30date,time,andnameofthepersonmakingthecorrection,addition,orchange,aswellas
31thereasonforthecorrection,addition,orchange,shallbeincluded.
32 5.Advancedpracticeregisterednursesshallensurethatmedicalrecordsare
33completedwithinthirtydaysfollowingeachpatientencounter.
335.051.1.Theboardshallissuealicensetopracticenursingas[either] an
2advancedpracticeregisterednurse,aregisteredprofessionalnurse, oralicensedpractical
3nursewithoutexaminationtoanapplicantwhohasdulybecomelicensedas[a]anadvanced
4practiceregisterednurse,registerednurse, orlicensedpracticalnursepursuanttothelaws
5ofanotherstate,territory,orforeigncountryiftheapplicantmeetsthequalificationsrequired
6ofadvancedpracticeregisterednurses,registerednurses, orlicensedpracticalnursesinthis
7stateatthetimetheapplicantwasoriginallylicensedintheotherstate,territory,orforeign
8country.
9 2.Applicantsfromforeigncountriesshallbelicensedasprescribedbyrule.
HCSHB271 14 10 3.Uponapplication,theboardshallissueatemporarypermittoanapplicantpursuant
11tosubsection1ofthissectionforalicenseas[either] anadvancedpracticeregistered
12nurse,aregisteredprofessionalnurse, oralicensedpracticalnursewhohasmadeaprima
13facieshowingthattheapplicantmeetsalloftherequirementsforsuchalicense.The
14temporarypermitshallbeeffectiveonlyuntiltheboardshallhavehadtheopportunityto
15investigatehisorherqualificationsforlicensurepursuanttosubsection1ofthissectionand
16tonotifytheapplicantthathisorherapplicationforalicensehasbeeneithergrantedor
17rejected.Innoeventshallsuchtemporarypermitbeineffectformorethantwelvemonths
18afterthedateofitsissuancenorshallapermitbereissuedtothesameapplicant.Nofeeshall
19bechargedforsuchtemporarypermit.Theholderofatemporarypermitwhichhasnot
20expired,orbeensuspendedorrevoked,shallbedeemedtobetheholderofalicenseissued
21pursuanttosection335.046untilsuchtemporarypermitexpires,isterminatedorissuspended
22orrevoked.
335.056.1.Thelicenseofeverypersonlicensedundertheprovisionsof[sections
2335.011to335.096] thischaptershallberenewedasprovided.Anapplicationforrenewal
3oflicenseshallbemailedtoeverypersontowhomalicensewasissuedorrenewedduringthe
4currentlicensingperiod.Theapplicantshallcompletetheapplicationandreturnittothe
5boardbytherenewaldatewitharenewalfeeinanamounttobesetbytheboard.Thefee
6shallbeuniformforallapplicants.Thecertificatesofrenewalshallrendertheholderthereof
7alegalpractitionerofnursingfortheperiodstatedinthecertificateofrenewal.Anyperson
8whopracticesnursingasanadvancedpracticeregisterednurse,aregisteredprofessional
9nurse, or[as]alicensedpracticalnurseduringthetimehisorherlicensehaslapsedshallbe
10consideredanillegalpractitionerandshallbesubjecttothepenaltiesprovidedforviolationof
11theprovisionsofsections335.011to[335.096] 335.099.
12 2.Therenewalofadvancedpracticeregisterednurselicensesandregistered
13professionalnurselicensesshalloccuratthesametime,asprescribedbyrule.Failure
14torenewandmaintaintheregisteredprofessionalnurselicenseorprivilegetopractice
15orfailuretoprovidetherequiredfeeandevidenceofactivecertificationormaintenance
16ofcertificationasprescribedbyrulesandregulationsshallresultinexpirationofthe
17advancedpracticeregisterednurselicense.
335.076.1.Anypersonwhoholdsalicensetopracticeprofessionalnursinginthis
2statemayusethetitle"RegisteredProfessionalNurse"andtheabbreviation["R.N."] "RN".
3Nootherpersonshallusethetitle"RegisteredProfessionalNurse"ortheabbreviation
4["R.N."] "RN". Nootherpersonshallassumeanytitleoruseanyabbreviationoranyother
5words,letters,signs,ordevicestoindicatethatthepersonusingthesameisaregistered
6professionalnurse.
HCSHB271 15 7 2.Anypersonwhoholdsalicensetopracticepracticalnursinginthisstatemayuse
8thetitle"LicensedPracticalNurse"andtheabbreviation["L.P.N."]"LPN". Nootherperson
9shallusethetitle"LicensedPracticalNurse"ortheabbreviation["L.P.N."]"LPN". Noother
10personshallassumeanytitleoruseanyabbreviationoranyotherwords,letters,signs,or
11devicestoindicatethatthepersonusingthesameisalicensedpracticalnurse.
12 3.Anypersonwhoholdsalicense[orrecognition] topracticeadvancedpractice
13nursinginthisstatemayusethetitle"AdvancedPracticeRegisteredNurse",the
14designationsof"certifiedregisterednurseanesthetist","certifiednursemidwife",
15"certifiedclinicalnursespecialist",and"certifiednursepractitioner",andthe
16[abbreviation] abbreviations"APRN",[andanyothertitledesignationsappearingonhis
17orherlicense] "CRNA","CNM","CNS",and"NP",respectively. Nootherpersonshall
18usethetitle"AdvancedPracticeRegisteredNurse"ortheabbreviation"APRN".Noother
19personshallassumeanytitleoruseanyabbreviationoranyotherwords,letters,signs,or
20devicestoindicatethatthepersonusingthesameisanadvancedpracticeregisterednurse.
21 4.Nopersonshallpracticeoroffertopracticeprofessionalnursing,practicalnursing,
22oradvancedpracticenursinginthisstateoruseanytitle,sign,abbreviation,card,ordeviceto
23indicatethatsuchpersonisapracticingprofessionalnurse,practicalnurse,oradvanced
24practicenurseunlessheorshehasbeendulylicensedundertheprovisionsofthischapter.
25 5.Intheinterestofpublicsafetyandconsumerawareness,itisunlawfulforany
26persontousethetitle"nurse"inreferencetohimselforherselfinanycapacity,except
27individualswhoareorhavebeenlicensedasaregisterednurse,licensedpracticalnurse,or
28advancedpracticeregisterednurseunderthischapter.
29 6.Notwithstandinganylawtothecontrary,nothinginthischaptershallprohibita
30ChristianSciencenursefromusingthetitle"ChristianSciencenurse",solongassuchperson
31providesonlyreligiousnonmedicalserviceswhenofferingorprovidingsuchservicestothose
32whochoosetorelyuponhealingbyspiritualmeansaloneanddoesnotholdhisorherown
33religiousorganizationanddoesnotholdhimselforherselfoutasaregisterednurse,advanced
34practiceregisterednurse,nursepractitioner,licensedpracticalnurse,nursemidwife,clinical
35nursespecialist,ornurseanesthetist,unlessotherwiseauthorizedbylawtodoso.
335.086.Noperson,firm,corporationorassociationshall:
2 (1)Sellorattempttosellorfraudulentlyobtainorfurnishorattempttofurnishany
3nursingdiploma,license,renewalorrecordoraidorabettherein;
4 (2)Practice[professionalorpractical] nursingasdefinedbysections335.011to
5[335.096] 335.099undercoverofanydiploma,license,orrecordillegallyorfraudulently
6obtainedorsignedorissuedunlawfullyorunderfraudulentrepresentation;
HCSHB271 16 7 (3)Practice[professionalnursingorpractical] nursingasdefinedbysections335.011
8to[335.096] 335.099unlessdulylicensedtodosoundertheprovisionsofsections335.011to
9[335.096] 335.099;
10 (4)Useinconnectionwithhisorhernameanydesignationtendingtoimplythathe
11orsheisalicensedadvancedpracticeregisterednurse,alicensedregisteredprofessional
12nurse, oralicensedpracticalnurseunlessdulylicensedsotopracticeundertheprovisionsof
13sections335.011to[335.096] 335.099;
14 (5)Practice[professionalnursingorpractical] nursingduringthetimehisorher
15licenseissuedundertheprovisionsofsections335.011to[335.096] 335.099shallbe
16suspendedorrevoked;or
17 (6)Conductanursingeducationprogramforthepreparationofprofessionalor
18practicalnursesunlesstheprogramhasbeenaccreditedbytheboard.
335.175.1.NolaterthanJanuary1,2014,thereisherebyestablishedwithinthestate
2boardofregistrationforthehealingartsandthestateboardofnursingthe"Utilizationof
3TelehealthbyNurses".Anadvancedpracticeregisterednurse(APRN)providingnursing
4servicesunderacollaborativepracticearrangementundersection334.104mayprovidesuch
5servicesoutsidethegeographicproximityrequirementsofsection334.104ifthe
6collaboratingphysicianandadvancedpracticeregisterednurseutilizetelehealth[inthe
7careofthepatientandiftheservicesareprovidedinaruralareaofneed]. Telehealth
8providersshallberequiredtoobtainpatientconsentbeforetelehealthservicesareinitiated
9andensureconfidentialityofmedicalinformation.
10 2.Asusedinthissection,"telehealth"shallhavethesamemeaningassuchtermis
11definedinsection191.1145.
12 [3.(1)Theboardsshalljointlypromulgaterulesgoverningthepracticeoftelehealth
13underthissection.Suchrulesshalladdress,butnotbelimitedto,appropriatestandardsfor
14theuseoftelehealth.
15 (2)Anyruleorportionofarule,asthattermisdefinedinsection536.010,thatis
16createdundertheauthoritydelegatedinthissectionshallbecomeeffectiveonlyifitcomplies
17withandissubjecttoalloftheprovisionsofchapter536and,ifapplicable,section536.028.
18Thissectionandchapter536arenonseverableandifanyofthepowersvestedwiththe
19generalassemblypursuanttochapter536toreview,todelaytheeffectivedate,orto
20disapproveandannularulearesubsequentlyheldunconstitutional,thenthegrantof
21rulemakingauthorityandanyruleproposedoradoptedafterAugust28,2013,shallbeinvalid
22andvoid.
HCSHB271 17 23 4.Forpurposesofthissection,"ruralareaofneed"meansanyruralareaofthisstate
24whichislocatedinahealthprofessionalshortageareaasdefinedinsection354.650.]
âś”
HCSHB271 18