COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0779S.03P Bill No.:Perfected SS for SCS for SB 157 Subject:Nurses; Physicians; Professional Registration and Licensing; Health Care
Professionals; Prisons and Jails
Type:Original Date:April 4, 2023Bill Summary:This proposal modifies provisions relating to the licensure of health care
professionals.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026Total Estimated Net
Effect on General
Revenue $0$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 0779S.03P
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2024FY 2025FY 2026Total Estimated Net
Effect on FTE 000
☐ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Local Government$0$0$0 L.R. No. 0779S.03P
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FISCAL ANALYSIS
ASSUMPTION
Senate Amendment 2, as amended
Sections 335.036 and 335.066 - APRN
Officials from the Department of Commerce and Insurance (DCI) state it is estimated that to
fully investigate and prosecute complaints, the board may need additional resources. An
unknown cost of up to $100,000 from the Board of Nursing Fund may be necessary, depending
on the number of cases and legal expenses that occur.
Oversight assumes because the potential for litigation is speculative that the Department of
Commerce and Insurance will not incur significant cost related to this proposal. If a fiscal impact
were to result, the DCI may request additional funding through the appropriation process.
Oversight contacted DCI officials and learned there are currently 14,673 registered APRNs in
Missouri. APRNs are required to pay a one-time fee of $150 for recognition of their APRN
status. DCI officials state this proposal does not change the fee structure or requirements related
to APRNs. The proposal instead changes the current APRN recognition model to a licensure
model.
Bill as a whole:
Officials from the Department of Corrections, the Missouri Office of Prosecution Services,
and the each assume the proposal
will have no fiscal impact on their organizations.
In response to a previous version, officials from the the Department of Health and Senior
ServicesDepartment of Social Services each assumed the proposal will have no fiscal
impact on their respective organizations. Oversight does not have any information to the
contrary. Therefore, Oversight will reflect a zero impact in the fiscal note for these agencies. L.R. No. 0779S.03P
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FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026$0$0$0FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026$0$0$0
FISCAL IMPACT – Small Business
Small medical businesses could be impacted by this proposal.
FISCAL DESCRIPTION
This act modifies several provisions relating to the licensure of health care professionals.
Currently, a requirement for licensure as an assistant physician is that the applicant must be a
graduate of any medical school. This act provides that the applicant must be a graduate of a
medical school accredited by certain organizations listed in the act. This act repeals a provision
of law that authorizes an assistant physician collaborative practice arrangement in any pilot
project areas established in which assistant physicians may practice.
This act modifies licensing and collaborative practice arrangements for advanced practice
registered nurses (APRNs). Under this act, an APRN may prescribe Schedule II controlled
substances for hospice patients, as described in the act. Additionally, collaborative practice
arrangements between the APRN and the collaborating physician may waive geographic
proximity requirements, as described in the act, including when the arrangement outlines the use
of telehealth and when the APRN is providing services in a correctional center. Collaborating
physicians or designated physicians shall be present with the APRN for sufficient periods of
time, at least once every two weeks, to participate in chart reviews and supervision.
Currently, an APRN shall practice with the collaborating physician continuously present for a
one-month period when entering into an arrangement with the physician. This act waives that
requirement when a primary care or behavioral health physician enters into an arrangement with
a primary care or behavioral health APRN, the physician is new to the patient population, and the
APRN is familiar with the patient population. L.R. No. 0779S.03P
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Currently, a nurse may be licensed to practice professional or practical nursing. This act adds a
license to practice advanced practice nursing and modifies the definitions of APRN and the
practice of professional nursing. Additionally, this act specifies the requirements for the
advanced practice nursing license, including the requirement that an applicant first hold a current
registered professional nurse license, and have completed certain graduate-level programs and
certifications, or hold a document of recognition to practice as an APRN that is current as of
August 28, 2023. License renewals for APRN licenses and registered professional nurse licenses
shall occur at the same time and failure to renew and maintain the registered professional nurse
license or failure to provide evidence of an active required certification shall result in the
expiration of the APRN license. This act further modifies the names of the specific certifying
organizations for nursing specialties.
Under this act, the State Board of Registration for the Healing Arts shall make information
publicly available about which physicians and other health care providers have entered into
collaborative practice arrangements.
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space.
SOURCES OF INFORMATION
Department of Commerce and Insurance
Department of Health and Senior Services
Department of Corrections
Department of Social Services
Department of Public Safety
Missouri Highway Patrol
Missouri Office of Prosecution Services
Office of the Secretary of State
Joint Committee on Administrative Rules
Julie MorffRoss StropeDirectorAssistant DirectorApril 4, 2023April 4, 2023