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Missouri Senate Bill SB1279

Missouri 2024 Regular Session

Missouri Senate Bill SB1279 Compare Versions

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22 EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
33 and is intended to be omitted in the law.
44 SECOND REGULAR SESSION
55 SENATE BILL NO. 1279
66 102ND GENERAL ASSEMBLY
77 INTRODUCED BY SENATOR MAY.
88 4814S.01I KRISTINA MARTIN, Secretary
99 AN ACT
1010 To repeal section 334.104, RSMo, and to enact in lieu thereof one new section relating to
1111 collaborative practice arrangements.
1212
1313 Be it enacted by the General Assembly of the State of Missouri, as follows:
1414 Section A. Section 334.104, RSMo, is repealed and one new 1
1515 section enacted in lieu thereof, to be known as section 334.104, 2
1616 to read as follows:3
1717 334.104. 1. A physician may enter into collaborative 1
1818 practice arrangements with registered professional nurses. 2
1919 Collaborative practice arrangements shall be in the form of 3
2020 written agreements, jointly agreed -upon protocols, or 4
2121 standing orders for the delivery of health care services. 5
2222 Collaborative practice arrangements, which shall be in 6
2323 writing, may delegate to a registered professional nurse the 7
2424 authority to administer or dispense drugs and provide 8
2525 treatment as long as the delivery of such health care 9
2626 services is within the scope of practice of the registered 10
2727 professional nurse and is consistent with that nurse's 11
2828 skill, training and competence. 12
2929 2. (1) Collaborative practice arrangements, which 13
3030 shall be in writing, may delegate to a registered 14
3131 professional nurse the authority to administer, dispense or 15
3232 prescribe drugs and provide treatment if the registered 16
3333 professional nurse is an advanced practice registered nurse 17
3434 as defined in subdivision (2) of section 335.016. 18 SB 1279 2
3535 Collaborative practice arran gements may delegate to an 19
3636 advanced practice registered nurse, as defined in section 20
3737 335.016, the authority to administer, dispense, or prescribe 21
3838 controlled substances listed in Schedules III, IV, and V of 22
3939 section 195.017, and Schedule II - hydrocodone; except that, 23
4040 the collaborative practice arrangement shall not delegate 24
4141 the authority to administer any controlled substances listed 25
4242 in Schedules III, IV, and V of section 195.017, or Schedule 26
4343 II - hydrocodone for the purpose of inducing sedation or 27
4444 general anesthesia for therapeutic, diagnostic, or surgical 28
4545 procedures. Schedule III narcotic controlled substance and 29
4646 Schedule II - hydrocodone prescriptions shall be limited to 30
4747 a one hundred twenty -hour supply without refill. 31
4848 (2) Notwithstanding any other provision of this 32
4949 section to the contrary, a collaborative practice 33
5050 arrangement may delegate to an advanced practice registered 34
5151 nurse the authority to administer, dispense, or prescribe 35
5252 Schedule II controlled substances for hospice patients ; 36
5353 provided, that the advanced practice registered nurse is 37
5454 employed by a hospice provider certified pursuant to chapter 38
5555 197 and the advanced practice registered nurse is providing 39
5656 care to hospice patients pursuant to a collaborative 40
5757 practice arrangement that designates the certified hospice 41
5858 as a location where the advanced practice registered nurse 42
5959 is authorized to practice and prescribe. 43
6060 (3) Such collaborative practice arrangements shall be 44
6161 in the form of written agreements, jointly agreed -upon 45
6262 protocols or standing orders for the delivery of health care 46
6363 services. 47
6464 (4) An advanced practice registered nurse may 48
6565 prescribe buprenorphine for up to a thirty -day supply 49
6666 without refill for patients receiving medication -assisted 50 SB 1279 3
6767 treatment for substance use disorders under the direction of 51
6868 the collaborating physician. 52
6969 3. The written collaborative practice arrangement 53
7070 shall contain at least the following provisions: 54
7171 (1) Complete names, home and business addresses, zip 55
7272 codes, and telephone numbers of the collaborating physician 56
7373 and the advanced practice registered nurse; 57
7474 (2) A list of all other offices or locations besides 58
7575 those listed in subdivision (1) of this subsection where the 59
7676 collaborating physician authorized the ad vanced practice 60
7777 registered nurse to prescribe; 61
7878 (3) A requirement that there shall be posted at every 62
7979 office where the advanced practice registered nurse is 63
8080 authorized to prescribe, in collaboration with a physician, 64
8181 a prominently displayed disclo sure statement informing 65
8282 patients that they may be seen by an advanced practice 66
8383 registered nurse and have the right to see the collaborating 67
8484 physician; 68
8585 (4) All specialty or board certifications of the 69
8686 collaborating physician and all certification s of the 70
8787 advanced practice registered nurse; 71
8888 (5) The manner of collaboration between the 72
8989 collaborating physician and the advanced practice registered 73
9090 nurse, including how the collaborating physician and the 74
9191 advanced practice registered nurse will : 75
9292 (a) Engage in collaborative practice consistent with 76
9393 each professional's skill, training, education, and 77
9494 competence; 78
9595 (b) Maintain geographic proximity, except as specified 79
9696 in this paragraph. The following provisions shall apply 80
9797 with respect to this requirement: 81 SB 1279 4
9898 a. Until August 28, 2025, an advanced practice 82
9999 registered nurse providing services in a correctional 83
100100 center, as defined in section 217.010, and his or her 84
101101 collaborating physician shall satisfy the geographic 85
102102 proximity requirement if they practice within two hundred 86
103103 miles by road of one another. An incarcerated patient who 87
104104 requests or requires a physician consultation shall be 88
105105 treated by a physician as soon as appropriate; 89
106106 b. The collaborative practice arrangement may allow 90
107107 for geographic proximity to be waived for a maximum of 91
108108 twenty-eight days per calendar year for rural health clinics 92
109109 as defined by [Pub.L.] P.L. 95-210 (42 U.S.C. Section 1395x, 93
110110 as amended), as long as the collaborative practice 94
111111 arrangement includes alternative plans as required in 95
112112 paragraph (c) of this subdivision. This exception to 96
113113 geographic proximity shall apply only to independent rural 97
114114 health clinics, provider -based rural health clinics where 98
115115 the provider is a critical access hospi tal as provided in 42 99
116116 U.S.C. Section 1395i -4, and provider-based rural health 100
117117 clinics where the main location of the hospital sponsor is 101
118118 greater than fifty miles from the clinic; 102
119119 c. The collaborative practice arrangement [may allow 103
120120 for] shall be exempt from the geographic proximity [to be 104
121121 waived] requirement when the written collaborative practice 105
122122 arrangement outlines the use of telehealth, as defined in 106
123123 section 191.1145; 107
124124 d. In addition to the waivers and exemptions provided 108
125125 in this subsection, an application for a waiver for any 109
126126 other reason of any applicable geographic proximity shall be 110
127127 available if a physician is collaborating with an advanced 111
128128 practice registered nurse in excess of any geographic 112
129129 proximity limit. The board of nursing and the state board 113 SB 1279 5
130130 of registration for the healing arts shall review each 114
131131 application for a waiver of geographic proximity and approve 115
132132 the application if the boards determine that adequate 116
133133 supervision exists between the collaborating physician an d 117
134134 the advanced practice registered nurse. The boards shall 118
135135 have forty-five calendar days to review the completed 119
136136 application for the waiver of geographic proximity. If no 120
137137 action is taken by the boards within forty -five days after 121
138138 the submission of the application for a waiver, then the 122
139139 application shall be deemed approved. If the application is 123
140140 denied by the boards, the provisions of section 536.063 for 124
141141 contested cases shall apply and govern proceedings for 125
142142 appellate purposes; and 126
143143 e. The collaborating physician is required to maintain 127
144144 documentation related to this requirement and to present it 128
145145 to the state board of registration for the healing arts when 129
146146 requested; and 130
147147 (c) Provide coverage during absence, incapacity, 131
148148 infirmity, or emergency by the collaborating physician; 132
149149 (6) A description of the advanced practice registered 133
150150 nurse's controlled substance prescriptive authority in 134
151151 collaboration with the physician, including a list of the 135
152152 controlled substances the physician au thorizes the nurse to 136
153153 prescribe and documentation that it is consistent with each 137
154154 professional's education, knowledge, skill, and competence; 138
155155 (7) A list of all other written practice agreements of 139
156156 the collaborating physician and the advanced pract ice 140
157157 registered nurse; 141
158158 (8) The duration of the written practice agreement 142
159159 between the collaborating physician and the advanced 143
160160 practice registered nurse; 144 SB 1279 6
161161 (9) A description of the time and manner of the 145
162162 collaborating physician's review of the advanced practice 146
163163 registered nurse's delivery of health care services. The 147
164164 description shall include provisions that the advanced 148
165165 practice registered nurse shall submit a minimum of ten 149
166166 percent of the charts documenting the advanced practice 150
167167 registered nurse's delivery of health care services to the 151
168168 collaborating physician for review by the collaborating 152
169169 physician, or any other physician designated in the 153
170170 collaborative practice arrangement, every [fourteen] thirty 154
171171 days; 155
172172 (10) The collaborating physician, or any other 156
173173 physician designated in the collaborative practice 157
174174 arrangement, shall review every fourteen days a minimum of 158
175175 twenty percent of the charts in which the advanced practice 159
176176 registered nurse prescribes controlled substances. The 160
177177 charts reviewed under this subdivision may be counted in the 161
178178 number of charts required to be reviewed under subdivision 162
179179 (9) of this subsection; and 163
180180 (11) If a collaborative practice arrangement is used 164
181181 in clinical situations where a collaborating advanced 165
182182 practice registered nurse provides health care services that 166
183183 include the diagnosis and initiation of treatment for 167
184184 acutely or chronically ill or injured persons, then the 168
185185 collaborating physician or any other physician designated in 169
186186 the collaborative practice arrangement shall be present for 170
187187 sufficient periods of time, at least once every two weeks, 171
188188 except in extraordinary circumstances that shall be 172
189189 documented, to participate in a chart review and to provide 173
190190 necessary medical direction, m edical services, 174
191191 consultations, and supervision of the health care staff. 175 SB 1279 7
192192 4. The state board of registration for the healing 176
193193 arts pursuant to section 334.125 and the board of nursing 177
194194 pursuant to section 335.036 may jointly promulgate rules 178
195195 regulating the use of collaborative practice arrangements. 179
196196 Such rules shall be limited to the methods of treatment that 180
197197 may be covered by collaborative practice arrangements and 181
198198 the requirements for review of services provided pursuant to 182
199199 collaborative practice arrangements including delegating 183
200200 authority to prescribe controlled substances. Any rules 184
201201 relating to geographic proximity shall allow a collaborating 185
202202 physician and a collaborating advanced practice registered 186
203203 nurse to practice within two hundred miles by road of one 187
204204 another until August 28, 2025, if the nurse is providing 188
205205 services in a correctional center, as defined in section 189
206206 217.010, and any such rules shall be consistent with and not 190
207207 more restrictive than the standards set forth in paragr aph 191
208208 (b) of subdivision (5) of subsection 3 of this section . Any 192
209209 rules relating to dispensing or distribution of medications 193
210210 or devices by prescription or prescription drug orders under 194
211211 this section shall be subject to the approval of the state 195
212212 board of pharmacy. Any rules relating to dispensing or 196
213213 distribution of controlled substances by prescription or 197
214214 prescription drug orders under this section shall be subject 198
215215 to the approval of the department of health and senior 199
216216 services and the state board of pharmacy. In order to take 200
217217 effect, such rules shall be approved by a majority vote of a 201
218218 quorum of each board. Neither the state board of 202
219219 registration for the healing arts nor the board of nursing 203
220220 may separately promulgate rules relating to collabo rative 204
221221 practice arrangements. Such jointly promulgated rules shall 205
222222 be consistent with guidelines for federally funded clinics. 206
223223 The rulemaking authority granted in this subsection shall 207 SB 1279 8
224224 not extend to collaborative practice arrangements of 208
225225 hospital employees providing inpatient care within hospitals 209
226226 as defined pursuant to chapter 197 or population -based 210
227227 public health services as defined by 20 CSR 2150 -5.100 as of 211
228228 April 30, 2008. 212
229229 5. The state board of registration for the healing 213
230230 arts shall not deny, revoke, suspend or otherwise take 214
231231 disciplinary action against a physician for health care 215
232232 services delegated to a registered professional nurse 216
233233 provided the provisions of this section and the rules 217
234234 promulgated thereunder are satisfied. Upon the written 218
235235 request of a physician subject to a disciplinary action 219
236236 imposed as a result of an agreement between a physician and 220
237237 a registered professional nurse or registered physician 221
238238 assistant, whether written or not, prior to August 28, 1993, 222
239239 all records of such disciplinary licensure action and all 223
240240 records pertaining to the filing, investigation or review of 224
241241 an alleged violation of this chapter incurred as a result of 225
242242 such an agreement shall be removed from the records of the 226
243243 state board of regist ration for the healing arts and the 227
244244 division of professional registration and shall not be 228
245245 disclosed to any public or private entity seeking such 229
246246 information from the board or the division. The state board 230
247247 of registration for the healing arts shall ta ke action to 231
248248 correct reports of alleged violations and disciplinary 232
249249 actions as described in this section which have been 233
250250 submitted to the National Practitioner Data Bank. In 234
251251 subsequent applications or representations relating to his 235
252252 or her medical practice, a physician completing forms or 236
253253 documents shall not be required to report any actions of the 237
254254 state board of registration for the healing arts for which 238
255255 the records are subject to removal under this section. 239 SB 1279 9
256256 6. Within thirty days of any cha nge and on each 240
257257 renewal, the state board of registration for the healing 241
258258 arts shall require every physician to identify whether the 242
259259 physician is engaged in any collaborative practice 243
260260 arrangement, including collaborative practice arrangements 244
261261 delegating the authority to prescribe controlled substances, 245
262262 or physician assistant collaborative practice arrangement 246
263263 and also report to the board the name of each licensed 247
264264 professional with whom the physician has entered into such 248
265265 arrangement. The board shall make this information 249
266266 available to the public. The board shall track the reported 250
267267 information and may routinely conduct random reviews of such 251
268268 arrangements to ensure that arrangements are carried out for 252
269269 compliance under this chapter. 253
270270 7. Notwithstanding any law to the contrary, a 254
271271 certified registered nurse anesthetist as defined in 255
272272 subdivision (8) of section 335.016 shall be permitted to 256
273273 provide anesthesia services without a collaborative practice 257
274274 arrangement provided that he or she is unde r the supervision 258
275275 of an anesthesiologist or other physician, dentist, or 259
276276 podiatrist who is immediately available if needed. Nothing 260
277277 in this subsection shall be construed to prohibit or prevent 261
278278 a certified registered nurse anesthetist as defined in 262
279279 subdivision (8) of section 335.016 from entering into a 263
280280 collaborative practice arrangement under this section, 264
281281 except that the collaborative practice arrangement may not 265
282282 delegate the authority to prescribe any controlled 266
283283 substances listed in Schedules II I, IV, and V of section 267
284284 195.017, or Schedule II - hydrocodone. 268
285285 8. A collaborating physician shall not enter into a 269
286286 collaborative practice arrangement with more than six full - 270
287287 time equivalent advanced practice registered nurses, full - 271 SB 1279 10
288288 time equivalent licensed physician assistants, or full -time 272
289289 equivalent assistant physicians, or any combination 273
290290 thereof. This limitation shall not apply to collaborative 274
291291 arrangements of hospital employees providing inpatient care 275
292292 service in hospitals as defined in chapter 197 or population - 276
293293 based public health services as defined by 20 CSR 2150 -5.100 277
294294 as of April 30, 2008, or to a certified registered nurse 278
295295 anesthetist providing anesthesia services under the 279
296296 supervision of an anesthesiologist or other physician, 280
297297 dentist, or podiatrist who is immediately available if 281
298298 needed as set out in subsection 7 of this section. 282
299299 9. It is the responsibility of the collaborating 283
300300 physician to determine and document the completion of at 284
301301 least a one-month period of time du ring which the [advanced 285
302302 practice registered nurse shall practice with the ] 286
303303 collaborating physician [continuously present before 287
304304 practicing in a setting where ] shall review thirty percent 288
305305 of the charts documenting the advanced practice registered 289
306306 nurse's delivery of health care services to the 290
307307 collaborating physician [is not continuously present ] for 291
308308 review by the collaborating physician, or any other 292
309309 physician designated in the collaborative practice 293
310310 arrangement. This limitation shall not apply t o 294
311311 collaborative arrangements of providers of population -based 295
312312 public health services, as defined by 20 CSR 2150 -5.100 as 296
313313 of April 30, 2008, or to collaborative practice arrangements 297
314314 between a primary care physician and a primary care advanced 298
315315 practice registered nurse or a behavioral health physician 299
316316 and a behavioral health advanced practice registered nurse, 300
317317 where the collaborating physician is new to a patient 301
318318 population to which the advanced practice registered nurse 302
319319 is familiar. 303 SB 1279 11
320320 10. No agreement made under this section shall 304
321321 supersede current hospital licensing regulations governing 305
322322 hospital medication orders under protocols or standing 306
323323 orders for the purpose of delivering inpatient or emergency 307
324324 care within a hospital as defined in sec tion 197.020 if such 308
325325 protocols or standing orders have been approved by the 309
326326 hospital's medical staff and pharmaceutical therapeutics 310
327327 committee. 311
328328 11. No contract or other term of employment shall 312
329329 require a physician to act as a collaborating physic ian for 313
330330 an advanced practice registered nurse against the 314
331331 physician's will. A physician shall have the right to 315
332332 refuse to act as a collaborating physician, without penalty, 316
333333 for a particular advanced practice registered nurse. No 317
334334 contract or other ag reement shall limit the collaborating 318
335335 physician's ultimate authority over any protocols or 319
336336 standing orders or in the delegation of the physician's 320
337337 authority to any advanced practice registered nurse, but 321
338338 this requirement shall not authorize a physician in 322
339339 implementing such protocols, standing orders, or delegation 323
340340 to violate applicable standards for safe medical practice 324
341341 established by hospital's medical staff. 325
342342 12. No contract or other term of employment shall 326
343343 require any advanced practice reg istered nurse to serve as a 327
344344 collaborating advanced practice registered nurse for any 328
345345 collaborating physician against the advanced practice 329
346346 registered nurse's will. An advanced practice registered 330
347347 nurse shall have the right to refuse to collaborate, wi thout 331
348348 penalty, with a particular physician. 332
349349