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Missouri Senate Bill SB807

Missouri 2024 Regular Session

Missouri Senate Bill SB807 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. 807
66 102ND GENERAL ASSEMBLY
77 INTRODUCED BY SENATOR BLACK.
88 3665S.02I 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1414 Section A. Section 334.104, RSMo, is repealed and one new 1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 hea lth 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 807 2
3535 Collaborative practice arrangem ents 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 807 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 advan ced 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 disclosur e 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 certifications o f 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 79
9696 specified in this paragraph. The following provisions shall 80
9797 apply with respect to this requirement: 81 SB 807 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 m ay 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. 95 -210 (42 U.S.C. Section 1395x, as 93
110110 amended), as long as the collaborative practice arrangement 94
111111 includes alternative plans as required in paragraph (c) of 95
112112 this subdivision. This exception to geographic proximity 96
113113 shall apply only to independent rural health clinics, 97
114114 provider-based rural health clinics where the provider is a 98
115115 critical access hospital as pr ovided in 42 U.S.C. Section 99
116116 1395i-4, and provider-based rural health clinics where the 100
117117 main location of the hospital sponsor is greater than fifty 101
118118 miles from the clinic; 102
119119 c. The collaborative practice arrangement may allow 103
120120 for geographic proximity to be waived when the arrangement 104
121121 outlines the use of telehealth, as defined in section 105
122122 191.1145; 106
123123 d. In addition to the waivers and exemptions provided 107
124124 in this subsection, an application for a waiver for any 108
125125 other reason of any applicable geogra phic proximity shall be 109
126126 available if a physician is collaborating with an advanced 110
127127 practice registered nurse in excess of any geographic 111
128128 proximity limit. The board of nursing and the state board 112
129129 of registration for the healing arts shall review each 113 SB 807 5
130130 application for a waiver of geographic proximity and approve 114
131131 the application if the boards determine that adequate 115
132132 supervision exists between the collaborating physician and 116
133133 the advanced practice registered nurse. The boards shall 117
134134 have forty-five calendar days to review the completed 118
135135 application for the waiver of geographic proximity. If no 119
136136 action is taken by the boards within forty -five days after 120
137137 the submission of the application for a waiver, then the 121
138138 application shall be deemed approved. If the application is 122
139139 denied by the boards, the provisions of section 536.063 for 123
140140 contested cases shall apply and govern proceedings for 124
141141 appellate purposes; and 125
142142 e. The collaborating physician is required to maintain 126
143143 documentation related to this requ irement and to present it 127
144144 to the state board of registration for the healing arts when 128
145145 requested;] and 129
146146 [(c)] (b) Provide coverage during absence, incapacity, 130
147147 infirmity, or emergency by the collaborating physician; 131
148148 (6) A description of the ad vanced practice registered 132
149149 nurse's controlled substance prescriptive authority in 133
150150 collaboration with the physician, including a list of the 134
151151 controlled substances the physician authorizes the nurse to 135
152152 prescribe and documentation that it is consistent wi th each 136
153153 professional's education, knowledge, skill, and competence; 137
154154 (7) A list of all other written practice agreements of 138
155155 the collaborating physician and the advanced practice 139
156156 registered nurse; 140
157157 (8) The duration of the written practice agree ment 141
158158 between the collaborating physician and the advanced 142
159159 practice registered nurse; 143
160160 (9) A description of the time and manner of the 144
161161 collaborating physician's review of the advanced practice 145 SB 807 6
162162 registered nurse's delivery of health care services. The 146
163163 description shall include provisions that the advanced 147
164164 practice registered nurse shall submit a minimum of ten 148
165165 percent of the charts documenting the advanced practice 149
166166 registered nurse's delivery of health care services to the 150
167167 collaborating physicia n for review by the collaborating 151
168168 physician, or any other physician designated in the 152
169169 collaborative practice arrangement, every fourteen days; 153
170170 (10) The collaborating physician, or any other 154
171171 physician designated in the collaborative practice 155
172172 arrangement, shall review every fourteen days a minimum of 156
173173 twenty percent of the charts in which the advanced practice 157
174174 registered nurse prescribes controlled substances. The 158
175175 charts reviewed under this subdivision may be counted in the 159
176176 number of charts requ ired to be reviewed under subdivision 160
177177 (9) of this subsection; and 161
178178 (11) If a collaborative practice arrangement is used 162
179179 in clinical situations where a collaborating advanced 163
180180 practice registered nurse provides health care services that 164
181181 include the diagnosis and initiation of treatment for 165
182182 acutely or chronically ill or injured persons, then the 166
183183 collaborating physician or any other physician designated in 167
184184 the collaborative practice arrangement shall be present for 168
185185 sufficient periods of time, at le ast once every two weeks, 169
186186 except in extraordinary circumstances that shall be 170
187187 documented, to participate in a chart review and to provide 171
188188 necessary medical direction, medical services, 172
189189 consultations, and supervision of the health care staff. 173
190190 4. The state board of registration for the healing 174
191191 arts pursuant to section 334.125 and the board of nursing 175
192192 pursuant to section 335.036 may jointly promulgate rules 176
193193 regulating the use of collaborative practice arrangements. 177 SB 807 7
194194 Such rules shall be limited to the methods of treatment that 178
195195 may be covered by collaborative practice arrangements and 179
196196 the requirements for review of services provided pursuant to 180
197197 collaborative practice arrangements including delegating 181
198198 authority to prescribe controlled substances. [Any rules 182
199199 relating to geographic proximity shall allow a collaborating 183
200200 physician and a collaborating advanced practice registered 184
201201 nurse to practice within two hundred miles by road of one 185
202202 another until August 28, 2025, if the nurse is providing 186
203203 services in a correctional center, as defined in section 187
204204 217.010.] The state board of registration for the healing 188
205205 arts and the board of nursing shall not promulgate rules to 189
206206 enforce any geographic proximity requirements, including any 190
207207 mileage or distance restrictions for a physician or advanced 191
208208 practice registered nurse, on collaborative practice 192
209209 arrangements between physicians and registered professional 193
210210 nurses located in this state. Any regulations governing 194
211211 proximity that are in effect on August 2 8, 2024, shall no 195
212212 longer be effective. Any provision of a collaborative 196
213213 practice arrangement that requires geographic proximity 197
214214 between a physician and a registered professional nurse 198
215215 shall be unenforceable. Any rules relating to dispensing or 199
216216 distribution of medications or devices by prescription or 200
217217 prescription drug orders under this section shall be subject 201
218218 to the approval of the state board of pharmacy. Any rules 202
219219 relating to dispensing or distribution of controlled 203
220220 substances by prescription or prescription drug orders under 204
221221 this section shall be subject to the approval of the 205
222222 department of health and senior services and the state board 206
223223 of pharmacy. In order to take effect, such rules shall be 207
224224 approved by a majority vote of a quorum of e ach board. 208
225225 Neither the state board of registration for the healing arts 209 SB 807 8
226226 nor the board of nursing may separately promulgate rules 210
227227 relating to collaborative practice arrangements. Such 211
228228 jointly promulgated rules shall be consistent with 212
229229 guidelines for federally funded clinics. The rulemaking 213
230230 authority granted in this subsection shall not extend to 214
231231 collaborative practice arrangements of hospital employees 215
232232 providing inpatient care within hospitals as defined 216
233233 pursuant to chapter 197 or population -based public health 217
234234 services as defined by 20 CSR 2150 -5.100 as of April 30, 218
235235 2008. 219
236236 5. The state board of registration for the healing 220
237237 arts shall not deny, revoke, suspend or otherwise take 221
238238 disciplinary action against a physician for health care 222
239239 services delegated to a registered professional nurse 223
240240 provided the provisions of this section and the rules 224
241241 promulgated thereunder are satisfied. Upon the written 225
242242 request of a physician subject to a disciplinary action 226
243243 imposed as a result of an agreement between a physician and 227
244244 a registered professional nurse or registered physician 228
245245 assistant, whether written or not, prior to August 28, 1993, 229
246246 all records of such disciplinary licensure action and all 230
247247 records pertaining to the filing, investigation or re view of 231
248248 an alleged violation of this chapter incurred as a result of 232
249249 such an agreement shall be removed from the records of the 233
250250 state board of registration for the healing arts and the 234
251251 division of professional registration and shall not be 235
252252 disclosed to any public or private entity seeking such 236
253253 information from the board or the division. The state board 237
254254 of registration for the healing arts shall take action to 238
255255 correct reports of alleged violations and disciplinary 239
256256 actions as described in this secti on which have been 240
257257 submitted to the National Practitioner Data Bank. In 241 SB 807 9
258258 subsequent applications or representations relating to his 242
259259 or her medical practice, a physician completing forms or 243
260260 documents shall not be required to report any actions of the 244
261261 state board of registration for the healing arts for which 245
262262 the records are subject to removal under this section. 246
263263 6. Within thirty days of any change and on each 247
264264 renewal, the state board of registration for the healing 248
265265 arts shall require every phys ician to identify whether the 249
266266 physician is engaged in any collaborative practice 250
267267 arrangement, including collaborative practice arrangements 251
268268 delegating the authority to prescribe controlled substances, 252
269269 or physician assistant collaborative practice arran gement 253
270270 and also report to the board the name of each licensed 254
271271 professional with whom the physician has entered into such 255
272272 arrangement. The board shall make this information 256
273273 available to the public. The board shall track the reported 257
274274 information and may routinely conduct random reviews of such 258
275275 arrangements to ensure that arrangements are carried out for 259
276276 compliance under this chapter. 260
277277 7. Notwithstanding any law to the contrary, a 261
278278 certified registered nurse anesthetist as defined in 262
279279 subdivision (8) of section 335.016 shall be permitted to 263
280280 provide anesthesia services without a collaborative practice 264
281281 arrangement provided that he or she is under the supervision 265
282282 of an anesthesiologist or other physician, dentist, or 266
283283 podiatrist who is immediately available if needed. Nothing 267
284284 in this subsection shall be construed to prohibit or prevent 268
285285 a certified registered nurse anesthetist as defined in 269
286286 subdivision (8) of section 335.016 from entering into a 270
287287 collaborative practice arrangement under this sec tion, 271
288288 except that the collaborative practice arrangement may not 272
289289 delegate the authority to prescribe any controlled 273 SB 807 10
290290 substances listed in Schedules III, IV, and V of section 274
291291 195.017, or Schedule II - hydrocodone. 275
292292 8. A collaborating physician shall not enter into a 276
293293 collaborative practice arrangement with more than six full - 277
294294 time equivalent advanced practice registered nurses, full - 278
295295 time equivalent licensed physician assistants, or full -time 279
296296 equivalent assistant physicians, or any combination 280
297297 thereof. This limitation shall not apply to collaborative 281
298298 arrangements of hospital employees providing inpatient care 282
299299 service in hospitals as defined in chapter 197 or population - 283
300300 based public health services as defined by 20 CSR 2150 -5.100 284
301301 as of April 30, 2008, or to a certified registered nurse 285
302302 anesthetist providing anesthesia services under the 286
303303 supervision of an anesthesiologist or other physician, 287
304304 dentist, or podiatrist who is immediately available if 288
305305 needed as set out in subsection 7 of this sectio n. 289
306306 9. It is the responsibility of the collaborating 290
307307 physician to determine and document the completion of at 291
308308 least a one-month period of time during which the advanced 292
309309 practice registered nurse shall practice with the 293
310310 collaborating physician cont inuously present before 294
311311 practicing in a setting where the collaborating physician is 295
312312 not continuously present. This limitation shall not apply 296
313313 to collaborative arrangements of providers of population - 297
314314 based public health services, as defined by 20 CSR 2150- 298
315315 5.100 as of April 30, 2008, or to collaborative practice 299
316316 arrangements between a primary care physician and a primary 300
317317 care advanced practice registered nurse or a behavioral 301
318318 health physician and a behavioral health advanced practice 302
319319 registered nurse, where the collaborating physician is new 303
320320 to a patient population to which the advanced practice 304
321321 registered nurse is familiar. 305 SB 807 11
322322 10. No agreement made under this section shall 306
323323 supersede current hospital licensing regulations governing 307
324324 hospital medication orders under protocols or standing 308
325325 orders for the purpose of delivering inpatient or emergency 309
326326 care within a hospital as defined in section 197.020 if such 310
327327 protocols or standing orders have been approved by the 311
328328 hospital's medical staff and ph armaceutical therapeutics 312
329329 committee. 313
330330 11. No contract or other term of employment shall 314
331331 require a physician to act as a collaborating physician for 315
332332 an advanced practice registered nurse against the 316
333333 physician's will. A physician shall have the rig ht to 317
334334 refuse to act as a collaborating physician, without penalty, 318
335335 for a particular advanced practice registered nurse. No 319
336336 contract or other agreement shall limit the collaborating 320
337337 physician's ultimate authority over any protocols or 321
338338 standing orders or in the delegation of the physician's 322
339339 authority to any advanced practice registered nurse, but 323
340340 this requirement shall not authorize a physician in 324
341341 implementing such protocols, standing orders, or delegation 325
342342 to violate applicable standards for safe me dical practice 326
343343 established by hospital's medical staff. 327
344344 12. No contract or other term of employment shall 328
345345 require any advanced practice registered nurse to serve as a 329
346346 collaborating advanced practice registered nurse for any 330
347347 collaborating physicia n against the advanced practice 331
348348 registered nurse's will. An advanced practice registered 332
349349 nurse shall have the right to refuse to collaborate, without 333
350350 penalty, with a particular physician. 334
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