EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 910
102ND GENERAL ASSEMBLY
INTRODUCED BY SENATOR BROWN (26).
3540S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 195.070, 334.104, and 335.019, RSMo, and to enact in lieu thereof five new
sections relating to certified registered nurse anesthetists.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 195.070, 334.104, and 335.019, RSMo, 1
are repealed and five new sections enacted in lieu thereof, to 2
be known as sections 195.070, 334.104, 335.019, 335.038, and 3
335.039, to read as follows:4
195.070. 1. A physician, podiatrist, dentist, a 1
registered optometrist certified to administer 2
pharmaceutical agents as provided in section 336.220, or an 3
assistant physician in accordance with section 334.037 or a 4
physician assistant in accordance with section 334.747 in 5
good faith and in the course of his or her professional 6
practice only, may prescribe, administer, and dispense 7
controlled substances or he or she may cause the same to be 8
administered or dispensed by an individual as authorized by 9
statute. 10
2. An advanced practice registered nurse, as defined 11
in section 335.016, but not a certified registered nurse 12
anesthetist as defined in subdivision (8) of section 13
335.016, who holds a certificate of controlled substance 14
prescriptive authority from the board of nursing under 15
section 335.019 and who is delegated the authority to 16
prescribe controlled substances under a collaborative 17 SB 910 2
practice arrangement under section 334.104 may prescribe any 18
controlled substances listed in Schedules III, IV, and V of 19
section 195.017, and may have restricted authority in 20
Schedule II. Prescriptions for Schedule II medications 21
prescribed by an advanced practice r egistered nurse who has 22
a certificate of controlled substance prescriptive authority 23
are restricted to only those medications containing 24
hydrocodone and Schedule II controlled substances for 25
hospice patients pursuant to the provisions of section 26
334.104. However, no such certified advanced practice 27
registered nurse shall prescribe controlled substance for 28
his or her own self or family. Schedule III narcotic 29
controlled substance and Schedule II - hydrocodone 30
prescriptions shall be limited to a one hundred twenty-hour 31
supply without refill. 32
3. A certified registered nurse anesthetist, as 33
defined in section 335.016, may select, issue orders for, 34
and administer controlled substances listed in Schedules II, 35
III, IV, and V of section 195.017 f or and during the course 36
of providing anesthesia care to a patient for a surgical, 37
obstetrical, therapeutic, or diagnostic procedure or 38
treatment in accordance with subsection 3 of section 335.019 39
and section 335.038; provided that the provisions of th is 40
subsection shall not be construed as authorizing a certified 41
registered nurse anesthetist to prescribe such controlled 42
substances. Notwithstanding any other provision of law to 43
the contrary, a certified registered nurse anesthetist shall 44
not be required to: 45
(1) Enter into a collaborative practice arrangement 46
pursuant to section 334.104; 47
(2) Provide anesthesia services under the supervision 48
of a physician, dentist, or podiatrist; or 49 SB 910 3
(3) Obtain a certificate of controlled substanc e 50
prescriptive authority from the board of nursing as provided 51
in section 335.019 52
in order to exercise the authority provided in this 53
subsection. 54
4. A veterinarian, in good faith and in the course of 55
the veterinarian's professional practice only, and not for 56
use by a human being, may prescribe, administer, and 57
dispense controlled substances and the veterinarian may 58
cause them to be administered by an assistant or orderly 59
under his or her direction and supervision. 60
[4.] 5. A practitioner shall not accept any portion of 61
a controlled substance unused by a patient, for any reason, 62
if such practitioner did not originally dispense the drug, 63
except: 64
(1) When the controlled substance is delivered to the 65
practitioner to administer to the patient for whom the 66
medication is prescribed as authorized by federal law. 67
Practitioners shall maintain records and secure the 68
medication as required by this chapter and regulations 69
promulgated pursuant to this chapter; or 70
(2) As provided in section 195.265. 71
[5.] 6. An individual practitioner shall not prescribe 72
or dispense a controlled substance for such practitioner's 73
personal use except in a medical emergency. 74
334.104. 1. A physician may enter into collaborative 1
practice arrangements with registered professional nurses. 2
Collaborative practice arrangements shall be in the form of 3
written agreements, jointly agreed -upon protocols, or 4
standing orders for the delivery of health care services. 5
Collaborative practice arrangements, which shall be in 6 SB 910 4
writing, may delegate to a registered professional nurse the 7
authority to administer or dispense drugs and provide 8
treatment as long as the delivery of such health care 9
services is within the scope of practice of th e registered 10
professional nurse and is consistent with that nurse's 11
skill, training and competence. 12
2. (1) Collaborative practice arrangements, which 13
shall be in writing, may delegate to a registered 14
professional nurse the authority to administe r, dispense or 15
prescribe drugs and provide treatment if the registered 16
professional nurse is an advanced practice registered nurse 17
as defined in subdivision (2) of section 335.016. 18
Collaborative practice arrangements may delegate to an 19
advanced practice registered nurse, as defined in section 20
335.016, the authority to administer, dispense, or prescribe 21
controlled substances listed in Schedules III, IV, and V of 22
section 195.017, and Schedule II - hydrocodone; except that, 23
the collaborative practice arrangement shall not delegate 24
the authority to [administer] prescribe any controlled 25
substances listed in Schedules III, IV, and V of section 26
195.017, or Schedule II - hydrocodone for the purpose of 27
inducing sedation or general anesthesia for therape utic, 28
diagnostic, or surgical procedures. Schedule III narcotic 29
controlled substance and Schedule II - hydrocodone 30
prescriptions shall be limited to a one hundred twenty -hour 31
supply without refill. 32
(2) Notwithstanding any other provision of this 33
section to the contrary, a collaborative practice 34
arrangement may delegate to an advanced practice registered 35
nurse the authority to administer, dispense, or prescribe 36
Schedule II controlled substances for hospice patients; 37
provided, that the advance d practice registered nurse is 38 SB 910 5
employed by a hospice provider certified pursuant to chapter 39
197 and the advanced practice registered nurse is providing 40
care to hospice patients pursuant to a collaborative 41
practice arrangement that designates the certif ied hospice 42
as a location where the advanced practice registered nurse 43
is authorized to practice and prescribe. 44
(3) Such collaborative practice arrangements shall be 45
in the form of written agreements, jointly agreed -upon 46
protocols or standing ord ers for the delivery of health care 47
services. 48
(4) An advanced practice registered nurse may 49
prescribe buprenorphine for up to a thirty -day supply 50
without refill for patients receiving medication -assisted 51
treatment for substance use disorders unde r the direction of 52
the collaborating physician. 53
3. The written collaborative practice arrangement 54
shall contain at least the following provisions: 55
(1) Complete names, home and business addresses, zip 56
codes, and telephone numbers of the colla borating physician 57
and the advanced practice registered nurse; 58
(2) A list of all other offices or locations besides 59
those listed in subdivision (1) of this subsection where the 60
collaborating physician authorized the advanced practice 61
registered nurse to prescribe; 62
(3) A requirement that there shall be posted at every 63
office where the advanced practice registered nurse is 64
authorized to prescribe, in collaboration with a physician, 65
a prominently displayed disclosure statement informing 66
patients that they may be seen by an advanced practice 67
registered nurse and have the right to see the collaborating 68
physician; 69 SB 910 6
(4) All specialty or board certifications of the 70
collaborating physician and all certifications of the 71
advanced practice registered nurse; 72
(5) The manner of collaboration between the 73
collaborating physician and the advanced practice registered 74
nurse, including how the collaborating physician and the 75
advanced practice registered nurse will: 76
(a) Engage in collaborative practice consistent with 77
each professional's skill, training, education, and 78
competence; 79
(b) Maintain geographic proximity, except as specified 80
in this paragraph. The following provisions shall apply 81
with respect to this requirement: 82
a. Until August 28, 2025, an advanced practice 83
registered nurse providing services in a correctional 84
center, as defined in section 217.010, and his or her 85
collaborating physician shall satisfy the geographic 86
proximity requirement if they practice wit hin two hundred 87
miles by road of one another. An incarcerated patient who 88
requests or requires a physician consultation shall be 89
treated by a physician as soon as appropriate; 90
b. The collaborative practice arrangement may allow 91
for geographic proximity to be waived for a maximum of 92
twenty-eight days per calendar year for rural health clinics 93
as defined by Pub.L. 95 -210 (42 U.S.C. Section 1395x, as 94
amended), as long as the collaborative practice arrangement 95
includes alternative plans as requir ed in paragraph (c) of 96
this subdivision. This exception to geographic proximity 97
shall apply only to independent rural health clinics, 98
provider-based rural health clinics where the provider is a 99
critical access hospital as provided in 42 U.S.C. Section 100
1395i-4, and provider-based rural health clinics where the 101 SB 910 7
main location of the hospital sponsor is greater than fifty 102
miles from the clinic; 103
c. The collaborative practice arrangement may allow 104
for geographic proximity to be waived when the arra ngement 105
outlines the use of telehealth, as defined in section 106
191.1145; 107
d. In addition to the waivers and exemptions provided 108
in this subsection, an application for a waiver for any 109
other reason of any applicable geographic proximity shall be 110
available if a physician is collaborating with an advanced 111
practice registered nurse in excess of any geographic 112
proximity limit. The board of nursing and the state board 113
of registration for the healing arts shall review each 114
application for a waiver of geographic proximity and approve 115
the application if the boards determine that adequate 116
supervision exists between the collaborating physician and 117
the advanced practice registered nurse. The boards shall 118
have forty-five calendar days to review the com pleted 119
application for the waiver of geographic proximity. If no 120
action is taken by the boards within forty -five days after 121
the submission of the application for a waiver, then the 122
application shall be deemed approved. If the application is 123
denied by the boards, the provisions of section 536.063 for 124
contested cases shall apply and govern proceedings for 125
appellate purposes; and 126
e. The collaborating physician is required to maintain 127
documentation related to this requirement and to present it 128
to the state board of registration for the healing arts when 129
requested; and 130
(c) Provide coverage during absence, incapacity, 131
infirmity, or emergency by the collaborating physician; 132 SB 910 8
(6) A description of the advanced practice registered 133
nurse's controlled substance prescriptive authority in 134
collaboration with the physician, including a list of the 135
controlled substances the physician authorizes the nurse to 136
prescribe and documentation that it is consistent with each 137
professional's education, knowledge, skill, and competence; 138
(7) A list of all other written practice agreements of 139
the collaborating physician and the advanced practice 140
registered nurse; 141
(8) The duration of the written practice agreement 142
between the collaborating ph ysician and the advanced 143
practice registered nurse; 144
(9) A description of the time and manner of the 145
collaborating physician's review of the advanced practice 146
registered nurse's delivery of health care services. The 147
description shall include prov isions that the advanced 148
practice registered nurse shall submit a minimum of ten 149
percent of the charts documenting the advanced practice 150
registered nurse's delivery of health care services to the 151
collaborating physician for review by the collaborating 152
physician, or any other physician designated in the 153
collaborative practice arrangement, every fourteen days; 154
(10) The collaborating physician, or any other 155
physician designated in the collaborative practice 156
arrangement, shall review every fourtee n days a minimum of 157
twenty percent of the charts in which the advanced practice 158
registered nurse prescribes controlled substances. The 159
charts reviewed under this subdivision may be counted in the 160
number of charts required to be reviewed under subdivis ion 161
(9) of this subsection; and 162
(11) If a collaborative practice arrangement is used 163
in clinical situations where a collaborating advanced 164 SB 910 9
practice registered nurse provides health care services that 165
include the diagnosis and initiation of treatm ent for 166
acutely or chronically ill or injured persons, then the 167
collaborating physician or any other physician designated in 168
the collaborative practice arrangement shall be present for 169
sufficient periods of time, at least once every two weeks, 170
except in extraordinary circumstances that shall be 171
documented, to participate in a chart review and to provide 172
necessary medical direction, medical services, 173
consultations, and supervision of the health care staff. 174
4. The state board of registration for the healing 175
arts pursuant to section 334.125 and the board of nursing 176
pursuant to section 335.036 may jointly promulgate rules 177
regulating the use of collaborative practice arrangements. 178
Such rules shall be limited to the methods of treatment that 179
may be covered by collaborative practice arrangements and 180
the requirements for review of services provided pursuant to 181
collaborative practice arrangements including delegating 182
authority to prescribe controlled substances. Any rules 183
relating to geographi c proximity shall allow a collaborating 184
physician and a collaborating advanced practice registered 185
nurse to practice within two hundred miles by road of one 186
another until August 28, 2025, if the nurse is providing 187
services in a correctional center, as defined in section 188
217.010. Any rules relating to dispensing or distribution 189
of medications or devices by prescription or prescription 190
drug orders under this section shall be subject to the 191
approval of the state board of pharmacy. Any rules relating 192
to dispensing or distribution of controlled substances by 193
prescription or prescription drug orders under this section 194
shall be subject to the approval of the department of health 195
and senior services and the state board of pharmacy. In 196 SB 910 10
order to take effect, such rules shall be approved by a 197
majority vote of a quorum of each board. Neither the state 198
board of registration for the healing arts nor the board of 199
nursing may separately promulgate rules relating to 200
collaborative practice arrangements. Such jointly 201
promulgated rules shall be consistent with guidelines for 202
federally funded clinics. The rulemaking authority granted 203
in this subsection shall not extend to collaborative 204
practice arrangements of hospital employees providing 205
inpatient care within hospitals as defined pursuant to 206
chapter 197 or population -based public health services as 207
defined by 20 CSR 2150 -5.100 as of April 30, 2008. 208
5. The state board of registration for the healing 209
arts shall not deny, revoke, suspend or otherw ise take 210
disciplinary action against a physician for health care 211
services delegated to a registered professional nurse 212
provided the provisions of this section and the rules 213
promulgated thereunder are satisfied. Upon the written 214
request of a physician subject to a disciplinary action 215
imposed as a result of an agreement between a physician and 216
a registered professional nurse or registered physician 217
assistant, whether written or not, prior to August 28, 1993, 218
all records of such disciplinary licensur e action and all 219
records pertaining to the filing, investigation or review of 220
an alleged violation of this chapter incurred as a result of 221
such an agreement shall be removed from the records of the 222
state board of registration for the healing arts and t he 223
division of professional registration and shall not be 224
disclosed to any public or private entity seeking such 225
information from the board or the division. The state board 226
of registration for the healing arts shall take action to 227
correct reports of alleged violations and disciplinary 228 SB 910 11
actions as described in this section which have been 229
submitted to the National Practitioner Data Bank. In 230
subsequent applications or representations relating to his 231
or her medical practice, a physician completing fo rms or 232
documents shall not be required to report any actions of the 233
state board of registration for the healing arts for which 234
the records are subject to removal under this section. 235
6. Within thirty days of any change and on each 236
renewal, the state board of registration for the healing 237
arts shall require every physician to identify whether the 238
physician is engaged in any collaborative practice 239
arrangement, including collaborative practice arrangements 240
delegating the authority to prescribe cont rolled substances, 241
or physician assistant collaborative practice arrangement 242
and also report to the board the name of each licensed 243
professional with whom the physician has entered into such 244
arrangement. The board shall make this information 245
available to the public. The board shall track the reported 246
information and may routinely conduct random reviews of such 247
arrangements to ensure that arrangements are carried out for 248
compliance under this chapter. 249
7. [Notwithstanding any law to the contra ry,] (1) A 250
certified registered nurse anesthetist , as defined in 251
subdivision (8) of section 335.016 , may, but shall [be 252
permitted to provide anesthesia services without a 253
collaborative practice arrangement provided that he or she 254
is under the supervi sion of an anesthesiologist or other 255
physician, dentist, or podiatrist who is immediately 256
available if needed] not be required to: 257
(a) Enter into a collaborative practice arrangement 258
for the provision of anesthesia care to a patient for a 259
surgical, obstetrical, therapeutic, or diagnostic procedure 260 SB 910 12
or treatment in accordance with subsection 3 of section 261
335.019 and section 335.038; 262
(b) Practice under the supervision of a physician, 263
dentist, or podiatrist for the provision of anesthesia car e 264
to a patient for a surgical, obstetrical, therapeutic, or 265
diagnostic procedure or treatment in accordance with 266
subsection 3 of section 335.019 and section 335.038; or 267
(c) Obtain a certificate of controlled substance 268
prescriptive authority from the board of nursing pursuant to 269
section 335.019 for selecting, ordering, and administering 270
the appropriate controlled substances, drugs, or anesthetic 271
agents for providing anesthesia care . 272
(2) Nothing in this subsection shall be construed to 273
prohibit or prevent a certified registered nurse anesthetist 274
as defined in subdivision (8) of section 335.016 from 275
entering into a collaborative practice arrangement under 276
this section, except that the collaborative practice 277
arrangement may not delegate t he authority to prescribe any 278
controlled substances listed in Schedules III, IV, and V of 279
section 195.017, or Schedule II - hydrocodone. 280
8. A collaborating physician shall not enter into a 281
collaborative practice arrangement with more than six full - 282
time equivalent advanced practice registered nurses, full - 283
time equivalent licensed physician assistants, or full -time 284
equivalent assistant physicians, or any combination 285
thereof. This limitation shall not apply to collaborative 286
arrangements of hospi tal employees providing inpatient care 287
service in hospitals as defined in chapter 197 or population - 288
based public health services as defined by 20 CSR 2150 -5.100 289
as of April 30, 2008, or to a certified registered nurse 290
anesthetist providing anesthesia s ervices under the 291
supervision of an anesthesiologist or other physician, 292 SB 910 13
dentist, or podiatrist who is immediately available if 293
needed as set out in subsection 7 of this section. 294
9. It is the responsibility of the collaborating 295
physician to determine and document the completion of at 296
least a one-month period of time during which the advanced 297
practice registered nurse shall practice with the 298
collaborating physician continuously present before 299
practicing in a setting where the collaborating phys ician is 300
not continuously present. This limitation shall not apply 301
to collaborative arrangements of providers of population - 302
based public health services, as defined by 20 CSR 2150 - 303
5.100 as of April 30, 2008, or to collaborative practice 304
arrangements between a primary care physician and a primary 305
care advanced practice registered nurse or a behavioral 306
health physician and a behavioral health advanced practice 307
registered nurse, where the collaborating physician is new 308
to a patient population to whic h the advanced practice 309
registered nurse is familiar. 310
10. No agreement made under this section shall 311
supersede current hospital licensing regulations governing 312
hospital medication orders under protocols or standing 313
orders for the purpose of deliv ering inpatient or emergency 314
care within a hospital as defined in section 197.020 if such 315
protocols or standing orders have been approved by the 316
hospital's medical staff and pharmaceutical therapeutics 317
committee. 318
11. No contract or other term of employment shall 319
require a physician to act as a collaborating physician for 320
an advanced practice registered nurse against the 321
physician's will. A physician shall have the right to 322
refuse to act as a collaborating physician, without penalty, 323
for a particular advanced practice registered nurse. No 324 SB 910 14
contract or other agreement shall limit the collaborating 325
physician's ultimate authority over any protocols or 326
standing orders or in the delegation of the physician's 327
authority to any advanced practice r egistered nurse, but 328
this requirement shall not authorize a physician in 329
implementing such protocols, standing orders, or delegation 330
to violate applicable standards for safe medical practice 331
established by hospital's medical staff. 332
12. No contract or other term of employment shall 333
require any advanced practice registered nurse to serve as a 334
collaborating advanced practice registered nurse for any 335
collaborating physician against the advanced practice 336
registered nurse's will. An advanced practice registered 337
nurse shall have the right to refuse to collaborate, without 338
penalty, with a particular physician. 339
335.019. 1. An advanced practice registered nurse's 1
prescriptive authority shall include authority to: 2
(1) Prescribe, dispense, and administer medications 3
and nonscheduled legend drugs, as defined in section 4
338.330, within such APRN's practice and specialty; and 5
(2) Notwithstanding any other provision of this 6
chapter to the contrary, receive, prescribe, adm inister, and 7
provide nonscheduled legend drug samples from pharmaceutical 8
manufacturers to patients at no charge to the patient or any 9
other party. 10
2. The board of nursing may grant a certificate of 11
controlled substance prescriptive authority to an advanced 12
practice registered nurse who: 13
(1) Submits proof of successful completion of an 14
advanced pharmacology course that shall include preceptorial 15
experience in the prescription of drugs, medicines, and 16
therapeutic devices; and 17 SB 910 15
(2) Provides documentation of a minimum of three 18
hundred clock hours preceptorial experience in the 19
prescription of drugs, medicines, and therapeutic devices 20
with a qualified preceptor; and 21
(3) Provides evidence of a minimum of one thousand 22
hours of practice in an advanced practice nursing category 23
prior to application for a certificate of prescriptive 24
authority. The one thousand hours shall not include 25
clinical hours obtained in the advanced practice nursing 26
education program. The one thousand hours of practice in an 27
advanced practice nursing category may include transmitting 28
a prescription order orally or telephonically or to an 29
inpatient medical record from protocols developed in 30
collaboration with and signed by a licensed physician; and 31
(4) Has a controlled substance prescribing authority 32
delegated in the collaborative practice arrangement under 33
section 334.104 with a physician who has an unrestricted 34
federal Drug Enforcement Administration registration number 35
and who is actively e ngaged in a practice comparable in 36
scope, specialty, or expertise to that of the advanced 37
practice registered nurse. 38
3. Notwithstanding any other provision of law to the 39
contrary, a certified registered nurse anesthetist may 40
select, issue orders for, and administer controlled 41
substances listed in Schedules II, III, IV, and V of section 42
195.017 or other drugs or anesthetic agents for and during 43
the course of providing anesthesia care to a patient for a 44
surgical, obstetrical, therapeutic, or dia gnostic procedure 45
or treatment. A certified registered nurse anesthetist 46
shall not be required to obtain a certificate of controlled 47
substance prescriptive authority from the board of nursing 48
for the provision of anesthesia care. 49 SB 910 16
335.038. 1. A certified registered nurse anesthetist 1
shall be authorized to provide anesthesia care for a 2
surgical, obstetrical, therapeutic, or diagnostic procedure 3
or treatment pursuant to this section including, but not 4
limited to, the authority to do the following during the 5
provision of such services: 6
(1) Provide pre-anesthesia and post-anesthesia care 7
assessment; 8
(2) Develop a plan of anesthesia care for the 9
procedure or treatment; 10
(3) Initiate and perform patient -specific anesthesia 11
care in accordance with the plan of anesthesia care for the 12
procedure or treatment; 13
(4) Cooperate with the physician, dentist, or 14
podiatrist for the provisions of patient care; 15
(5) Order necessary tests and interpret diagnostic 16
procedures in the period anesthesia care is provided for the 17
procedure or treatment based on patient assessment and 18
response to interventions; 19
(6) Select, issue orders for, and administer 20
controlled substances listed in Schedules II, III, IV, and V 21
of section 195.017, in accordance with the provisions of 22
subsection 3 of section 195.070, or other medications or 23
anesthetic agents during the period anesthesia care is 24
provided for the procedure or treatment based on patient 25
assessment and response to interventions or cause such 26
controlled substances, medications, or anesthetic agents to 27
be administered or dispensed during the period anesthesia 28
care is provided for the procedure or treatment by a 29
registered professional nurse or licensed practical n urse as 30
long as the services provided are within the scope of 31
practice of the registered professional nurse or licensed 32 SB 910 17
practical nurse and consistent with that nurse's skill, 33
training, and competence. 34
2. In providing anesthesia care for a surgic al, 35
obstetrical, therapeutic, or diagnostic procedure or 36
treatment, nothing in this section shall be construed to 37
exempt a certified registered nurse anesthetist from 38
complying with a health care facility's policies, protocols, 39
standing orders, or sta ff bylaws for the provision of 40
anesthesia care. 41
3. Nothing in this section shall be construed as a 42
designation of the entirety of a certified registered nurse 43
anesthetist's scope of practice nor as any limitation on the 44
authority of a certified r egistered nurse anesthetist to 45
function and clinically perform all such health care 46
services that are within the scope of practice and standards 47
of the certified registered nurse anesthetist role and 48
consistent with the certified registered nurse anest hetist's 49
licensure, education, training, knowledge, skill, and 50
competence as a certified registered nurse anesthetist. 51
335.039. 1. For purposes of this section, the 1
following terms mean: 2
(1) "Chronic pain management", the pr actice of 3
performing invasive techniques devoted to the diagnosis and 4
treatment of pain syndromes, often involving the use of 5
medical imaging. When used in reference to certified 6
registered nurse anesthetists, the term "chronic pain 7
management" means those chronic pain management techniques 8
that are within the scope of practice of certified 9
registered nurse anesthetists and are consistent with the 10
skill, training, and competence of the certified registered 11
nurse anesthetist who is to perform the t echnique; 12 SB 910 18
(2) "Infusion therapy", the intravenous, 13
musculocutaneous, subcutaneous, or dermal administration of 14
medication or other therapeutic substances, such as 15
vitamins, minerals, antioxidants, and fluids, to a patient. 16
2. A certified registered nurse anesthetist may 17
provide infusion therapy and chronic pain management 18
treatment in accordance with subsection 3 of section 335.019 19
and section 335.038 if the certified registered nurse 20
anesthetist: 21
(1) Enters into a collaborative pra ctice arrangement 22
pursuant to section 334.104 for the delivery of infusion 23
therapy or chronic pain management treatment with a 24
physician; or 25
(2) Provides infusion therapy and chronic pain 26
management treatment under the supervision of a physician. 27
3. Nothing in this section shall be construed to 28
prohibit or restrict the provision of anesthesia care by a 29
certified registered nurse anesthetist for a surgical, 30
obstetrical, therapeutic, or diagnostic procedure or 31
treatment, or for the treatme nt of pain related to such 32
procedure or treatment, except with respect to infusion 33
therapy and chronic pain management treatment in accordance 34
with subsection 3 of section 335.019 and section 335.038. 35