| 1 | 1 | | FIRSTREGULARSESSION |
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| 2 | 2 | | HOUSEBILLNO.327 |
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| 3 | 3 | | 103RDGENERALASSEMBLY |
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| 4 | 4 | | INTRODUCEDBYREPRESENTATIVECASTEEL. |
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| 5 | 5 | | 0987H.01I DANARADEMANMILLER,ChiefClerk |
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| 6 | 6 | | ANACT |
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| 7 | 7 | | Torepealsections195.070and334.104,RSMo,andtoenactinlieuthereoftwonewsections |
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| 8 | 8 | | relatingtotheprescriptiveauthorityofadvancedpracticeregisterednurses. |
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| 9 | 9 | | BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows: |
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| 10 | 10 | | SectionA.Sections195.070and334.104,RSMo,arerepealedandtwonewsections |
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| 11 | 11 | | 2enactedinlieuthereof,tobeknownassections195.070and334.104,toreadasfollows: |
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| 12 | 12 | | 195.070.1.Aphysician,podiatrist,dentist,aregisteredoptometristcertifiedto |
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| 13 | 13 | | 2administerpharmaceuticalagentsasprovidedinsection336.220,oranassistantphysicianin |
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| 14 | 14 | | 3accordancewithsection334.037oraphysicianassistantinaccordancewithsection334.747 |
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| 15 | 15 | | 4ingoodfaithandinthecourseofhisorherprofessionalpracticeonly,mayprescribe, |
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| 16 | 16 | | 5administer,anddispensecontrolledsubstancesorheorshemaycausethesametobe |
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| 17 | 17 | | 6administeredordispensedbyanindividualasauthorizedbystatute. |
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| 18 | 18 | | 7 2.Anadvancedpracticeregisterednurse,asdefinedinsection335.016,butnota |
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| 19 | 19 | | 8certifiedregisterednurseanesthetistasdefinedinsubdivision(8)ofsection335.016,who |
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| 20 | 20 | | 9holdsacertificateofcontrolledsubstanceprescriptiveauthorityfromtheboardofnursing |
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| 21 | 21 | | 10undersection335.019andwhoisdelegatedtheauthoritytoprescribecontrolledsubstances |
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| 22 | 22 | | 11underacollaborativepracticearrangementundersection334.104mayprescribeany |
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| 23 | 23 | | 12controlledsubstanceslistedinSchedulesIII,IV,andVofsection195.017,andmayhave |
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| 24 | 24 | | 13restrictedauthorityinScheduleII.PrescriptionsforScheduleIImedicationsprescribedbyan |
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| 25 | 25 | | 14advancedpracticeregisterednursewhohasacertificateofcontrolledsubstanceprescriptive |
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| 26 | 26 | | 15authorityarerestrictedtoonlythosemedicationscontaininghydrocodone[and],ScheduleII |
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| 27 | 27 | | 16controlledsubstancesforhospicepatients, andScheduleIIbenzodiazepinesandstimulants |
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| 28 | 28 | | 17pursuanttotheprovisionsofsection334.104.However,nosuchcertifiedadvancedpractice |
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| 29 | 29 | | EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis |
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| 30 | 30 | | intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 18registerednurseshallprescribecontrolledsubstanceforhisorherownselforfamily. |
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| 31 | 31 | | 19ScheduleIIInarcoticcontrolledsubstanceandScheduleII-hydrocodoneprescriptionsshall |
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| 32 | 32 | | 20belimitedtoaonehundredtwenty-hoursupplywithoutrefill. |
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| 33 | 33 | | 21 3.Aveterinarian,ingoodfaithandinthecourseoftheveterinarian'sprofessional |
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| 34 | 34 | | 22practiceonly,andnotforusebyahumanbeing,mayprescribe,administer,anddispense |
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| 35 | 35 | | 23controlledsubstancesandtheveterinarianmaycausethemtobeadministeredbyanassistant |
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| 36 | 36 | | 24ororderlyunderhisorherdirectionandsupervision. |
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| 37 | 37 | | 25 4.Apractitionershallnotacceptanyportionofacontrolledsubstanceunusedbya |
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| 38 | 38 | | 26patient,foranyreason,ifsuchpractitionerdidnotoriginallydispensethedrug,except: |
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| 39 | 39 | | 27 (1)Whenthecontrolledsubstanceisdeliveredtothepractitionertoadministertothe |
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| 40 | 40 | | 28patientforwhomthemedicationisprescribedasauthorizedbyfederallaw.Practitioners |
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| 41 | 41 | | 29shallmaintainrecordsandsecurethemedicationasrequiredbythischapterandregulations |
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| 42 | 42 | | 30promulgatedpursuanttothischapter;or |
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| 43 | 43 | | 31 (2)Asprovidedinsection195.265. |
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| 44 | 44 | | 32 5.Anindividualpractitionershallnotprescribeordispenseacontrolledsubstancefor |
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| 45 | 45 | | 33suchpractitioner'spersonaluseexceptinamedicalemergency. |
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| 46 | 46 | | 334.104.1.Aphysicianmayenterintocollaborativepracticearrangementswith |
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| 47 | 47 | | 2registeredprofessionalnurses.Collaborativepracticearrangementsshallbeintheformof |
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| 48 | 48 | | 3writtenagreements,jointlyagreed-uponprotocols,orstandingordersforthedeliveryof |
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| 49 | 49 | | 4healthcareservices.Collaborativepracticearrangements,whichshallbeinwriting,may |
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| 50 | 50 | | 5delegatetoaregisteredprofessionalnursetheauthoritytoadministerordispensedrugsand |
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| 51 | 51 | | 6providetreatmentaslongasthedeliveryofsuchhealthcareservicesiswithinthescopeof |
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| 52 | 52 | | 7practiceoftheregisteredprofessionalnurseandisconsistentwiththatnurse'sskill,training |
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| 53 | 53 | | 8andcompetence. |
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| 54 | 54 | | 9 2.(1)Collaborativepracticearrangements,whichshallbeinwriting,maydelegateto |
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| 55 | 55 | | 10aregisteredprofessionalnursetheauthoritytoadminister,dispenseorprescribedrugsand |
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| 56 | 56 | | 11providetreatmentiftheregisteredprofessionalnurseisanadvancedpracticeregisterednurse |
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| 57 | 57 | | 12asdefinedinsubdivision(2)ofsection335.016.Collaborativepracticearrangementsmay |
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| 58 | 58 | | 13delegatetoanadvancedpracticeregisterednurse,asdefinedinsection335.016,theauthority |
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| 59 | 59 | | 14toadminister,dispense,orprescribecontrolledsubstanceslistedinSchedulesIII,IV,andVof |
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| 60 | 60 | | 15section195.017[, and];ScheduleII-hydrocodone; andScheduleIIbenzodiazepinesand |
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| 61 | 61 | | 16stimulants; exceptthat,thecollaborativepracticearrangementshallnotdelegatethe |
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| 62 | 62 | | 17authoritytoadministeranycontrolledsubstanceslistedinSchedulesIII,IV,andVofsection |
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| 63 | 63 | | 18195.017[, or];ScheduleII-hydrocodone; orScheduleIIbenzodiazepinesorstimulantsfor |
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| 64 | 64 | | 19thepurposeofinducingsedationorgeneralanesthesiafortherapeutic,diagnostic,orsurgical |
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| 65 | 65 | | 20procedures.ScheduleIIInarcoticcontrolledsubstanceandScheduleII-hydrocodone |
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| 66 | 66 | | 21prescriptionsshallbelimitedtoaonehundredtwenty-hoursupplywithoutrefill. |
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| 67 | 67 | | HB327 2 22 (2)Notwithstandinganyotherprovisionofthissectiontothecontrary,acollaborative |
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| 68 | 68 | | 23practicearrangementmaydelegatetoanadvancedpracticeregisterednursetheauthorityto |
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| 69 | 69 | | 24administer,dispense,orprescribeScheduleIIcontrolledsubstancesforhospicepatients; |
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| 70 | 70 | | 25provided,thattheadvancedpracticeregisterednurseisemployedbyahospiceprovider |
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| 71 | 71 | | 26certifiedpursuanttochapter197andtheadvancedpracticeregisterednurseisprovidingcare |
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| 72 | 72 | | 27tohospicepatientspursuanttoacollaborativepracticearrangementthatdesignatesthe |
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| 73 | 73 | | 28certifiedhospiceasalocationwheretheadvancedpracticeregisterednurseisauthorizedto |
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| 74 | 74 | | 29practiceandprescribe. |
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| 75 | 75 | | 30 (3)Suchcollaborativepracticearrangementsshallbeintheformofwritten |
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| 76 | 76 | | 31agreements,jointlyagreed-uponprotocolsorstandingordersforthedeliveryofhealthcare |
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| 77 | 77 | | 32services. |
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| 78 | 78 | | 33 (4)Anadvancedpracticeregisterednursemayprescribebuprenorphineforuptoa |
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| 79 | 79 | | 34thirty-daysupplywithoutrefillforpatientsreceivingmedication-assistedtreatmentfor |
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| 80 | 80 | | 35substanceusedisordersunderthedirectionofthecollaboratingphysician. |
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| 81 | 81 | | 36 3.Thewrittencollaborativepracticearrangementshallcontainatleastthefollowing |
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| 82 | 82 | | 37provisions: |
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| 83 | 83 | | 38 (1)Completenames,homeandbusinessaddresses,zipcodes,andtelephonenumbers |
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| 84 | 84 | | 39ofthecollaboratingphysicianandtheadvancedpracticeregisterednurse; |
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| 85 | 85 | | 40 (2)Alistofallotherofficesorlocationsbesidesthoselistedinsubdivision(1)ofthis |
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| 86 | 86 | | 41subsectionwherethecollaboratingphysicianauthorizedtheadvancedpracticeregistered |
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| 87 | 87 | | 42nursetoprescribe; |
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| 88 | 88 | | 43 (3)Arequirementthatthereshallbepostedateveryofficewheretheadvanced |
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| 89 | 89 | | 44practiceregisterednurseisauthorizedtoprescribe,incollaborationwithaphysician,a |
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| 90 | 90 | | 45prominentlydisplayeddisclosurestatementinformingpatientsthattheymaybeseenbyan |
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| 91 | 91 | | 46advancedpracticeregisterednurseandhavetherighttoseethecollaboratingphysician; |
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| 92 | 92 | | 47 (4)Allspecialtyorboardcertificationsofthecollaboratingphysicianandall |
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| 93 | 93 | | 48certificationsoftheadvancedpracticeregisterednurse; |
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| 94 | 94 | | 49 (5)Themannerofcollaborationbetweenthecollaboratingphysicianandthe |
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| 95 | 95 | | 50advancedpracticeregisterednurse,includinghowthecollaboratingphysicianandthe |
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| 96 | 96 | | 51advancedpracticeregisterednursewill: |
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| 97 | 97 | | 52 (a)Engageincollaborativepracticeconsistentwitheachprofessional'sskill,training, |
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| 98 | 98 | | 53education,andcompetence; |
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| 99 | 99 | | 54 (b)Maintaingeographicproximity,exceptasspecifiedinthisparagraph.The |
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| 100 | 100 | | 55followingprovisionsshallapplywithrespecttothisrequirement: |
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| 101 | 101 | | 56 a.UntilAugust28,2025,anadvancedpracticeregisterednurseprovidingservicesin |
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| 102 | 102 | | 57acorrectionalcenter,asdefinedinsection217.010,andhisorhercollaboratingphysician |
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| 103 | 103 | | 58shallsatisfythegeographicproximityrequirementiftheypracticewithintwohundredmiles |
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| 104 | 104 | | HB327 3 59byroadofoneanother.Anincarceratedpatientwhorequestsorrequiresaphysician |
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| 105 | 105 | | 60consultationshallbetreatedbyaphysicianassoonasappropriate; |
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| 106 | 106 | | 61 b.Thecollaborativepracticearrangementmayallowforgeographicproximitytobe |
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| 107 | 107 | | 62waivedforamaximumoftwenty-eightdayspercalendaryearforruralhealthclinicsas |
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| 108 | 108 | | 63definedbyPub.L.95-210(42U.S.C.Section1395x,asamended),aslongasthecollaborative |
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| 109 | 109 | | 64practicearrangementincludesalternativeplansasrequiredinparagraph(c)ofthis |
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| 110 | 110 | | 65subdivision.Thisexceptiontogeographicproximityshallapplyonlytoindependentrural |
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| 111 | 111 | | 66healthclinics,provider-basedruralhealthclinicswheretheproviderisacriticalaccess |
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| 112 | 112 | | 67hospitalasprovidedin42U.S.C.Section1395i-4,andprovider-basedruralhealthclinics |
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| 113 | 113 | | 68wherethemainlocationofthehospitalsponsorisgreaterthanfiftymilesfromtheclinic; |
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| 114 | 114 | | 69 c.Thecollaborativepracticearrangementmayallowforgeographicproximitytobe |
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| 115 | 115 | | 70waivedwhenthearrangementoutlinestheuseoftelehealth,asdefinedinsection191.1145; |
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| 116 | 116 | | 71 d.Inadditiontothewaiversandexemptionsprovidedinthissubsection,an |
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| 117 | 117 | | 72applicationforawaiverforanyotherreasonofanyapplicablegeographicproximityshallbe |
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| 118 | 118 | | 73availableifaphysicianiscollaboratingwithanadvancedpracticeregisterednurseinexcess |
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| 119 | 119 | | 74ofanygeographicproximitylimit.Theboardofnursingandthestateboardofregistration |
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| 120 | 120 | | 75forthehealingartsshallrevieweachapplicationforawaiverofgeographicproximityand |
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| 121 | 121 | | 76approvetheapplicationiftheboardsdeterminethatadequatesupervisionexistsbetweenthe |
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| 122 | 122 | | 77collaboratingphysicianandtheadvancedpracticeregisterednurse.Theboardsshallhave |
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| 123 | 123 | | 78forty-fivecalendardaystoreviewthecompletedapplicationforthewaiverofgeographic |
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| 124 | 124 | | 79proximity.Ifnoactionistakenbytheboardswithinforty-fivedaysafterthesubmissionof |
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| 125 | 125 | | 80theapplicationforawaiver,thentheapplicationshallbedeemedapproved.Iftheapplication |
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| 126 | 126 | | 81isdeniedbytheboards,theprovisionsofsection536.063forcontestedcasesshallapplyand |
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| 127 | 127 | | 82governproceedingsforappellatepurposes;and |
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| 128 | 128 | | 83 e.Thecollaboratingphysicianisrequiredtomaintaindocumentationrelatedtothis |
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| 129 | 129 | | 84requirementandtopresentittothestateboardofregistrationforthehealingartswhen |
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| 130 | 130 | | 85requested;and |
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| 131 | 131 | | 86 (c)Providecoverageduringabsence,incapacity,infirmity,oremergencybythe |
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| 132 | 132 | | 87collaboratingphysician; |
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| 133 | 133 | | 88 (6)Adescriptionoftheadvancedpracticeregisterednurse'scontrolledsubstance |
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| 134 | 134 | | 89prescriptiveauthorityincollaborationwiththephysician,includingalistofthecontrolled |
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| 135 | 135 | | 90substancesthephysicianauthorizesthenursetoprescribeanddocumentationthatitis |
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| 136 | 136 | | 91consistentwitheachprofessional'seducation,knowledge,skill,andcompetence; |
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| 137 | 137 | | 92 (7)Alistofallotherwrittenpracticeagreementsofthecollaboratingphysicianand |
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| 138 | 138 | | 93theadvancedpracticeregisterednurse; |
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| 139 | 139 | | 94 (8)Thedurationofthewrittenpracticeagreementbetweenthecollaborating |
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| 140 | 140 | | 95physicianandtheadvancedpracticeregisterednurse; |
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| 141 | 141 | | HB327 4 96 (9)Adescriptionofthetimeandmannerofthecollaboratingphysician'sreviewof |
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| 142 | 142 | | 97theadvancedpracticeregisterednurse'sdeliveryofhealthcareservices.Thedescriptionshall |
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| 143 | 143 | | 98includeprovisionsthattheadvancedpracticeregisterednurseshallsubmitaminimumoften |
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| 144 | 144 | | 99percentofthechartsdocumentingtheadvancedpracticeregisterednurse'sdeliveryofhealth |
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| 145 | 145 | | 100careservicestothecollaboratingphysicianforreviewbythecollaboratingphysician,orany |
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| 146 | 146 | | 101otherphysiciandesignatedinthecollaborativepracticearrangement,everyfourteendays; |
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| 147 | 147 | | 102 (10)Thecollaboratingphysician,oranyotherphysiciandesignatedinthe |
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| 148 | 148 | | 103collaborativepracticearrangement,shallrevieweveryfourteendaysaminimumoftwenty |
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| 149 | 149 | | 104percentofthechartsinwhichtheadvancedpracticeregisterednurseprescribescontrolled |
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| 150 | 150 | | 105substances.Thechartsreviewedunderthissubdivisionmaybecountedinthenumberof |
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| 151 | 151 | | 106chartsrequiredtobereviewedundersubdivision(9)ofthissubsection;and |
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| 152 | 152 | | 107 (11)Ifacollaborativepracticearrangementisusedinclinicalsituationswherea |
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| 153 | 153 | | 108collaboratingadvancedpracticeregisterednurseprovideshealthcareservicesthatincludethe |
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| 154 | 154 | | 109diagnosisandinitiationoftreatmentforacutelyorchronicallyillorinjuredpersons,thenthe |
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| 155 | 155 | | 110collaboratingphysicianoranyotherphysiciandesignatedinthecollaborativepractice |
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| 156 | 156 | | 111arrangementshallbepresentforsufficientperiodsoftime,atleastonceeverytwoweeks, |
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| 157 | 157 | | 112exceptinextraordinarycircumstancesthatshallbedocumented,toparticipateinachart |
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| 158 | 158 | | 113reviewandtoprovidenecessarymedicaldirection,medicalservices,consultations,and |
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| 159 | 159 | | 114supervisionofthehealthcarestaff. |
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| 160 | 160 | | 115 4.Thestateboardofregistrationforthehealingartspursuanttosection334.125and |
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| 161 | 161 | | 116theboardofnursingpursuanttosection335.036mayjointlypromulgaterulesregulatingthe |
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| 162 | 162 | | 117useofcollaborativepracticearrangements.Suchrulesshallbelimitedtothemethodsof |
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| 163 | 163 | | 118treatmentthatmaybecoveredbycollaborativepracticearrangementsandtherequirements |
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| 164 | 164 | | 119forreviewofservicesprovidedpursuanttocollaborativepracticearrangementsincluding |
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| 165 | 165 | | 120delegatingauthoritytoprescribecontrolledsubstances.Anyrulesrelatingtogeographic |
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| 166 | 166 | | 121proximityshallallowacollaboratingphysicianandacollaboratingadvancedpractice |
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| 167 | 167 | | 122registerednursetopracticewithintwohundredmilesbyroadofoneanotheruntilAugust28, |
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| 168 | 168 | | 1232025,ifthenurseisprovidingservicesinacorrectionalcenter,asdefinedinsection217.010. |
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| 169 | 169 | | 124Anyrulesrelatingtodispensingordistributionofmedicationsordevicesbyprescriptionor |
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| 170 | 170 | | 125prescriptiondrugordersunderthissectionshallbesubjecttotheapprovalofthestateboard |
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| 171 | 171 | | 126ofpharmacy.Anyrulesrelatingtodispensingordistributionofcontrolledsubstancesby |
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| 172 | 172 | | 127prescriptionorprescriptiondrugordersunderthissectionshallbesubjecttotheapprovalof |
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| 173 | 173 | | 128thedepartmentofhealthandseniorservicesandthestateboardofpharmacy.Inordertotake |
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| 174 | 174 | | 129effect,suchrulesshallbeapprovedbyamajorityvoteofaquorumofeachboard.Neitherthe |
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| 175 | 175 | | 130stateboardofregistrationforthehealingartsnortheboardofnursingmayseparately |
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| 176 | 176 | | 131promulgaterulesrelatingtocollaborativepracticearrangements.Suchjointlypromulgated |
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| 177 | 177 | | 132rulesshallbeconsistentwithguidelinesforfederallyfundedclinics.Therulemaking |
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| 178 | 178 | | HB327 5 133authoritygrantedinthissubsectionshallnotextendtocollaborativepracticearrangementsof |
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| 179 | 179 | | 134hospitalemployeesprovidinginpatientcarewithinhospitalsasdefinedpursuanttochapter |
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| 180 | 180 | | 135197orpopulation-basedpublichealthservicesasdefinedby20CSR2150-5.100asofApril |
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| 181 | 181 | | 13630,2008. |
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| 182 | 182 | | 137 5.Thestateboardofregistrationforthehealingartsshallnotdeny,revoke,suspend |
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| 183 | 183 | | 138orotherwisetakedisciplinaryactionagainstaphysicianforhealthcareservicesdelegatedtoa |
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| 184 | 184 | | 139registeredprofessionalnurseprovidedtheprovisionsofthissectionandtherules |
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| 185 | 185 | | 140promulgatedthereunderaresatisfied.Uponthewrittenrequestofaphysiciansubjecttoa |
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| 186 | 186 | | 141disciplinaryactionimposedasaresultofanagreementbetweenaphysicianandaregistered |
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| 187 | 187 | | 142professionalnurseorregisteredphysicianassistant,whetherwrittenornot,priortoAugust |
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| 188 | 188 | | 14328,1993,allrecordsofsuchdisciplinarylicensureactionandallrecordspertainingtothe |
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| 189 | 189 | | 144filing,investigationorreviewofanallegedviolationofthischapterincurredasaresultof |
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| 190 | 190 | | 145suchanagreementshallberemovedfromtherecordsofthestateboardofregistrationforthe |
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| 191 | 191 | | 146healingartsandthedivisionofprofessionalregistrationandshallnotbedisclosedtoany |
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| 192 | 192 | | 147publicorprivateentityseekingsuchinformationfromtheboardorthedivision.Thestate |
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| 193 | 193 | | 148boardofregistrationforthehealingartsshalltakeactiontocorrectreportsofalleged |
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| 194 | 194 | | 149violationsanddisciplinaryactionsasdescribedinthissectionwhichhavebeensubmittedto |
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| 195 | 195 | | 150theNationalPractitionerDataBank.Insubsequentapplicationsorrepresentationsrelatingto |
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| 196 | 196 | | 151hisorhermedicalpractice,aphysiciancompletingformsordocumentsshallnotberequired |
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| 197 | 197 | | 152toreportanyactionsofthestateboardofregistrationforthehealingartsforwhichthe |
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| 198 | 198 | | 153recordsaresubjecttoremovalunderthissection. |
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| 199 | 199 | | 154 6.Withinthirtydaysofanychangeandoneachrenewal,thestateboardof |
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| 200 | 200 | | 155registrationforthehealingartsshallrequireeveryphysiciantoidentifywhetherthephysician |
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| 201 | 201 | | 156isengagedinanycollaborativepracticearrangement,includingcollaborativepractice |
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| 202 | 202 | | 157arrangementsdelegatingtheauthoritytoprescribecontrolledsubstances,orphysician |
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| 203 | 203 | | 158assistantcollaborativepracticearrangementandalsoreporttotheboardthenameofeach |
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| 204 | 204 | | 159licensedprofessionalwithwhomthephysicianhasenteredintosucharrangement.Theboard |
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| 205 | 205 | | 160shallmakethisinformationavailabletothepublic.Theboardshalltrackthereported |
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| 206 | 206 | | 161informationandmayroutinelyconductrandomreviewsofsucharrangementstoensurethat |
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| 207 | 207 | | 162arrangementsarecarriedoutforcomplianceunderthischapter. |
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| 208 | 208 | | 163 7.Notwithstandinganylawtothecontrary,acertifiedregisterednurseanesthetistas |
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| 209 | 209 | | 164definedinsubdivision(8)ofsection335.016shallbepermittedtoprovideanesthesiaservices |
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| 210 | 210 | | 165withoutacollaborativepracticearrangementprovidedthatheorsheisunderthesupervision |
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| 211 | 211 | | 166ofananesthesiologistorotherphysician,dentist,orpodiatristwhoisimmediatelyavailableif |
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| 212 | 212 | | 167needed.Nothinginthissubsectionshallbeconstruedtoprohibitorpreventacertified |
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| 213 | 213 | | 168registerednurseanesthetistasdefinedinsubdivision(8)ofsection335.016fromenteringinto |
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| 214 | 214 | | 169acollaborativepracticearrangementunderthissection,exceptthatthecollaborativepractice |
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| 215 | 215 | | HB327 6 170arrangementmaynotdelegatetheauthoritytoprescribeanycontrolledsubstanceslistedin |
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| 216 | 216 | | 171SchedulesIII,IV,andVofsection195.017[, or];ScheduleII-hydrocodone; orScheduleII |
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| 217 | 217 | | 172benzodiazepinesorstimulants. |
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| 218 | 218 | | 173 8.Acollaboratingphysicianshallnotenterintoacollaborativepracticearrangement |
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| 219 | 219 | | 174withmorethansixfull-timeequivalentadvancedpracticeregisterednurses,full-time |
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| 220 | 220 | | 175equivalentlicensedphysicianassistants,orfull-timeequivalentassistantphysicians,orany |
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| 221 | 221 | | 176combinationthereof.Thislimitationshallnotapplytocollaborativearrangementsofhospital |
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| 222 | 222 | | 177employeesprovidinginpatientcareserviceinhospitalsasdefinedinchapter197or |
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| 223 | 223 | | 178population-basedpublichealthservicesasdefinedby20CSR2150-5.100asofApril30, |
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| 224 | 224 | | 1792008,ortoacertifiedregisterednurseanesthetistprovidinganesthesiaservicesunderthe |
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| 225 | 225 | | 180supervisionofananesthesiologistorotherphysician,dentist,orpodiatristwhoisimmediately |
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| 226 | 226 | | 181availableifneededassetoutinsubsection7ofthissection. |
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| 227 | 227 | | 182 9.Itistheresponsibilityofthecollaboratingphysiciantodetermineanddocument |
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| 228 | 228 | | 183thecompletionofatleastaone-monthperiodoftimeduringwhichtheadvancedpractice |
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| 229 | 229 | | 184registerednurseshallpracticewiththecollaboratingphysiciancontinuouslypresentbefore |
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| 230 | 230 | | 185practicinginasettingwherethecollaboratingphysicianisnotcontinuouslypresent.This |
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| 231 | 231 | | 186limitationshallnotapplytocollaborativearrangementsofprovidersofpopulation-based |
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| 232 | 232 | | 187publichealthservices,asdefinedby20CSR2150-5.100asofApril30,2008,orto |
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| 233 | 233 | | 188collaborativepracticearrangementsbetweenaprimarycarephysicianandaprimarycare |
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| 234 | 234 | | 189advancedpracticeregisterednurseorabehavioralhealthphysicianandabehavioralhealth |
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| 235 | 235 | | 190advancedpracticeregisterednurse,wherethecollaboratingphysicianisnewtoapatient |
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| 236 | 236 | | 191populationtowhichtheadvancedpracticeregisterednurseisfamiliar. |
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| 237 | 237 | | 192 10.Noagreementmadeunderthissectionshallsupersedecurrenthospitallicensing |
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| 238 | 238 | | 193regulationsgoverninghospitalmedicationordersunderprotocolsorstandingordersforthe |
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| 239 | 239 | | 194purposeofdeliveringinpatientoremergencycarewithinahospitalasdefinedinsection |
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| 240 | 240 | | 195197.020ifsuchprotocolsorstandingordershavebeenapprovedbythehospital'smedical |
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| 241 | 241 | | 196staffandpharmaceuticaltherapeuticscommittee. |
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| 242 | 242 | | 197 11.Nocontractorothertermofemploymentshallrequireaphysiciantoactasa |
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| 243 | 243 | | 198collaboratingphysicianforanadvancedpracticeregisterednurseagainstthephysician'swill. |
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| 244 | 244 | | 199Aphysicianshallhavetherighttorefusetoactasacollaboratingphysician,withoutpenalty, |
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| 245 | 245 | | 200foraparticularadvancedpracticeregisterednurse.Nocontractorotheragreementshalllimit |
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| 246 | 246 | | 201thecollaboratingphysician'sultimateauthorityoveranyprotocolsorstandingordersorinthe |
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| 247 | 247 | | 202delegationofthephysician'sauthoritytoanyadvancedpracticeregisterednurse,butthis |
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| 248 | 248 | | 203requirementshallnotauthorizeaphysicianinimplementingsuchprotocols,standingorders, |
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| 249 | 249 | | 204ordelegationtoviolateapplicablestandardsforsafemedicalpracticeestablishedbyhospital's |
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| 250 | 250 | | 205medicalstaff. |
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| 251 | 251 | | HB327 7 206 12.Nocontractorothertermofemploymentshallrequireanyadvancedpractice |
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| 252 | 252 | | 207registerednursetoserveasacollaboratingadvancedpracticeregisterednurseforany |
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| 253 | 253 | | 208collaboratingphysicianagainsttheadvancedpracticeregisterednurse'swill.Anadvanced |
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| 254 | 254 | | 209practiceregisterednurseshallhavetherighttorefusetocollaborate,withoutpenalty,witha |
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| 255 | 255 | | 210particularphysician. |
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| 256 | 256 | | âś” |
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| 257 | 257 | | HB327 8 |
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