SPONSOR: Stephens (128)
COMMITTEE ACTION: Voted "Do Pass" by the Standing Committee on Health and Mental Health Policy by a vote of 13 to 1. Voted "Do Pass" by the Standing Committee on Rules- Administrative Oversight by a vote of 12 to 0.
This bill modifies provisions regarding advanced practice registered nurses (APRNs) working in a collaborative practice arrangement.
Under current law, a collaborating physician cannot enter into a collaborative practice arrangement with more than six full-time equivalent assistant physicians, physician assistants, or APRNs, or any combination thereof. This bill removes that limitation for APRNs.
The bill requires an APRN to have a certificate of controlled substance prescriptive authority to administer, dispense, or prescribe certain controlled substances.
This bill removes several collaborative practice requirements, including the requirement to post a notice at every office, the geographic proximity requirement, the requirement that the physician review the APRNs health care services, and the completion of a one-month practice period before practicing without the collaborating physician being continuously present. The bill states that rules promulgated by the State Board of Registration for the Healing Arts, within the Department of Commerce and Insurance, must be limited to delegating authority to prescribe controlled substances and any previously adopted rules that are not so limited are null and void.
This bill is similar to provisions in HB 2226 (2020).
PROPONENTS: Supporters say these changes are needed to improve health care quality in rural areas. Supporters also believe that Telehealth is an effective way to operate remotely and the distance restriction currently in place is an outdated rule.
Testifying for the bill were Representative Stephens; Alaina Wyatt- Durk; Amanda Kurtz, Skin Solutions Spa & Boutique, LLC DBA: Revive Medical Aesthetics; Brandon Forester; Dennis Conrow; Elise Schaller; Jennifer Bernstein, National Council of Jewish Women St. Louis; Americans for Prosperity; Missouri Family Health Council, Inc.; Maria Lena Walls; Nicholas Fleming; Rachel Melson; Raymond E. Sisk; Shanna Denae Chapman; Tamara McGuire; Leadingage Missouri; Association of Missouri Nurse Practitioners; and AARP Missouri; Christine Marie Corbett; Susan Klotz; Ashley Carpenter; Missouri Hospital Association; Bruce Fletcher; Elaine Briggs DNP-APRN-FNP- BC; BJC Healthcare, Missouri Association of Rural Health Clinics; Missouri Nurses Association; SSM Health; National Council State Board of Nursing; Laura L. Kuensting; Mary Beck, RN, University of Missouri Health Care; Sarah Thompson, University Missouri Sinclair School Nursing; Nathan Granneman, Big Tree Medical Home; and Carl H Smith.
OPPONENTS: Those who oppose the bill say you can't do a proper exam via telehealth. Opponents also say the level of training for an Advanced Practice Registered Nurse is not sufficient enough to not be under a doctor's direct supervision.
Testifying against the bill were Wesley Powell; Arnie Dienoff; Missouri Association of Osteopathic Physicians and Surgeons; George Hubbell, MD, Missouri State Medical Association; Missouri Dermatological Society; Todd Shaffer, MD, Missouri Academy of Family Physicians.
Testifying on the bill was Heidi B. Miller, MD, St. Louis Regional Health Commission.
Written testimony has been submitted for this bill. The full written testimony can be found under Testimony on the bill page on the House website.
Statutes affected: