Missouri HB 1574: Modifies provisions relating to advanced practice registered nurses in collaborative practice arrangements

Bill Text

SECOND REGULAR SESSION
[PERFECTED]
HOUSE COMMITTEE SUBSTITUTE FOR
HOUSE BILL NO. 1574
99TH GENERAL ASSEMBLY
4512H.02P D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To repeal sections 334.037, 334.104, and 334.735, RSMo, and to enact in lieu thereof three new
sections relating to advanced practice registered nurses in collaborative practice
arrangements.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 334.037, 334.104, and 334.735, RSMo, are repealed and three new
2 sections enacted in lieu thereof, to be known as sections 334.037, 334.104, and 334.735, to read
3 as follows:
334.037. 1. A physician may enter into collaborative practice arrangements with
2 assistant physicians. Collaborative practice arrangements shall be in the form of written
3 agreements, jointly agreed-upon protocols, or standing orders for the delivery of health care
4 services. Collaborative practice arrangements, which shall be in writing, may delegate to an
5 assistant physician the authority to administer or dispense drugs and provide treatment as long
6 as the delivery of such health care services is within the scope of practice of the assistant
7 physician and is consistent with that assistant physician's skill, training, and competence and the
8 skill and training of the collaborating physician.
9 2. The written collaborative practice arrangement shall contain at least the following
10 provisions:
11 (1) Complete names, home and business addresses, zip codes, and telephone numbers
12 of the collaborating physician and the assistant physician;
13 (2) A list of all other offices or locations besides those listed in subdivision (1) of this
14 subsection where the collaborating physician authorized the assistant physician to prescribe;
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended
to be omitted from the law. Matter in bold-face type in the above bill is proposed language.

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15 (3) A requirement that there shall be posted at every office where the assistant physician
16 is authorized to prescribe, in collaboration with a physician, a prominently displayed disclosure
17 statement informing patients that they may be seen by an assistant physician and have the right
18 to see the collaborating physician;
19 (4) All specialty or board certifications of the collaborating physician and all
20 certifications of the assistant physician;
21 (5) The manner of collaboration between the collaborating physician and the assistant
22 physician, including how the collaborating physician and the assistant physician shall:
23 (a) Engage in collaborative practice consistent with each professional's skill, training,
24 education, and competence;
25 (b) Maintain geographic proximity; except, the collaborative practice arrangement may
26 allow for geographic proximity to be waived for a maximum of twenty-eight days per calendar
27 year for rural health clinics as defined by P.L. 95-210, as long as the collaborative practice
28 arrangement includes alternative plans as required in paragraph (c) of this subdivision. Such
29 exception to geographic proximity shall apply only to independent rural health clinics, provider-
30 based rural health clinics if the provider is a critical access hospital as provided in 42 U.S.C.
31 Section 1395i-4, and provider-based rural health clinics if the main location of the hospital
32 sponsor is greater than fifty miles from the clinic. The collaborating physician shall maintain
33 documentation related to such requirement and present it to the state board of registration for the
34 healing arts when requested; and
35 (c) Provide coverage during absence, incapacity, infirmity, or emergency by the
36 collaborating physician;
37 (6) A description of the assistant physician's controlled substance prescriptive authority
38 in collaboration with the physician, including a list of the controlled substances the physician
39 authorizes the assistant physician to prescribe and documentation that it is consistent with each
40 professional's education, knowledge, skill, and competence;
41 (7) A list of all other written practice agreements of the collaborating physician and the
42 assistant physician;
43 (8) The duration of the written practice agreement between the collaborating physician
44 and the assistant physician;
45 (9) A description of the time and manner of the collaborating physician's review of the
46 assistant physician's delivery of health care services. The description shall include provisions
47 that the assistant physician shall submit a minimum of ten percent of the charts documenting the
48 assistant physician's delivery of health care services to the collaborating physician for review by
49 the collaborating physician, or any other physician designated in the collaborative practice
50 arrangement, every fourteen days; and

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51 (10) The collaborating physician, or any other physician designat