HB 1816 Modifies provisions relating to health care professionals and prescription refills
Sponsor: Wasson
LR Number: 4462S.04T Fiscal Notes
Committee: Financial and Governmental Organizations and Elections
Last Action: 7/5/2016 - Signed by Governor Journal Page: S3714
Title: SS SCS HB 1816 Calendar Position:
Effective Date: Varies
House Handler: Koenig

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SS/SCS/HB 1816 - This act modifies provisions relating to health care professionals and prescription refills.

HEALTHCARE PROFESSIONALS WORKFORCE DATA COLLECTION - 324.001

This act provides that the State Board of Nursing, Board of Pharmacy, Missouri Dental Board, State Committee of Psychologists, State Board of Chiropractic Examiners, State Board of Optometry, State Board of Occupational Therapy, and State Board of Registration for the Healing Arts may enter into contractual agreements with the Department of Health and Senior Services, public institutions of higher education, and nonprofit entities in order to collect and analyze workforce data from its licensees for the purpose of future workforce planning and to assess the accessibility and availability of qualified health care services and practitioners in Missouri.

Data collection is controlled by the applicable state board requesting the collection, and the boards may release identifying data to the contractor to facilitate data analysis of the health care workforce. The data collected is the property of the board requesting the data, and shall be maintained as provided in existing law. Data shall only be released in the aggregate form in a manner that cannot be used to identify a specific individual. A board cannot request or collect income or other financial earnings information. Contractors shall maintain the confidentiality of data received and shall not release any data without approval from the applicable board.

This provision is identical to HCS/HB 1850 (2016), HCS/SB 831 (2016), and SCS/HB 1466 (2016), substantially similar to a provision in HCS/HB 1465 (2016) and CCS/HCS/SB 635 (2016), and is similar to HCS/HB 112 (2015), HCS/SCS/SB 197 (2015), HCS/SCS/SB 230 (2015), and HCS/SS/SCS/SB 354 (2015).

LICENSURE REQUIREMENTS FOR PHYSICIANS - 334.040, 334.285

The act provides that applicants for licensure as a physician or surgeon must provide proof of successful completion of the USMLE or the COMLEX, rather than just proof of completion. The act repeals the provision authorizing the Board of Registration for the Healing Arts to determined the passing score of the USMLE. Currently, an applicant must pass all three steps of the USMLE within seven years with no more than three attempts on any step. This act adds that an applicant who took the COMLEX must also take all three steps in 7 years with no more than three attempts on any step.

The act removes the provision that states that in order for the Board to waive licensure requirements for an applicant who is licensed in another state the applicant must be certified by a certifying agency in the applicant's area of speciality.

The state shall not require adherence to the Federation of State Medical Boards' framework as a condition for physician license renewal or any form of specialty medical board certification to practice medicine within the state. The State Board of Registration for the Healing Arts or any other state agency shall not discriminate against physicians who do not maintain specialty medical board certification.

These provisions are identical to provisions in SCS/HB 1682 (2016) and similar to SCS/SB 772 (2016), HB 2304 (2016), HB 2554 (2016), HB 683 (2015), SB 411 (2015), SS/SB 400 (2015), and HB 671 (2015).

PHYSICAL THERAPIST COMPACT - 334.1200 - 334.1233

The act creates a physical therapist compact. To participate in the compact a state must 1) participate in the Physical Therapy Compact Commission's data system; 2) have a mechanism in place for receiving and investigating complaints; 3) notify the Commission of any adverse action regarding a licensee; 4) implement a criminal background check; 5) comply with the rules of the Commission; 6) use a recognized national examination as a requirement for licensure; and 7) have continuing education as a requirement for license renewal.

A member state shall grant the compact privilege to a licensee holding a valid license in another member state. In order to have a compact privilege a licencee must 1) have an unencumbered license in his or her home state; 2) have not had any adverse action against the license in the previous 2 years; 3) notify the Commission that he or she is seeking compact privilege within a remote state; 4) pay a fee; 5) meet any jurisprudence requirements established by the remote state; and 6) report to the Commission adverse action taken by a nonmember state within 30 days from the date the adverse action is taken. The compact privilege is valid until the expiration date of the home license. The licensee providing physical therapy in a remote state is subject to the laws and regulations of the remote state. If a home state license is encumbered then the licensee shall lose the compact privilege until certain conditions are met as established in the act.

A remote state has the authority to take adverse action against a licensee's compact privilege in that state, but only a home state may impose adverse action against a license issued by the home state. Additionally, any member state may investigate violations of physical therapy statutes and rules in any other member state in which a physical therapist holds a license or compact privilege. Member states may also participate in joint investigations of licensees.

The act creates the Physical Therapy Compact Commission. Each member state shall have one delegate who shall be a current member of the member state's licensing board. The Commission shall establish bylaws and promulgate rules, which shall have the force and effect of law and shall be binding in all member states. Within the Commission, there is an executive board composed of 9 members with the authority to act on behalf of the Commission. The Commission may collect an annual assessment from each member state or impose fees on other parties to cover the cost of the operations and activities of the Commission and its staff.

The Commission shall develop, maintain, and use a coordinated database and reporting system containing licensure, adverse action, and investigative information on all licensed individuals in member states. Member states are required to submit a uniform data set to the data system on all individuals to whom the compact is applicable. The data shall include 1) identifying information; 2) licensure data; 3) adverse actions against the licensee or compact privilege; 4) nonconfidential information related to alternative program participation; 5) denial of application for licensure; and 6) any other information that may facilitate the administration of the compact.

If a member state defaults in its performance of its obligations under the compact or promulgated rules then the defaulting state may be terminated from the compact as provided in the act.

The compact shall not become effective until ten states enact the compact into law.

These sections are identical to sections in HCS/HB 1465 (2016), CCS/HCS/SCS/SB 973, HB 2328 (2016), CCS #2/HCS/SS/SB 608 (2016), CCS/HCS/SB 635 (2016), HCS/SB 831 (2016), HCS/SB 835 (2016), and HCS/SCS/SB 836 (2016).

NURSING EDUCATION INCENTIVE PROGRAM - 335.203

Currently, the Nursing Education Incentive Program is administered by the Department of Higher Education. This act makes the State Board of Nursing the administrative agency responsible for implementing the program.

This provision is substantially similar to a provision in HCS/SB 835 (2016) and HCS/SB 831 (2016).

NURSING LICENSURE COMPACT - 335.360 - 335.415

This act establishes a new nursing licensure compact in which states who are members of the compact, known as party states, may issue multistate nursing licenses for the practice of registered, licensed practical, or vocational nursing. A multistate nursing license shall authorize a nurse to practice under a multistate licensure privilege in each party state. The act does not affect the requirements established by a party state for the issuance of a single-state license.

This compact shall become effective and binding on the earlier of the date of legislative enactment of this compact by no less than twenty-six states or December 31, 2018. All party states to this compact that were also parties to the prior nurse licensure compact shall be deemed to have withdrawn from the prior compact within six months after the effective date of this compact.

Under the act, a party state must adopt procedures for considering the criminal history of applicants for an initial multistate license, and require an applicant for multistate licensure to 1) meet certain educational requirements as specified in the act, 2) pass the NCLEX-RN or NCLEX-PN examination, 3) hold or be eligible for an active, unencumbered license, 4) submit fingerprints for a criminal background check, 5) not have been convicted of a felony or a misdemeanor related to the practice of nursing, or enrolled in an alternative licensure disciplinary program, and 6) have a valid Social Security number.

A nurse practicing in a party state, not his or her home state, is subject to the jurisdiction of the licensing board, courts, and laws, of the party state in which the client is located at the time service is provided. A party state may take adverse action against a nurse's multistate licensure privilege, and shall notify the administrator of the coordinated licensure information system of any disciplinary action. The administrator shall then inform the licensee's home state of any such action by another state against the licensee.

All party states shall participate in a coordinated licensure information system, which shall include information on the licensure and disciplinary history of each nurse, and shall be administered by a nonprofit organization composed of and controlled by the party states' licensing boards. Any personally identifiable information obtained from the coordinated licensure information system by a party state licensing board shall not be shared with non-party states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information.

A nurse who holds a multistate license issued by his or her home state on the effective date the compact may retain and renew the multistate license issued by the current home state. However, a nurse who changes primary state of residence after the effective date of the compact shall meet the requirements to obtain a multistate license from a new home state. A nurse may hold a multistate license issued by the home state, in only one party state at a time. If a nurse moves to a new party state, he or she must apply for licensure in the new home state, and the multistate license issued by the prior home state will be deactivated. If a nurse moves to a non-party state then the multistate license issued by the prior home state will convert to a single-state license, valid only in the prior home state.

The licensing board of each state shall have the authority to take disciplinary action against a nurse's multistate licensure privilege to practice within the party state, but only the home state shall have the power to take adverse action against a nurse's license issued by the home state.

The Interstate Commission of Nurse Licensure Compact Administrators, composed of one designee from each party state, shall have the authority to promulgate uniform rules to implement and administer the compact. Such rules shall be binding in all party states and have force and effect of law. The act sets forth procedures and requirements that the Commission must follow in order to exercise its rulemaking powers. The Commission shall meet at least once a year and the meetings shall be open to the public. The Commission shall establish bylaws or rules to govern its conduct which shall be published on the Commission's website.

If the Commission determines that a party state has defaulted in the performance of its responsibilities under the Compact and fails to cure such default, then the party state's membership in the Compact shall be terminated upon an affirmative vote of the members of the Commission.

This act shall become effective upon notification to the Revisor of Statutes by the Commission that no less than twenty-six states have enacted the Compact, or December 31, 2018, whichever occurs earlier.

These provisions are substantially similar to SB 985 (2016) and identical to provisions in HCS/HB 1465 (2016), CCS #2/HCS/SS/SB 608 (2016), CCS/HCS/SB 635 (2016), HCS/SB 831 (2016), and HCS/SB 835 (2016).

OPTOMETRY STUDENTS - 336.020

The act provides that the statutory prohibition of the unlawful practice of optometry shall not apply to students enrolled in an accredited school of optometry training under the direct supervision of a licensed physician or optometrist.

This provision is similar to HB 2153 (2016) and identical to provisions in HCS/SB 831 (2016), HCS/SCS/SB 836 (2016), and HCS/SB 835 (2016).

MAINTENANCE MEDICATION - 338.202

This act provides that a pharmacist may dispense varying quantities of maintenance medication per fill up to the total number of dosage units as authorized by the prescriber, unless the prescriber has specified that dispensing a prescription for maintenance medication in an initial amount is medically necessary. When the dispensing of the maintenance medication is based on refills then the pharmacist shall dispense no more than a 90 day supply and the patient must have already been prescribed the medication for 3 months.

This provision is identical to provisions in CCS/HCS/SS/SCS/SBs 865 & 866 , CCS/HCS/SCS/SB 973 (2016), CCS #2/HCS/SS/SB 608 (2016), HCS/SB 831 (2016), HCS/SB 864 (2016), and similar to SCS/HB 1682 (2016) and HB 2406 (2016).

EARLY REFILLS OF PRESCRIPTION EYE DROPS - 376.1237

The act extends the sunset provision for coverage of early refills of prescription eye drops from January 1, 2017, to January 1, 2020.

This provision is identical to provisions in CCS/HCS/SS/SCS/SBs 865 &866 (2016), HB 1852 (2016), CCS #2/HCS/SS/SB 608 (2016), CCS/HCS/SB 635 (2016), HCS/SB 831 (2016), SCS/HB 1682 (2016), SB 868 (2016), and CCS/HCS/SCS/SB 973 (2016).

USE OF RESTRAINT BY A PHYSICIAN ASSISTANT OR ASSISTANT PHYSICIAN - 630.175

The act allows a physician assistant or an assistant physician with a supervision agreement with the attending physician to determine that the physical or chemical restraint, isolation, or seclusion of a patient in a mental health facility or program is or is not necessary.

This provision is identical to provisions in SCS/HB 1682 (2016) and similar to SB 1056 (2016) and HCS/SB 831 (2016).

JESSI BAKER