House Amendment

HEALTH PROFESSION GRANTS AND LOANS (Sections 191.430-191.450, 191.500-191.550, 191.600, 191.828, 191.831, and 335.203-335.257)

The act repeals current law relating to student loans for certain health professional students and establishes the "Health Professional Loan Repayment Program". Under this program, the Department of Health and Senior Services shall provide forgivable loans in order to repay existing loans for eligible educational expenses for health professional students.

The Director of the Department shall have the discretion to select the health professionals who are eligible for the forgivable loans in accordance with the greatest need in the best interest of the public. Individuals receiving loans under this program shall agree to serve at least 2 years in an area of defined need as a condition of receipt of the funds, among other criteria that must be met as delineated in the act. An individual who fails to uphold the loan agreement shall be liable for the amount paid to the individual by the Department under this program. Furthermore, if an individual breaches a written contract executed pursuant to this provision by failing to begin or complete his or her service obligation, the state shall be entitled to recover from such person an amount equal to:

· The total amount of the loan awarded by the Department or, if the Department had already awarded partial forgiveness at the time of the breach, the amount of the loan not yet forgiven;

· The interest on the amount that would be payable if at the time the loan was awarded it was a loan bearing interest at the maximum prevailing rate as determined by the Treasurer of the United States;

· An amount equal to any damages incurred by the Department as a result of the breach; and

· Any legal fees or associated costs incurred by the Department or the state of Missouri in the collection of damages.

The act additionally creates the Health Professional Loan Incentive Fund for the purpose of allowing the Department to provide loans under this provision. The fund will consist of funds appropriated to it by the General Assembly.

These provisions are identical to provisions in SS/HB 402 (2023) and HB 542 (2023) and substantially similar to SB 555 (2023).

The act modifies the Nursing Education Incentive Program. Under current law, grant awards made under the program are limited to $150,000. This act repeals that limit. Additionally, the State Board of Nursing is required to collect, at the time of any license application or license renewal application, a Nursing Education Incentive Program surcharge from each person licensed or relicensed as a nurse under Missouri law. Such surcharge shall be equal to $1 for practical nurses and $5 for registered professional nurses.

The act repeals the Nursing Student Loan Program and the Nursing Student Loan Repayment Program.

These provisions are identical to provisions in SS/HB 402 (2023) and HB 775 (2023).

PRESCRIPTION LABELING REQUIREMENTS (Sections 195.100 and 334.735)

Currently, the name of the collaborating physician for an advanced practice registered nurse or physician assistant shall be included on any label of a controlled substance sold or dispensed by a pharmacist. This act repeals this requirement and only the name of the prescribing health care provider is needed.

These provisions are identical to provisions in SS/HB 402 (2023) and SB 551 (2023).

INTERSTATE MEDICAL LICENSURE COMPACT (Sections 334.043 and 334.1600-334.1720)

This act modifies provisions relating to physician licensure reciprocity. Under this act, those applicants for licensure who are licensed in another state, territory, or branch or unit of the military for at least one year may submit to the Board of Registration for the Healing Arts an application and proof of current licensure. The Board shall, within 6 months of receipt of the application, waive any examination, educational, or experience requirements for licensure in this state as described in the act, but may require the applicant to take and pass an examination specific to the laws of Missouri. In the case of an applicant who is a nonresident or resident military spouse, the Board shall waive any examination, educational, or experience requirements for licensure within 30 days of receipt of the application.

Additionally, this act adopts the "Interstate Medical Licensure Compact". The purpose of the compact is to strengthen access to health care and streamline the licensure process. The compact sets forth the requirements to be met in order for a state to join the compact. Each member state shall require an applicant for a physician license to obtain or retain a license in the state of principal residence and meet that state's qualifications for licensure or renewal of licensure as well as all other applicable laws. Physicians seeking to practice in member states shall obtain an expedited license with the board of the principal state and register to receive a license with a member state. This license shall authorize the physician to practice medicine in the issuing state. An expedited license shall be terminated if the physician fails to maintain a license in the state of principal licensure.

The compact creates a joint public agency known as the Interstate Medical Licensure Compact Commission. The Commission has powers and duties listed in the compact and shall enforce the provisions and rules of the compact. The compact shall come into effect on the date on which the compact is enacted into law in the seventh member state. Any member state may withdraw from the compact by enacting a statute repealing the same. The compact shall be binding upon member states and shall supersede any conflict with state law.

These provisions are substantially similar to SB 393 (2023).

PHYSICAL THERAPISTS (Sections 334.100, 334.506, and 334.613)

This act modifies provisions relating to the practice of physical therapy. Under this act, physical therapists with a doctorate of physical therapy or 5 years of clinical experience may evaluate and initiate treatment on a patient without a prescription or referral from an approved health care provider. Physical therapists may provide certain educational information, fitness or wellness programs, screenings, and consultations without a prescription or referral regardless of whether a patient is symptomatic.

This act repeals provisions limiting the ability of a physical therapist to examine and treat certain conditions or injuries without a prescription or referral. Under this act, physical therapists shall refer to an approved health care provider patients with certain conditions, including those with conditions beyond the scope of practice of physical therapy, as well as any patient who does not demonstrate measurable or functional improvement within ten visits or 30 days, whichever occurs first.

A physical therapist shall consult with an approved health care provider after ten visits or 30 days, whichever occurs first, before continuing physical therapy if a patient's condition has improved and the physical therapist believes that continued physical therapy is reasonable and necessary. The physical therapist shall provide the provider certain information specified in the act during such consultation and continued physical therapy shall proceed in accordance with input from the provider. The physical therapist shall notify the provider of continuing physical therapy every 10 visits or 30 days unless the provider directs otherwise. This provision shall not apply to physical therapy services performed within a primary or secondary school for individuals under 21.

This act allows the Board of Registration for the Healing Arts to file a complaint against a physical therapist for evaluating or treating a patient in a manner inconsistent with provisions of the act and existing law governing the scope of practice for physical therapists, rather than allowing the Board to file a complaint for practicing or offering to practice independent of a prescription and the direction of certain health care providers listed in current law.

This act is substantially similar to the truly agreed to and finally passed SS/SB 51 (2023), HB 1555 (2022), and provisions in HCS/SB 330 (2021).

PHYSICIAN ASSISTANTS (Sections 334.735 and 334.747)

This act authorizes a collaborative practice arrangement between a physician assistant and a physician to delegate prescriptive authority to physician assistant for Schedule II controlled substances for hospice patients and limits prescriptions for Schedule III narcotics to a 5-day supply without refill, as described in the act.

These provisions are in SS/HB 402 (2023).

PROFESSIONAL COUNSELORS (Sections 337.510 and 337.550)

This act modifies provisions relating to license reciprocity for professional counselors. Currently, those applicants who are licensed in another state or territory may receive a license in this state if they are approved or in good standing with certain professional organizations. This act repeals this provision and implements a provision permitting any person who, for at least one year, has held a valid, current license issued by another state, a branch or unit of the military, a U.S. territory, or the District of Columbia, to apply for an equivalent Missouri license through the Board, subject to procedures and limitations as provided in the act.

This act adopts the "Counseling Interstate Compact". The purpose of the compact is to facilitate the interstate practice of licensed professional counselors with the goal of improving public access to professional counseling services. The compact sets forth the requirements to be met in order for a state to join the compact. Each member state shall require an applicant for a professional counselor license to obtain or retain a license in the home state and meet the home state's qualifications for licensure or renewal of licensure as well as all other applicable state laws.

The compact creates a joint public agency known as the Counseling Compact Commission. The Commission has powers and duties as listed in the compact and shall enforce the provisions and rules of the compact. The Commission shall provide for the development, maintenance, and utilization of a coordinated database and reporting system containing licenses, adverse actions, and investigative information on all licensed individuals in member states.

The compact shall come into effect on the date on which the compact is enacted into law in the tenth member state. Any member state may withdraw from the compact by enacting a statute repealing the same. The compact shall be binding upon member states and shall supersede any conflict with state law.

Provisions of this act are substantially similar to HB 2749 (2022).

SOCIAL WORKERS (Sections 337.615, 337.644, 337.665, 337.1000-337.1075)

This act modifies provisions relating to license reciprocity for clinical social workers, master social workers, and baccalaureate social workers. Currently, those applicants who are licensed in another state or territory may receive a license in this state if they are approved or in good standing with certain professional organizations. This act repeals this provision and implements a provision permitting any person who, for at least one year, has held a valid, current license issued by another state, a branch or unit of the military, a U.S. territory, or the District of Columbia, to apply for an equivalent Missouri license through the State Committee for Social Workers, subject to procedures and limitations as provided in the act.

This act adopts the "Social Work Licensure Compact". The purpose of the compact is to facilitate the interstate practice of licensed regulated social workers with the goal of improving public access to competent social work services. The compact sets forth the requirements to be met in order for a state to join the compact. Each member state shall require an applicant for a social work license to obtain or retain a license in the home state and meet the home state's qualifications for licensure or renewal of licensure as well as all other applicable state laws.

The compact creates a joint public agency known as the Social Work Licensure Compact Commission. The Commission has powers and duties as listed in the compact and shall enforce the provisions and rules of the compact. The Commission shall provide for the development, maintenance, and utilization of a coordinated database and reporting system containing licenses, adverse actions, and investigative information on all licensed individuals in member states.

The compact shall come into effect on the date on which the compact is enacted into law in the seventh member state. Any member state may withdraw from the compact by enacting a statute repealing the same. The compact shall be binding upon member states and shall supersede any conflict with state law.

These provisions are substantially similar to SB 670 (2023).

SARAH HASKINS

HA#1: ADDS PROVISIONS RELATING TO TATTOOING

HA#2: ADDS PROVISIONS RELATING TO APRNS AND ASSISTANT PHYSICIANS

HA#3: ADDS PROVISIONS RELATING TO OPIOID OVERDOSES AND FENTANYL TESTING

HA#4: ADDS LANGUAGE DIRECTING DHSS TO INCLUDE AN ADVANCE HEALTH CARE DIRECTIVE FORM ON ITS WEBSITE; REMOVES A PROVISION RELATING TO VOLUNTARY NONOPIOID DIRECTIVE FORMS AS TRULY AGREED TO AND FINALLY PASSED IN SS/HB 402