S0579.09T

To repeal sections 327.031, 332.311, 334.031, 334.040, 334.080, 334.100, 334.715, 337.021, 337.035, 338.043, 338.057, 338.059, 338.060, 338.065, 338.070, 338.100, 338.120, 338.130, 338.140, 338.220, 338.365, 339.507, 339.525 and 620.140, RSMo 1994, and sections 331.030, 334.046, 334.655, 334.735, 334.740, 334.745 and 337.020, RSMo Supp. 1996, relating to the division of professional registration, and to enact in lieu thereof sixty-nine new sections relating to the same subject, with penalty provisions.

Be it enacted by the General Assembly of the State of Missouri, as follows:

     Section A. Sections 327.031, 332.311, 334.031, 334.040, 334.080, 334.100, 334.715, 337.021, 337.035, 338.043, 338.057, 338.059, 338.060, 338.065, 338.070, 338.100, 338.120, 338.130, 338.140, 338.220, 338.365, 339.507, 339.525 and 620.140, RSMo 1994, and sections 331.030, 334.046, 334.655, 334.735, 334.740, 334.745 and 337.020, RSMo Supp. 1996, are repealed and sixty-nine new sections enacted in lieu thereof, to be known as sections 327.031, 331.030, 332.311, 334.031, 334.040, 334.046, 334.080, 334.100, 334.655, 334.715, 334.735, 334.740, 334.745, 337.020, 337.021, 337.035, 338.013, 338.043, 338.057, 338.059, 338.060, 338.065, 338.070, 338.100, 338.120, 338.130, 338.140, 338.220, 338.365, 339.507, 339.525, 620.140, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36 and 37, to read as follows:

     327.031. 1. The "Missouri Board for Architects, Professional Engineers, and Land Surveyors" shall consist of eleven members: a chairman, who may be either a registered architect [or], a registered professional engineer or a professional land surveyor; three registered architects, who shall constitute the architectural division of the board; three registered professional engineers, who shall constitute its professional engineering division; three registered land surveyors, who shall constitute its land surveying division; and a voting public member.

     2. After receiving his commission and before entering upon the discharge of his official duties, each member of the board shall take, subscribe to and file in the office of the secretary of state the official oath required by the constitution.

     3. The chairman shall be the administrative and executive officer of the board, and it shall be his duty to supervise and expedite the work of the board and its divisions, and, at his election, when a tie exists between the divisions of the board, to break the tie by recording his vote for or against the action upon which the divisions are in disagreement. Each member of the architectural division shall have one vote or action pending before the board; each member of the professional engineering division shall have one vote when voting on action pending before the board; and the three members of the land surveying division shall each have one vote when voting on action before the board. Every motion or proposed action upon which the divisions of the board are tied shall be deemed lost, and the chairman shall so declare, unless he shall elect to break the tie as provided in this section. Six members of the board and two members of each division shall constitute a quorum, respectively, for the transaction of business.

     4. Each division of the board shall, at its first meeting in each even-numbered year, elect one of its members as division chairman for a term of two years. The chairmen of the architectural division and of the professional engineering division so elected shall be vice chairmen of the board, and when the chairman of the board is an architect, the chairman of the architectural division shall be the ranking vice chairman, and when the chairman of the board is a professional engineer, the chairman of the professional engineering division shall be the ranking vice chairman. The chairman of each division shall be the administrative and executive officer of his division, and it shall be his duty to supervise and expedite the work of the division, and, in case of a tie vote on any matter, he shall, at his election, break the tie by his vote. Every motion or question pending before the division upon which a tie exists shall be deemed lost, and so declared by the chairman of the division, unless he shall elect to break such tie by his vote.

     5. Any person appointed to the board, except a public member, shall be a currently registered architect, registered professional engineer, or registered land surveyor in Missouri, as the vacancy on the board may require, who has been a resident of Missouri for at least five years, who has been engaged in active practice as a registered or licensed architect, professional engineer or land surveyor, as the case may be, for at least ten consecutive years immediately preceding his appointment and who is and has been a citizen of the United States for at least five years immediately preceding his appointment. Active service as a faculty member while holding the rank of assistant professor or higher in an accredited school of engineering shall be regarded as active practice of engineering, for the purposes of this chapter. Active service as a faculty member, after meeting the qualifications required by section 327.314, while holding the rank of assistant professor or higher in an accredited school of engineering and teaching land surveying courses shall be regarded an active practice of land surveying for the purposes of this chapter. Active service as a faculty member while holding the rank of assistant professor or higher in an accredited school of architecture shall be regarded as active practice of architecture for the purposes of this chapter; provided, however, that no faculty member of an accredited school of architecture shall be eligible for appointment to the board unless he has had at least three years' experience in the active practice of architecture other than in teaching. The public member shall be at the time of his appointment a citizen of the United States; a resident of this state for a period of one year and a registered voter; a person who is not and never was a member of any profession licensed or regulated under this chapter or the spouse of such person; and a person who does not have and never has had a material, financial interest in either the providing of the professional services regulated by this chapter, or an activity or organization directly related to any profession licensed or regulated under this chapter. All members, including public members, shall be chosen from lists submitted by the director of the department of economic development. The duties of the public member shall not include the determination of the technical requirements to be met for licensure or whether any person meets such technical requirements or of the technical competence or technical judgment of a licensee or a candidate for licensure.

     6. The governor shall appoint the [chairman] chairperson and the other members of the board when a vacancy occurs either by the expiration of a term or otherwise, and each board member shall serve until [his] such member's successor is appointed and has qualified. [The governor shall appoint on September 29, 1986, one land surveyor to serve until September 28, 1988, one land surveyor to serve until September 28, 1989, and one land surveyor to serve until September 28, 1990.] The position of chairperson shall alternate among an architect, a professional engineer and a professional land surveyor. All [other] appointments, except to fill an unexpired term, shall be for terms of four years; but no person shall serve on the board for more than two consecutive four-year terms, and each four-year term shall be deemed to have begun on the date of the expiration of the term of the board member who is being replaced or reappointed, as the case may be. Any appointment to the board which is made when the senate is not in session shall be submitted to the senate for its advice and consent at its next session following the date of the appointment.

     7. In the event that a vacancy is to occur on the board because of the expiration of a term, then ninety days prior to the expiration, or as soon as feasible after a vacancy otherwise occurs, the president of the Missouri Council of Architects if the vacancy to be filled requires the appointment of an architect, the president of the Missouri Society of Professional Engineers if the vacancy to be filled requires the appointment of an engineer, and the president of the Missouri Association of Registered Land Surveyors if the vacancy to be filled requires the appointment of a land surveyor, shall submit to the director of the department of economic development a list of five architects or five professional engineers, or five land surveyors, as the case may require, qualified and willing to fill the vacancy in question, with the recommendation that the governor appoint one of the five persons so listed; and with the list of names so submitted, the president of the appropriate organization above named shall include in a letter of transmittal a description of the method by which the names were chosen. This subsection shall not apply to public member vacancies.

     8. The board may sue and be sued as the Missouri board for architects, professional engineers, and land surveyors, and its members need not be named as parties. Members of the board shall not be personally liable either jointly or severally for any act or acts committed in the performance of their official duties as board members, nor shall any board member be personally liable for any court costs which accrue in any action by or against the board.

     331.030. 1. No person shall engage in the practice of chiropractic without having first secured a chiropractic license as provided in this chapter.

     2. Any person desiring to procure a license authorizing [him] the person to practice chiropractic in this state shall be at least twenty-one years of age and shall make application on the form prescribed by the board. The application shall contain a statement that it is made under oath or affirmation and that representations contained thereon are true and correct to the best knowledge and belief of the person signing the application, subject to the penalties of making a false affidavit or declaration, and shall give the applicant's name, address, age, sex, name of chiropractic schools or colleges which [he] the person attended or of which [he] the person is a graduate, and such other reasonable information as the board may require. The applicant shall give evidence satisfactory to the board of the successful completion of the educational requirements of this chapter, that [he] the applicant is of good moral character, and that the chiropractic school or college of which [he] the applicant is a graduate is teaching chiropractic in accordance with the requirements of this chapter. The board may make a final determination as to whether or not the school from which the applicant graduated is so teaching.

     3. Before a person shall be eligible to sit for [the licensure] a practical examination [in this state], the applicant shall furnish evidence satisfactory to the board that [he] the applicant has received, prior to entering chiropractic college, a minimum of sixty credit hours, leading to a baccalaureate degree, from a preprofessional college, which credit must be in those subjects, hours and course content as may be provided for by the Council on Chiropractic Education or, in the absence of the Council on Chiropractic Education or its provision for such subjects, hours and course content, as adopted by rule of the board. The examination applicant shall also provide evidence satisfactory to the board of having graduated from a chiropractic college having status with the Commission on Accreditation of the Council on Chiropractic Education or its successor. Any senior student in a chiropractic college having status with the Commission on Accreditation on the Council on Chiropractic Education or its successor, may take [the Missouri chiropractic] a practical examination administered or approved by the board under such requirements and conditions as are adopted by the board by rule, but no license shall be issued until all of the requirements for licensure have been met.

     4. Each applicant shall pay upon application an application or examination fee [which is in addition to the license fee which shall be paid prior to the board's issuance of a license to the qualifying applicant]. All moneys collected [under] pursuant to the provisions of this chapter shall be nonrefundable and shall be collected by the director of the division of professional registration who shall transmit it to the department of revenue for deposit in the state treasury to the credit of the chiropractic board fund. Any person failing to pass [the] a practical examination [given] administered or approved by the board may be reexamined upon [payment of the reexamination fee and upon] fulfilling such requirements, including the payment of a reexamination fee, as the board may by rule prescribe.

     5. Every applicant for licensure by examination shall[, prior to the time he makes application to sit for the Missouri chiropractic examination,] have taken and successfully passed all required and optional parts of the written examination given by the National Board of Chiropractic Examiners, including the written clinical competency examination, under such conditions as established by rule of the board, and all applicants for licensure by examination shall successfully pass a practical examination [given] administered or approved by the board and a written examination testing the applicant's knowledge and understanding of the laws and regulations regarding the practice of chiropractic in this state. The board shall issue to each applicant who meets the standards and successful completion of the examinations, as established by rule of the board, a license to practice chiropractic. The board shall not recognize any correspondence work in any chiropractic school or college as credit for meeting the requirements of this chapter.

     6. The board shall issue a license without examination to persons who have been regularly licensed to practice chiropractic in any other state, territory, or the District of Columbia, or in any foreign country, provided that the licensing authority grants equivalent reciprocal licensing to Missouri licensees and provided that the regulations for securing a license in the other jurisdiction are equivalent to those required for licensure in the state of Missouri, when the applicant furnishes satisfactory evidence that [he] the applicant has continuously practiced chiropractic for at least one year immediately preceding [his] the applicant's application to the board and that [he] the applicant is of good moral character, and upon the payment of [a fee equivalent to the sum of the examination fee and the license fee] the reciprocity license fee as established by rule of the board. The board may require an applicant to successfully complete the special purposes examination for chiropractic (SPEC) administered by the National Board of Chiropractic Examiners if the applicant's licensing authority does not grant equivalent reciprocal licensing to Missouri licensees, or if the requirements for securing a license in the other jurisdiction are not equivalent to those required for licensure in the state of Missouri.

     7. Any applicant who has failed any portion of the [Missouri] practical examination administered or approved by the board three times shall be required to return to an accredited chiropractic college for a semester of additional study in the subjects failed, as provided by rule of the board.

     332.311. A duly registered and currently licensed dental hygienist [shall be employed by and work only under the continuous supervision of a] may only practice as a dental hygienist so long as the dental hygienist is employed by a dentist who is duly registered and currently licensed [dentist] in Missouri, or as an employee of such other person or entity approved by the board in accordance with rules promulgated by the board. In accordance with this chapter and the rules promulgated by the board pursuant thereto, a dental hygienist shall only practice under the supervision of a dentist who is duly registered and currently licensed in Missouri.

     334.031. 1. Candidates for licenses as physicians and surgeons shall furnish satisfactory evidence of their good moral character, and their preliminary qualifications, to wit: A certificate of graduation from an accredited high school or its equivalent, and satisfactory evidence of completion of preprofessional education consisting of a minimum of sixty semester hours of college credits in acceptable subjects leading towards the degree of Bachelor of Arts or Bachelor of Science from an accredited college or university. They shall also furnish satisfactory evidence of having attended throughout at least four terms of thirty-two weeks of actual instructions in each term and of having received a diploma from some reputable medical college or osteopathic college that enforces requirements of four terms of thirty-two weeks for actual instruction in each term, including, in addition to class work, such experience in operative and hospital work during the last two years of instruction as is required by the American Medical Association and the American Osteopathic Association before the college is approved and accredited as reputable. Any medical college approved and accredited as reputable by the American Medical Association or the Liaison Committee on Medical Education and any osteopathic college approved and accredited as reputable by the American Osteopathic Association is deemed to have complied with the requirements of this subsection.

     2. In determining the qualifications necessary for licensure as a qualified physician and surgeon, the board, by rule and regulation, may accept the certificate of the National Board of Medical Examiners of the United States, chartered [under] pursuant to the laws of the District of Columbia, of the National Board of Examiners for Osteopathic Physicians and Surgeons chartered [under] pursuant to the laws of the state of Indiana, or of the Licentiate of the Medical Counsel of Canada (LMCC) in lieu of and as equivalent to its own professional examination. Every applicant for a license on the basis of such certificate, upon making application showing necessary qualifications as [above set out] provided in subsection 1 of this section, shall be required to pay the same fee required of applicants to take the examination before the board.

     334.040. 1. Except as provided in section 334.260, all persons desiring to practice as physicians and surgeons in this state shall be examined as to their fitness to engage in such practice by the board. All persons applying for examination shall file a completed application with the board at least eighty days before the date set for examination upon blanks furnished by the board.

     2. The examination shall be sufficient to test the applicant's fitness to practice as a physician and surgeon. The examination shall be conducted in such a manner as to conceal the identity of the applicant until all examinations have been scored. In all such examinations an average score of not less than seventy-five percent is required to pass; provided, however, that the board may require applicants to take the Federation Licensing Examination, also known as FLEX, or the United States Medical Licensing Examination (USMLE). If the FLEX examination is required, a weighted average score of no less than seventy-five percent is required to pass. The passing score of the United States Medical Licensing Examination shall be determined by the board through rule and regulation. The board shall not issue a permanent license as a physician and surgeon or allow the Missouri state board examination to be administered to any applicant who has failed to achieve a passing score within three attempts on licensing examinations administered in one or more states or territories of the United States [or], the District of Columbia or Canada. The steps one, two and three of the United States Medical Licensing Examination [must] shall be taken within a seven-year period with no more than three attempts on any step of the examination. The board may waive the provisions of this section if the applicant is [American Board-certified,] licensed to practice as a physician and surgeon in another state of the United States [or], the District of Columbia or Canada and the applicant has achieved a passing score on a licensing examination administered in a state or territory of the United States or the District of Columbia and no license issued to the applicant has been disciplined in any state or territory of the United States or the District of Columbia. Prior to waiving the provisions of this section, the board may require the applicant to achieve a passing score on one of the following:

     (1) The American Specialty Board's certifying examination in the physician's field of specialization;

     (2) Part II of the FLEX; or

     (3) The Federation portion of the State Medical Board's Special Purpose Examination (SPEX).

     3. If the board waives the provisions of this section, then the license issued to the applicant may be limited or restricted to the applicant's board specialty. Scores from one test administration shall not be combined or averaged with scores from other test administrations to achieve a passing score. The board shall not be permitted to favor any particular school or system of healing.

     334.046. 1. Notwithstanding any other provisions of law to the contrary, the board may grant a temporary license to any otherwise qualified physician to teach or lecture in a program sponsored by an accredited medical school in the state of Missouri or any accredited [teaching] hospital. The temporary license shall not extend beyond twelve months from the date of its issuance and shall terminate automatically. To be granted a temporary license [under] pursuant to this section, a physician [must] shall meet all requirements for permanent licensure in the state of Missouri, including those imposed by rule and regulation; except that, the board may recognize and take into account the credentials of a physician licensed in other states or in foreign countries. Nothing contained in this section shall be construed so as to permit the issuance of a temporary license for locum tenens or other itinerant practices of the healing arts.

     2. Within guidelines established by rule and regulation, the board may authorize an intern or a resident who is otherwise properly enrolled and duly licensed to participate in a program of graduate medical or osteopathic education in an accredited program in a contiguous state, to act as an intern or resident in this state; provided, that such activity is a recognized part of the educational experience offered by that program.

     3. Notwithstanding any other provision of law to the contrary, the board may waive the provisions of sections 334.035 and 334.040, but not section 334.031, and grant a permanent license to practice as a physician and surgeon to the holder of a temporary license issued pursuant to this section. The board shall not grant a waiver pursuant to this section unless and until the applicant has held a temporary license for a minimum of twelve months preceding the date of application and complies with all requirements the board may impose by rule or regulation. An applicant for a permanent license pursuant to this section shall present evidence to the board that the applicant holds a certificate of licensure in any state or territory of the United States, of the District of Columbia or in a foreign country, authorizing the applicant to practice in the same manner and to the same extent as physicians and surgeons are authorized to practice by this chapter.

     4. Before granting a waiver pursuant to this section, the board may require the applicant to achieve a passing score on the federation portion of the state medical board's special purpose examination (SPEX).

     5. If the board grants a waiver pursuant to this section, then the license issued to the applicant may be limited or restricted to the applicant's board specialty.

     6. The board may not grant a waiver pursuant to this section to any applicant who has failed to achieve a passing score within three attempts on licensing examinations administered in one or more states or territories of the United States, the District of Columbia or in any foreign country.

     7. Any waiver granted by the board pursuant to this section, or pursuant to section 334.040, shall be granted in the sole discretion of the board. A refusal by the board to grant such a waiver shall not be appealable to the administrative hearing commission or circuit court.

     334.080. 1. Every person licensed under the provisions of this chapter shall renew his certificate of registration on or before the registration renewal date. The application shall be made under oath on a form furnished by the board. The application shall include, but not be limited to, disclosure of the following: the applicant's full name and his office and residence address and the date and number of his license; all final disciplinary actions taken against the applicant by any professional medical or osteopathic association or society, licensed hospital or medical staff of the hospital, state, territory federal agency or country; and, information concerning the applicant's current physical and mental fitness to practice as a physician and surgeon.

     2. A blank form for application for registration shall be mailed to each person licensed in this state at his last known office or residence address. The failure to receive it does not, however, relieve any person of the duty to register and pay the fee required by the chapter nor exempt him from the penalties provided by this chapter for failure to register.

     3. If a person licensed, certified, or registered by the Board of Healing Arts does not renew such license, certification, or registration for two consecutive renewal periods, such license, certification, or registration shall be deemed void.

     334.100. 1. The board may refuse to issue or renew any certificate of registration or authority, permit or license required pursuant to this chapter for one or any combination of causes stated in subsection 2 of this section. The board shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of [his] the applicant's right to file a complaint with the administrative hearing commission as provided by chapter 621, RSMo. As an alternative to a refusal to issue or renew any certificate, registration or authority, the board may, at its discretion, issue a license which is subject to probation, restriction or limitation to an applicant for licensure for any one or any combination of causes stated in subsection 2 of this section. The board's order of probation, limitation or restriction shall contain a statement of the discipline imposed, the basis therefore, the date such action shall become effective, and a statement that the applicant has thirty days to request in writing a hearing before the administrative hearing commission. If the board issues a probationary, limited or restricted license to an applicant for licensure, either party may file a written petition with the administrative hearing commission within thirty days of the effective date of the probationary, limited or restricted license seeking review of the board's determination. If no written request for a hearing is received by the administrative hearing commission within the thirty-day period, the right to seek review of the board's decision shall be considered as waived.

     2. The board may cause a complaint to be filed with the administrative hearing commission as provided by chapter 621, RSMo, against any holder of any certificate of registration or authority, permit or license required by this chapter or any person who has failed to renew or has surrendered [his] the person's certificate of registration or authority, permit or license for any one or any combination of the following causes:

     (1) Use of any controlled substance, as defined in chapter 195, RSMo, or alcoholic beverage to an extent that such use impairs a person's ability to perform the work of any profession licensed or regulated by this chapter;

     (2) The person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any profession licensed or regulated [under] pursuant to this chapter, for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

     (3) Use of fraud, deception, misrepresentation or bribery in securing any certificate of registration or authority, permit or license issued pursuant to this chapter or in obtaining permission to take any examination given or required pursuant to this chapter;

     (4) Misconduct, fraud, misrepresentation, dishonesty, unethical conduct or unprofessional conduct in the performance of the functions or duties of any profession licensed or regulated by this chapter, including, but not limited to, the following:

     (a) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud, deception or misrepresentation; willfully and continually overcharging or overtreating patients; or charging for visits to the physician's office which did not occur unless the services were contracted for in advance, or for services which were not rendered or documented in the patient's records;

     (b) Attempting, directly or indirectly, by way of intimidation, coercion or deception, to obtain or retain a patient or discourage the use of a second opinion or consultation;

     (c) Willfully and continually performing inappropriate or unnecessary treatment, diagnostic tests or medical or surgical services;

     (d) Delegating professional responsibilities to a person who is not qualified by training, skill, competency, age, experience or licensure to perform [them] such responsibilities;

     (e) Misrepresenting that any disease, ailment or infirmity can be cured by a method, procedure, treatment, medicine or device;

     (f) Performing or prescribing medical services which have been declared by board rule to be of no medical or osteopathic value;

     (g) Final disciplinary action by any professional medical or osteopathic association or society or licensed hospital or medical staff of such hospital in this or any other state or territory, whether agreed to voluntarily or not, and including, but not limited to, any removal, suspension, limitation, or restriction of [his] the person's license or staff or hospital privileges, failure to renew such privileges or license for cause, or other final disciplinary action, if the action was in any way related to unprofessional conduct, professional incompetence, malpractice or any other violation of any provision of this chapter;

     (h) Signing a blank prescription form; or dispensing, prescribing, administering or otherwise distributing any drug, controlled substance or other treatment without sufficient examination, or for other than medically accepted therapeutic or experimental or investigative purposes duly authorized by a state or federal agency, or not in the course of professional practice, or not in good faith to relieve pain and suffering, or not to cure an ailment, physical infirmity or disease, except as authorized in section 334.104;

     (i) Exercising influence within a physician-patient relationship for purposes of engaging a patient in sexual activity;

     (j) Terminating the medical care of a patient without adequate notice or without making other arrangements for the continued care of the patient;

     (k) Failing to furnish details of a patient's medical records to other treating physicians or hospitals upon proper request; or failing to comply with any other law relating to medical records;

     (l) Failure of any applicant or licensee, other than the licensee subject to the investigation, to cooperate with the board during any investigation;

     (m) Failure to comply with any subpoena or subpoena duces tecum from the board or an order of the board;

     (n) Failure to timely pay license renewal fees specified in this chapter;

     (o) Violating a probation agreement with this board or any other licensing agency;

     (p) Failing to inform the board of the physician's current residence and business address;

     (q) Advertising by an applicant or licensee which is false or misleading, or which violates any rule of the board, or which claims without substantiation the positive cure of any disease, or professional superiority to or greater skill than that possessed by any other physician. An applicant or licensee shall also be in violation of this provision if [he] the applicant or licensee has a financial interest in any organization, corporation or association which issues or conducts such advertising;

     (5) Any conduct or practice which is or might be harmful or dangerous to the mental or physical health of a patient or the public; or incompetency, gross negligence or repeated negligence in the performance of the functions or duties of any profession licensed or regulated by this chapter. For the purposes of this subdivision, "repeated negligence" means the failure, on more than one occasion, to use that degree of skill and learning ordinarily used under the same or similar circumstances by the member of the applicant's or licensee's profession;

     (6) Violation of, or attempting to violate, directly or indirectly, or assisting or enabling any person to violate, any provision of this chapter, or of any lawful rule or regulation adopted pursuant to this chapter;

     (7) Impersonation of any person holding a certificate of registration or authority, permit or license or allowing any person to use his or her certificate of registration or authority, permit, license or diploma from any school;

     (8) Revocation, suspension, restriction, modification, limitation, reprimand, warning, censure, probation or other final disciplinary action against the holder of or applicant for a license or other right to practice any profession regulated by this chapter by another state, territory, federal agency or country, whether or not voluntarily agreed to by the licensee or applicant, including, but not limited to, the denial of licensure, surrender of the license, allowing the license to expire or lapse, or discontinuing or limiting the practice of medicine while subject to an investigation or while actually under investigation by any licensing authority, medical facility, branch of the armed forces of the United States of America, insurance company, court, agency of the state or federal government, or employer;

     (9) A person is finally adjudged incapacitated or disabled by a court of competent jurisdiction;

     (10) Assisting or enabling any person to practice or offer to practice any profession licensed or regulated by this chapter who is not registered and currently eligible to practice [under] pursuant to this chapter; or knowingly performing any act which in any way aids, assists, procures, advises, or encourages any person to practice medicine who is not registered and currently eligible to practice [under] pursuant to this chapter. A physician who works in accordance with standing orders or protocols or in accordance with the provisions of section 334.104 shall not be in violation of this subdivision;

     (11) Issuance of a certificate of registration or authority, permit or license based upon a material mistake of fact;

     (12) Failure to display a valid certificate or license if so required by this chapter or any rule promulgated [under] pursuant to this chapter;

     (13) Violation of the drug laws or rules and regulations of this state, any other state or the federal government;

     (14) Knowingly making, or causing to be made, or aiding, or abetting in the making of, a false statement in any birth, death or other certificate or document executed in connection with the practice of [his] the person's profession;

     (15) Soliciting patronage in person or by agents or representatives, or by any other means or manner, under [his] the person's own name or under the name of another person or concern, actual or pretended, in such a manner as to confuse, deceive, or mislead the public as to the need or necessity for or appropriateness of health care services for all patients, or the qualifications of an individual person or persons to diagnose, render, or perform health care services;

     (16) Using, or permitting the use of, [his] the person's name under the designation of "Doctor", "Dr.", "M.D.", or "D.O.", or any similar designation with reference to the commercial exploitation of any goods, wares or merchandise;

     (17) Knowingly making or causing to be made a false statement or misrepresentation of a material fact, with intent to defraud, for payment [under] pursuant to the provisions of chapter 208, RSMo, or chapter 630, RSMo, or for payment from Title XVIII or Title XIX of the federal medicare program;

     (18) Failure or refusal to properly guard against contagious, infectious or communicable diseases or the spread thereof; maintaining an unsanitary office or performing professional services under unsanitary conditions; or failure to report the existence of an unsanitary condition in the office of a physician or in any health care facility to the board, in writing, within thirty days after the discovery thereof;

     (19) Any candidate for licensure or person licensed to practice as a physical therapist, paying or offering to pay a referral fee or practicing or offering to practice professional physical therapy independent of the prescription and direction of a person licensed and registered as a physician and surgeon [under] pursuant to this chapter, as a dentist [under] pursuant to chapter 332, RSMo, or as a podiatrist [under] pursuant to chapter 330, RSMo, whose license is in good standing;

     (20) Any candidate for licensure or person licensed to practice as a physical therapist, treating or attempting to treat ailments or other health conditions of human beings other than by professional physical therapy and as authorized by sections 334.500 to 334.620;

     (21) Any person licensed to practice as a physician or surgeon, requiring, as a condition of the physician-patient relationship, that the patient receive prescribed drugs, devices or other professional services directly from facilities of that physician's office or other entities under that physician's ownership or control. A physician shall provide the patient with a prescription which may be taken to the facility selected by the patient and a physician knowingly failing to disclose to a patient on a form approved by the advisory commission for professional physical therapists as established by section 334.625 which is dated and signed by a patient or guardian acknowledging that the patient or guardian has read and understands that the physician has a pecuniary interest in a physical therapy or rehabilitation service providing prescribed treatment and that the prescribed treatment is available on a competitive basis. This subdivision [does] shall not apply to a referral by one physician to another physician within a group of physicians practicing together;

     (22) A pattern of personal use or consumption of any controlled substance unless it is prescribed, dispensed or administered by another physician who is authorized by law to do so;

     (23) Revocation, suspension, limitation or restriction of any kind whatsoever of any controlled substance authority, whether agreed to voluntarily or not;

     (24) For a physician to operate, conduct, manage, or establish an abortion facility, or for a physician to perform an abortion in an abortion facility, if such facility comes under the definition of an ambulatory surgical center pursuant to sections 197.200 to 197.240, RSMo, and such facility has failed to obtain or renew a license as an ambulatory surgical center;

     (25) Being unable to practice as a physician and surgeon or with a specialty with reasonable skill and safety to patients by reasons of medical or osteopathic incompetency, or because of illness, drunkenness, excessive use of drugs, narcotics, chemicals, or as a result of any mental or physical condition. The following shall apply to this subdivision:

     (a) In enforcing this subdivision the board shall, after a hearing by the board, upon a finding of probable cause, require a physician to submit to a reexamination for the purpose of establishing his or her competency to practice as a physician or surgeon or with a specialty conducted in accordance with rules adopted for this purpose by the board, including rules to allow the examination of the pattern and practice of [said] such physician's or surgeon's professional conduct, or to submit to a mental or physical examination or combination thereof by at least three physicians, one selected by the physician compelled to take the examination, one selected by the board, and one selected by the two physicians so selected who are graduates of a professional school approved and accredited as reputable by the association which has approved and accredited as reputable the professional school from which the licentiate graduated. However, if the physician is a graduate of a medical school not accredited by the American Medical Association or American Osteopathic Association, then each party shall choose any physician who is a graduate of a medical school accredited by the American Medical Association or the American Osteopathic Association[.];

     (b) For the purpose of this subdivision, every physician licensed [under] pursuant to this chapter is deemed to have consented to submit to a mental or physical examination when directed in writing by the board and further to have waived all objections to the admissibility of the examining physician's testimony or examination reports on the ground that [same] the examining physician's testimony or examination is privileged[.];

     (c) In addition to ordering a physical or mental examination to determine competency, the board may, notwithstanding any other law limiting access to medical or other health data, obtain medical data and health records relating to a physician or applicant without the physician's or applicant's consent[.];

     (d) Written notice of the reexamination or the physical or mental examination shall be sent to the physician, by registered mail, addressed to the physician at [his] the physician's last known address. Failure of a physician to designate an examining physician to the board or failure to submit to the examination when directed shall constitute an admission of the allegations against [him] the physician, in which case the board may enter a final order without the presentation of evidence, unless the failure was due to circumstances beyond [his] the physician's control. A physician whose right to practice has been affected under this subdivision shall, at reasonable intervals, be afforded an opportunity to demonstrate that [he] the physician can resume the competent practice as a physician and surgeon with reasonable skill and safety to patients[.];

     (e) In any proceeding [under] pursuant to this subdivision neither the record of proceedings nor the orders entered by the board shall be used against a physician in any other proceeding. Proceedings under this subdivision shall be conducted by the board without the filing of a complaint with the administrative hearing commission[.];

     (f) When the board finds any person unqualified because of any of the grounds set forth in this subdivision, it may enter an order imposing one or more of the disciplinary measures set forth in subsection 4 of this section.

     3. Collaborative practice arrangements, protocols and standing orders shall be in writing and signed and dated by a physician prior to their implementation.

     4. After the filing of such complaint before the administrative hearing commission, the proceedings shall be conducted in accordance with the provisions of chapter 621, RSMo. Upon a finding by the administrative hearing commission that the grounds, provided in subsection 2 of this section, for disciplinary action are met, the board may, singly or in combination, warn, censure or place the person named in the complaint on probation on such terms and conditions as the board deems appropriate for a period not to exceed ten years, or may suspend [his] the person's license, certificate or permit for a period not to exceed three years, or restrict or limit [his] the person's license, certificate or permit for an indefinite period of time, or revoke [his] the person's license, certificate, or permit, or administer a public or private reprimand, or deny [his] the person's application for a license, or permanently withhold issuance of a license or require [him] the person to submit to the care, counseling or treatment of physicians designated by the board at the expense of the individual to be examined, or require [him] the person to attend such continuing educational courses and pass such examinations as the board may direct.

     5. In any order of revocation, the board may provide that the person may not apply for reinstatement of [his] the person's license for a period of time ranging from two to seven years following the date of the order of revocation. All stay orders shall toll this time period.

     6. Before restoring to good standing a license, certificate or permit issued [under] pursuant to this chapter which has been in a revoked, suspended or inactive state for any cause for more than two years, the board may require the applicant to attend such continuing medical education courses and pass such examinations as the board may direct.

     7. In any investigation, hearing or other proceeding to determine a licensee's or applicant's fitness to practice, any record relating to any patient of the licensee or applicant shall be discoverable by the board and admissible into evidence, regardless of any statutory or common law privilege which such licensee, applicant, record custodian or patient might otherwise invoke. In addition, no such licensee, applicant, or record custodian may withhold records or testimony bearing upon a licensee's or applicant's fitness to practice on the ground of privilege between such licensee, applicant or record custodian and a patient.

     334.655. 1. A candidate for licensure to practice as a physical therapist assistant shall be at least nineteen years of age. A candidate shall furnish evidence of the person's good moral character and of the person's educational qualifications. The educational requirements for licensure as a physical therapist assistant are:

     (1) A certificate of graduation from an accredited high school or its equivalent; and

     (2) Satisfactory evidence of completion of an associate degree program of physical therapy education accredited by the commission on accreditation of physical therapy education.

     2. Persons desiring to practice as a physical therapist assistant in this state shall appear before the board at such time and place as the board may direct and be examined as to the person's fitness to engage in such practice. Applications for examination shall be in writing, on a form furnished by the board and shall include evidence satisfactory to the board that the applicant possesses the qualifications provided in subsection 1 of this section. Each application shall contain a statement that the statement is made under oath of affirmation and that its representations are true and correct to the best knowledge and belief of the person signing the statement, subject to the penalties of making a false affidavit or declaration.

     3. The examination of qualified candidates for licensure to practice as physical therapist assistants shall embrace a written examination and which shall cover the curriculum taught in accredited associate degree programs of physical therapy assistant education. Such examination shall be sufficient to test the qualification of the candidates as practitioners. The examination shall be given by the board at least once each year. The examination given at any particular time shall be the same for all candidates and the same curriculum shall be included and the same questions shall be asked.

     4. The examination shall include, as related to the human body, the subjects of anatomy, kinesiology, pathology, physiology, psychology, physical therapy theory and procedures as related to medicine and such other subjects, including medical ethics, as the board deems useful to test the fitness of the candidate to practice as a physical therapist assistant.

     5. Examination grades or scores shall be preserved by the board subject to public inspection. Examination papers retained by the board shall be subject to public inspection for a period of three years and thereafter may be destroyed.

     6. The board shall license without examination any legally qualified person who is a resident of this state and who was actively engaged in practice as a physical therapist assistant on August 28, 1993. The board may license such person pursuant to this subsection until [August 28, 1997] ninety days after rules developed by the state board of registration for the healing arts regarding physical therapist assistant licensing become effective.

     7. A candidate to practice as a physical therapist assistant who does not meet the educational qualifications may submit to the board an application for examination if such person can furnish written evidence to the board that the person has been employed in this state for at least three of the last five years under the supervision of a licensed physical therapist and such person possesses the knowledge and training equivalent to that obtained in an accredited school. The board may license such persons pursuant to this subsection until [August 28, 1997] ninety days after rules developed by the state board of healing arts regarding physical therapist assistant licensing become effective.

     334.715. 1. The board may refuse to register any applicant or may suspend, revoke, or refuse to renew the registration of any registrant [if it finds that the applicant or registrant has:

     (1) Secured or attempted to secure registration by fraud or deceit; or

     (2)] for any one or any combination of the causes provided in section 334.100, or if the applicant or registrant:

     (1) Violated or conspired to violate any provision of sections 334.700 to 334.725 or any provision of any rule promulgated pursuant to sections 334.700 to 334.725; or

     [(3) Been convicted of a felony or misdemeanor in connection with the practice of the profession; or

     (4)] (2) Has been found guilty of unethical conduct as defined in the ethical standards of the National Athletic Trainers Association or the National Athletic Trainers Association Board of Certification as adopted and published by the committee and the board and filed with the secretary of state.

     2. Upon receipt of a written application made in the form and manner prescribed by the board, the board may reinstate any registration which has expired, been suspended or been revoked or may issue any registration which has been denied; provided, that no application for reinstatement or issuance of registration shall be considered until at least six months have elapsed from the date of denial, expiration, suspension, or revocation when the registration to be reinstated or issued was denied issuance or renewal or was suspended or revoked for one of the causes listed in subsection 1 of this section.

     334.735. As used in sections 334.735 to 334.748, the following terms mean:

     (1) "Applicant", any individual who seeks to become a registered health care professional [in one of the following health care professions: occupational therapist or] as a physician assistant;

     (2) "Certificate of registration", a document issued to an applicant by the department acknowledging that the applicant has been entered on the register of individuals successfully completing the requirements of a certifying entity, and is entitled to practice in the health care profession for which the certificate applies;

     (3) "Certification" or "registration", a process by a certifying entity that grants recognition to applicants meeting predetermined qualifications specified by [that] such certifying entity;

     (4) "Certifying entity", the nongovernmental agency or association which certifies or registers individuals who have completed academic and training requirements;

     (5) "Department", the department of economic development or a designated agency thereof;

     (6) ["Occupational therapist", one engaged in the use of purposeful activity with individuals who are limited in their ability to function by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, poverty and cultural differences or the aging process in order to maximize independence, prevent disability and maintain health. The practice encompasses evaluation, treatment and consultation. Specific occupational therapy services include: teaching daily living skills; developing perceptual motor skills and sensory integrative functioning; developing vocational and prevocational capacities; designing, fabricating, or applying selected orthotic and prosthetic devices or selective adaptive equipment; specifically designed manual, creative, prevocational activities and exercises to enhance functional performance; administering and interpreting tests such as manual muscle and range of motion; and adaptive environments for the handicapped. The services may be provided individually, in groups, or through social systems;

     (7)] "Physician assistant", a person who has graduated from a physician assistant program accredited by the American Medical Association's Committee on Allied Health Education and Accreditation or by its successor agency, who has passed the certifying examination administered by the National Commission on Certification of Physician Assistants and has active certification by the National Commission on Certification of Physician Assistants who provides health care services delegated by a licensed physician. A person who has been employed as a physician assistant for three years prior to August 28, 1989, who has passed the National Commission on Certification of Physicians Assistants examination, and has active certification of the National Commission on Certification of Physician Assistants shall be eligible for registration;

     (a) The scope of practice of a physician assistant shall consist only of the following services and procedures:

     a. Taking patient histories;

     b. Performing physical examinations of a patient;

     c. Performing or assisting in the performance of routine office laboratory and patient screening procedures;

     d. Performing routine therapeutic procedures;

     e. Recording diagnostic impressions and evaluating situations calling for attention of a physician to institute treatment procedures;

     f. Instructing and counseling patients regarding mental and physical health using procedures reviewed and approved by a licensed physician;

     g. Assisting the supervising physician in institutional settings, including reviewing of treatment plans, ordering of tests and diagnostic laboratory and radiological services, and ordering of therapies, using procedures reviewed and approved by a licensed physician;

     h. Assisting in surgery;

     i. Performing such other tasks not prohibited by law under the supervision of a licensed physician as the physician's assistant has been trained and is proficient to perform;

     (b) Physician assistants shall not prescribe nor dispense any drug, medicine, device or therapy independent of consultation with the supervising physician, nor prescribe lenses, prisms or contact lenses for the aid, relief or correction of vision or the measurement of visual power or visual efficiency of the human eye, nor administer or monitor general or regional block anesthesia during diagnostic tests, surgery or obstetric procedures;

     (c) A physician assistant shall clearly identify himself or herself as a physician assistant and shall not use or permit to be used in the physician assistant's behalf the terms "doctor", "Dr." or "doc" nor hold himself or herself out in any way to be a physician or surgeon. No physician assistant shall practice or attempt to practice without physician supervision or in any location where the supervising physician is not immediately available for consultation, assistance and intervention, except in an emergency situation, nor shall any physician assistant bill a patient independently or directly for any services or procedure by the physician assistant;

     (d) The physician assistant shall be a person who is a graduate of a physician assistant program accredited by the [Commission for the Accreditation of Allied Health Education Programs] American Medical Association's Committee on Allied Health Education and Accreditation or its successor or is certified by a national nongovernmental agency or association, who has passed the National Commission on Certification of Physician Assistants examination and has [been certified] active certification by the National Commission on Certification of Physician Assistants or its successor. A person who has been employed as a physician assistant for three years prior to August 28, 1989, and has passed the National Commission on Certification of Physician Assistants examination shall be deemed to have met the academic requirements necessary for registration or certification;

     (e) For purposes of this section, the registration of physician assistants shall take place within processes established by the state board of registration for the healing arts through rule and regulation. The board of healing arts is authorized to establish rules and regulations establishing registration and renewal procedures, supervision, supervision agreements, fees, and addressing such other matters as are necessary to protect the public and discipline the profession. An application for registration may be denied or the registration of a physician assistant may be suspended or revoked by the board in the same manner and for violation of the standards as set forth by section 334.100, or such other standards of conduct set by the board by rule or regulation. Persons licensed pursuant to the provisions of chapter 335, RSMo, shall not be required to register as physicians assistants;

     [(8)] (7) "Recognition", the formal process of becoming a certifying entity as required by the provisions of sections 334.735 to 334.743;

     [(9)] (8) "Supervision", control exercised over a physician assistant working within the same office facility of the supervising physician except a physician assistant may make follow-up patient examinations in hospitals, nursing homes and correctional facilities, each such examination being reviewed, approved and signed by the supervising physician. The board shall develop rules for the proximity of practice between the physician assistant and the supervising physician and documentation of joint review of the physician assistant activity by the supervising physician and the physician assistant.

     334.740. 1. No person shall hold himself or herself out to the public by any title or description including the words [registered occupational therapist,] registered physician assistant or physician assistant as defined in section 334.735 unless the person is duly registered [under] pursuant to the provisions of sections 334.735 to 334.748, if for that profession a certifying entity has been recognized by the department.

     2. Nothing in sections 334.735 to 334.748 shall be construed as prohibiting any individual whether registered pursuant to sections 334.735 to 334.748 or not from providing the services of [occupational therapist or] physician assistant.

     3. [Nothing in sections 334.735 to 334.748 shall be construed as prohibiting credentialed assistants from providing services under the supervision of the same health care professional who is registered in accordance with sections 334.735 to 334.748.

     4.] Any person found guilty of violating any provision of subsections 1 [to 3] and 2 of this section is guilty of an infraction and upon conviction thereof shall be punished as provided by law. For purposes of this subsection, the maximum fine for a violation hereunder shall be one thousand dollars.

     334.745. 1. All fees payable [under] pursuant to the provisions of sections 334.735 to 334.748 shall be collected by the division of professional registration, which shall transmit them to the department of revenue for deposit in the state treasury to the credit of the [designated fund: (1) for physician assistants, to the "Board of Registration for the Healing Arts Fund"; and (2) for occupational therapists, to the "Missouri Health Care Providers Fund", which is hereby created.] board of registration for the healing arts fund.

     2. Upon appropriation by the general assembly, the money in the [designated funds] fund shall be used to administer the provisions of sections 334.735 to 334.749.

     [2. The provisions of section 33.080, RSMo, to the contrary notwithstanding, money in the Missouri health care providers fund shall not be transferred and placed to the credit of general revenue until the amount in the fund at the end of the biennium exceeds two times the amount of appropriation from the board's funds for the preceding fiscal year, or if the board requires by rule permit renewal less frequently than yearly, then three times the appropriation from the board's funds for the preceding fiscal year. The amount, if any, in the fund which shall lapse is that amount in the fund which exceeds the appropriate multiple of the appropriation from the board's funds for the preceding fiscal year.]

     337.020. 1. Each person desiring to obtain a license as a psychologist shall make application to the committee upon such forms and in such manner as may be prescribed by the committee and shall pay the required application fee. The application fee shall not be refundable. Each application shall contain a statement that it is made under oath or affirmation and that its representations are true and correct to the best knowledge and belief of the person signing [same] the application, subject to the penalties of making a false affidavit or declaration.

     2. Each applicant shall submit evidence satisfactory to the committee that [he] the applicant is at least twenty-one years of age, is of good moral character, and meets the appropriate educational and supervised training requirements as set forth in either section 337.021 or 337.025, or is qualified for licensure without examination pursuant to section 337.029. In determining the acceptability of the applicant's qualifications, the committee may require evidence that it deems reasonable and proper, in accordance with law, and the applicant shall furnish the evidence in the manner required by the committee.

     3. The committee with assistance from the division shall license and register as a psychologist any applicant who, in addition to having fulfilled the other requirements of sections 337.010 to 337.090, passes the Examination for Professional Practice in Psychology or such other examination in psychology which may be adopted by the committee, except that an applicant fulfilling the requirement of section 337.029 shall be licensed without examination.

     4. Written and oral examinations [under] pursuant to sections 337.010 to 337.090 shall be administered by the committee at least twice each year to those applicants who meet the other requirements for licensure. The committee shall examine in the areas of professional knowledge, techniques and applications, research and its interpretation, professional affairs, ethics, and Missouri law and regulations governing the practice of psychology. The committee may use, in whole or in part, the Examination for Professional Practice in Psychology national examination in psychology or such other national examination in psychology which may be available.

     5. If an applicant fails any examination, [he] the applicant shall be permitted to take a subsequent examination, upon the payment of an additional reexamination fee. This reexamination fee shall not be refundable.

     [6. The provisions of this chapter shall not apply to hypnotherapists.]

     337.021. 1. The provisions of this section shall govern, except as provided in subsection 3 of this section, the education and experience requirements for initial licensure as a psychologist for the following persons:

     (1) A person who has completed a graduate program which is primarily psychological in nature prior to August 28, 1990; or

     (2) A person who is matriculated in a graduate program which is primarily psychological in nature prior to August 28, 1990; provided that, such person who does not complete all requirements for initial licensure prior to August 28, 1996, except as provided in subsection 5 of this section, shall be governed by the licensure requirements of section 337.025.

     2. Each applicant shall submit evidence satisfactory to the committee that [he] the applicant either:

     (1) Has received a doctoral degree, based upon a program of studies from a recognized educational institution the contents of which were primarily psychological, as defined by rule, and who has had at least one year of satisfactory supervised professional experience in the general field of psychology, as defined by rule; or

     (2) Received a master's degree, based upon a program of studies from a recognized educational institution the contents of which were primarily psychological, as defined by rule, and who has had at least three years of satisfactory professional experience in the general field of psychology, as defined by rule.

     3. Notwithstanding the provisions of subsection 1 of this section, an applicant who has received a doctoral degree from a graduate program which is primarily psychological in nature prior to August 28, 1990, may elect at [his] the applicant's option to have [his] the applicant's application and licensure evaluated [under] pursuant to the provisions of either section 337.021 or 337.025.

     4. The rules referred to in subsection 2 of this section shall be those rules as previously promulgated by the department pursuant to the provisions of sections 337.020 and 337.050 as were in force and effect on August 28, 1989.

     5. Notwithstanding any provision of section 337.025 or this section to the contrary, any person who qualifies for initial licensure pursuant to subdivision (2) of subsection 2 of this section that has taken the Missouri licensing examination but has not received a passing score on the licensing examination before August 28, 1996, shall be allowed the same amount of attempts, within the same allotted time, to pass such examination as a person who meets the requirements for licensure pursuant to subdivision (1) of subsection 2 of this section.

     337.035. 1. The committee may refuse to issue any certificate of registration or authority, permit or license required pursuant to this chapter for one or any combination of causes stated in subsection 2 of this section. The committee shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of [his] the applicant's right to file a complaint with the administrative hearing commission as provided by chapter 621, RSMo.

     2. The committee may cause a complaint to be filed with the administrative hearing commission as provided by chapter 621, RSMo, against any holder of any certificate of registration or authority, permit or license required by this chapter or any person who has failed to renew or has surrendered [his] the person's certificate of registration or authority, permit or license for any one or any combination of the following causes:

     (1) Use of any controlled substance, as defined in chapter 195, RSMo, or alcoholic beverage to an extent that such use impairs a person's ability to perform the work of any profession licensed or regulated by this chapter;

     (2) The person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any profession licensed or regulated under this chapter, for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

     (3) Use of fraud, deception, misrepresentation or bribery in securing any certificate of registration or authority, permit or license issued pursuant to this chapter or in obtaining permission to take any examination given or required pursuant to this chapter;

     (4) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud, deception or misrepresentation;

     (5) Incompetency, misconduct, gross negligence, fraud, misrepresentation or dishonesty in the performance of the functions or duties of any profession licensed or regulated by this chapter;

     (6) Violation of, or assisting or enabling any person to violate, any provision of this chapter, or of any lawful rule or regulation adopted pursuant to this chapter;

     (7) Impersonation of any person holding a certificate of registration or authority, permit or license or allowing any person to use his or her certificate of registration or authority, permit, license or diploma from any school;

     (8) Disciplinary action against the holder of a license or other right to practice any profession regulated by this chapter granted by another state, territory, federal agency or country upon grounds for which revocation or suspension is authorized in this state;

     (9) A person is finally adjudged insane or incapacitated by a court of competent jurisdiction;

     (10) Assisting or enabling any person to practice or offer to practice any profession licensed or regulated by this chapter who is not registered and currently eligible to practice [under] as provided this chapter;

     (11) Issuance of a certificate of registration or authority, permit or license based upon a material mistake of fact;

     (12) Failure to display a valid certificate or license if so required by this chapter or any rule promulgated [hereunder] pursuant to this chapter;

     (13) Violation of any professional trust or confidence;

     (14) Use of any advertisement or solicitation which is false, misleading or deceptive to the general public or persons to whom the advertisement or solicitation is primarily directed;

     (15) Being guilty of unethical conduct as defined in "Ethical Rules of Conduct" as adopted by the committee and filed with the secretary of state.

     3. After the filing of such complaint, the proceedings shall be conducted in accordance with the provisions of chapter 621, RSMo. Upon a finding by the administrative hearing commission that the grounds, provided in subsection 2, for disciplinary action are met, the committee may, singly or in combination, censure or place the person named in the complaint on probation on such terms and conditions as the department deems appropriate for a period not to exceed five years, or may suspend, for a period not to exceed three years, or revoke the license, certificate, or permit.

     4. An interested third party may file a complaint or appear or present evidence relative to such complaint or another complaint filed pursuant to this section. For purposes of this section, an interested third party includes a parent or guardian of a person who received treatment by a psychologist or any person who is related within the second degree of consanguinity or affinity and who is financially responsible for the payment of such treatment.

     338.013. 1. Any person desiring to assist a pharmacist in the practice of pharmacy as defined in this chapter shall apply to the board of pharmacy for registration as a pharmacy technician. Such applicant shall not have engaged in conduct or behavior determined to be grounds for discipline pursuant to this chapter. Such applicant shall forward to the board the appropriate fee and written application on a form provided by the board. Such registration shall be the sole authorization permitted to allow persons to assist licensed pharmacists in the practice of pharmacy as defined in this chapter.

     2. If an applicant has submitted the required fee and an application for registration to the board of pharmacy, the applicant for registration as a pharmacy technician may assist a licensed pharmacist in the practice of pharmacy as defined in this chapter for a period of up to ninety days prior to the issuance of a certificate of registration. The applicant shall keep a copy of the submitted application on the premises where the applicant is employed.

     3. A certificate of registration issued by the board shall be conspicuously displayed in the pharmacy or place of business where the registrant is employed.

     4. Every pharmacy technician who desires to continue to be registered as provided in this section shall, within thirty days before the registration expiration date, file an application for the renewal, accompanied by the fee prescribed by the board. No registration as provided in this section shall be valid if the registration has expired and has not been renewed as provided in this subsection.

     5. The board shall maintain an employment disqualification list of the names of all pharmacy technicians who have been adjudicated and found guilty, or has entered a plea of guilty or nolo contendere to violation of any state, territory or federal drug law, been found guilty, pled guilty or nolo contendere to any felony or has violated any provision of subdivision (2), (3), (4), (6), (7), (11), (12) or (15) of subsection 2 of section 338.055.

     6. After an investigation and a determination has been made to place a person's name on the employment disqualification list, the board shall notify such person in writing mailed to the person's last known address that:

     (1) An allegation has been made against the person, the substance of the allegation and that an investigation has been conducted which tends to substantiate the allegation;

     (2) Such person's name will be included in the employment disqualification list of the board;

     (3) The consequences to the person of being listed and the length of time the person's name will be on the list; and

     (4) The person's rights and the procedure to challenge the inclusion of the person's name on the disqualification list.

     7. If no reply has been received by the board within thirty days after the board mailed the notice, the board may include the name of such person on such disqualification list. The length of time a person's name shall remain on the disqualification list shall be determined by the board. The board may, also, provide for alternative sanctions, including, but not limited to, conditional employment based on a requirement that the person submit certain documentation within a certain period of time. Any person who receives notice that the board intends to place the person's name on the employment disqualification list may file an appeal with the administrative hearing commission as provided in chapter 621, RSMo.

     8. No hospital or licensed pharmacy shall knowingly employ any person whose name appears on the employee disqualification list. Compliance with the foregoing sentence may be interposed as an affirmative defense by the employer.

     338.043. 1. Notwithstanding any provision of law to the contrary, the board of pharmacy may grant a temporary license [to any graduate of a school or college of pharmacy whose requirements for graduation are satisfactory to and approved by the board of pharmacy and who holds a license to practice pharmacy by examination in another state and] to an applicant who meets such [other] requirements as the board may prescribe by rule and regulation.

     2. The temporary license provided in subsection 1 of this section shall limit the right of the licensee to practice only in locations approved by the board under the supervision of a pharmacist licensed to practice pharmacy in this state.

     3. The license shall be renewable at the discretion of and with the approval of the board of pharmacy. A temporary license fee shall accompany the original application for a temporary license and a similar amount shall be paid in the event the temporary license is renewed.

     338.057. The [department of economic development] board of pharmacy shall publish a list of drug products for which substitution as provided in section 338.056 shall not be permitted. The list of drug products to be included on this list shall be based upon a joint determination made by the department of health, the state board of registration for the healing arts, and the state board of pharmacy. The [department of economic development] board of pharmacy shall publish the list not less often than semiannually, and shall publish amendments to the list as required.

     338.059. 1. It shall be the duty of a licensed pharmacist or a physician to affix or have affixed by someone under [his] the pharmacist's or physician's supervision a label to each and every container provided to a consumer in which is placed any prescription drug upon which is typed or written the following information:

     (1) The date [of] the prescription is filled;

     (2) The sequential number;

     (3) The patient's name;

     (4) The prescriber's directions for usage;

     (5) The [prescribing doctor's] prescriber's name;

     (6) The name and address of the pharmacy;

     (7) The exact name and dosage of the drug dispensed;

     (8) There may be one line under the [words written] information provided in subdivisions (1) to (7) of this subsection stating "Refill" with a blank line or squares following[; immediately under the word "Refill"] or the words "No Refill";

     (9) When a generic substitution is dispensed, the name of the manufacturer or an abbreviation thereof shall appear on the label or in the pharmacist's records as required in section 338.100.

     2. The label of any drug which is sold at wholesale in this state and which requires a prescription to be dispensed at retail shall contain the name of the manufacturer, expiration date, if applicable, batch or lot number and national drug code.

     338.060. 1. Every licensed pharmacist or permit holder who desires to continue in the practice of this profession shall, within thirty days before the license expiration date, file an application for the renewal, which application shall be accompanied by the fee [herein] prescribed in sections 338.010 to 338.198.

     2. If any pharmacist [shall fail] fails, for a period of sixty days after the expiration of [his] the pharmacist's license, to make application to the board for its renewal, [his] the pharmacist's name shall be [erased] removed from the register of licensed pharmacists, and such person, in order to again become registered as a licensed pharmacist, shall be required to pay all delinquent fees. Any pharmacist who fails to renew [his] the pharmacist's license within two years of its expiration and then desires to be reregistered shall be treated in the same manner as a person who has never been licensed. Any registered pharmacist whose certificate of registration has expired while [he] the pharmacist has been engaged in active duty with the United States Army, United States Navy, United States Air Force, the Marine Corps, Coast Guard, or any other branch of the armed services or the state militia called into the service or training of the United States of America, or in training or education under the supervision of the United States preliminary to induction into the military services may have [his] the pharmacist's certificate of registration renewed without paying any lapse, renewal or registration fee or without passing any examination, if within one year after the termination of such service, training or education, other than by dishonorable discharge, [he] the pharmacist furnishes the board with an affidavit to the effect that [he] the pharmacist has been so engaged and that [his] the pharmacist's service, training or education has [been so] terminated.

     3. Except as provided in subsection 5 of this section, when applying for a renewal of the license as required by the provisions of this section, each licensed pharmacist shall submit proof of the completion of at least [ten] fifteen hours of board-approved continuing education courses during the twelve-month period immediately preceding the date of the application for renewal of the license. The board shall prescribe the form to be completed. No license shall be renewed unless the holder thereof has complied with the provisions of this subsection.

     4. The proof of completion of such continuing education shall be in such form as the board may require. The approved courses shall include those offered by correspondence, but the board shall approve all courses of instruction which may be used to satisfy the education requirements of subsection 3 of this section.

     5. Each licensed pharmacist may, instead of submitting proof of the completion of the required continuing education courses, apply for an inactive license at the time [he] the pharmacist makes application for the renewal of [his] the pharmacist's license and pay the required renewal fee. An inactive license shall then be issued, and may be renewed annually. While the inactive license is in effect the pharmacist shall not practice pharmacy. The inactive license may be changed to a regular license without other examination whenever the pharmacist submits proof of the completion of continuing education courses for the total amount of such courses not completed since [he] the pharmacist was last licensed on an active basis.

     338.065. 1. After August 28, 1990, at such time as the final trial proceedings are concluded whereby a [pharmacist] licensee or registrant has been adjudicated and found guilty, or has entered a plea of guilty or nolo contendere, in a felony prosecution [under] pursuant to the laws of the state of Missouri, the laws of any other state, territory or the laws of the United States of America for any offense reasonably related to the qualifications, functions or duties of a [pharmacist] licensee or registrant pursuant to this chapter or any felony offense, an essential element of which is fraud, dishonesty or an act of violence, or for any felony offense involving moral turpitude, whether or not sentence is imposed, the board of pharmacy may hold a disciplinary hearing to singly or in combination censure or place the pharmacist named in the complaint on probation on such terms and conditions as the board deems appropriate for a period not to exceed five years, or may suspend, for a period not to exceed three years, or revoke the license, certificate, registration or permit.

     2. Anyone who has been revoked or denied a license, permit or certificate to practice in another state may automatically be denied a license or permit to practice in this state. However, the board of pharmacy may establish other qualifications by which a person may ultimately be qualified and licensed to practice in Missouri.

     338.070. 1. The board of pharmacy shall set the amount of the fees which this chapter authorizes and requires by rules and regulations promulgated pursuant to [section 536.021] chapter 536, RSMo. The fees shall be set at a level to produce revenue which shall not substantially exceed the cost and expense of administering this chapter. All fees shall be paid before an applicant may be admitted to examination or his or her name placed upon the register of pharmacists, or before any license or permit, or any renewal thereof, is issued by the board.

     2. All fees payable [under] pursuant to the provisions of this chapter shall be collected by the division of professional registration and transmitted to the department of revenue for deposit in the state treasury to the credit of the fund to be known as the "Board of Pharmacy Fund".

     3. The provisions of section 33.080, RSMo, to the contrary notwithstanding, money in this fund shall not be transferred and placed to the credit of general revenue until the amount in the fund at the end of the biennium exceeds two times the amount of the appropriation from the board's funds for the preceding fiscal year or, if the board requires by rule permit renewal less frequently than yearly, then three times the appropriation from the board's funds for the preceding fiscal year. The amount, if any, in the fund which shall lapse is that amount in the fund which exceeds the appropriate multiple of the appropriations from the board's funds for the preceding fiscal year.

     338.100. 1. Every permit holder of a licensed pharmacy shall cause to be kept in a uniform fashion consistent with this section a suitable file in which shall be preserved, for a period of not less than five years, the original or order of each drug which has been compounded or dispensed at such pharmacy, numbering, dating and filing them in the order in which they are compounded or dispensed, and shall produce the same in court or before any grand jury whenever lawfully required. A licensed pharmacy may maintain its prescription file on readable microfilm for records maintained over three years. After September, 1999, a licensed pharmacy may preserve prescription files on microfilm or by electronic media storage for records maintained over three years. The pharmacist in charge shall be responsible for complying with the permit holder's record keeping system in compliance with this section. Records maintained by a pharmacy that contain medical or drug information on patients or their care shall be considered as confidential and shall only be released according to standards provided by the board. Upon request, the pharmacist in charge of such pharmacy shall furnish to the prescriber, and may[, except when otherwise instructed by the prescriber,] furnish to the person for whom such prescription was compounded or dispensed, a true and correct copy of the original prescription[, and]. The file of original prescriptions and other confidential records, as defined by law, shall at all times be open for inspection by [duly authorized officers of the law] board of pharmacy representatives.

     2. An institutional pharmacy located in a hospital shall be responsible for maintaining records of the transactions of the pharmacy as required by federal and state laws and as necessary to maintain adequate control and accountability of all drugs. This shall include a system of controls and records for the requisitioning and dispensing of pharmaceutical supplies where applicable to patients, nursing care units and to other departments or services [on] of the institution. Inspection performed pursuant to this subsection shall be consistent with the provisions of section 197.100, RSMo.

     338.120. Annually the board of pharmacy shall organize by the election of a president and [secretary] vice president who shall hold their offices for one year and until their successors shall have been elected and qualified.

     338.130. 1. [The secretary, if a member of the board, shall receive such salary as is prescribed by the board of pharmacy not to exceed the sum of five hundred dollars monthly and his necessary expenses while engaged in the performance of his official duties.] Each member of the board shall receive as compensation an amount set by the board not to exceed fifty dollars for each day devoted to the affairs of the board, and shall be entitled to reimbursement of [his] the member's expenses necessarily incurred in the discharge of [his] the member's official duties.

     2. The board may employ such board personnel, as defined in subdivision (4) of subsection [16] 15 of section 620.010, RSMo, as it deems necessary to carry out the provisions of this chapter. The compensation and expenses of such personnel and all expenses incurred by the board in carrying into execution the provisions of this chapter, shall be paid out of the board of pharmacy fund upon a warrant on the state treasurer.

     338.140. 1. The board of pharmacy shall have a common seal, and shall have power to adopt such rules and bylaws not inconsistent with law as may be necessary for the regulation of its proceedings and for the discharge of the duties imposed [under] pursuant to sections 338.010 to [338.190] 338.198, and shall have power to employ an attorney to conduct prosecutions or to assist in the conduct of prosecutions [under] pursuant to sections 338.010 to [338.190] 338.198.

     2. The board shall keep a record of its proceedings.

     3. The board of pharmacy shall make annually to the governor and, upon written request, to persons licensed [under] pursuant to the provisions of this chapter a written report of its proceedings.

     4. The board of pharmacy shall appoint an advisory committee composed of five members, one of whom shall be a representative of pharmacy but who shall not be a member of the pharmacy board, three of whom shall be representatives of wholesale drug distributors as defined in section 338.330, and one of whom shall be a representative of drug manufacturers. The committee shall review and make recommendations to the board on the merit of all rules and regulations dealing with pharmacy distributors, wholesale drug distributors and drug manufacturers which are proposed by the board.

     5. A majority of the board shall constitute a quorum for the transaction of business.

     6. Notwithstanding any other provisions of law to the contrary, the board may issue letters of reprimand, censure or warning to any holder of a license or registration required pursuant to this chapter for any violations that could result in disciplinary action as defined in section 338.055.

     338.220. 1. It shall be unlawful for any person, copartnership, association [or], corporation or any other business entity to open, establish, operate or maintain any pharmacy, as defined by statute without first obtaining a permit or license to do so from the Missouri board of pharmacy. The following classes of pharmacy permits or licenses are hereby established:

     (1) Class A: Community/ambulatory;

     (2) Class B: Hospital outpatient pharmacy;

     (3) Class C: Long-term care;

     (4) Class D: Home health care;

     (5) Class E: Radiopharmaceutical;

     (6) Class F: Renal dialysis;

     (7) Class G: Medical gas.

     2. Application for such permit or license shall be made upon a form furnished to the applicant; shall contain a statement that it is made under oath or affirmation and that its representations are true and correct to the best knowledge and belief of the person signing same, subject to the penalties of making a false affidavit or declaration; and shall be accompanied by a permit or license fee. The permit or license issued shall be renewable upon payment of a renewal fee. Separate applications shall be made and separate permits or licenses required for each pharmacy opened, established, operated or maintained by the same owner.

     3. All permits, licenses or renewal fees collected [under] pursuant to the provisions of sections 338.210 to 338.370 shall be deposited in the state treasury to the credit of the Missouri board of pharmacy fund, to be used by the Missouri board of pharmacy in the enforcement of the provisions of sections 338.210 to 338.370, when appropriated for that purpose by the general assembly.

     338.365. 1. Upon proper application by the board of pharmacy, a court of competent jurisdiction may grant an injunction, restraining order or other order as may be appropriate to enjoin a person from:

     (1) Offering to engage or engaging in the performance of any acts or practices for which a certificate of registration or authority, permit or license is required [in sections 338.010 to 338.370] by this chapter upon a showing that such acts or practices were performed or offered to be performed without a certificate of registration or authority, permit or license[.]; or

     (2) Engaging in any practice or business authorized by a certificate of registration or authority, permit or license issued pursuant to this chapter upon a showing that the holder presents a probability of serious danger to the health, safety or welfare of any resident of the state or client or patient.

     2. Any such actions shall be commenced either in the county in which such conduct occurred or in the county in which defendant resides.

     3. Any action brought [under] pursuant to this section shall be in addition and not in lieu of any penalty provided by law and may be brought concurrently with other actions to enforce this chapter.

     339.507. 1. There is hereby created within the division of professional registration of the department of economic development the "Missouri Real Estate Appraisers Commission", which shall consist of seven members appointed by the governor with the advice and consent of the senate, six of whom shall be appraiser members, and one shall be a public member. Each member shall be a resident of this state and a registered voter for a period of one year prior to [his] the person's appointment. The public member shall have never been engaged in the businesses of real estate appraisal, real estate sales or making loans secured by real estate. The governor shall designate one of the appraiser appointees to be chairperson.

     2. The real estate appraiser members appointed by the governor shall be Missouri residents who have real estate appraisal experience in the state of Missouri for not less than five years immediately preceding their appointment. The real estate appraiser members appointed to the commission shall be designated members in good standing of nationally recognized real estate appraisal organizations that required, as of June 1, 1988, in order to become a designated member, appraisal experience, education and testing, and recertification that is at least equal to that required for certification or licensure [under] pursuant to sections 339.500 to 339.545, provided that not more than one member of the commission shall be a designated member of the same nationally recognized real estate appraisal organization. Successor appraiser members of the commission shall be appointed from the registry of state certified real estate appraisers and state licensed real estate appraisers and not more than one successor appraiser member of the commission shall be a designated member in good standing of the same nationally recognized real estate appraisal organization as provided in this subsection. The governor shall not exclude a state certified real estate appraiser or a state licensed real estate appraiser from appointment as a successor appraiser member of the commission by virtue of membership or lack of membership of the state certified real estate appraiser or state licensed real estate appraiser in any particular real estate appraisal organization.

     3. Of the initial members appointed, two members shall be appointed for one-year terms, two members for two-year terms, and three members for three-year terms, provided that the initial public member shall be appointed for a three-year term. All successor members shall be appointed for three-year terms. All members shall serve until their successors have been appointed and qualified. Vacancies occurring in the membership of the commission for any reason shall be filled by appointment by the governor for the unexpired term. Upon expiration of their terms, members of the commission shall continue to hold office until the appointment and qualification of their successors. No more than four members of the commission shall be members of the same political party. No person shall be appointed for more than two consecutive terms. The governor may remove a member for cause. The executive director of the commission shall be employed by the division of professional registration, subject to approval and confirmation by the commission.

     4. The commission shall meet at least once each calendar quarter to conduct its business. The location in Missouri of future meetings shall be decided by a vote of the members present at the current meeting. The executive director shall give written notice by certified mail to each member of the time and place of each meeting of the commission at least ten days before the scheduled date of the meeting, and notice of any special meeting shall state the specific matters to be considered in the special meeting which is not a regular quarterly meeting. A quorum of the commission shall consist of [five] four members.

     5. Each member of the commission shall be entitled to a per diem allowance of fifty dollars for each meeting of the commission at which the member is present and shall be entitled to reimbursement of the member's expenses necessarily incurred in the discharge of the member's official duties. Each member of the commission shall be entitled to reimbursement of travel expenses necessarily incurred in attending meetings of the commission.

     339.525. 1. To obtain a renewal certificate or license, a state certified real estate appraiser or state licensed real estate appraiser shall make application and pay the prescribed fee to the commission not earlier than one hundred twenty days nor later than thirty days prior to the expiration date of the certificate or license then held. With the application for renewal, the state certified real estate appraiser or state licensed real estate appraiser shall present evidence in the form prescribed by the commission of having completed the continuing education requirements for renewal specified in section 339.530.

     2. If the commission determines that a state certified real estate appraiser or state licensed real estate appraiser has failed to meet the requirements for renewal of certification or licensure through mistake, misunderstanding, or circumstances beyond [his] the appraiser's control, the commission may extend the term of the certificate or license for good cause shown for a period not to exceed six months, upon payment of a prescribed fee for the extension.

     3. If a state certified real estate appraiser or state licensed real estate appraiser satisfies the requirements for renewal during the extended term of certification or licensure, the beginning date of the new renewal certificate or license shall be the day following the expiration of the certificate or license previously held by the state certified real estate appraiser or state licensed real estate appraiser.

     4. [If a state certified real estate appraiser or state licensed real estate appraiser fails to renew his certification or license prior to its expiration or within a period of extension granted by the commission pursuant to this section, the person may obtain a renewal certificate or license by satisfying all of the requirements for renewal and paying a late renewal fee.] If a person is otherwise eligible to renew the person's certification or license, the person may renew an expired certification or license within one year from the date of expiration. To renew such expired certification or license, the person shall submit an application for renewal, pay the renewal fee and pay a delinquent renewal fee as established by the commission. Upon a finding of extenuating circumstances, the commission may waive the payment of the delinquent fee.

     5. If a person has failed to renew the person's license within one year of its expiration, the person may renew such expired certification or license by completing either the number of hours of continuing education equal to fifty percent of the hours required for initial certification or licensure or pass the state examination for such classification, submit an application for renewal, pay the renewal fee and pay a delinquent renewal fee not to exceed an amount as established by the commission. Upon a finding of extenuating circumstances, the commission may waive the payment of the delinquent fee.

     6. If a state certified real estate appraiser or state licensed real estate appraiser renews an expired certification or license pursuant to subsection 5 of this section, the beginning date of the new term of certification or licensure shall be the day following the expiration of the certification or license term previously held by the state certified real estate appraiser or state licensed real estate appraiser.

     620.140. 1. All fees charged by each board assigned to the division of professional registration shall be collected by that division and promptly transmitted to the department of revenue for deposit in the state treasury, credited to the proper account as provided by law.

     2. The division and its component agencies shall permit any licensee to submit payment for fees established by rule in the form of personal check, money order, or cashier's check. All checks or money orders shall be made payable to the appropriate board. Any check or financial instrument which is returned to the division or one of its agencies due to insufficient funds, a closed account, or for other circumstances in which the check or financial instrument is not honored may subject an individual to additional costs, substantial penalties, or other actions by the division or one of its agencies. In such cases involving renewal of licenses, the renewal license may be withheld, and if issued, is not valid until the appropriate fee and any additional costs are collected. The division may require the payment of collection costs or other expenses. The affected board may establish penalty fees by rule and may suspend or revoke a license if such behavior is repetitive or the licensee fails to pay required penalty fees.

     3. License renewal fees are generally nonrefundable. Overpayments or other incorrect fees may be refundable. The division shall establish a refund reserve through the appropriation to the professional registration fees fund.

     4. Notwithstanding any other provision of law to the contrary, no board, commission or any other registration, licensing or certifying agency of the division of professional registration shall be required to collect or distribute any fee which is required for administering any test to qualify for a license, registration or certificate, if any portion of the fee is to be remitted to a private testing service.

     Section 1. Sections 1 to 14 of this act shall be known and may be cited as the "Occupational Therapy Practice Act".

     Section 2. For the purposes of sections 1 to 14 of this act, the following terms mean:

     (1) "Board", the Missouri board of occupational therapy;

     (2) "Certifying entity", the nongovernmental agency or association which certifies or registers individuals who have completed academic and training requirements;

     (3) "Director", the director of the division of professional registration;

     (4) "Division", the division of professional registration of the department of economic development;

     (5) "Occupational therapist", a person licensed to practice occupational therapy as defined in this section and whose license issued pursuant to sections 1 to 14 of this act;

     (6) "Occupational therapy", the use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, physical disability or other disorder or condition. It shall include assessment by means of skill observation or evaluation through the administration and interpretation of standardized or nonstandardized tests and measurements. Occupational therapy services include, but are not limited to:

     (a) The assessment and provision of treatment in consultation with the individual, family or other appropriate persons;

     (b) Interventions directed toward developing, improving, sustaining or restoring daily living skills, including self-care skills and activities that involve interactions with others and the environment, work readiness or work performance, play skills or leisure capacities or enhancing educational performances skills;

     (c) Developing, improving, sustaining or restoring sensorimotor, oral-motor, perceptual or neuromuscular functioning; or emotional, motivational, cognitive or psychosocial components of performance; and

     (d) Education of the individual, family or other appropriate persons in carrying out appropriate interventions.

Such services may encompass assessment of need and the design, development, adaptation, application or training in the use of assistive technology devices; the design, fabrication or application of rehabilitative technology such as selected orthotic devices, training in the use of orthotic or prosthetic devices; the application of ergonomic principles; the adaptation of environments and processes to enhance functional performance; or the promotion of health and wellness;

     (7) "Occupational therapy aid", a person who assists in the practice of occupational therapy under the direct supervision of an occupational therapist or occupational therapy assistant and whose activities require an understanding of occupational therapy but do not require training in the basic anatomical, biological, psychological and social sciences involved in the practice of occupational therapy;

     (8) "Occupational therapy assistant", a person who is licensed as an occupational therapy assistant by the division, in collaboration with the board. The function of an occupational therapy assistant is to assist an occupational therapist in the delivery of occupational therapy services in compliance with federal regulations and rules promulgated by the division, in collaboration with the Missouri board of occupational therapy.

     Section 3. 1. No person shall practice occupational therapy or hold himself or herself out as an occupational therapist or occupational therapy assistant or as being able to practice occupational therapy, or to render occupational therapy services in this state unless such person is licensed or holds a valid permit pursuant to sections 1 to 14 of this act.

     2. A licensed occupational therapy assistant shall be directly supervised by a licensed occupational therapist at all times. The licensed occupational therapist shall have the responsibility of supervising the occupational therapy treatment program. No licensed occupational therapist shall have under his or her direct supervision more than four occupational therapy assistants.

     Section 4. If a person does not represent or hold himself or herself out as an occupational therapist or occupational therapy assistant as defined in section 1 of this act, nothing in sections 1 to 14 of this act shall be construed to limit, preclude or otherwise interfere with:

     (1) The practice, service or activities of any person licensed in this state pursuant to any other law from engaging in the profession or occupation for which the person is licensed;

     (2) Employed as an occupational therapist or occupational therapy assistant by the government of the United States or any agency of it, if such person provides occupational therapy solely under the direction or control of the organization by which the person is employed;

     (3) Pursuing a supervised course of study leading to a degree or certificate in occupational therapy at an accredited or approved educational program, if such person is designated by a title which clearly indicates the person's status as a student or trainee.

     Section 5. 1. There is hereby created within the division of professional registration a board to be known as the "Missouri Board of Occupational Therapy". The board shall consist of six members, all of whom shall be citizens of the United States and registered voters of the state of Missouri. The governor shall appoint the members of the board with the advice and consent of the senate for terms of three years; except as provided in subsection 3 of this section. Nonpublic members shall have been engaged in rendering occupational therapy services, in teaching or in research in occupational therapy for at least five years immediately preceding the person's appointment to the board. Three board members shall be occupational therapists. One member shall be an occupational therapy assistant. Such members shall at all times be holders of licenses for the practice of occupational therapy in this state; except for the members of the first board who shall be registered pursuant to section 334.838, RSMo, on the effective date of sections 1 to 14 of this act and shall meet the requirements for licensure pursuant to sections 1 to 14 of this act. The remaining two members shall be members of the public. All members shall be chosen from lists submitted by the director of the department of economic development.

     2. No member of the board shall serve more than two consecutive three-year terms. A vacancy in the office of any member shall only be filled for the unexpired term.

     3. The initial appointments to the board shall be two members for terms of one year, two members for terms of two years and two members for terms of three years.

     4. The public members of the board shall not be and never have been members of any profession regulated by the provisions of sections 1 to 14 of this act, or the spouse of any such person; and persons who do not have and never have had a material financial interest in either the providing of the professional services regulated by the provisions of sections 1 to 14 of this act or an activity or organization directly related to the profession regulated pursuant to sections 1 to 14 of this act.

     5. Any member of the board may be removed from the board by the governor for neglect of duty required by law, for incompetency or for unethical or dishonest conduct. Upon the death, resignation, disqualification or removal of any member of the board, the governor shall appoint a successor.

     Section 6. 1. The board shall elect annually a chairperson and a vice chairperson from their number.

     2. The division, in collaboration with the board, shall adopt, implement, rescind, amend and administer such rules and regulations as may be necessary to carry out the provisions of sections 1 to 14 of this act. The division, in collaboration with the board, may promulgate necessary rules compatible with sections 1 to 14 of this act, including, but not limited to, rules relating to professional conduct, continuing competency requirements for renewal of licenses, approval of continuing competency programs and to the establishment of ethical standards of practice for persons holding a license or permit to practice occupational therapy in this state.

     3. The board shall convene at the request of the director or as the board shall determine. The board shall hold regular meetings at least four times per year.

     4. Each member of the board shall receive as compensation, an amount set by the division not to exceed fifty dollars per day, for each day devoted to the affairs of the board and may be reimbursed for actual and necessary expenses incurred in the performance of the member's official duties.

     5. No rule or portion of a rule promulgated pursuant to the authority of sections 1 to 14 of this act shall become effective unless it has been promulgated pursuant to the provisions of section 536.024, RSMo.

     Section 7. For the purpose of sections 1 to 14 of this act, the division shall:

     (1) Employ, within the limits of the appropriations for that purpose, employees as are necessary to carry out the provisions of sections 1 to 14 of this act;

     (2) Exercise all administrative functions;

     (3) Establish all applicable fees; set at an amount which shall not substantially exceed the cost of administering sections 1 to 14 of this act;

     (4) Deposit all fees collected pursuant to sections 1 to 14 of this act, by transmitting such funds to the department of revenue for deposit to the state treasury to the credit of the Missouri board of occupational therapy fund;

     (5) Approve or disapprove certifying entities for the profession of occupational therapy included in the scope of sections 1 to 14 of this act; and

     (6) The division may terminate recognition of any certifying entity included in the scope of sections 1 to 14 of this act following a subsequent review of the certification of registration procedures of a certifying entity.

     Section 8. 1. The applicant applying for a license to practice occupational therapy shall provide evidence of being currently certified by a certifying entity and has completed an application for licensure and all applicable fees have been paid.

     2. The certification requirement shall be waived for those persons who hold a current registration by the division as an occupational therapist or occupational therapy assistant on the effective date of sections 1 to 14 this act provided that this application is made on or before October 31, 1997, and all applicable fees have been paid. All other requirements of sections 1 to 14 this act must be satisfied.

     3. The person shall have no violations, suspensions, revocation or pending complaints for violation of regulations from a certifying entity or any governmental regulatory agency in the past five years.

     4. The division, in collaboration with the board, may negotiate reciprocal contracts with other states, the District of Columbia, or territories of the United States which require standards for licensure, registration or certification considered to be equivalent or more stringent than the requirements for licensure pursuant to sections 1 to 14 of this act.

     Section 9. All money held in the health care providers fund shall be transferred to the "Missouri Board of Occupational Therapy Fund" which is hereby created. The provisions of section 33.080, RSMo, to the contrary notwithstanding, money in the Missouri board of occupational therapy fund shall not be transferred and placed to the credit of general revenue until the amount in the fund at the end of the biennium exceeds three times the amount of appropriation from the fund for the preceding fiscal year. All fees shall be set at an amount which shall not substantially exceed the cost of administering sections 1 to 14 of this act.

     Section 10. The division, in collaboration with the board, may issue a limited permit, upon the payment of applicable fees and completion of the required application, to a person who sufficiently provides proof of eligibility to set for the first available examination upon completion of all other necessary requirements for certification by the certifying entity. The limited permit shall allow the person to practice occupational therapy under the supervision of a person currently licensed pursuant to sections 1 to 14 of this act. A limited permit shall only be effective up to but not to exceed the time the results of the second available examination are received by the board unless the person successfully passes the examination in which instance the limited permit shall remain valid for an additional sixty days.

     Section 11. 1. The division shall mail a renewal notice to the last known address of each licensee prior to the renewal date. Failure to provide the division with the information required for renewal or to pay the required fee after such notice shall result in the license being declared inactive and the licensee shall not practice occupational therapy until he or she applies for reinstatement and pays the required fees. The license shall be restored if the application is received within two years of the renewal date.

     2. Upon request, the division, in collaboration with the board, may grant inactive status to a licensee, if the person:

     (1) Does not practice occupational therapy in the state of Missouri;

     (2) Does not hold himself or herself out as an occupational therapist or an occupational therapy assistant in the state of Missouri;

     (3) Maintains any continuing competency requirements established by the division, in collaboration with the board; and

     (4) Remits any fee that may be required.

     Section 12. 1. The division, in collaboration with the board, may refuse to issue or renew, suspend or revoke a license or permit, or place a license or permit holder on probation or otherwise reprimand a licensee or permit holder, when the licensee, permit holder or applicant has been found guilty of unprofessional conduct which has endangered, or is likely to endanger, the health, welfare or safety of any person, as provided in sections 1 to 14 of this act or by any rule or regulation promulgated by the division, in collaboration with the board.

     2. If the division, in collaboration with the board, refuses to issue or renew a license or permit, the person shall be notified in writing of the reasons for such refusal and shall advise the person of the person's right to file a complaint with the administrative hearing commission as provided in chapter 621, RSMo.

     3. The division, in collaboration with the board, may cause a complaint to be filed concerning a person who is the holder of a license or permit issued pursuant to sections 1 to 14 of this act or any complaint regarding any professional practice regulated by sections 1 to 14 of this act shall be recorded as received and the date received. The division, in collaboration with the board:

     (1) Shall investigate all complaints concerning alleged violations of the provisions of sections 1 to 14 of this act. Division investigators shall investigate complaints and make inspections and any inquiries as, in the judgment of the division, are appropriate to enforce the provisions of sections 1 to 14 of this act;

     (2) May, if the evidence supports such action, cause a complaint to be filed with the administrative hearing commission as provided in chapter 621, RSMo, against any holder of any license or permit issued pursuant to sections 1 to 14 of this act.

     Section 13. The division, in collaboration with the board, may discipline or sanction any holder of a license or permit issued pursuant to sections 1 to 14 of this act for any one or any combination of the following:

     (1) Use of any controlled substance, as defined in chapter 195, RSMo, or alcoholic beverage to an extent that such use impairs a person's professional performance or responsibility;

     (2) Finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state, the United States or any territory of the United States, for any offense reasonably related to the qualifications, functions or duties of an occupational therapist or occupational therapy assistant; for any offense for which an essential element is fraud, dishonesty or an act of violence; or for any offense involving moral turpitude, whether or not sentence is imposed;

     (3) Use of fraud, deception, misrepresentation or bribery in securing any credential, license or permit, or to aid or abet any person in a violation of this section;

     (4) Incompetency, misconduct, fraud, misrepresentation or dishonesty in the performance of the functions or duties of an occupational therapist or occupational therapy assistant or a violation of any professional trust or confidence;

     (5) Violation of, or assisting or enabling any person to violate, any provision of sections 1 to 14 of this act or any lawful rule or regulation promulgated thereunder;

     (6) Impersonate, in any manner, or pretend to be any person holding a valid license or permit as an occupational therapist or occupational therapy assistant or allowing any other person to use such person's credentials;

     (7) Finally adjudged incapacitated by a court of competent jurisdiction;

     (8) Assisting or enabling any person to practice, or offer to practice, occupational therapy services if such person does not hold a valid license or permit issued pursuant to sections 1 to 14 of this act;

     (9) Use of any advertisement or solicitation which is false, misleading or deceptive to the general public or persons to whom the advertisement or solicitation is primarily directed;

     (10) Being guilty of unethical conduct as defined in the ethical standards for occupational therapists and occupational therapy assistants adopted by the division and filed with the secretary of state;

     (11) Failure to give notification of the suspension, probation or revocation of any past or currently held licenses, certificates or registrations required to practice occupational therapy in this or any other jurisdiction or the failure to renew or surrender such license, certificate or registration; or

     (12) Otherwise violate any provision of sections 1 to 14 of this act.

     Section 14. 1. Any person or corporation who knowingly violates any provision of sections 1 to 14 of this act is guilty of a class B misdemeanor.

     2. Any officer or agent of a corporation or member or agent of a partnership or association, who knowingly and personally participates in, or is an accessory to, any violation of sections 1 to 14 of this act is guilty of a class B misdemeanor.

     3. The provisions of this section shall not be construed to release any person from civil liability or criminal prosecution pursuant to any other law of this state.

     4. The division, in collaboration with the board, may cause a complaint to be filed for any violation of sections 1 to 14 of this act in any court of competent jurisdiction and perform such other acts as may be necessary to enforce the provisions of sections 1 to 14 of this act.

     Section 15. Sections 15 to 35 of this act shall be known and may be cited as the "Clinical Perfusionist Licensure Act".

     Section 16. As used in sections 15 to 35 of this act, the following terms mean:

     (1) "Board", the state board of registration for the healing arts;

     (2) "Division", the division of professional registration of the department of economic development;

     (3) "Extracorporeal circulation", the diversion of a patient's blood through a heart-lung machine or a similar device that assumes the functions of the patient's heart, lungs, kidney, liver or other organs;

     (4) "Licensed clinical perfusionist", a person licensed pursuant to sections 15 to 35 of this act;

     (5) "Perfusion", the functions necessary for the support, treatment, measurement or supplementation of the cardiovascular, circulatory, respiratory systems or other organs, or a combination of such activities, and to ensure the safe management of physiologic functions by monitoring and analyzing the parameters of the systems under an order and under the supervision of a licensed physician, including:

     (a) The use of extracorporeal circulation, long-term cardiopulmonary support techniques including extracorporeal carbon-dioxide removal and extracorporeal membrane oxygenation and associated therapeutic and diagnostic technologies;

     (b) Counterpulsation, ventricular assistance, autotransfusion, blood conservation techniques, myocardial and organ preservation, extracorporeal life support and isolated limb perfusion;

     (c) The use of techniques involving blood management, advanced life support and other related functions; and

     (d) In the performance of the acts described in this subdivision:

     a. The administration of:

     i. Pharmacological and therapeutic agents;

     ii. Blood products or anesthetic agents through the extracorporeal circuit or through an intravenous line as ordered by a physician;

     b. The performance and use of:

     i. Anticoagulation monitoring and analysis;

     ii. Physiologic monitoring and analysis;

     iii. Blood gas and chemistry monitoring and analysis;

     iv. Hematologic monitoring and analysis;

     v. Hypothermia;

     vi. Hemoconcentration and hemodilution;

     vii. Hemodialysis;

     c. The observation of signs and symptoms related to perfusion services, the determination of whether the signs and symptoms exhibit abnormal characteristics and the implementation of appropriate reporting, clinical perfusion protocols or changes in, or the initiation of, emergency procedures;

     (6) "Perfusion protocols", perfusion related policies and protocols developed or approved by a licensed health care facility or a physician through collaboration with administrators, licensed clinical perfusionists and other health care professionals;

     (7) "Provisional clinical licensed perfusionist", a person provisionally licensed pursuant to sections 15 to 35 of this act.

     Section 17. Notwithstanding the provisions of sections 15 to 35 of this act, a person is eligible to make application to the board and receive a license, if the person is actively engaged in the practice of perfusion consistent with sections 15 to 35 of this act and if the person meets one of the following requirements:     

     (1) The person, on the effective date of sections 15 to 35 of this act, was operating cardiopulmonary bypass systems during cardiac surgical cases in a licensed health care facility as the person's primary function and had been operating the systems for at least the immediately preceding eight years; or

     (2) The person has at least six years experience, within the last eight years, operating cardiopulmonary bypass systems during cardiac surgical cases in a licensed health care facility as the person's primary function.

     Section 18. The board shall license by examination, or otherwise as provided in sections 15 to 35 of this act, all licensed clinical perfusionist in this state, who meet the requirements of sections 15 to 35 of this act.

     Section 19. 1. A candidate for a license to practice as a licensed clinical perfusionist shall submit a sworn application accompanied by the required fees. The board shall prescribe the form of the application and by rule may establish dates by which applications and fees must be received.

     2. To qualify for the licensing examination, the applicant shall have successfully completed a perfusion education program approved by the board. In approving perfusion education programs necessary for qualification for licensing examination, the board shall approve only a program that has education standards established by the Accreditation Committee for Perfusion Education and approved by the Commission on Accreditation of Allied Health Education Programs or its successor.

     3. All fees payable pursuant to sections 15 to 35 of this act shall be collected by the division of professional registration and transmitted to the department of revenue for deposit in the state treasury to the credit of the "Licensed Perfusionists Fund", which is hereby created. Notwithstanding the provisions of section 33.080, RSMo, moneys in the fund shall not be transferred and placed to the credit of general revenue until the amount in the fund at the end of a biennium exceeds two times the amount appropriated from the fund in the preceding fiscal year or, if the board requires by rule license renewal less frequently than annually, then three times the appropriation from the fund for the preceding fiscal year. The amount, if any, in the fund which shall lapse is that amount in the fund which exceeds the appropriate multiple of the appropriation from the board's fund for the preceding fiscal year.

     Section 20. 1. To qualify for a license, an applicant shall pass a competency examination given by the American Board of Cardiovascular Perfusion or its successor organization.

     2. Not later than forty-five days after the date on which a licensing examination is administered pursuant to sections 15 to 35 of this act, the division shall notify each examinee of the results of the examination.

     3. The board by rule shall establish:

     (1) A limit on the number of times an applicant who fails an examination may retake the examination; and

     (2) The requirements for reexamination and the amount of any reexamination fee.

     Section 21. A person licensed pursuant to the provisions of sections 15 to 35 of this act shall display the license certificate issued pursuant to sections 15 to 35 of this act in a prominent place at the site, location or office from which such person practices such person's profession or such license holder shall maintain on file at all times during which the license holder provides services in a health care facility a true and correct copy of the license certificate in the appropriate records of the facility. A license holder shall inform the division of any change of address for the license holder. A license certificate issued by the board is the property of the board and shall be surrendered upon demand.

     Section 22. 1. The board may establish by administrative rule a system which provides that licenses expire on various dates. A person may renew an unexpired license by submitting proof satisfactory to the board of compliance with the continuing professional education requirements prescribed by the board and paying the required renewal fee to the board before the expiration date of the license.

     2. If a person's license has been expired for not more than two years, the person may renew the license by submitting proof, satisfactory to the board, of compliance with the continuing professional education requirements prescribed by the board and any penalty fee prescribed by the board.

     3. If a person's license has been expired two years or more, the person may not renew the license. The person may obtain a new license by submitting to reexamination and complying with the current requirements and procedures for obtaining a license.

     4. The board may renew without reexamination an expired license of a person who was licensed in this state, moved to another state or states, and is currently appropriately licensed or certified and has been in practice in another state or states for two years immediately preceding the person's application to renew a license. The person shall be required to pay the required fee as established by the board.

     5. The board shall notify each license holder in writing of the license expiration date before the thirteenth day before such date by notice to the license holder at the license holder's last known address accordingly to the records of the board.

     Section 23. 1. A license as a provisional licensed clinical perfusionist may be issued by the board to a person who has successfully completed an approved perfusion education program and upon the filing of an application, payment of an application fee and the submission of evidence satisfactory to the board of the successful completion of the education requirements as provided in section 19 of this act.

     2. A provisional licensed clinical perfusionist shall be under supervision and direction of a licensed clinical perfusionist at all times during which the provisional licensed clinical perfusionist performs perfusion. The board may adopt rules governing such supervision and direction which do not require the immediate physical presence of the supervising licensed clinical perfusionist.

     3. A provisional license shall be valid for one year from the date it is issued and may be renewed, subject to rules adopted by the board, by the same procedures established for the renewal of licenses pursuant to section 22 of this act, if the application for renewal is signed by a supervising licensed clinical perfusionist.

     4. If the person fails any portion of the licensure examination, such person shall surrender the person's provisional license to the board.

     Section 24. On receipt of an application and application fee, the board may waive the examination and educational requirements for an applicant who at the time of application:

     (1) Is appropriately licensed or certified by another state, territory or possession of the United States, if the requirements of such state, territory or possession for the license or certificate are substantially equivalent to the requirements of sections 15 to 35 of this act as determined by the board; or

     (2) Holds a current certificate as a certified clinical perfusionist issued by the American Board of Cardiovascular Perfusion, or its successor, prior to the effective date of sections 15 to 35 of this act.

     Section 25. 1. A person may not engage or offer to engage in perfusion, as defined in sections 15 to 35 of this act, for compensation or use the title or represent or imply that the person has the title of "licensed clinical perfusionist" or "provisional licensed clinical perfusionist" or use the letters "LCP" or "PLCP" and may not use any facsimile of such titles in any manner to indicate or imply that the person is a licensed perfusionist or provisional licensed perfusionist unless the person holds an appropriate license issued pursuant to sections 15 to 35 of this act.

     2. A person may not use the title or represent or imply that such person has the title of "certified clinical perfusionist" or use the letters "CCP" and may not use any facsimile of such title in any manner to indicate or imply that such person is a certified clinical perfusionist by the American Board of Cardiovascular Perfusion unless the person holds a certificate as a certified clinical perfusionist issued by the American Board of Cardiovascular Perfusion.

     3. Any person who violates the provisions of subsection 1 or 2 of this section is guilty of a class B misdemeanor.

     Section 26. The provisions of sections 15 to 35 of this act shall not apply to:

     (1) A person licensed as a health care professional pursuant to the Revised Statutes of Missouri, if:

     (a) The person does not represent to the public, directly or indirectly, that the person is licensed pursuant to sections 15 to 35 of this act, and does not use any name, title or designation indicating that the person is licensed pursuant to sections 15 to 35 of this act; and

     (b) The person limits the person's acts or practice to the scope of practice authorized by the appropriate licensing agency;

     (2) A student enrolled in an accredited perfusion education program, if perfusion services performed by the student:

     (a) Are an integral part of the student's course of study; and

     (b) Are performed under the direct supervision of a licensed clinical perfusionist assigned to supervise the student and who is on duty and immediately available in the assigned patient care area;

     (3) The practice of any legally qualified perfusionist employed by the United States government while in the discharge of the person's official duties.

     Section 27. The board shall:

     (1) Adopt and publish a code of ethics;

     (2) Establish the qualifications and fitness of applicants of licenses, renewal of licenses and reciprocal licenses;

     (3) Revoke, suspend or deny a license, suspend a license or reprimand a license holder for a violation of sections 15 to 35 of this act, the code of ethics or the rules adopted by the board;

     (4) Provide for the expenditure of funds necessary for the proper administration of its assigned duties;

     (5) Establish reasonable and necessary fees for the administration and implementation of sections 15 to 35 of this act. Fees shall be established at a rate that does not significantly exceed the cost of administering the provisions of sections 15 to 35 of this act;

     (6) Establish continuing professional education requirements for licensed clinical perfusionists and provisional licensed clinical perfusionists, the standards of which shall be at least as stringent as those of the American Board of Cardiovascular Perfusion or its successor agency;

     (7) Within the limits of its appropriation, employ and remove board personnel, as defined in subdivision (4) of subsection 15 of section 620.010, RSMo, as may be necessary for the efficient operation of the board;

     (8) Adopt the training and clinical competency requirements established by the department of health through hospital licensing regulations promulgated pursuant to chapter 197, RSMo. The provisions of sections 15 to 35 of this act to the contrary notwithstanding, the board shall not regulate a perfusionist's training, education or fitness to practice except as specifically provided by the hospital licensing regulations of the department of health. In promulgating such regulations, the department of health shall adopt the standards of the American Board of Cardiovascular Perfusion, or its successor organization, or comparable standards for training and experience. The department shall by rule and regulation provide that individuals providing perfusion services who do meet such standards may continue their employment in accordance with section 17 of this act. The department shall also establish standards for provisional licensed clinical perfusionists pursuant to section 23 of this act.

     Section 28. 1. The board shall keep an information file about each complaint filed with the board. The board's information file shall be kept current and contain a record for each complaint of:

     (1) All persons contacted in relation to the complaint;

     (2) A summary of findings made at each step of the complaint process;

     (3) An explanation of the legal basis and reason for a complaint that is dismissed; and

     (4) Other relevant information.

     2. If a written complaint is filed with the board that the board has authority to resolve, the board, at least as frequently as quarterly and until final disposition of the complaint, shall notify the parties to the complaint of the status of the complaint unless the notice would jeopardize an ongoing investigation.

     3. The board shall adopt by rule a form to standardize information concerning complaints made to the board. The board shall prescribe by rule information to be provided to a person when the person files a complaint with the board.

     4. The board shall provide reasonable assistance to a person who wishes to file a complaint with the board.

     Section 29. 1. The board shall adopt rules concerning the investigation of a complaint filed with the board. The rules adopted pursuant to this subsection shall:

     (1) Distinguish between categories of complaints;

     (2) Ensure that complaints are not dismissed without appropriate consideration;

     (3) Require that the board be advised of a complaint that is dismissed and that a letter be sent to the person who filed the complaint explaining the action taken on the dismissed complaint;

     (4) Ensure that the person who filed the complaint has an opportunity to explain the allegations made in the complaint; and

     (5) Prescribe guidelines concerning the categories of complaints that require the use of a private investigator and the procedures for the board to obtain the services of a private investigator.

     2. The board shall dispose of all complaints in a timely manner. The board shall establish a schedule for conducting each phase of a complaint that is under the control of the board not later than the tenth day after the date the complaint is received by the board. The schedule shall be kept in the information file for the complaint and all parties shall be notified of the projected time requirements for pursuing the complaint. A change in the schedule shall be noted in the complaint information file and all parties to the complaint shall be notified not later than five days after the date the change is made.

     3. The executive director of the board shall notify the board of a complaint that extends beyond the time prescribed by the board for resolving the complaint so that the board may take necessary action on the complaint.

     Section 30. The board shall develop by rule a system for monitoring a license holder's compliance with the requirements of sections 15 to 35 of this act. Rules adopted pursuant to this section shall include procedures for monitoring a license holder who is ordered by the board to perform certain acts to ascertain that the license holder performs the required acts and to identify and monitor license holders who represent a risk to the public.

     Section 31. The board shall revoke or suspend a license, place on probation a person whose license has been suspended or reprimand a license holder if there is proof of:

     (1) Any violation of sections 15 to 35 of this act;

     (2) Any violation of a rule or code of ethics adopted by the board; or

     (3) Unprofessional conduct, which includes, but is not limited to, the following:

     (a) Incompetence or gross negligence in carrying out usual perfusion functions;

     (b) A conviction of practicing perfusion without a license or a provisional license;

     (c) The use of advertising relating to perfusion in a way that violates state law;

     (d) Procuring a license or provisional license by fraud, misrepresentation or mistake;

     (e) Making or giving any false statement or information in connection with the application for a license or provisional license;

     (f) Conviction of a felony or of any offense substantially related to the qualifications, functions and duties of a perfusionist, in which event the record of the conviction shall be conclusive evidence of such offense; or

     (g) Impersonating an applicant or acting as proxy for an applicant in any examination required pursuant to sections 15 to 35 of this act for the issuance of a license.

     Section 32. For the purposes of sections 15 to 35 of this act, the board:

     (1) Shall request and receive necessary assistance from state educational institutions or other state agencies;

     (2) Shall prepare a registry of licensed clinical perfusionists and provisional licensed clinical perfusionists and make this information available to the general public, license holders and appropriate state agencies;

     (3) May request the attorney general or an appropriate prosecuting attorney to institute a suit to enjoin a violation of sections 15 to 35 of this act in addition to any other action, proceeding or remedy authorized by law.

     Section 33. 1. There is hereby established an "Advisory Commission for Clinical Perfusionists" which shall guide, advise and make recommendations to the board. The commission shall approve the examination required by section 18 of this act and shall assist the board in carrying out the provisions of sections 15 to 35 of this act.

     2. The advisory commission shall consist of five perfusionist members and two public members which shall be appointed by the governor with the advice and consent of the senate. The members of the commission shall be appointed for terms of six years; except those first appointed, of which one shall be appointed for a term of one year, one shall be appointed for a term of two years, one shall be appointed for a term of three years, one shall be appointed for a term of four years, one shall be appointed for a term of five years and one shall be appointed for a term of six years. The nonpublic commission members shall be residents of the state of Missouri for at least one year, shall be United States citizens and shall meet all the requirements for licensing provided in sections 15 to 35 of this act, shall be licensed pursuant to sections 15 to 35 of this act, except the members of the first commission, who shall be licensed within six months of their appointment and are actively engaged in the practice of perfusion. If a member of the commission shall, during the member's term as a commission member, remove the member's domicile from the state of Missouri, then the commission shall immediately notify the governor and the seat of that commission member shall be declared vacant. All such vacancies shall be filled by appointment as in the same manner as the preceding appointment. The public members shall be at the time of the members' appointment citizens of the United States; residents of the state for a period of at least one year and registered voters; persons who are not and never were members of any profession licensed or regulated pursuant to sections 15 to 35 of this act or the spouse of such person; persons who do not have and never have had a material, financial interest in either the provision of the professional services regulated by sections 15 to 35 of this act, or an activity or organization directly related to any profession licensed or regulated by sections 15 to 35 of this act.

     3. No member of the commission shall be entitled to any compensation for the performance of the member's official duties, but each member shall be reimbursed for necessary and actual expenses incurred in the performance of the member's official duties. All staff for the commission shall be provided by the division of professional registration.

     4. A member of the commission may be removed if, the member:

     (1) Does not have, at the time of appointment, the qualifications required for appointment to the commission;

     (2) Does not maintain during service on the commission the qualifications required for appointment to the commission;

     (3) Violates any provision of sections 15 to 35 of this act;

     (4) Cannot discharge the member's duties for a substantial part of the term for which the member is appointed because of illness or disability; or

     (5) Is absent from more than half of the regularly scheduled commission meetings that the member is eligible to attend during a calendar year, unless the absence is excused by a majority vote of the commission.

     Section 34. Not later than thirty days after the governor appoints the initial members of the commission and annually thereafter, the commission shall meet and elect one of its members as chairperson and one of its members as vice chairperson. The commission shall meet at least quarterly or at any other time if called by the chairperson or a majority of the commission. A majority of the members of the commission shall constitute a quorum.

     Section 35. The board may promulgate administrative rules not inconsistent with sections 15 to 35 of this act necessary to administer the provisions of sections 15 to 35 of this act as provided in chapter 536, RSMo. No rule or portion of a rule promulgated pursuant to the authority of sections 15 to 35 of this act shall become effective unless it has been promulgated pursuant to the provisions of section 536.024, RSMo.

     Section 36. 1. Any rule or portion of a rule promulgated pursuant to this act shall become effective only as provided pursuant to chapter 536, RSMo, including, but not limited to, section 536.028, RSMo, if applicable, after the effective date of this act. All rulemaking authority delegated prior to the effective date of this act is of no force and effect and repealed. The provisions of this section are nonseverable and if any of the powers vested with the general assembly pursuant to section 536.028, RSMo, if applicable, to review, to delay the effective date, or to disapprove and annul a rule or portion of a rule are held unconstitutional or invalid, the purported grant of rulemaking authority and any rule so proposed and contained in the order of rulemaking shall be invalid and void.

     2. In any action challenging any rule promulgated pursuant to the provisions of this bill, the agency as defined in section 536.010, RSMo, promulgating such rule shall be required to prove by a preponderance of the evidence that the rule or threatened application of the rule is valid, is authorized by law, is not in conflict with any law and is not arbitrary and capricious.

     3. The court shall award reasonable fees and expenses as defined in section 536.085, RSMo, to any party who prevails in such action.

     4. All rules promulgated pursuant to the provisions of this section shall expire on August twenty-eighth of the year after the year in which the rule became effective unless the general assembly extends by statute the rule or set of rules beyond that date to a date specified by the general assembly.

     5. Any rulemaking authority granted pursuant to the provisions of this bill is subject to any rulemaking authority contained in chapter 536, RSMo, including any subsequent amendments to chapter 536, RSMo.

     6. The provisions of this section shall terminate if legislation amending the provisions of section 536.024, RSMo, has been signed into law prior to the effective date of this act.

     Section 37. 1. Except as provided in this section, no disciplinary proceeding against any person or entity licensed, registered or certified to practice a profession within the department of economic development, division of professional registration shall be initiated unless such action is commenced within three years of the date upon which the licensing, registering or certifying agency received notice of an alleged violation of an applicable statute or regulation.

     2. For the purpose of this section, notice shall be limited to:

     (1) A written complaint;

     (2) Notice of final disposition of a malpractice claim, including exhaustion of all extraordinary remedies and appeals;

     (3) Notice of exhaustion of all extraordinary remedies and appeals of a conviction based upon a criminal statute of this state, any other state or the federal government;

     (4) Notice of exhaustion of all extraordinary remedies and appeals in a disciplinary action by a hospital, state licensing, registering or certifying agency, or an agency of the federal government.

     3. For the purposes of this section, an action is commenced when a complaint is filed by the agency with the administrative hearing commission, any other appropriate agency or in a court; or when a complaint is filed by the agency's legal counsel with the agency in respect to an automatic revocation or a probation violation.

     4. Disciplinary proceedings based upon repeated negligence shall be exempt from all limitations set forth in this section.

     5. Disciplinary proceedings based upon a complaint involving sexual misconduct shall be exempt from all limitations set forth in this section.

     6. Any time limitation provided in this section shall be tolled:

     (1) During any time the accused licensee, registrant or certificant is practicing exclusively outside the state of Missouri or residing outside the state of Missouri and not practicing in Missouri;

     (2) As to an individual complainant, during the time when such complainant is less than eighteen years of age;

     (3) During any time the accused licensee, registrant or certificant maintains legal action against the agency; or

     (4) When a settlement agreement is offered to the accused licensee, registrant or certificant, in an attempt to settle such disciplinary matter without formal proceeding pursuant to section 621.045, RSMo, until the accused licensee, registrant or certificant rejects or accepts the settlement agreement.

     7. The licensing agency may, in its discretion, toll any time limitation when the accused licensee, registrant or certificant enters into and participates in a treatment program for chemical dependency or mental impairment.

     8. This section shall become effective January 1, 1998. The above statute of limitations shall not apply to any notice received by the agency prior to January 1, 1998.