SS/HCS/HBs 115 & 99 - This act modifies several provisions relating to licensing of health care professionals, including: (1) nurses; (2) assistant physicians; (3) physical therapists; (4) professional counselors; and (5) pharmacists. NURSES (Sections 195.070, 334.104, 335.016, 335.019, 335.036, 335.046, 335.051, 335.056, 335.076, 335.086, and 335.175) This act modifies licensing and collaborative practice arrangements for advanced practice registered nurses (APRNs). Under this act, an APRN may prescribe Schedule II controlled substances for hospice patients, as described in the act. Additionally, collaborative practice arrangements between the APRN and the collaborating physician may waive geographic proximity requirements, as described in the act, including when the arrangement outlines the use of telehealth and when the APRN is providing services in a correctional center. Collaborating physicians or designated physicians shall be present with the APRN for sufficient periods of time, at least once every two weeks, to participate in chart reviews and supervision. Currently, an APRN shall practice with the collaborating physician continuously present for a one-month period when entering into an arrangement with the physician. This act waives that requirement when a primary care or behavioral health physician enters into an arrangement with a primary care or behavioral health APRN, the physician is new to the patient population, and the APRN is familiar with the patient population. Currently, a nurse may be licensed to practice professional or practical nursing. This act adds a license to practice advanced practice nursing and modifies the definitions of APRN and the practice of professional nursing. Additionally, this act specifies the requirements for the advanced practice nursing license, including the requirement that an applicant first hold a current registered professional nurse license, and have completed certain graduate-level programs and certifications, or hold a document of recognition to practice as an APRN that is current as of August 28, 2023. License renewals for APRN licenses and registered professional nurse licenses shall occur at the same time and failure to renew and maintain the registered professional nurse license or failure to provide evidence of an active required certification shall result in the expiration of the APRN license. This act further modifies the names of the specific certifying organizations for nursing specialties. Under this act, the State Board of Registration for the Healing Arts shall make information publicly available about which physicians and other health care providers have entered into collaborative practice arrangements. These provisions are identical to provisions of the truly agreed to and finally passed SS/HB 402 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), and the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), substantially similar to SCS/SB 79 (2023) and HCS/HB 271 (2023), and similar to provisions in HB 1578 (2022) and HB 693 (2019). ASSISTANT PHYSICIANS (Section 334.036) Currently, a requirement for licensure as an assistant physician is that the applicant must be a graduate of any medical school. This act provides that the applicant must be a graduate of a medical school accredited by certain organizations listed in the act. This act repeals a provision of law that authorizes an assistant physician collaborative practice arrangement in any pilot project areas established in which assistant physicians may practice. This provision is identical to a provision in the truly agreed to and finally passed SS/HB 402 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), and the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023) and substantially similar to SS#2/SCS/SB 938 (2022). PHYSICAL THERAPISTS (Sections 334.100, 334.506, and 334.613) This act modifies provisions relating to the practice of physical therapy. Under this act, physical therapists with a doctorate of physical therapy or 5 years of clinical experience may evaluate and initiate treatment on a patient without a prescription or referral from an approved health care provider. Physical therapists may provide certain educational information, fitness or wellness programs, screenings, and consultations without a prescription or referral regardless of whether a patient is symptomatic. This act repeals provisions limiting the ability of a physical therapist to examine and treat certain conditions or injuries without a prescription or referral. Under this act, physical therapists shall refer to an approved health care provider patients with certain conditions, including those with conditions beyond the scope of practice of physical therapy, as well as any patient who does not demonstrate measurable or functional improvement within ten visits or 30 days, whichever occurs first. A physical therapist shall consult with an approved health care provider after ten visits or 30 days, whichever occurs first, before continuing physical therapy if a patient's condition has improved and the physical therapist believes that continued physical therapy is reasonable and necessary. The physical therapist shall provide the provider certain information specified in the act during such consultation and continued physical therapy shall proceed in accordance with input from the provider. The physical therapist shall notify the provider of continuing physical therapy every 10 visits or 30 days unless the provider directs otherwise. This provision shall not apply to physical therapy services performed within a primary or secondary school for individuals under 21. This act allows the Board of Registration for the Healing Arts to file a complaint against a physical therapist for evaluating or treating a patient in a manner inconsistent with provisions of the act and existing law governing the scope of practice for physical therapists, rather than allowing the Board to file a complaint for practicing or offering to practice independent of a prescription and the direction of certain health care providers listed in current law. These provisions are identical to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), and the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), substantially similar to provisions in the truly agreed to and finally passed SS/SB 51 (2023), and similar to provisions in HB 144 (2023), SB 205 (2023), HB 1555 (2022), and HCS/SB 330 (2021). PROFESSIONAL COUNSELORS (Sections 337.510 and 337.550) This act modifies provisions relating to license reciprocity for professional counselors. Currently, those applicants who are licensed in another state or territory may receive a license in this state if they are approved or in good standing with certain professional organizations. This act repeals this provision and implements a provision permitting any person who, for at least one year, has held a valid, current license issued by another state, a branch or unit of the military, a U.S. territory, or the District of Columbia, to apply for an equivalent Missouri license through the Board, subject to procedures and limitations as provided in the act. This act adopts the "Counseling Interstate Compact". The purpose of the compact is to facilitate the interstate practice of licensed professional counselors with the goal of improving public access to professional counseling services. The compact sets forth the requirements to be met in order for a state to join the compact. Each member state shall require an applicant for a professional counselor license to obtain or retain a license in the home state and meet the home state's qualifications for licensure or renewal of licensure as well as all other applicable state laws. The compact creates a joint public agency known as the Counseling Compact Commission. The Commission has powers and duties as listed in the compact and shall enforce the provisions and rules of the compact. The Commission shall provide for the development, maintenance, and utilization of a coordinated database and reporting system containing licenses, adverse actions, and investigative information on all licensed individuals in member states. The compact shall come into effect on the date on which the compact is enacted into law in the tenth member state. Any member state may withdraw from the compact by enacting a statute repealing the same. The compact shall be binding upon member states and shall supersede any conflict with state law. These provisions are identical to the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023) and substantially similar to provisions in the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023) and HB 2749 (2022). PHARMACISTS (Sections 338.010 and 338.012) This act modifies several provisions relating to the administration of medications by pharmacists. First, this act modifies the definition of a medication therapeutic plan by repealing language defining it by the prescription order so long as the prescription order is specific to each patient for care by a pharmacist. This act also repeals language from current law defining the practice of pharmacy as including the administration of specific vaccines by written physician protocol for specific patients and adds language defining the practice of pharmacy as including the ordering and administering of certain FDA-approved or authorized vaccines to persons at least 7 years of age or the CDC-approved age, whichever is older, pursuant to rules promulgated by the Board of Pharmacy and the Board of Registration for the Healing Arts or rules promulgated under a state of emergency. Under current law, any pharmacist who accepts a prescription order for a medication therapeutic plan shall have a written protocol from the referring physician. This act repeals this provision and permits a pharmacist with a certificate of medication therapeutic plan authority to provide medication therapy services pursuant to a written physician protocol to patients with an established physician-patient relationship with the protocol physician. Under this act, a licensed pharmacist may order and administer vaccines approved or authorized by the FDA to address a public health need, as authorized by the state or federal government, during a state or federally-declared public health emergency. Finally, a pharmacist with a certificate of medication therapeutic plan authority may provide influenza, group A streptococcus, and COVID-19 medication therapy services pursuant to a statewide standing order issued by the Director of the Department of Health and Senior Services or a physician licensed by the Department. These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS/SS/SCS/SBs 45 & 90 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 157 (2023), the perfected SS/SCS/SB 41 (2023), and SCS/HCS/HBs 117, 343, & 1091 (2023) and substantially similar to provisions in HCS/HB 2452 (2022), SB 1126 (2022), and HCS/SS/SB 690 (2022). SARAH HASKINS