CCS/HCS/SS/SCS/SB 157 - This act modifies several provisions relating to the professions requiring licensure, including: (1) opioid overdoses; (2) health professional loans and grants; (3) advance health care directives; (4) death certificates; (5) advanced practice registered nurses; (6) prescription labeling requirements; (7) pesticide certification and training; (8) tattooing; (9) animal chiropractic practitioners; (10) assistant physicians; (11) the Interstate Medical Licensure Compact; (12) physical therapists; (13) physician assistants; (14) professional counselors; (15) social workers; (16) the administration of medications by pharmacists; and (17) nursing home administrators. OPIOID OVERDOSES (Sections 190.255 and 195.206) Currently, qualified first responders may obtain and administer naloxone to a person suffering from an apparent narcotic or opiate-related overdose. This act allows first responders to obtain and administer any drug or device approved by the FDA to block the effects of an opioid overdose. Licensed drug distributors or pharmacies may sell such drugs or devices to first responders for this purpose. Under current law, state or local law enforcement agency staff members are required to act under the directives and protocols of a medical director of a local licensed ground ambulance service in order to administer naloxone or similar drugs or devices to a person suffering from an apparent narcotic or opiate-related overdose. Under this act, state or local law enforcement agency staff members would not need to act under such directives and protocols to administer naloxone or similar drugs or devices. This act modifies the definition of "opioid antagonist" in a statute relating to standing orders for opioid antagonists. Currently, opioid antagonists are defined as naloxone hydrochloride and this act adds any other drug or device approved by the FDA that blocks the effect of an opioid overdose. These provisions are identical to provisions in the truly agreed to and finally passed CCS/HCS/SS/SCS/SBs 45 & 90 (2023) and SCS/HCS/HBs 117, 343, & 1091 (2023) and substantially similar 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/SB 24 (2023), and the truly agreed to and finally passed CCS/HCS/SB 186 (2023). HEALTH PROFESSIONAL LOANS AND GRANTS (Sections 191.430-191.450, 191.592, 191.600, 191.828, 191.831, 335.203, and 335.205 and the repeal of Sections 191.500-191.550 and 335.212-335.257) This act repeals current law relating to student loans for certain health professional students and establishes the "Health Professional Loan Repayment Program". Under this program, the Department of Health and Senior Services shall provide forgivable loans in order to repay existing loans for eligible educational expenses for health professional students. The Director of the Department shall have the discretion to select the health professionals who are eligible for the forgivable loans in accordance with the greatest need in the best interest of the public. Individuals receiving loans under this program shall agree to serve at least 2 years in an area of defined need as a condition of receipt of the funds, among other criteria that must be met as delineated in the act. An individual who fails to uphold the loan agreement shall be liable for the amount paid to the individual by the Department under this program. Furthermore, if an individual breaches a written contract executed pursuant to this provision by failing to begin or complete his or her service obligation, the state shall be entitled to recover from such person an amount equal to: · The total amount of the loan awarded by the Department or, if the Department had already awarded partial forgiveness at the time of the breach, the amount of the loan not yet forgiven; · The interest on the amount that would be payable if at the time the loan was awarded it was a loan bearing interest at the maximum prevailing rate as determined by the Treasurer of the United States; · An amount equal to any damages incurred by the Department as a result of the breach; and · Any legal fees or associated costs incurred by the Department or the state of Missouri in the collection of damages. The act additionally creates the Health Professional Loan Incentive Fund for the purpose of allowing the Department to provide loans under this provision. The fund will consist of funds appropriated to it by the General Assembly. These provisions are identical to provisions in the truly agreed to and finally passed SS/HB 402 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SBs 45 & 90 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), and HB 542 (2023) and substantially similar to SB 555 (2023). This act establishes a medical residency grant program to award grants, subject to appropriation, for eligible entities for the purpose of establishing and funding new general primary care and psychiatry medical residency positions in Missouri and continuing the funding of the new positions for the duration of the residency. Funding shall be available for 3 years for residency positions in family medicine, general internal medicine, and general pediatrics. The Department of Health and Senior Services shall establish criteria for the grants as described in the act and report on the program to the General Assembly. This provision expires on January 1, 2038. This provision has an emergency clause. This provision is identical to a provision in the truly agreed to and finally passed SS/SCS/HCS/HB 417 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SBs 45 & 90 (2023), and the perfected HCS/HB 1162 (2023) and similar to HB 1179 (2023). The act modifies the Nursing Education Incentive Program. Under current law, grant awards made under the program are limited to $150,000. This act repeals that limit. Additionally, the State Board of Nursing is required to collect, at the time of any license application or license renewal application, a Nursing Education Incentive Program surcharge from each person licensed or relicensed as a nurse under Missouri law. Such surcharge shall be equal to $1 for practical nurses and $5 for registered professional nurses. The act repeals the Nursing Student Loan Program and the Nursing Student Loan Repayment Program. These provisions are identical to provisions in the truly agreed to and finally passed SS/HB 402 (2023), the truly agreed to and finally passed SS/SCS/HCS/HB 417 (2023), 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), the truly agreed to and finally passed CCS/HCS/SS/SCS/SBs 45 & 90 (2023), HB 775 (2023), and SB 552 (2023). ADVANCE HEALTH CARE DIRECTIVES (Section 1 and the repeal of Section 192.530 as enacted by the TATFP SS/HB 402) This act repeals a provision of law relating to voluntary nonopioid directives as enacted by the truly agreed to and finally passed SS/HB 402 (2023). This act requires the Department of Health and Senior Services to include on its website an advance health care directive form and directions for completing such form, as described in the act. This provision is identical to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023) and the truly agreed to and finally passed HCS/SS/SB 24 (2023). DEATH CERTIFICATES (Section 193.145 and 193.265) Currently, all data providers in the death registration process shall be required to use the electronic death registration system, with exceptions. This act repeals provisions of current law permitting a funeral director to enter data into the electronic death registration system and presenting the signed cause of death certificate to the local registrar if the person or entity certifying the cause of death is not part of the electronic system, as well as repeals provisions permitting the state registrar to adopt pilot programs until the electronic death registration system is certified. Currently, a certified copy of a death record by a local registrar can only be issued within 24 hours of receipt of the record by the local registrar, including computer generated certifications of death records. Under this act, a certified copy of a death record can only be issued after acceptance and registration with the state registrar. These provisions are identical to provisions of SB 421 (2023). ADVANCED PRACTICE REGISTERED 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), HCS/SS/SCS/SB 70 (2023), and SS/HCS/HBs 115 & 99 (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). PRESCRIPTION LABELING REQUIREMENTS (Sections 195.100 and 334.735) Currently, the name of the collaborating physician for an advanced practice registered nurse or physician assistant shall be included on any label of a controlled substance sold or dispensed by a pharmacist. This act repeals this requirement and only the name of the prescribing health care provider is needed. These provisions are identical to provisions in the truly agreed to and finally passed SS/HB 402 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), SB 551 (2023), and the perfected HB 1102 (2023). PESTICIDE CERTIFICATION AND TRAINING (Section 281.102) This act extends the effective date for implementation of certain provisions relating to pesticide certification and training from January 1, 2024 to January 1, 2025. This provision is identical to provisions in the truly agreed to and finally passed HS/HCS/SS/SB 138 (2023) and SB 570 (2023). TATTOOING (Section 324.520) This act modifies the laws regulating tattooing in Missouri by modifying the definition of tattooing to include the insertion of ink with the aid of needles or blades using hand-held or machine-powered instruments, as well as including marks made for cosmetic, scar coverage, or other corrective purposes on the face or body of another by the insertion of a pigment, ink, or both under the skin with the aid of needles. This provision is identical to a provision in the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023) and HCS/HBs 45 & 1066 (2023) and similar to SB 605 (2023). ANIMAL CHIROPRACTIC PRACTITIONERS (Sections 331.020, 331.060, and 340.200-240.222) This act allows animal chiropractic practitioners to engage in the practice of animal chiropractic without being licensed or regulated as a veterinarian. An "animal chiropractic practitioner" is defined in the act as either a licensed veterinarian or an individual who is licensed by the State Board of Chiropractic Examiners, who is certified by a veterinary chiropractic association, who has graduated from a certification course in animal chiropractic with at least 210 hours of instruction, and whose practice shall be regulated by the State Board of Chiropractic Examiners. Animal chiropractic practitioners shall not engage in the practice of animal chiropractic without a patient referral from a licensed veterinarian with a current veterinarian-client-patient relationship. These provisions are identical to SCS/SB 471 (2023) and HCS/HB 88 (2023). 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 HCS/SS/SCS/SB 70 (2023), and the truly agreed to and finally passed SS/HCS/HBs 115 & 99 (2023) and substantially similar to SS#2/SCS/SB 938 (2022). INTERSTATE MEDICAL LICENSURE COMPACT (Sections 334.043 and 334.1600-334.1720) This act modifies provisions relating to physician licensure reciprocity. Under this act, those applicants for licensure who are licensed in another state, territory, or branch or unit of the military for at least one year may submit to the State Board of Registration for the Healing Arts an application and proof of current licensure. The Board shall, within 6 months of receipt of the application, waive any examination, educational, or experience requirements for licensure in this state as described in the act, but may require the applicant to take and pass an examination specific to the laws of Missouri. In the case of an applicant who is a nonresident or resident military spouse, the Board shall waive any examination, educational, or experience requirements for licensure within 30 days of receipt of the application. Additionally, this act adopts the "Interstate Medical Licensure Compact". The purpose of the compact is to strengthen access to health care and streamline the licensure process. The compact sets forth the requirements to be met in order for a state to join the compact. Each member state shall require an applicant for a physician license to obtain or retain a license in the state of principal residence and meet that state's qualifications for licensure or renewal of licensure as well as all other applicable laws. Physicians seeking to practice in member states shall obtain an expedited license with the board of the principal state and register to receive a license with a member state. This license shall authorize the physician to practice medicine in the issuing state. An expedited license shall be terminated if the physician fails to maintain a license in the state of principal licensure. The compact creates a joint public agency known as the Interstate Medical Licensure Compact Commission. The Commission has powers and duties listed in the compact and shall enforce the provisions and rules of the compact. The compact shall come into effect on the date on which the compact is enacted into law in the seventh member state. Any member state may withdraw from the compact by enacting a statute repealing the same. The compact shall be binding upon member states and shall supersede any conflict with state law. These provisions are identical to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023), HB 285 (2023), HB 348 (2023), and HB 407 (2023) and substantially similar to SB 393 (2023). PHYSICAL THERAPISTS (Sections 334.100, 334.506, and 334.613) This act modifies provisions relating to the practice of physical therapy. Under this act, physical therapists with a doctorate of physical therapy or 5 years of clinical experience may evaluate and initiate treatment on a patient without a prescription or referral from an approved health care provider. Physical therapists may provide certain educational information, fitness or wellness programs, screenings, and consultations without a prescription or referral regardless of whether a patient is symptomatic. This act repeals provisions limiting the ability of a physical therapist to examine and treat certain conditions or injuries without a prescription or referral. Under this act, physical therapists shall refer to an approved health care provider patients with certain conditions, including those with conditions beyond the scope of practice of physical therapy, as well as any patient who does not demonstrate measurable or functional improvement within ten visits or 30 days, whichever occurs first. A physical therapist shall consult with an approved health care provider after ten visits or 30 days, whichever occurs first, before continuing physical therapy if a patient's condition has improved and the physical therapist believes that continued physical therapy is reasonable and necessary. The physical therapist shall provide the provider certain information specified in the act during such consultation and continued physical therapy shall proceed in accordance with input from the provider. The physical therapist shall notify the provider of continuing physical therapy every 10 visits or 30 days unless the provider directs otherwise. This provision shall not apply to physical therapy services performed within a primary or secondary school for individuals under 21. This act allows the Board of Registration for the Healing Arts to file a complaint against a physical therapist for evaluating or treating a patient in a manner inconsistent with provisions of the act and existing law governing the scope of practice for physical therapists, rather than allowing the Board to file a complaint for practicing or offering to practice independent of a prescription and the direction of certain health care providers listed in current law. These provisions are identical to provisions in the truly agreed to and finally passed SS/HCS/HBs 115 & 99 (2023), the truly agreed to and finally passed HCS/SS/SCS/SB 106 (2023), and the truly agreed to and finally passed HCS/SS/SCS/SB 70 (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). PHYSICIAN ASSISTANTS (Sections 334.735 and 334.747) This act authorizes a collaborative practice arrangement between a physician assistant and a physician to delegate prescriptive authority to physician assistant for Schedule II controlled substances for hospice patients and limits prescriptions for Schedule III narcotics to a 5-day supply without refill, as described in the act. Collaborating physicians or designated physicians shall be present with the physician assistant for sufficient periods of time, at least once every two weeks, to participate in chart reviews and supervision. These provisions are identical to provisions in the truly agreed to and finally passed SS/HB 402 (2023). PROFESSIONAL COUNSELORS (Sections 337.510 and 337.550) This act modifies provisions relating to license reciprocity for professional counselors. Currently, those applicants who are licensed in another state or territory may receive a license in this state if they are approved or in good standing with certain professional organizations. This act repeals this provision and implements a provision permitting any person who, for at least one year, has held a valid, current license issued by another state, a branch or unit of the military, a U.S. territory, or the District of Columbia, to apply for an equivalent Missouri license through the Committee for Professional Counselors, 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 substantially similar to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023) and HB 2749 (2022). SOCIAL WORKERS (Sections 337.615, 337.644, 337.665, 337.1000-337.1075) This act modifies provisions relating to license reciprocity for clinical social workers, master social workers, and baccalaureate social workers. Currently, those applicants who are licensed in another state or territory may receive a license in this state if they are approved or in good standing with certain professional organizations. This act repeals this provision and implements a provision permitting any person who, for at least one year, has held a valid, current license issued by another state, a branch or unit of the military, a U.S. territory, or the District of Columbia, to apply for an equivalent Missouri license through the State Committee for Social Workers, subject to procedures and limitations as provided in the act. This act adopts the "Social Work Licensure Compact". The purpose of the compact is to facilitate the interstate practice of licensed regulated social workers with the goal of improving public access to competent social work services. The compact sets forth the requirements to be met in order for a state to join the compact. Each member state shall require an applicant for a social work license to obtain or retain a license in the home state and meet the home state's qualifications for licensure or renewal of licensure as well as all other applicable state laws. The compact creates a joint public agency known as the Social Work Licensure Compact Commission. The Commission has powers and duties as listed in the compact and shall enforce the provisions and rules of the compact. The Commission shall provide for the development, maintenance, and utilization of a coordinated database and reporting system containing licenses, adverse actions, and investigative information on all licensed individuals in member states. The compact shall come into effect on the date on which the compact is enacted into law in the seventh member state. Any member state may withdraw from the compact by enacting a statute repealing the same. The compact shall be binding upon member states and shall supersede any conflict with state law. These provisions are substantially similar to provisions in the truly agreed to and finally passed HCS/SS/SCS/SB 70 (2023) and SB 670 (2023). ADMINISTRATION OF MEDICATIONS BY 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 SS/HCS/HBs 115 & 99 (2023), the truly agreed to and finally passed CCS/HCS/SS/SCS/SBs 45 & 90 (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). NURSING HOME ADMINISTRATORS (Sections 344.045, 344.055, and 344.102) Under this act, the Missouri Board of Nursing Home Administrators shall establish a procedure for receiving and handling complaints concerning its licensees' professional practices, as described in the act. No complaint, investigatory report, or information received from any sources shall be disclosed prior to review by the Board. The Board may disclose complaints, completed investigatory reports, and certain information for purposes specified in the act. Under this act, all educational transcripts, test scores, complaints, investigatory reports, and information pertaining to applicants or licensees shall be confidential and not disclosed to the public, except with the written consent of the person whose records are involved, except as otherwise specified. Finally, no person shall practice as a nursing home administrator if his or her license is revoked or expired. These provisions are identical to HCS/HB 773 (2023) and a provision in HCS/HBs 45 & 1066 (2023). SARAH HASKINS