Bill Text: MO HB685 | 2013 | Regular Session | Comm Sub
Bill Title: Allows pharmacists to dispense emergency medication without prior authorization from the prescriber
Sponsorship: Partisan Bill (Republican 1)
Status: (Introduced - Dead) 2013-05-02 - Rules - Reported Do Pass (H) [HB685 Detail]
Download: Missouri-2013-HB685-Comm_Sub.html
FIRST REGULAR SESSION
HOUSE COMMITTEE SUBSTITUTE FOR
97TH GENERAL ASSEMBLY
1731H.06C D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To repeal sections 331.100, 332.093, 334.735, 337.503, 344.040, 346.050, 346.055, 346.085, and 453.070, RSMo, and to enact in lieu thereof eighteen new sections relating to professional licenses.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 331.100, 332.093, 334.735, 337.503, 344.040, 346.050, 346.055, 346.085, and 453.070, RSMo, are repealed and eighteen new sections, to be known as sections 196.298, 320.400, 320.402, 320.406, 320.408, 320.410, 320.412, 320.414, 320.416, 331.100, 332.093, 334.735, 337.503, 338.200, 344.040, 346.055, 346.085, and 453.070, to read as follows:
196.298. 1. As used in this section, the following terms shall mean:
(1) "Baked good", includes cookies, cakes, breads, Danish, donuts, pastries, pies, and other items that are prepared by baking the item in an oven. A baked good does not include a potentially hazardous food item as defined by department rule;
(2) "Cottage food production operation", an individual operation out of an individual's home which meets the following conditions:
(a) Only nonpotentially hazardous processed foods, except low acid canned and acidified foods, including but not limited to breads, cookies, fruit pies, jams, jellies, preserves, fruit butters, honey, sorghum, cracked nuts, packaged spices and spice mixes, dry cookie, cake, bread, and soup mixes are sold, sampled, or served;
(b) The seller is the individual actually producing the food or an immediate family member residing in the producer's household with extensive knowledge about the food;
(c) The seller only sells, samples, or serves the food directly to the end consumer;
(d) All processed packaged foods bear a label stating the name and address of the manufacturer or processor preparing the food, common name of the food, name of all the ingredients in the food and a statement that the product is prepared in a kitchen that is not subject to inspection by the department of health and senior services. It is recommended that honey manufacturers or processors include the following additional statement on its label: "Honey is not recommended for infants under twelve months of age";
(e) The consumer is informed by a clearly visible placard at the sales or service location that the food is prepared in a kitchen that is not subject to inspection by the department of health and senior services if the foods specified in paragraph (a) of this subdivision are sold, sampled, or served in unpackaged, individual portions.
The department of health and senior services shall have final authority in determining whether a food is nonpotentially hazardous and may enjoin individuals who violate the provisions of this subdivision from selling, sampling, or serving such foods;
(3) "Department", the department of health and senior services;
(4) "Home", a primary residence that contains a kitchen and appliances designed for common residential usage.
2. A cottage food production operation is not a food service establishment and shall not be subject to any health or food code laws or regulations of the state or department other than this section and sections 196.030 to 196.075, and rules promulgated thereunder for a cottage food production operation.
3. (1) A local health department shall not regulate the production of food at a cottage food production operation. Nothing in this subdivision shall be construed as prohibiting the department of health and senior services from contracting with a local health department to provide services for the department under state law and regulation.
(2) Each local health department and the department shall maintain a record of a complaint made by a person against a cottage food production operation.
4. The department shall promulgate rules requiring a cottage food production operation to label all of the foods described in this section which the operation intends to sell to consumers. The label shall include the name and address of the cottage food production operation and a statement that the food is not inspected by the department or local health department.
320.400. As used in sections 320.400 to 320.416, the following terms shall mean:
(1) "Certificate of registration", the document issued to a contractor under sections 320.400 to 320.416;
(2) "Contractor", an organization that offers to undertake, represents itself as being able to undertake, or does undertake the proposed layout and specifications, planning, installation, or servicing of a fire sprinkler system or any part of such a system for pay;
(3) "Fire sprinkler system", a suppression system which requires individual calculation and layout in accordance with nationally recognized standards, such as those of the National Fire Protection Association, to protect the interior or exterior of a specific building, structure, or special hazard from fire by conveying water, with or without other agents, to dispersal openings or devices. Such systems also include any overhead and underground fire mains beginning at the point of service, fire hydrants and hydrant mains, standpipes and hoses connected to sprinkler systems, sprinkler tank heaters, air lines, thermal systems used in connection with fire sprinkler systems, and tanks and pumps connected to fire sprinkler systems;
(4) "Inspection", a visual examination of a fire sprinkler system or portion thereof to verify that it appears to be in operating condition and is free of physical damage;
(5) "Installation", the initial placement of fire sprinkler equipment or the extension, modification, or alteration of equipment after the initial placement, and includes the inspection and testing of equipment attendant to the placement or alteration of fire sprinkler equipment;
(6) "NICET", National Institute of Certification in Engineering Technologies;
(7) "Organization", a corporation, a partnership or other business association, a sole proprietorship, a governmental entity, or any other legal or commercial entity;
(8) "Person", a natural person, including an owner, manager, officer, employee, or occupant;
(9) "Point of service", the point at which the underground piping for a sprinkler system using water as the extinguishing agent becomes used exclusively for the sprinkler system;
(10) "Registered firm", an organization holding a valid certificate of registration issued under sections 320.400 to 320.416;
(11) "Service", to inspect, test, or repair fire sprinkler equipment in order to furnish or return the fire sprinkler system to operational condition, and including maintenance contracts;
(12) "Special agent fire suppression system", an approved system, and components thereof, which requires individual calculations and layout in accordance with the manufacturer's instructions to determine the flow rates, nozzle pressures, quantities of extinguishing agent, and number and types of nozzles for protecting one or more hazards by suppressing or extinguishing fire. These systems include kitchen hood fire suppression systems, dry chemical systems, carbon dioxide systems, halogenated and gaseous agent systems, foam systems, and wet chemical systems not connected to fire sprinkler systems. Special agent fire suppression systems shall not include a fire sprinkler system.
320.402. 1. Any contractor that engages in the installation of fire sprinkler systems or services fire sprinkler systems may register with the state fire marshal for a certificate of registration.
2. The provisions of sections 320.400 to 320.416 and the rules and regulations promulgated under sections 320.400 to 320.416 shall have uniform force and effect throughout the state. A municipality, county, or any other local governmental body or jurisdiction may enact or enforce registration or licensing requirements, and the registration provisions of sections 320.400 to 320.416 shall not supercede them.
3. A municipality, county, or any other local governmental body or jurisdiction may require a contractor to obtain a permit and pay a fee for the installation of a fire sprinkler system and require the installation of such system in conformance with the building code or other construction requirements of the municipality, county, or any other local governmental body or jurisdiction.
4. Sections 320.400 to 320.416 shall not apply to:
(1) A person or organization that only sells or supplies products or materials used in fire sprinkler systems;
(2) A person or organization that designs, plans, sells, places, or maintains special agent fire suppression systems; or
(3) Inspection activities performed by a government official as part of code enforcement activities.
5. Nothing in sections 320.400 to 320.416 shall be deemed to limit or restrict the practice of engineering by licensed professional engineers.
320.406. 1. The state fire marshal is authorized to promulgate rules and regulations regarding:
(1) The content of applications and the procedures for filing an application for an initial or renewal certificate of registration in this state;
(2) All applicable fees, set at a level to produce revenue which shall not exceed the cost and expense of administering the provisions of sections 320.400 to 320.416;
(3) Establishment of procedures for granting reciprocity with other states.
2. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2013, shall be invalid and void.
320.408. 1. One of the following requirements shall be fulfilled in order to obtain a certificate of registration from the state fire marshal:
(1) The applicant shall employ or contract with a professional engineer licensed in the state of Missouri who is disciplined in fire protection;
(2) The applicant shall employ or contract with a person with a NICET Level III General Plans and Hydraulics and Water Supply Planning, a NICET IV certification, or an equivalent as approved by the Missouri state fire marshall, in the Water-Based System Layout subfield; or
(3) The applicant shall employ or contract with a person with a NICET Level III certification in the automatic sprinkler system layout subfield demonstrating the certified person has received training in planning, installation, or servicing of fire sprinkler systems.
2. Any organization that holds a certificate of registration in this state under sections 320.400 to 320.416 may use the title "certified fire sprinkler contractor". No other person or organization may use the title "certified fire sprinkler contractor". No other person or organization shall assume any title or use any abbreviation or any other words, letters, signs, or devices to indicate that the person or organization using the same is a certified fire sprinkler contractor.
3. A certificate of registration shall be valid for a period of two years from the date of issue and is renewable biennially on payment of a fee; provided however, that the initial certificates of registration issued on or after August 28, 2013, may be issued for periods of less than two years and the fee shall be prorated proportionally.
4. A fee shall be charged by the state fire marshal for any request for a duplicate certificate of registration or any request requiring change to a certificate of registration. The fee shall be set by the fire marshal.
5. Each contractor holding itself out as a "certified fire sprinkler contractor" shall display its certificate of registration issued under sections 320.400 to 320.416 in a conspicuous place at the contractor's place of business.
6. Plans, bids, proposals, offers, and installation drawings for fire sprinkler systems may display the contractor's certificate of registration number.
7. A certificate of registration issued under sections 320.400 to 320.416 shall not be transferable.
8. There is hereby created in the state treasury the "Fire Sprinkler Contractor Registration Fund", which shall consist of money collected under sections 320.400 to 320.416. The state treasurer shall be custodian of the fund and may approve disbursements from the fund in accordance with sections 30.170 and 30.180. Upon appropriation, money in the fund shall be used solely for the administration of sections 320.400 to 320.416. Any money remaining in the fund at the end of the biennium shall revert to the credit of the general revenue fund. The state treasurer shall invest moneys in the fund in the same manner as other funds are invested. Any interest and moneys earned on such investments shall be credited to the fund.
320.410. 1. As provided in subsection 3 of section 320.408, each renewal of a certificate of registration issued under sections 320.400 to 320.416 is valid for a period of two years. The certificate of registration fee is payable on renewal.
2. At least thirty days before the expiration of a certificate of registration, the state fire marshal shall send written notice of the impending certificate of registration expiration to the registrant at the last known address.
3. The state fire marshal may, by rule, adopt a system under which certificates of registration expire on various dates during the year. When the certificate of registration expiration date is less than two years from its issuance or anniversary date, the fee shall be prorated on a monthly basis so that each registrant shall pay only that portion of the fee that is allocable to the number of months during which the registration is valid. On each subsequent renewal, the total renewal fee is payable.
320.412. The state fire marshal shall not issue a certificate of registration under sections 320.400 to 320.416 unless the applicant files evidence of a general liability insurance policy that includes products and completed operations coverage. The limits of insurance coverage required by this section shall be in an amount not less than one million dollars aggregate for all occurrences per policy year. The general liability policy shall be conditioned to pay on behalf of the insured those amounts that the insured is legally obligated to pay as damages because of bodily injury and property damage caused by an occurrence involving the insured or the insured's servant, officer, agent, or employee in the conduct of any business registered under sections 320.400 to 320.416.
320.414. 1. The state fire marshal may refuse to issue any certificate of registration or renew any certificate of registration required by one or any provisions of sections 320.400 to 320.416 for one or any combination of reasons stated in subsection 2 of this section. The state fire marshal shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of the right to file a complaint with the administrative hearing commission as provided in chapter 621.
2. The state fire marshal may cause a complaint to be filed with the administrative hearing commission as provided in chapter 621 against the holder of any certificate of registration required by sections 320.400 to 320.416 or any person or organization that has failed to renew or has surrendered its certificate for any one or any combination of the following causes:
(1) Use of fraud, deception, misrepresentation, or bribery in securing a certificate issued pursuant to the provisions of sections 320.400 to 320.416;
(2) Impersonation of any organization holding a certificate or allowing any person or organization to use its certificate;
(3) Disciplinary action against the holder of a certificate by another state, territory, federal agency, or country upon grounds for which revocation or suspension is authorized in this state;
(4) Issuance of a certificate based upon a material mistake of fact;
(5) Final adjudication and finding of guilty, or plea of guilty or nolo contendere of a person or organization 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 regulated under sections 320.400 to 320.416, 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;
(6) Incompetence, misconduct, gross negligence, fraud, misrepresentation, or dishonesty in the performance of the functions or duties of the profession that is regulated by sections 320.400 to 320.416;
(7) Violation of, or assisting or enabling any person or organization to violate, any provision of sections 320.400 to 320.416, or any lawful rule or regulation adopted pursuant to such sections;
(8) Final adjudication of a person as insane or incompetent by a court of competent jurisdiction;
(9) Operating without at least one million dollars in liability insurance coverage.
3. After the filing of a complaint pursuant to subsection 2 of this section, the proceedings shall be conducted in accordance with the provisions of chapter 621. Upon a finding by the administrative hearing commission that the grounds, provided in subsection 2 of this section, for disciplinary action are met, the state fire marshal may, singly or in combination, censure or place the person or organization named in the complaint on probation on such terms and conditions as the state fire marshal deems appropriate for a period not to exceed five years, or may suspend, for a period not to exceed three years, or revoke the certificate of registration of the person or organization. An individual whose certificate of registration has been revoked shall wait three years from the date of revocation to apply for another certificate. Certification shall be at the discretion of the state fire marshal after compliance with all requirements of sections 320.400 to 320.416 relative to the certification of an applicant for the first time.
4. The state fire marshal shall maintain an information file containing each complaint filed with the state fire marshal relating to a holder of a certificate of registration.
320.416. 1. Upon proper application by the state fire marshal, a court of competent jurisdiction may grant an injunction, restraining order, or other order as may be appropriate to enjoin a person or organization from holding himself, herself, or itself out as a certified fire sprinkler contractor.
2. Any such actions shall be commenced either in the county in which such conduct occurred or in the county in which the defendant resides.
3. Any action brought under this section shall be in addition to and not in lieu of any penalty provided by law and may be brought concurrently with other actions to enforce sections 320.400 to 320.416.
331.100. 1. The board shall elect a president and secretary at the first regular meeting held after January first of each year. Each member of the board shall receive as compensation for his services the sum of fifty dollars per day while discharging the actual duties of the board, and each member shall receive necessary traveling expenses while actually engaged in the performance of his duties as a member of the board.
2. The board shall have a common seal, and shall adopt rules and regulations for the application and enforcement of this chapter. The president and secretary shall have power to administer oaths. Four members shall constitute a quorum. They shall publish the dates and places for examinations at least thirty days prior to the meeting. The board shall create no expenses exceeding the sums received from time to time as herein provided.
3. The board shall employ such board personnel as may be necessary to carry out the provisions of this chapter. Board personnel shall include an executive secretary or comparable position, inspectors, investigators, attorneys, and secretarial support staff for these positions.
4. Board personnel shall have their duties and compensation prescribed by the board within appropriations for that purpose, except that compensation for board personnel shall not exceed that established for comparable positions, as determined by the board, under the job and pay plan of the department of insurance, financial institutions and professional registration.
5. Members of the board shall not be personally liable either jointly or separately for any act or acts committed in the performance of their official duties as board members [except gross negligence].
332.093. Any person "practices as a dental assistant" within the meaning of this chapter who provides patient services in cooperation with and under the direct supervision of a currently registered and licensed dentist in Missouri. A currently registered and licensed dentist may delegate to a dental assistant, certified dental assistant or expanded functions dental assistant, under their direct supervision, such reversible acts that would be considered the practice of dentistry as defined in section 332.071 provided such delegation is done pursuant to the terms and conditions of a rule adopted by the Missouri dental board pursuant to section 332.031; except that, no such rule may allow delegation of acts that conflict with the practice of dental hygiene as defined in section 332.091, with the exception that polishing of teeth, placement of pit or fissure sealants, and application of topical fluoride may be delegated to a dental assistant, certified dental assistant or expanded-functions dental assistant.
334.735. 1. As used in sections 334.735 to 334.749, the following terms mean:
(1) "Applicant", any individual who seeks to become licensed as a physician assistant;
(2) "Certification" or "registration", a process by a certifying entity that grants recognition to applicants meeting predetermined qualifications specified by such certifying entity;
(3) "Certifying entity", the nongovernmental agency or association which certifies or registers individuals who have completed academic and training requirements;
(4) "Department", the department of insurance, financial institutions and professional registration or a designated agency thereof;
(5) "License", a document issued to an applicant by the board acknowledging that the applicant is entitled to practice as a physician assistant;
(6) "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 Physician Assistants examination, and has active certification of the National Commission on Certification of Physician Assistants;
(7) "Recognition", the formal process of becoming a certifying entity as required by the provisions of sections 334.735 to 334.749;
(8) "Supervision", control exercised over a physician assistant working [within the same facility as] with the supervising physician [sixty-six percent of the time a physician assistant provides patient care, except a physician assistant may make follow-up patient examinations in hospitals, nursing homes, patient homes, and correctional facilities, each such examination being reviewed, approved and signed by the supervising physician, except as provided by subsection 2 of this section. For the purposes of this section, the percentage of time a physician assistant provides patient care with the supervising physician on-site shall be measured each calendar quarter] and oversight of the activities of and accepting responsibility for the physician assistant's delivery of care. The physician assistant shall only practice at a location where the physician routinely provides patient care, except existing patients of the supervision physician in the patient's home and correctional facilities. The supervising physician must be [readily] immediately available in person or via telecommunication during the time the physician assistant is providing patient care. Prior to commencing practice, the supervising physician and physician assistant shall attest on a form provided by the board that the physician shall provide supervision appropriate to the physician assistant's training and that the physician assistant shall not practice beyond the physician assistant's training and experience. Appropriate supervision shall require the supervising physician to be working within the same facility as the physician assistant for at least four hours within one calendar day for every fourteen days on which the physician assistant provides patient care as described in subsection 3 of this section. Only days in which the physician assistant provides patient care as described in subsection 3 of this section shall be counted toward the fourteen-day period. The requirement of appropriate supervision shall be applied so that no more than thirteen calendar days in which a physician assistant provides patient care shall pass between the physician's four hours working within the same facility. The board shall promulgate rules pursuant to chapter 536 for documentation of joint review of the physician assistant activity by the supervising physician and the physician assistant. [The physician assistant shall be limited to practice at locations where the supervising physician is no further than thirty miles by road using the most direct route available, or in any other fashion so distanced as to create an impediment to effective intervention and supervision of patient care or adequate review of services. Any other provisions of this chapter notwithstanding, for up to ninety days following the effective date of rules promulgated by the board to establish the waiver process under subsection 2 of this section, any physician assistant practicing in a health professional shortage area as of April 1, 2007, shall be allowed to practice under the on-site requirements stipulated by the supervising physician on the supervising physician form that was in effect on April 1, 2007.]
2. [The board shall promulgate rules under chapter 536 to direct the advisory commission on physician assistants to establish a formal waiver mechanism by which an individual physician-physician assistant team may apply for alternate minimum amounts of on-site supervision and maximum distance from the supervising physician. After review of an application for a waiver, the advisory commission on physician assistants shall present its recommendation to the board for its advice and consent on the approval or denial of the application. The rule shall establish a process by which the public is invited to comment on the application for a waiver, and shall specify that a waiver may only be granted if a supervising physician and physician assistant demonstrate to the board's satisfaction in accordance with its uniformly applied criteria that:
(1) Adequate supervision will be provided by the physician for the physician assistant, given the physician assistant's training and experience and the acuity of patient conditions normally treated in the clinical setting;
(2)] (1) A supervision agreement shall limit the physician assistant [shall be limited] to practice only at locations described in subdivision (8) of subsection 1 of this section, where the supervising physician is no further than fifty miles by road using the most direct route available[, or in any other fashion so distanced] and where the location is not so situated as to create an impediment to effective intervention and supervision of patient care or adequate review of services[;
(3) The community or communities served by the supervising physician and physician assistant would experience reduced access to health care services in the absence of a waiver;
(4) The applicant will practice in an area designated at the time of application as a health professional shortage area;
(5) Nothing in this section shall be construed to require a physician-physician assistant team to increase their on-site requirement allowed in their initial waiver in order to qualify for renewal of such waiver;
(6) If a waiver has been granted by the board of healing arts on or after August 28, 2009, to] .
(2) A physician-physician assistant team working in a rural health clinic under the federal Rural Health Clinic Services Act, P.L. 95-210, as amended, no [additional waiver shall be required for the physician-physician assistant team, so long as the rural health clinic maintains its status as a rural health clinic under such federal act, and such physician-physician assistant team comply with federal supervision requirements. No] supervision requirements in addition to the minimum federal law shall be required for the physician-physician assistant team in a rural health clinic [if a waiver has been granted by the board. However, the board shall be able to void a current waiver after conducting a hearing and upon a finding of fact that the physician-physician assistant team has failed to comply with such federal act or either member of the team has violated a provision of this chapter;
(7) A physician assistant shall only be required to seek a renewal of a waiver every five years or when his or her supervising physician is a different physician than the physician shown on the waiver application or they move their primary practice location more than ten miles from the location shown on the waiver application].
3. The scope of practice of a physician assistant shall consist only of the following services and procedures:
(1) Taking patient histories;
(2) Performing physical examinations of a patient;
(3) Performing or assisting in the performance of routine office laboratory and patient screening procedures;
(4) Performing routine therapeutic procedures;
(5) Recording diagnostic impressions and evaluating situations calling for attention of a physician to institute treatment procedures;
(6) Instructing and counseling patients regarding mental and physical health using procedures reviewed and approved by a licensed physician;
(7) 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;
(8) Assisting in surgery; and
(9) 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;
(10) Physician assistants shall not perform or prescribe abortions.
4. Physician assistants shall not prescribe nor dispense any drug, medicine, device or therapy unless pursuant to a physician supervision agreement in accordance with the law, 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. Prescribing and dispensing of drugs, medications, devices or therapies by a physician assistant shall be pursuant to a physician assistant supervision agreement which is specific to the clinical conditions treated by the supervising physician and the physician assistant shall be subject to the following:
(1) A physician assistant shall only prescribe controlled substances in accordance with section 334.747;
(2) The types of drugs, medications, devices or therapies prescribed or dispensed by a physician assistant shall be consistent with the scopes of practice of the physician assistant and the supervising physician;
(3) All prescriptions shall conform with state and federal laws and regulations and shall include the name, address and telephone number of the physician assistant and the supervising physician;
(4) A physician assistant, or advanced practice registered nurse as defined in section 335.016 may request, receive and sign for noncontrolled professional samples and may distribute professional samples to patients;
(5) A physician assistant shall not prescribe any drugs, medicines, devices or therapies the supervising physician is not qualified or authorized to prescribe; and
(6) A physician assistant may only dispense starter doses of medication to cover a period of time for seventy-two hours or less.
5. 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 as otherwise provided in this section, and in an emergency situation, nor shall any physician assistant bill a patient independently or directly for any services or procedure by the physician assistant.
6. For purposes of this section, the licensing 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 pursuant to chapter 536 establishing licensing 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 licensing may be denied or the license 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 shall not be required to be licensed as physician assistants. All applicants for physician assistant licensure who complete a physician assistant training program after January 1, 2008, shall have a master's degree from a physician assistant program.
7. "Physician assistant supervision agreement" means a written agreement, jointly agreed-upon protocols or standing order between a supervising physician and a physician assistant, which provides for the delegation of health care services from a supervising physician to a physician assistant and the review of such services. The agreement shall contain at least the following provisions:
(1) Complete names, home and business addresses, zip codes, telephone numbers, and state license numbers of the supervising physician and the physician assistant;
(2) A list of all offices or locations where the physician routinely provides patient care, and in which of such offices or locations the supervising physician has authorized the physician assistant to practice;
(3) All specialty or board certifications of the supervising physician;
(4) The manner of supervision between the supervising physician and the physician assistant, including how the supervising physician and the physician assistant shall:
(a) Attest on a form provided by the board that the physician shall provide supervision appropriate to the physician assistant's training and experience and that the physician assistant shall not practice beyond the scope of the physician assistant's training and experience nor the supervising physician's capabilities and training; and
(b) Provide coverage during absence, incapacity, infirmity, or emergency by the supervising physician;
(5) The duration of the supervision agreement between the supervising physician and physician assistant; and
(6) A description of the time and manner of the supervising physician's review of the physician assistant's delivery of health care services. Such description shall include provisions that a supervising physician, or a designated supervising physician listed in the supervision agreement review a minimum of ten percent of the charts of the physician assistant's delivery of health care services every fourteen days.
8. When a physician assistant supervision agreement is utilized to provide health care services for conditions other than acute self-limited or well-defined problems, the supervising physician or other physician designated in the supervision agreement shall see the patient for evaluation and approve or formulate the plan of treatment for new or significantly changed conditions as soon as practical, but in no case more than two weeks after the patient has been seen by the physician assistant.
9. At all times the physician is responsible for the oversight of the activities of, and accepts responsibility for, health care services rendered by the physician assistant.
10. It is the responsibility of the supervising physician to determine and document the completion of at least a one-month period of time during which the licensed physician assistant shall practice with a supervising physician continuously present before practicing in a setting where a supervising physician is not continuously present.
11. No contract or other agreement shall require a physician to act as a supervising physician for a physician assistant against the physician's will. A physician shall have the right to refuse to act as a supervising physician, without penalty, for a particular physician assistant. No contract or other agreement shall limit the supervising physician's ultimate authority over any protocols or standing orders or in the delegation of the physician's authority to any physician assistant, but this requirement shall not authorize a physician in implementing such protocols, standing orders, or delegation to violate applicable standards for safe medical practice established by the hospital's medical staff.
12. Physician assistants shall file with the board a copy of their supervising physician form.
13. No physician shall be designated to serve as supervising physician for more than three full-time equivalent licensed physician assistants. This limitation shall not apply to physician assistant agreements of hospital employees providing inpatient care service in hospitals as defined in chapter 197.
337.503. No official, employee, board, commission, county, municipality, school district, agency of the state, or any other political subdivision thereof shall discriminate between persons licensed under sections 337.500 to 337.540 and other mental health professionals licensed under this chapter or as defined in section 632.005 when promulgating regulations or when requiring or recommending services that legally may be performed by persons licensed under sections 337.500 to 337.540.
338.200. 1. In the event a pharmacist is unable to obtain refill authorization from the prescriber due to death, incapacity, or inability of the prescriber to provide medical services to the patient, or when the pharmacist is unable to obtain refill authorization from the prescriber, a pharmacist may dispense an emergency supply of medication if:
(1) In the pharmacist's professional judgment, interruption of therapy might reasonably produce undesirable health consequences;
(2) The pharmacy previously dispensed or refilled a prescription from the applicable prescriber for the same patient and medication;
(3) The medication dispensed is not a controlled substance;
(4) The pharmacist informs the patient or the patient's agent verbally, electronically, or in writing at the time of dispensing that authorization of a prescriber is required for future refills; and
(5) The pharmacist documents the emergency dispensing in the patient's prescription record, as provided by the board by rule.
2. (1) If the pharmacist is unable to obtain refill authorization from the prescriber, the amount dispensed shall be limited to the amount determined by the pharmacist within his or her professional judgment as needed for the emergency period, provided the amount dispensed shall not exceed a seven-day supply;
(2) In the event of prescriber death or incapacity or inability of the prescriber to provide medical services, the amount dispensed shall not exceed a thirty-day supply.
3. Pharmacists or permit holders dispensing an emergency supply pursuant to this section shall promptly notify the prescriber or the prescriber's office of the emergency dispensing, as required by the board by rule.
4. An emergency supply may not be dispensed pursuant to this section if the pharmacist has knowledge that the prescriber has otherwise prohibited or restricted emergency dispensing for the applicable patient.
5. The board shall promulgate rules to implement the provisions of this section. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2013, shall be invalid and void.
344.040. 1. Every license issued under this chapter shall expire on June thirtieth of the year following the year of issuance and every other year thereafter, provided that licenses issued or renewed during the year 2006 may be issued or renewed by the board for a period of either one or two years, as provided by rule. Licensees seeking renewal shall, during the month of May of the year of renewal, file an application for renewal on forms furnished by the board, which shall include evidence satisfactory to the board of completion of the approved continuing education hours required by the board, and shall be accompanied by a renewal fee as provided by rule payable to the department of health and senior services.
2. Upon receipt of an incomplete application for renewal, the board shall grant the applicant a temporary permit which shall be in effect for thirty days. The applicant is required to submit the required documentation or fee within the thirty-day period, or the board may refuse to renew his or her application. The thirty-day period can be extended for good cause shown for an additional thirty days. Upon receipt of the approved continuing education credits or other required documentation or fee within the appropriate time period, the board shall issue a license. 3. The board shall renew the license of an applicant who has met all of the requirements for renewal.
4. As a requirement for renewal of license, the board may require not more than forty-eight clock hours of continuing education a year. The continuing education provided for under this section shall be approved by the board. There shall be a separate, nonrefundable fee for each single offering provider. The board shall set the amount of fee for any single offering provided by rules and regulations promulgated pursuant to section 536.021. The fee shall be set at a level to produce revenue which shall not substantially exceed the cost and expense in administering and reviewing any single offering.
5. By April first of each year, the board shall [mail an application for renewal of license to] notify every person whose license shall be renewed during the current year. The applicant must submit such information as will enable the board to determine if the applicant's license should be renewed. Information provided in the application shall be attested by signature to be true and correct to the best of the applicant's knowledge and belief.
6. Any licensee who fails to apply to renew his or her license by June thirtieth of the licensee's year of renewal may be relicensed by the board if he meets the requirements set forth by the board pursuant to sections 344.010 to 344.108 and pays the renewal fee required by rule, plus a penalty of twenty-five dollars. No action shall be taken by the board in addition to a penalty of twenty-five dollars imposed by this section against any such licensee whose license has not expired for a period of more than two months, and who has had no action in the preceding five years taken against them by the board, and who has met all other licensure requirements by June thirtieth of the year of renewal; provided, however, that nothing in this section shall prevent the board from taking any other disciplinary action against a licensee if there shall exist a cause for discipline pursuant to section 344.050. A person whose license has expired for a period of more than twelve months must meet the requirements set out in section 344.030 for initial licensure.
346.055. 1. An applicant may obtain a license by successfully passing a qualifying examination of the type described in sections 346.010 to 346.250, provided the applicant:
(1) Is at least [twenty-one] eighteen years of age; and
(2) Is of good moral character ; and
(3) [Until December 31, 2008, has an education equivalent to at least a high school diploma from an accredited high school.
2. Beginning January 1, 2009, an applicant for a hearing instrument specialist license or a hearing instrument specialist-in-training permit shall demonstrate successful completion of a minimum of sixty semester hours, or its equivalent, at a state or regionally accredited institution of higher education.
3. Beginning January 1, 2011, an applicant for a hearing instrument specialist license or a hearing instrument specialist-in-training permit shall hold an associate's level degree or higher from a state or regionally accredited institution of higher education.
4. Beginning January 1, 2013, or any date thereafter when an associate degree program in hearing instrument sciences is available from a state or regionally accredited institution within Missouri, an applicant for a hearing instrument specialist license or a hearing instrument specialist-in-training permit shall hold:
(1) An associate's degree or higher in hearing instrument sciences; or
(2) A master's or doctoral degree in audiology from a state or regionally accredited institution] (a) Holds an associate’s degree or higher, from a state or regionally accredited institution of higher education, in hearing instrument sciences; or
(b) Holds an associate’s level degree or higher, from a state or regionally accredited institution of higher education, and submits proof of completion of the International Hearing Society’s Distance Learning for Professionals in Hearing Health Sciences course, and submits proof of completion of the Hearing Instrument Specialists in Training program as established by the Board of Examiners for Hearing Instrument Specialists; or
(c) Holds a master’s or doctoral degree in audiology from a state or regionally accredited institution; or
(d) Holds a current, unsuspended, unrevoked license from another jurisdiction if the standards for licensing in such other jurisdiction, as determined by the board, are substantially equivalent to or exceed those required in subdivisions (3)(a) or (3)(b) of this subsection; or
(e) Holds a current, unsuspended, unrevoked license from another jurisdiction, has been actively practicing as a licensed hearing aid fitter or dispenser in another jurisdiction for no less than forty-eight of the last seventy-two months, and submits proof of completion of advance certification from either the International Hearing Society of the National Board for Certification in Hearing Instrument Sciences.
[5.] 2. The provisions of [subsections 2, 3, and 4] subsection 1 of this section shall not apply to any person holding a valid Missouri hearing instrument specialist license under this chapter when applying for the renewal of that license. These provisions shall apply to any person holding a hearing instrument specialist-in-training permit at the time of their application for licensure or renewal of said permit.
3. (1) The board shall promulgate reasonable standards and rules for the evaluation of applicants for purposes of determining the course of instruction and training required of each applicant for a hearing instrument specialist license under the requirement of subdivision (3) of subsection 1 of this section.
(2) Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective ate, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2013 shall be invalid and void.
346.085. 1. The qualifying examination provided in section 346.060 shall be designed to demonstrate the applicant's adequate technical qualifications in the practice of fitting hearing instruments as defined by the board.
2. The board shall promulgate reasonable standards and rules that identifies and describes the required technical knowledge and skill of fitting hearing instruments necessary to prepare each applicant for licensure by testing. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2013, shall be invalid and void.
453.070. 1. Except as provided in subsection 5 of this section, no decree for the adoption of a child under eighteen years of age shall be entered for the petitioner or petitioners in such adoption as ordered by the juvenile court having jurisdiction, until a full investigation, which includes an assessment of the adoptive parents, an appropriate postplacement assessment and a summary of written reports as provided for in section 453.026, and any other pertinent information relevant to whether the child is suitable for adoption by the petitioner and whether the petitioner is suitable as a parent for the child, has been made. The report shall also include a statement to the effect that the child has been considered as a potential subsidy recipient.
2. Such investigation shall be made, as directed by the court having jurisdiction, either by the division of family services of the [state] department of social services, a juvenile court officer, a licensed child-placement agency, a social worker [licensed pursuant to chapter 337], a professional counselor, or a psychologist licensed under chapter 337 and associated with a licensed child-placement agency, or other suitable person appointed by the court. The results of such investigation shall be embodied in a written report that shall be submitted to the court within ninety days of the request for the investigation.
3. The department of social services, division of family services, shall develop rules and regulations regarding the content of the assessment of the petitioner or petitioners. The content of the assessment shall include but not be limited to, a report on the condition of the petitioner's home and information on the petitioner's education, financial, marital, medical and psychological status and criminal background check. If an assessment is conducted after August 28, 1997, but prior to the promulgation of rules and regulations by the department concerning the contents of such assessment, any discrepancy between the contents of the actual assessment and the contents of the assessment required by department rule shall not be used as the sole basis for invalidating an adoption. No rule or portion of a rule promulgated pursuant to the authority of this section shall become effective unless it has been promulgated pursuant to the provisions of chapter 536. 4. The assessment of petitioner or petitioners shall be submitted to the petitioner and to the court prior to the scheduled hearing of the adoptive petition.
5. In cases where the adoption or custody involves a child under eighteen years of age that is the natural child of one of the petitioners and where all of the parents required by this chapter to give consent to the adoption or transfer of custody have given such consent, the juvenile court may waive the investigation and report, except the criminal background check, and enter the decree for the adoption or order the transfer of custody without such investigation and report.
6. In the case of an investigation and report made by the division of family services by order of the court, the court may order the payment of a reasonable fee by the petitioner to cover the costs of the investigation and report.
7. Any adult person or persons over the age of eighteen, who, as foster parent or parents, have cared for a foster child continuously for a period of nine months or more and bonding has occurred as evidenced by the positive emotional and physical interaction between the foster parent and child, may apply to such authorized agency for the placement of such child with them for the purpose of adoption if the child is eligible for adoption. The agency and court shall give preference and first consideration for adoptive placements to foster parents. However, the final determination of the propriety of the adoption of such foster child shall be within the sole discretion of the court.
8. (1) Nothing in this section shall be construed to permit discrimination on the basis of disability or disease of a prospective adoptive parent.
(2) The disability or disease of a prospective adoptive parent shall not constitute a basis for a determination that the petitioner is unfit or not suitable to be an adoptive parent without a specific showing that there is a causal relationship between the disability or disease and a substantial and significant risk of harm to a child.
[346.050. Whenever the board determines that another state or jurisdiction has requirements equivalent to or higher than those in effect pursuant to sections 346.010 to 346.250 and that such state or jurisdiction has a program equivalent to or stricter than the program for determining whether an applicant, pursuant to sections 346.010 to 346.250 is qualified to engage in the practice of fitting hearing instruments, the board shall issue a license to applicants who hold current, unsuspended and unrevoked certificates or licenses to fit hearing instruments in such other state or jurisdiction provided that such jurisdiction extends like privileges for reciprocal licensing or certification to persons licensed by this state with similar qualifications. No such applicant for licensure shall be required to submit to or undergo a qualifying examination other than the payment of fees pursuant to sections 346.045 and 346.095. Such applicant shall be registered in the same manner as licensees in this state. The fee for an initial license issued pursuant to this section shall be the same as the fee for an initial license issued pursuant to section 346.045. Fees, grounds for renewal, and procedures for the suspension and revocation of licenses granted pursuant to this section shall be the same as for renewal, suspension and revocation of an initial license issued pursuant to section 346.045.]
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