Modifies provisions relating to the administration of controlled substances by nurses
HB831 revises Missouri law governing who may prescribe, administer, dispense, and otherwise handle controlled substances in collaborative practice settings, with a particular focus on advanced practice registered nurses (APRNs) and certified registered nurse anesthetists (CRNAs). The bill repeals and reenacts sections 195.070 and 334.104 to clarify the authority of physicians, APRNs, CRNAs, and veterinarians, and to set detailed conditions for nurse prescribing authority, including limits on drug schedules, supply duration, and patient categories such as hospice and medication-assisted treatment patients.
Under the bill, APRNs with controlled substance prescriptive authority and a physician collaboration agreement may prescribe Schedules III, IV, and V controlled substances, with limited Schedule II authority for hydrocodone and hospice patients. CRNAs are expressly allowed to select, issue orders for, and administer controlled substances for anesthesia care in licensed facilities, but not to prescribe them, and they are not required to obtain a separate controlled substance prescriptive certificate for that role. The bill also expands and codifies the structure of collaborative practice arrangements, including written agreement requirements, chart review obligations, public disclosure, geographic proximity rules and waivers, telehealth allowances, and limits on how many APRNs, physician assistants, or assistant physicians a physician may supervise in these arrangements.
HB831 would significantly update the statutory framework for collaborative practice in Missouri by expanding and clarifying nurse authority over controlled substances while preserving physician oversight requirements. It would amend the controlled substances statute and the collaborative practice statute to define the scope of APRN and CRNA practice, establish specific prescribing limits, require written agreements and periodic chart review, and create procedures for geographic proximity waivers, public reporting, and joint rulemaking by the relevant licensing boards. The bill also affects hospitals, correctional centers, rural health clinics, hospice providers, and patients receiving anesthesia or substance use disorder treatment, while maintaining restrictions on self-prescribing and on certain anesthesia-related prescribing by CRNAs.
The bill appears generally supportive of expanded nursing practice authority, especially for APRNs and CRNAs, while retaining a structured physician-supervision model. The text suggests an effort to balance access to care, particularly in rural areas, correctional settings, hospice, and telehealth contexts, with oversight and patient-safety safeguards. No committee transcripts or vote records were provided, so there is no recorded floor or committee sentiment beyond the bill’s policy design.
The main points of contention likely center on the scope of nurse prescribing authority, the extent of physician supervision, and the limits on collaborative practice arrangements. The bill preserves physician control over collaboration, requires chart review and proximity rules, and caps the number of practitioners a physician may supervise, which may reflect concerns about oversight and safety. At the same time, the bill includes exceptions and waivers for correctional facilities, rural clinics, telehealth, hospice, and buprenorphine treatment, suggesting likely debate over access to care versus regulatory control. The bill also distinguishes CRNAs from APRNs by allowing anesthesia-related administration but not prescribing, which may be another area of professional boundary concern.