SB 979 revises Missouri law governing advanced practice registered nurses (APRNs), especially their authority to prescribe controlled substances and their relationship with collaborating physicians. The bill updates sections dealing with controlled substance prescribing, collaborative practice arrangements, and APRN prescriptive authority. It allows APRNs with the proper certificate and physician delegation to prescribe Schedules III, IV, and V controlled substances, and in limited circumstances Schedule II drugs such as hydrocodone, hospice-related Schedule II medications, and certain Schedule II stimulants for behavioral health patients. It also authorizes APRNs to prescribe buprenorphine for medication-assisted treatment under physician direction.
The bill also changes the rules for collaborative practice arrangements. It sets detailed requirements for written agreements, chart review, physician oversight, disclosure to patients, and reporting to the state board. It creates or expands exceptions to geographic proximity requirements, including for correctional centers, rural health clinics, telehealth, and board-approved waivers. In addition, it preserves the ability of certified registered nurse anesthetists to provide anesthesia services under supervision and clarifies that APRNs with 2,000 documented hours of collaborative practice may practice without a collaborative agreement, subject to specified conditions.
SB 979 would amend Missouri statutes 195.070, 334.104, and 335.019 to expand and clarify APRN prescribing authority and collaborative practice rules. It affects the scope of practice for advanced practice registered nurses, collaborating physicians, hospitals, correctional facilities, hospice providers, rural health clinics, and patients receiving behavioral health, hospice, or substance use disorder treatment. The bill would also alter board oversight by requiring public reporting of collaborative arrangements and preserving joint rulemaking authority for the nursing and healing arts boards.
The available record shows no committee transcript or vote history, so there is no direct evidence of debate, support, or opposition in the materials provided. Based on the bill text alone, the measure appears designed to incrementally expand APRN practice authority while retaining physician oversight and detailed safeguards, suggesting a policy approach that balances access to care with regulatory control.
The main likely points of contention are the extent of APRN independence and the degree of physician supervision required. Supporters would likely favor broader access to care, especially in rural areas, correctional settings, hospice, telehealth, and behavioral health treatment, while opponents may object to APRNs prescribing controlled substances, the waiver of geographic proximity, and the provision allowing practice without a collaborative arrangement after 2,000 hours. The bill also preserves physician authority to refuse collaboration and imposes chart-review and disclosure requirements, indicating an effort to address concerns about oversight and patient safety.