Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 2150 - State Board of Registration for the Healing Arts › Chapter 2 - Licensing of Physicians and Surgeons › Section 20 CSR 2150-2.240 - Assistant Physician Collaborative Practice Agreements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment is necessary to implement the
				  provision of Senate Bill 718 (2018) passed by the 99th General Assembly. The
				  proposed amendment change permits an advanced practice registered nurse (APRN)
				  to prescribe buprenorphine, a Schedule III drug, for thirty (30) days without
				  refill for patients receiving medication-assisted treatment for substance use
				  disorders under the direction of the collaborating physician. It also prohibits
				  the collaborating physician or supervising physician from entering into a
				  collaborative practice arrangement or supervision agreement with more than six
				  (6) full-time equivalent advanced practice registered nurses, full-time
				  equivalent licensed physician assistants, or full-time equivalent assistant
				  physicians, or any combination thereof.
PURPOSE: In accordance with section
				  334.036,
				  RSMo, this rule defines collaborative practice arrangement terms and implements
				  section 630.875, RSMo related to
				  "Improved Access to Treatment for Opioid Addictions Act"
				  (IATOA).
(1) Geographic
				areas.
(A) The collaborating physician in a
				collaborative practice arrangement with an assistant physician shall not be so
				geographically distanced from the collaborating assistant physician as to
				create an impediment to effective collaboration in the delivery of health care
				services or the adequate review of those services.
(B) The following shall apply in the use of a
				collaborative practice arrangement by an assistant physician who provides
				health care services that include the diagnosis and initiation of treatment for
				acutely or chronically ill or injured persons:
1. If the collaborating physician and
				assistant physician are utilizing telehealth in providing services in a
				medically underserved area no mileage limitation shall apply; or
2. If the assistant physician is not
				utilizing telehealth in providing services the collaborating physician, or
				other physician designated in the collaborative practice arrangement, shall be
				no further than seventy five (75) miles by road, using the most direct route
				available, from the collaborating assistant physician; or
3. Pursuant to 630.875 RSMo, an assistant
				physician collaborating with a physician who is waiver-certified for the use of
				buprenorphine, may participate in the "Improved Access to Treatment for Opioid
				Addictions Program" (IATOAP) in any area of the state and provide all services
				and functions of an assistant physician. A remote collaborating physician
				working with an on-site APRN shall be considered to be on-site for the purposes
				of IATOAP.
(C) An
				assistant physician who desires to enter into a collaborative practice
				arrangement at a location where the collaborating physician is not continuously
				present shall practice together at the same location with the collaborating
				physician continuously present for a period of at least one (1) month before
				the collaborating assistant physician practices at a location where the
				collaborating physician is not present. During this one (1) month period, the
				collaborating physician must review ten percent (10%) of the assistant
				physicians' patient's records. It is the responsibility of the collaborating
				physician to determine and document the completion of the same location
				practice and records review as described above.
(D) For purposes of this rule, the following
				shall apply:
1. The term "continuously
				present" shall mean the supervising physician is physically present and seeing
				each and every patient with the assistant physician when said assistant
				physician is seeing and/or treating a patient;
2. The term "one (1) month period" shall mean
				a minimum of one hundred twenty (120) hours of clinic time, where the
				supervising physician and assistant physician are seeing and treating
				patients.
(E) A
				collaborating physician shall not enter into a collaborative practice
				arrangement with more than six (6) full-time equivalent assistant physicians,
				full-time equivalent physician assistants, full-time equivalent assistant
				physicians, or any combination thereof. This limitation shall not apply to
				collaborative arrangements of hospital employees providing inpatient care
				service in hospitals as defined in Chapter 197, RSMo, or population-based
				public health services or to a certified registered nurse anesthetist providing
				anesthesia services under the supervision of an anesthesiologist or other
				physician, dentist, or podiatrist who is immediately available if needed as set
				out in 334.104(7) RSMo.