Healthcare (Healthcare Workforce)

SB 1445 would allow certified registered nurse anesthetists (CRNAs) to independently select, issue orders for, and administer certain controlled substances without requiring a physician's order. This change directly affects CRNAs by expanding their scope of practice in anesthesia care, particularly for pain management and surgical procedures involving these medications. The bill does not specify which controlled substances are included but would remove current barriers for CRNAs to manage them within their professional role. The bill is currently in early legislative stages, having been prefaced in 2025 and scheduled for its first reading in 2026.

HB 2137 modifies Missouri's rules for dental hygienists, primarily requiring them to work under the supervision of a licensed dentist in most settings. The bill creates two key exceptions: (1) hygienists can provide basic services like oral screenings and fluoride varnish in any location without a dentist's supervision, and (2) experienced hygienists (with 3+ years in public health) can perform cleanings, sealants, and fluoride treatments for Medicaid-eligible children without supervision, with Medicaid reimbursing providers. This directly affects dental hygienists, dentists, public health facilities, and Medicaid-eligible children. The changes aim to expand access to preventive dental care in community settings while maintaining oversight for more complex procedures.

HB 1636 modifies rules for collaborative practice between physicians and advanced practice registered nurses (APRNs). It allows APRNs to prescribe certain controlled substances (including Schedule III-V drugs and hydrocodone) under written agreements, with a 120-hour supply limit for most prescriptions. The law requires clear patient disclosure about seeing an APRN, specifies physician review of APRN care, and adds flexibility for rural areas and telehealth regarding geographic proximity requirements between physicians and APRNs. This directly affects APRNs, their patients, and collaborating physicians by expanding prescribing authority while maintaining oversight safeguards.

HB 2287 expands prescribing authority for advanced practice registered nurses (APRNs) in specific scenarios. It allows APRNs with a controlled substance prescriptive certificate to prescribe Schedule III-V controlled substances and limited Schedule II (hydrocodone) medications for hospice patients or those under designated mental health providers, with prescriptions capped at a 120-hour supply without refill. The bill requires written collaborative agreements between APRNs and physicians, including patient disclosure statements about seeing an APRN instead of a physician. It prohibits APRNs from prescribing for themselves or family members and maintains existing restrictions on Schedule II prescribing for sedation or anesthesia.