2023

  • Passed APRN Compromise language including APRN licensure, changes to mileage, changes to telehealth, changes to prescriptive authority for APRNs working in hospice and more
  • Passed surgical smoke legislation, making Missouri the 14th state in the country to pass legislation addressing surgical smoke in operating rooms.
  • Passed Postpartum Expansion legislation to extend coverage from 60 days to 1 year for low-income, pregnant women.
  • Stopped harmful anti-DEI legislation that would have affected nursing schools and hospitals.
  • Moved the “Health Professional Loan Repayment Program” from the Department of Health and Senior Services, to the Missouri State Board of Nursing, and secured $8 million in loans for nursing schools’ education expenses for nurses statewide.
  • Prescription Labeling Requirements: Currently, the name of the collaborating physician for an advanced practice registered nurse or physician assistant shall be included on any label of a controlled substance sold or dispensed by a pharmacist. This bill repeals this requirement and only the name of the prescribing health care provider is needed.


2022

  • Successfully lobbied and passed legislation that adds APRNs and physician assistants to those who can create a plan of treatment for home health services.
  • Successfully lobbied for changes and funding for the Nursing Student Loan Program.
  • Successfully lobbied for Visitation Rights at Healthcare facilities for families.
  • Lobbied for the Licensure of APRNs and killed a proposal to put APRN licensure under the Board of Healing Arts.
  • Lobbied for the elimination of the geographic mileage striction for APRNs.
  • Lobbied for the extension of other waivers authorized during the state of emergency for COVID.
  • MONA was active in negotiating language for the supplemental health care service agencies, which is defined as persons or entities engaged in the business of providing or procuring temporary employment in health care facilities for health care personnel. MONA was instrumental/successful in removing the language that would have capped nurses salaries.
  • Lobbied against anti-vaccination legislation for children.
  • Introduced and lobbied for legislation to require each hospital and ambulatory surgical center that performs procedures that produce surgical smoke plume, on or before January 1, 2024, to adopt and implement policies and procedures to ensure the evacuation of surgical smoke plume by use of a surgical smoke plume evacuation system for each procedure that generates surgical smoke plume from the use of energy-based devices, including, but not limited to, electrosurgery and lasers.
  • MONA has mental health as one of our key priorities. These two provisions added to the omnibus education bill are of interest to MONA members:
  • SUICIDE AWARENESS & PREVENTION (Sections 170.047 & 170.048)
  • Beginning July 1, 2023, this bill requires a public school or charter school with pupils in grades seven to 12 that issues pupil or student identification cards to print the 3-digit dialing code that directs calls and routes text messages to the Suicide and Crisis Lifeline, 988.
  • MENTAL HEALTH AWARENESS TRAINING (Section 170.307)
  • This bill establishes a mental health awareness training requirement for pupils in public schools and charter schools that shall be given any time during a pupil’s four years of high school. Instruction shall be included in the district’s existing health or physical education curriculum. Instruction shall be based on a program established by DESE.


2021

  • Successfully lobbied for a Prescription Drug Monitoring Program (PDMP)
  • Successfully lobbied for legislation to address workplace violence for healthcare workers. This bill creates the offense of interference with a health care facility and the offense of interference with an ambulance service.
  • Successfully lobbied to create the Mental Health Parity and Addiction Equity Act, which requires health insurers to cover mental health care in the same way they cover physical health conditions.
  • APRN Legislation to make permanent the waivers put into practice by Governor Parson due to COVID, were ultimately stopped in the last week of session due to a threat of a filibuster by our opponents. That legislation would have removed mileage barriers, the one-month preceptor requirement, and opened up telehealth in all areas of need, not just in rural areas.


2020

  • Introduced and lobbied for language to allow APRN’s to work independently from a collaborative practice arrangement after working in one for six months. It was called the Access for Missourians – AIM.
  • Introduced and lobbied for language to allow APRN’s to have their own license, instead of a document of recognition. This was killed after Senator Bob Onder, R-Lake St. Louis (who is a physician) tried to put APRN’s licensure under the Board of Healing Arts.
  • Introduced and lobbied for legislation that would have removed what we call “barriers to care” under the collaborative practice requirements, such as mileage, nurse to physician ratios, chart reviews, and eliminating the one-month preceptorship with a new collaborator.
  • Introduced and lobbied for language to remove one of the barriers – the mileage barriers for APRN’s in both rural areas of Missouri and in alternative to abortion agencies.
  • Defeated legislation that would expand what an Assistant Physician can do in Missouri.
  • Defeated “Truth in Advertising and Titling” legislation, that would have prohibited nurses from using certain titles.
  • Successfully lobbied for Protections for Victims of Sexual Assault – The legislation would give victims of sexual assault access to a secure electronic tracking system for their Sexual Assault Forensic Evidence (SAFE) kits.
  • Unsuccessfully lobbied against the repeal of the motorcycle helmet law. Governor would not veto the legislation this year.
  • GOVERNOR PARSON – COVID-19 – WAIVERS
    • On March 24, Governor Mike Parson issued the following waivers during the State of Emergency – which has been extended to June 15, 2020:
    • The Director of the Department of Commerce and Insurance and the Division of Professional Registration and its Boards are hereby vested with authority to temporarily waive or suspend the operation of any statutory requirement or administrative rule under their purview, upon approval of the Office of the Governor, in order to best serve public health and safety during the period of the emergency and subsequent recovery period.
    • This allowed the State Board of Nursing to remove all mileage restrictions for APRN’s, removes the requirement to work thirty days directly with a new collaborating physician, and removes chart reviews for APRN’s and physicians that are not prescribing controlled substances.
    • Legislation was drafted after the COVID-19 return of the legislature to make these waivers permanent in law; however, the legislation was not taken up for debate or passage.


2019

  • Successfully lobbied for legislation to establish the “Pregnancy-Associated Mortality Review Board” within the Department of Health and Senior Services to improve data collection and reporting regarding maternal mortality and to develop initiatives that support at-risk populations.
  • Successfully lobbied to require certified nursing assistant training programs to be offered at skilled nursing or intermediate care facility units in Missouri veterans’ homes and hospitals.
  • Successfully lobbied to make modifications to the rulemaking authority of the Missouri 911 Service Board.
  • Successfully lobbied the Governor to VETO the passage of the motorcycle helmet repeal.
  • One of MONA’s priority pieces of legislation was to require a licensed hospital to adopt a workplace violence prevention plan that is designed to protect health care employees and other hospital personnel from aggressive and violent behavior.
  • Lobbied in support of the Narcotics Control Act (PDMP)
  • Lobbied in support of the Syringe Access Programs.
  • Introduced and lobbied for full practice authority for Advanced Practice Registered Nurses (APRN’s), and to create an APRN license instead of a “document of recognition”.
  • Defeated legislation to create a new license for a “mid-level” practitioner position called a Paramedic Practitioner.
  • Defeated anti-vaccination legislation for children.


2018

  • Successfully lobbied for legislation increases the ratio of APRN’s in a collaborative practice arrangement from three to six.
  • Successfully lobbied for is a new profession created to include psychiatric advanced practice registered nurses as mental health.
  • Worked with the Board of Nursing and the Board of Healing Arts to change the mileage requirements for APRN’s in a collaborative practice agreement from 30/50-miles to 75-mile limitations.
  • Successfully lobbied for a requirement that at least one member of the Missouri State Board of Nursing be an advanced practice registered nurse.
  • Successfully lobbied for bill specifies that pregnant women receiving substance abuse treatment within 60 days of giving birth shall be eligible for MO HealthNet benefits for substance abuse treatment and mental health treatment for substance abuse for up to 12 additional months, as long as the woman remains adherent with treatment.
  • Successfully lobbied for an expansion of telehealth services.
  • Lobbied in support of the Narcotics Control Act (PDMP).
  • Lobbied in support of prohibiting tanning bed usage of minors under 18.
  • Lobbied in support of Syringe Access Programs.


2017

  • Introduced and lobbied for to remove collaborative practice barriers to care for Advanced Practice Registered Nurses, such as mileage restraints, chart reviews, one-month preceptorships, etc.
  • Introduced and lobbied for bills to give prescriptive authority to APRNs for Schedule II medications containing amphetamine or methylphenidate
  • Lobbied in support of the Narcotics Control Act (PDMP).
  • Lobbied the State Board of Healing Arts and the State Board of Nursing to repeal rules and regulations relating to APRNs in a collaborative practice arrangement.
  • Successfully lobbied to stop Senate Bill 28 which required Missouri to apply for a Medicaid “global waiver” from the federal government. The bill did not expand Medicaid and could have meant substantial cuts to federal Medicaid funding; including a loss of coverage for vulnerable seniors, people with disabilities, children, pregnant women, and low-income parents who now depend on Medicaid.
  • Lobbied in support of a change in the laws regarding funding for 911 services


2016

  • Successfully lobbied for nurse practitioner reimbursement for mental health services from the Crime Victims Compensation Fund.
  • Introduced and lobbied for Full Practice Authority Bill to remove collaborative practice arrangements (CPA) and allow Advanced Practice Registered Nurses (APRN) to practice to their full scope of practice. The bill also added a definition, license, and scope of practice for APRNs to the Board of Nursing Chapter 335.
  • Introduced and lobbied for bills to give prescriptive authority to APRNs for all Schedule II medications.
  • Successfully lobbied to allow the State Board of Nursing (and other providers) to collect and analyze workforce data from its licensees for the purpose of future workforce planning and to assess the accessibility and availability of qualified health care services and practitioners in Missouri.
  • Successfully lobbied to update the Nurse Licensure Compact for registered nurses (RN) to require background checks.
  • Lobbied in support of the Narcotics Control Act (PDMP).
  • Successfully lobbied for a Missouri Telehealth Network for all practitioners. This act also defines “telehealth” or “telemedicine” as the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.


2015

  • Introduced and successfully lobbied for APRNs to prescribe Schedule II – Hydrocodone.
  • Successfully lobbied for APRNs to be added to specified phases of the death certification process, including data provision, certification of death, and authorization for the final disposition of the decedent’s body.
  • Successfully lobbied to allow a board or commission to only address topics relating to the qualifications, functions, or duties of the profession they license or regulate.
  • Supported that when a physician reviews pursuant to a collaborative practice arrangement an advanced practice registered nurse’s delivery of health care services, which includes chart review, the collaborating physician need not be present at the health care practitioner’s site.
  • Introduced and lobbied for support legislation to create Missouri Healthcare Professional Workforce Data Collection.
  • Lobbied in support of the Retail Clinics legislation to remove various barriers to care for APRNs in a collaborative practice arrangement.
  • Lobbied in support of the Prescription Drug Monitoring Program (PDMP).
  • Introduced legislation to repeal the Assistant Physician statute.
  • Lobbied the State Board of Healing Arts and the State Board of Nursing to repeal rules and regulations relating to APRNs in a collaborative practice arrangement, specifically to allow referrals of patients to physicians other than those who serve as the collaborating physician.


2014

  • Supported APRN Scope of Practice and Licensure Bill
  • Supported removing barriers to APRN practice bill
  • Supported the Oral Chemotherapy Bill
  • Supported Medicaid Transformation
  • Supported Prescription Drug Monitoring Bill
  • Opposed Assistant Physician Bill
  • Opposed the repeal of the MOHealthNet Committee


2013

  • Lobbied for “APRN Access to Care” Legislation
  • Successfully lobbied in support to establish “Utilization of Telehealth” by APRNs in certain rural areas
  • Successfully lobbied for change to MOHealthNet statute to add APRNs to the list of those who can prescribe drugs covered by MOHealthNet payments
  • Successfully lobbied in support of “Prompt Credentialing” requiring health carriers to credential healthcare practitioners within 60 business days of receiving a completed application and to pay the practitioner for treatment services pending approval
  • Lobbied in support of Medicaid Transformation
  • Lobbied in support of the Prescription Drug Monitoring Program


2012

  • Lobbied for “Barrier Free Care” for APRNs and Missouri Citizens
  • Successfully lobbied  in support of periodic review of state administrative rules every five years
  • Lobbied in support of the Prescription Drug Monitoring Program
  • Successfully lobbied in opposition of sweeping future nursing fees from the State Board of Nursing and other Professional Registration groups


2011

  • Successfully lobied for legislation to add a nurse to MO HealthNet Committee
  • Supported legislation for the Nursing Incentive Program
  • Lobbied for legislation to protect health care workers against workplace violence making it a felony
  • Successfully defeated all amendments that threatened nurses use of the title “doctor”, if they have earned the title


2010

  • Successfully lobbied to add Advanced Practice Registered Nurses (APRNs) to the list of approved health care providers who physical therapists are able to accept an order/ prescription
  • Successfully lobbied for employers of nurses be required to have a system in place for verifying that the applicant for a position as a registered, licensed practical, or advanced practice registered nurse has a current valid license and verify the licensure status at each license renewal
  • Successfully lobbied to support prompt pay of insurance claims
  • Lobbied for legislation to modify the membership of the MO HealthNet Oversight Committee by adding a licensed registered nurse
  • Successfully lobbied to support allowing expedited partner therapy under certain conditions by dispensing and prescribing medications for the partner of a person diagnosed with certain sexually transmitted diseases even when there is no existing physician/patient relationship


2009

  • Successfully lobbied to revise the definition of “eligible student” as it relates to the Nursing Student Loan Program to allow individuals seeking doctoral degrees in nursing or education on a full-time or part-time basis to participate
  • Lobbied to support physical therapists accepting orders for therapy from Advanced Practice Registered Nurses (APRNs)
  • Lobbied for legislation to modify the membership of the MO HealthNet Oversight Committee by adding a licensed registered nurse
  • Lobbied to support an increase in school nurses pay equivalent to school teachers
  • Successfully supported adoption of the interstate compact for multi-state licensure


2008

  • Successfully lobbied for the ability of advance practice registered nurses (APRNs) to prescribe controlled substances
  • Lobbied to oppose legislation and/or regulation that reduce patient access to health care and prescription medications
  • Lobbied to support the elimination of the “step-therapy” clause that many health plans enforce in health insurance plans
  • Lobbied for an increase in school nurses pay equivalent to school teachers
  • Lobbied for legislation to modify the membership of MO HealthNet Oversight Committee by adding a licensed registered nurse


2007

  • Lobbied for the ability of advance practice registered nurses (APRNs) to prescribe controlled substances
  • Lobbied to oppose legislation and/or regulation that reduces patient access to health care and prescription medications
  • Lobbied to support out-of-hospital due not resuscitate legislation
  • Lobbied to amend the Nurse Loan Repayment Program to include employment at for-profit facilities in eligibility criteria


2006

  • Introduced legislation expanding APRN prescriptive authority to include schedule II-V controlled substances
  • Successfully opposed a proposed joint rule enacting further restrictions and combining APRN collaboration & physician assistant (PA) supervision
  • Successfully lobbied for revisions to the MO Student Nurse Loan Repayment Program
  • Successfully lobbied for a sunset date extension for Technical Advisory Committee on Quality of Patient Care & Nursing Practices
  • Successfully lobbied for APRN authority to certify handicapped placard eligibility for patients
  • Successfully lobbied for APRN authority to prescribe pseudoephedrine products
  • Successfully opposed adoption of the interstate compact for multi-state licensure


2005

  • Introduced legislation expanding APRN prescriptive authority to include Schedule II-V controlled substances
  • Successfully opposed adoption of the interstate compact for multi-state licensure
  • Participated in developing hospital licensure rules limiting the use of mandatory overtime as a staffing tool.
  • Lobbied for expungement of certain records in select circumstances following Missouri State Board of Nursing complaint investigations
  • Lobbied to require health plans to cover all services provided by registered nurse first assistants (RNFAs) and to require the Board of Nursing to determine which specialty nursing organization certification will be recognized for RNs seeking RNFA titling, allowing those practicing as independent contractors to achieve direct reimbursement