FIRST REGULAR SESSION
HOUSE COMMITTEE SUBSTITUTE FOR
HOUSE BILL NO. 536
95TH GENERAL ASSEMBLY
1246L.02C D. ADAM CRUMBLISS, Chief Clerk
To repeal sections 195.070, 195.100, 337.010, 337.015, 337.020, 337.050, and 338.198, RSMo, and to enact in lieu thereof eight new sections relating to psychologist licensing.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 195.070, 195.100, 337.010, 337.015, 337.020, 337.050, and 338.198, RSMo, are repealed and eight new sections enacted in lieu thereof, to be known as sections 195.070, 195.100, 337.010, 337.015, 337.020, 337.031, 337.050, and 338.198, to read as follows:
195.070. 1. A physician, podiatrist, dentist, or a registered optometrist certified to administer pharmaceutical agents as provided in section 336.220, RSMo, in good faith and in the course of his or her professional practice only, may prescribe, administer, and dispense controlled substances or he or she may cause the same to be administered or dispensed by an individual as authorized by statute.
2. An advanced practice registered nurse, as defined in section 335.016, RSMo, but not a certified registered nurse anesthetist as defined in subdivision (8) of section 335.016, RSMo, who holds a certificate of controlled substance prescriptive authority from the board of nursing under section 335.019, RSMo, and who is delegated the authority to prescribe controlled substances under a collaborative practice arrangement under section 334.104, RSMo, may prescribe any controlled substances listed in Schedules III, IV, and V of section 195.017. However, no such certified advanced practice registered nurse shall prescribe controlled substance for his or her own self or family. Schedule III narcotic controlled substance prescriptions shall be limited to a one hundred twenty-hour supply without refill.
3. A veterinarian, in good faith and in the course of his professional practice only, and not for use by a human being, may prescribe, administer, and dispense controlled substances and he may cause them to be administered by an assistant or orderly under his direction and supervision.
4. A prescribing psychologist licensed under section 337.015, RSMo, in good faith and in the course of professional practice only, may prescribe psychotropic drugs as referenced in subsection 4 of section 337.015, RSMo. Such prescribing psychologist shall not purchase, administer, or dispense any medication.
5. A practitioner shall not accept any portion of a controlled substance unused by a patient, for any reason, if such practitioner did not originally dispense the drug.
[5.] 6. An individual practitioner may not prescribe or dispense a controlled substance for such practitioner's personal use except in a medical emergency.
195.100. 1. It shall be unlawful to distribute any controlled substance in a commercial container unless such container bears a label containing an identifying symbol for such substance in accordance with federal laws.
2. It shall be unlawful for any manufacturer of any controlled substance to distribute such substance unless the labeling thereof conforms to the requirements of federal law and contains the identifying symbol required in subsection 1 of this section.
3. The label of a controlled substance in Schedule II, III or IV shall, when dispensed to or for a patient, contain a clear, concise warning that it is a criminal offense to transfer such narcotic or dangerous drug to any person other than the patient.
4. Whenever a manufacturer sells or dispenses a controlled substance and whenever a wholesaler sells or dispenses a controlled substance in a package prepared by him, he shall securely affix to each package in which that drug is contained a label showing in legible English the name and address of the vendor and the quantity, kind, and form of controlled substance contained therein. No person except a pharmacist for the purpose of filling a prescription under sections 195.005 to 195.425, shall alter, deface, or remove any label so affixed.
5. Whenever a pharmacist or practitioner sells or dispenses any controlled substance on a prescription issued by a physician, dentist, podiatrist, veterinarian, licensed prescribing psychologist, or advanced practice registered nurse, he shall affix to the container in which such drug is sold or dispensed a label showing his own name and address of the pharmacy or practitioner for whom he is lawfully acting; the name of the patient or, if the patient is an animal, the name of the owner of the animal and the species of the animal; the name of the physician, dentist, podiatrist, advanced practice registered nurse, [or] veterinarian, or licensed prescribing psychologist by whom the prescription was written; the name of the collaborating physician if the prescription is written by an advanced practice registered nurse, and such directions as may be stated on the prescription. No person shall alter, deface, or remove any label so affixed.
337.010. As used in sections 337.010 to 337.090 the following terms mean:
(1) "Committee", the state committee of psychologists;
(2) "Department", the department of insurance, financial institutions and professional registration;
(3) "Division", the division of professional registration;
(4) "Licensed prescribing psychologist", any licensed psychologist who is also a certified health service provider and who holds a license as a prescribing psychologist;
(5) "Licensed psychologist", any person who offers to render psychological services to individuals, groups, organizations, institutions, corporations, schools, government agencies or the general public for a fee, monetary or otherwise, implying that such person is trained, experienced and licensed to practice psychology and who holds a current and valid, whether temporary, provisional or permanent, license in this state to practice psychology;
[(5)] (6) "Provisional licensed psychologist", any person who is a graduate of a recognized educational institution with a doctoral degree in psychology as defined in section 337.025, and who otherwise meets all requirements to become a licensed psychologist except for passage of the licensing exams, oral examination and completion of the required period of postdegree supervised experience as specified in subsection 2 of section 337.025;
[(6)] (7) "Recognized educational institution":
(a) A school, college, university or other institution of higher learning in the United States, which, at the time the applicant was enrolled and graduated, had a graduate program in psychology and was accredited by one of the regional accrediting associations approved by the Council on Postsecondary Accreditation; or
(b) A school, college, university or other institution of higher learning outside the United States, which, at the time the applicant was enrolled and graduated, had a graduate program in psychology and maintained a standard of training substantially equivalent to the standards of training of those programs accredited by one of the regional accrediting associations approved by the Council of Postsecondary Accreditation;
[(7)] (8) "Temporary license", a license which is issued to a person licensed as a psychologist in another jurisdiction, who has applied for licensure in this state either by reciprocity or endorsement of the score from the Examination for Professional Practice in Psychology, and who is awaiting either a final determination by the committee relative to such person's eligibility for licensure or who is awaiting the results of the jurisprudence examination or oral examination.
337.015. 1. No person shall represent himself as a psychologist in the state of Missouri unless he is validly licensed and registered under the provisions of this chapter. No person shall engage in the practice of psychology in the state of Missouri unless he is validly licensed and registered under the provisions of this chapter unless otherwise exempt under the provisions of sections 337.010 to 337.090.
2. A person represents himself as a "psychologist" within the meaning of this chapter when he holds himself out to the public by any title or description of services incorporating the words "psychology", "psychological", or "psychologist", or any term of like import, "psychometry", "psychometrics", "psychometrist", "psychotherapy", "psychotherapists", "psychoanalysis", "psychoanalyst", or variants thereof or when the person purports to be trained, experienced or an expert in the field of psychology, and offers to render or renders services as defined below to individuals, groups, organizations, or the public for a fee, monetary or otherwise; provided, however, that professional counselors licensed to practice under this chapter, or a physician licensed to practice pursuant to chapter 334, RSMo, who specializes in psychiatry, may use any of such terms except "psychology", "psychological", or "psychologist" so long as such is consistent with their respective licensing laws.
3. The "practice of psychology" within the meaning of this chapter is defined as the observation, description, evaluation, interpretation, treatment, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing, treating, or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychometric or psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability in both inpatient and outpatient settings, alcoholism and substance abuse, disorders of habit or conduct, as well as the psychological aspects of physical illness, accident, injury, or disability; psychoeducational evaluation, therapy, remediation, and consultation; and teaching and training of psychological competence. Psychological services may be rendered to individuals, families, groups, and the public. The practice of psychology shall be construed within the meaning of this definition without regard to whether payment is received for services rendered.
4. For a licensed prescribing psychologist, the practice of psychology shall include the authority to prescribe but not purchase, administer, or dispense medication. This authority shall include Schedule II stimulants and Schedule IV benzodiazepines. Such psychologists may also prescribe antianxiety drugs, antidepressants, antiepileptics, antipsychotics, cognitive enhancers, and mood stabilizers. Standard medications for the limited treatment of side effects of authorized psychotropic medications are also authorized. Licensed prescribing psychologists shall not prescribe other controlled substances. Laboratory testing of blood and urine are authorized to monitor treatment. Authority to order electro-convulsive therapy is not granted by the provisions of this subsection.
5. The application of these principles and methods includes, but is not restricted to: diagnosis, prevention, treatment, and amelioration of adjustment problems and emotional and mental disturbances of individuals and groups; hypnosis; counseling; educational and vocational counseling; personnel selection and management; the evaluation and planning for effective work and learning situations; advertising and market research; and the resolution of interpersonal and social conflicts.
337.020. 1. Each person desiring to obtain a license, whether temporary, provisional or permanent, as a psychologist shall make application to the committee upon such forms and in such manner as may be prescribed by the committee and shall pay the required application fee. The application fee shall not be refundable. Each application shall contain a statement that it is made under oath or affirmation and that its representations are true and correct to the best knowledge and belief of the person signing the application, subject to the penalties of making a false affidavit or declaration.
2. Each applicant, whether for temporary, provisional or permanent licensure, shall submit evidence satisfactory to the committee that the applicant is at least twenty-one years of age, is of good moral character, and meets the appropriate educational requirements as set forth in either section 337.021 or 337.025, or is qualified for licensure without examination pursuant to section 337.029. In determining the acceptability of the applicant's qualifications, the committee may require evidence that it deems reasonable and proper, in accordance with law, and the applicant shall furnish the evidence in the manner required by the committee.
3. The committee with assistance from the division shall issue a permanent license to and register as a psychologist any applicant who, in addition to having fulfilled the other requirements of sections 337.010 to 337.090, passes the examination for professional practice in psychology and such other examinations in psychology which may be adopted by the committee, except that an applicant fulfilling the requirement of section 337.029 shall upon successful completion of the jurisprudence examination and completion of the oral examination be permanently licensed without having to retake the examination for professional practice in psychology.
4. The committee, with assistance from the division, shall issue a provisional license to, and register as being a provisionally licensed psychologist, any applicant who is a graduate of a recognized educational institution with a doctoral degree in psychology as defined in section 337.025, and who otherwise meets all requirements to become a licensed psychologist, except for passage of the national and state licensing exams, oral examination and completion of the required period of postdegree supervised experience as specified in subsection 2 of section 337.025.
5. A provisional license issued pursuant to subsection 4 of this section shall only authorize and permit the applicant to render those psychological services which are under the supervision and the full professional responsibility and control of such person's postdoctoral degree licensed supervisor. A provisional license shall automatically terminate upon issuance of a permanent license, upon a finding of cause to discipline after notice and hearing pursuant to section 337.035, upon the expiration of one year from the date of issuance whichever event first occurs, or upon termination of supervision by the licensed supervisor. The provisional license may be renewed after one year with a maximum issuance of two years total per provisional licensee. The committee by rule shall provide procedures for exceptions and variances from the requirement of a maximum issuance of two years due to vacations, illness, pregnancy and other good causes.
6. The committee, with assistance from the division, shall immediately issue a temporary license to any applicant for licensure either by reciprocity pursuant to section 337.029, or by endorsement of the score from the examination for professional practice in psychology upon receipt of an application for such licensure and upon proof that the applicant is either licensed as a psychologist in another jurisdiction, is a diplomate of the American Board of Professional Psychology, or is a member of the National Register of Health Services Providers in Psychology.
7. A temporary license issued pursuant to subsection 6 of this section shall authorize the applicant to practice psychology in this state, the same as if a permanent license had been issued. Such temporary license shall be issued without payment of an additional fee and shall remain in full force and effect until the earlier of the following events:
(1) A permanent license has been issued to the applicant following successful completion of the jurisprudence examination and the oral interview examination;
(2) In cases where the committee has found the applicant ineligible for licensure and no appeal has been taken to the administrative hearing commission, then at the expiration of such appeal time; or
(3) In cases where the committee has found the applicant ineligible for licensure and the applicant has taken an appeal to the administrative hearing commission and the administrative hearing commission has also found the applicant ineligible, then upon the rendition by the administrative hearing commission of its findings of fact and conclusions of law to such effect.
8. The committee, with assistance from the division, shall issue a prescribing psychologist license to and register as a licensed prescribing psychologist any person who in addition to being a licensed psychologist and a certified health service provider also meets the training, education, experience, and examination requirements necessary for licensure as a prescribing psychologist promulgated by the division under section 337.031.
9. Written and oral examinations pursuant to sections 337.010 to 337.090 shall be administered by the committee at least twice each year to any applicant who meets the educational requirements set forth in either section 337.021 or 337.025 or to any applicant who is seeking licensure either by reciprocity pursuant to section 337.029, or by endorsement of the score from the examination of professional practice in psychology. The committee shall examine in the areas of professional knowledge, techniques and applications, research and its interpretation, professional affairs, ethics, and Missouri law and regulations governing the practice of psychology. The committee may use, in whole or in part, the examination for professional practice in psychology national examination in psychology or such other national examination in psychology which may be available.
[9.] 10. If an applicant fails any examination, the applicant shall be permitted to take a subsequent examination, upon the payment of an additional reexamination fee. This reexamination fee shall not be refundable.
337.031. 1. The provisions of this section shall govern the training, education, experience, and examination requirements necessary for licensure as a prescribing psychologist.
2. The division shall promulgate rules establishing requirements necessary for licensure as a prescribing psychologist which shall include requirements that the applicant for licensure as a prescribing psychologist:
(1) Complete a minimum of four hundred hours of didactic educational instruction consistent with the model curriculum standards for prescriptive authority as currently established by the American Psychological Association and which meets or exceeds the biomedical education requirements established for physicians assistants under section 334.735, RSMo, or complete a post-doctoral masters degree in psychopharmacology;
(2) Complete a one-year supervised fellowship. The psychologist shall have weekly supervision by a physician and maintain a full-time caseload of patients during the year, with duties that shall include medication management, psychological evaluations, and therapeutic services;
(3) Pass a national examination testing competency to engage in the practice of prescriptive authority such as the examination offered by the American Psychological Association Practice Organization's College of Professional Psychology or the International College of Prescribing Psychologists Examination with passage levels for any such national examination to be based on recommendations from the committee;
(4) Be awarded a prescribing psychologist’s license following the satisfactory completion of the one year supervised fellowship and passage of the national examination referenced in subdivisions (2) and (3) of this subsection;
(5) Enter into a collaborative practice arrangement with a physician licensed under chapter 334, RSMo;
(a) Collaborative practice arrangements entered into under this subdivision shall be in writing and may delegate to a psychologist the authority to prescribe drugs if the psychologist is a prescribing psychologist as defined in subdivision (4) of section 337.010. Such collaborative practice arrangements shall be in the form of written agreements, jointly agreed-upon protocols, standing orders for the delivery of mental health treatment, and requirements for review of prescribing services;
(b) The state board of registration for the healing arts under section 334.125, RSMo, and the state committee of psychologists under section 337.050, shall jointly promulgate rules regulating the use of collaborative practice arrangements governed by this subdivision. Such rules shall be limited to specifying geographic areas to be covered and the methods of treatment that may be covered by collaborative practice arrangements and shall not mandate particular requirements for review of prescribing services. In order to take effect, such rules shall be approved by a majority vote of a quorum of each board. Neither the state board of registration for the health arts nor the state committee of psychologists may separately promulgate rules relating to collaborative practice arrangements. Such jointly promulgated rules shall be consistent with guidelines for federally funded clinics. The rulemaking authority granted in this subdivision shall not extend to collaborative practice arrangements of hospital employees providing inpatient care within hospitals as defined under chapter 197, RSMo;
(c) The state board of registration for the healing arts shall not deny, revoke, suspend, or otherwise take disciplinary action against a physician for mental health care services provided by a prescribing psychologist, provided the provisions of this subdivision and the rules promulgated thereunder are satisfied;
(d) Within thirty days of any change and on each renewal, the state board of registration for the healing arts shall require every physician to identify whether the physician is engaged in any collaborative practice agreement under this subsection and also report to the board the name of each licensed professional with whom the physician has entered into such agreement. The board may make this information available to the public. The board shall track the reported information and may routinely conduct random reviews of such agreements to ensure that agreements are carried out for compliance under this subdivision;
(6) Maintain medical liability insurance at levels appropriate to the profession both during the training period and thereafter.
3. In addition to the requirements for licensure under subsection 2 of this section, the division may promulgate rules establishing additional requirements for licensure as a prescribing psychologist that are based on current educational guidelines stated in the American Psychological Association's publication of Recommended Postdoctoral Training in Psychopharmacology for Prescription Privileges. Such additional requirements shall relate to any number of the following didactic subject areas and preceptorship-supervision models:
(1) Pharmacology/psychopharmacology: child, adult, geriatric, general clinical:
(a) Pharmacokinetics and pharmacodynamics, drug interactions, side effects, substance abuse; and
(b) Serology, laboratory and maintenance of therapeutic drug levels;
(2) Related sciences:
(a) Neuroanatomy, neurophysiology, neurochemistry; and
(b) Pathophysiology, organ, and anatomy systems of functioning and nonfunctioning and metabolism/biotransformation;
(3) Treatment applications:
(a) Consultation with other professionals;
(b) Ethics and professional issues; and
(c) Computer-enhanced record and history accountability.
4. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2009, shall be invalid and void.
337.050. 1. There is hereby created and established a "State Committee of Psychologists", which shall consist of seven licensed psychologists and one public member. The state committee of psychologists existing on August 28, 1989, is abolished. Nothing in this section shall be construed to prevent the appointment of any current member of the state committee of psychologists to the new state committee of psychologists created on August 28, 1989.
2. Appointments to the committee shall be made by the governor upon the recommendations of the director of the division, upon the advice and consent of the senate. The division, prior to submitting nominations, shall solicit nominees from professional psychological associations and licensed psychologists in the state. The term of office for committee members shall be five years, and committee members shall not serve more than ten years. No person who has previously served on the committee for ten years shall be eligible for appointment. In making initial appointments to the committee, the governor shall stagger the terms of the appointees so that two members serve initial terms of two years, two members serve initial terms of three years, and two members serve initial terms of four years.
3. Each committee member shall be a resident of the state of Missouri for one year, shall be a United States citizen, and shall, other than the public member, have been licensed as a psychologist in this state for at least three years. Committee members shall reflect a diversity of practice specialties. To ensure adequate representation of the diverse fields of psychology, the committee shall consist of at least two psychologists who are engaged full time in the doctoral teaching and training of psychologists, and at least two psychologists who are engaged full time in the professional practice of psychology. In addition, the first appointment to the committee shall include at least one psychologist who shall be licensed on the basis of a master's degree who shall serve a full term of five years. Nothing in sections 337.010 to 337.090 shall be construed to prohibit full membership rights on the committee for psychologists licensed on the basis of a master's degree. If a member of the committee shall, during the member's term as a committee member, remove the member's domicile from the state of Missouri, then the committee shall immediately notify the director of the division, and the seat of that committee member shall be declared vacant. All such vacancies shall be filled by appointment of the governor with the advice and consent of the senate, and the member so appointed shall serve for the unexpired term of the member whose seat has been declared vacant.
4. The public member shall be at the time of the public member's appointment a citizen of the United States; a resident of this state for a period of one year and a registered voter; a person who is not and never was a member of any profession licensed or regulated pursuant to sections 337.010 to 337.093 or the spouse of such person; and a person who does not have and never has had a material, financial interest in either the providing of the professional services regulated by sections 337.010 to 337.093, or an activity or organization directly related to any profession licensed or regulated pursuant to sections 337.010 to 337.093. The duties of the public member shall not include the determination of the technical requirements to be met for licensure or whether any person meets such technical requirements or of the technical competence or technical judgment of a licensee or a candidate for licensure.
5. The committee shall hold a regular annual meeting at which it shall select from among its members a chairperson and a secretary. A quorum of the committee shall consist of a majority of its members. In the absence of the chairperson, the secretary shall conduct the office of the chairperson.
6. Each member of the committee shall receive, as compensation, an amount set by the division not to exceed fifty dollars for each day devoted to the affairs of the committee and shall be entitled to reimbursement for necessary and actual expenses incurred in the performance of the member's official duties.
7. Staff for the committee shall be provided by the director of the division of professional registration.
8. The governor may remove any member of the committee for misconduct, inefficiency, incompetency, or neglect of office.
9. In addition to the powers set forth elsewhere in sections 337.010 to 337.090, the division may adopt rules and regulations, not otherwise inconsistent with sections 337.010 to 337.090, to carry out the provisions of sections 337.010 to 337.090. The committee may promulgate, by rule, "Ethical Rules of Conduct" governing the practices of psychology which rules shall be based upon the ethical principles promulgated and published by the American Psychological Association.
10. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is promulgated to administer and enforce sections 337.010 to 337.090, shall become effective only if the agency has fully complied with all of the requirements of chapter 536, RSMo, including but not limited to, section 536.028, RSMo, if applicable, after August 28, 1998. All rulemaking authority delegated prior to August 28, 1998, is of no force and effect and repealed as of August 28, 1998, however nothing in this act shall be interpreted to repeal or affect the validity of any rule adopted and promulgated prior to August 28, 1998. If the provisions of section 536.028, RSMo, apply, the provisions of this section are nonseverable and if any of the powers vested with the general assembly pursuant to section 536.028, RSMo, to review, to delay the effective date, or to disapprove and annul a rule or portion of a rule are held unconstitutional or invalid, the purported grant of rulemaking authority and any rule so proposed and contained in the order of rulemaking shall be invalid and void, except that nothing in this act shall affect the validity of any rule adopted and promulgated prior to August 28, 1998.
11. The committee may sue and be sued in its official name, and shall have a seal which shall be affixed to all certified copies or records and papers on file, and to such other instruments as the committee may direct. All courts shall take judicial notice of such seal. Copies of records and proceedings of the committee, and of all papers on file with the division on behalf of the committee certified under the seal shall be received as evidence in all courts of record.
12. When applying for a renewal of a license pursuant to section 337.030, each licensed psychologist shall submit proof of the completion of at least forty hours of continuing education credit within the two-year period immediately preceding the date of the application for renewal of the license. The type of continuing education to be considered shall include, but not be limited to:
(1) Attending recognized educational seminars, the content of which are primarily psychological, as defined by rule;
(2) Attending a graduate level course at a recognized educational institution where the contents of which are primarily psychological, as defined by rule;
(3) Presenting a recognized educational seminar, the contents of which are primarily psychological, as defined by rule;
(4) Presenting a graduate level course at a recognized educational institution where the contents of which are primarily psychological, as defined by rule; and
(5) Independent course of studies, the contents of which are primarily psychological, which have been approved by the committee and defined by rule.
Those psychologists holding licensed prescribing authorization shall complete at least twenty hours of psychopharmacology continuing education credit within the two-year period immediately preceding the date of the application for renewal of the license in addition to the general forty-hour continuing education requirements of this subsection. The committee shall determine by administrative rule the amount of training, instruction, self-instruction or teaching that shall be counted as an hour of continuing education credit.
338.198. Other provisions of law to the contrary notwithstanding, a pharmacist may fill a physician's prescription, a prescription of a licensed prescribing psychologist, or the prescription of an advanced practice nurse working under a collaborative practice arrangement with a physician, when it is forwarded to the pharmacist by a registered professional nurse or registered physician's assistant or other authorized agent. The written collaborative practice arrangement shall specifically state that the registered professional nurse or registered physician assistant is permitted to authorize a pharmacist to fill a prescription on behalf of the physician.