Missouri

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance companies.

Health plans must cover buprenorphine tablets, methadone, naloxone, extended-release injectable naltrexone and buprenorphine/naloxone combination (and these dispensed when through an opioid treatment program), without prior authorization. MO. REV. STAT. § 191.1165

The MO HealthNet program shall cover on its preferred drug list (PDL): buprenorphine tablets, methadone, naloxone, extended-release injectable naltrexone and buprenorphine/naloxone combination. The PDL must include all current and new FDA-approved formulations and medications. MO. REV. STAT. § 191.1165(6)

Missouri credentials five types of addiction counselors. A Missouri Associate Alcohol and Drug Counselor I (MAADC I) requires a high school diploma, 160 hours of relevant work experience and additional education hours. A Missouri Associate Alcohol and Drug Counselor II (MAADC II) requires a high school diploma, 2,000 hours of relevant work experience and additional education hours. A Certified Alcohol and Drug Counselor (CADC) requires a high school diploma, 4,000 hours of related work experience and additional education hours. A Certified Reciprocal Alcohol and Drug Counselor (CRADC) requires a high school diploma, 6,000 hours of related work experience and additional education hours. A Certified Reciprocal Advanced Alcohol and Drug Counselor (CRAADC) requires a masters degree, 2,000 hours of applicable work experience, and additional education requirements. A higher level degree can be used to decrease required work experience or additional education requirements. Mo. Rev. Stat. §631.005, Mo. Rev. Stat. §631.010, 9 Mo. Code of State Reg. §30-3.110,  Missouri Credentialing Board 

A professional counselor may provide services to individuals, couples, groups, organizations, institutions, corporations, schools, government agencies, or the general public involving the application of counseling procedures to assist in achieving more effective intrapersonal or interpersonal, marital, decisional, social, educational, vocational, developmental or rehabilitative adjustments. Diagnostic ability is not outlined in statute. Mo. Rev. Stat. §337.500

The law requires the certification of peer recovery specialists to include minimum education levels and training and testing as required. The administration and process for the certification of peer recovery specialists is administered by a third-party, non-profit certification provider. Mo. Code Regs. tit.9, § 30-4.030(2)(H)

Physician relationship required for practice and prescriptive authority.

Written collaborative practice agreements are required between a physician and the NM. The agreement must outline geographic practice areas for the physician and the NM and methods of treatment within an NM’s scope of practice.

Prescriptive authority can be delegated in a written collaborative practice arrangement by the collaborating physician for Schedules III-V.  Mo. Code of State Reg. §20-2200-4.200

Physician relationship required for practice and prescriptive authority.

Written collaborative practice agreements are required between a physician and an NP. The agreement must outline geographic practice areas for the physician and the NP and methods of treatment within an NP’s scope of practice. 

Prescriptive authority and privileges must be outlined in the written practice agreement. Drugs dispensed must be within the NP’s scope of practice. If outlined in the agreement, the NP may prescribe Schedules II-V controlled substances. Mo. Code of State Reg. §20-2200-4.200

Missouri has not codified language around POLST. Only physicians may sign transportable physician orders for patient preference (TPOPP) forms. Please see the TPOPP website for more information.

NPs are not explicitly recognized in state policy as primary care providers.

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Mo. Rev. Stat. §336.010

Optometrists may not administer medication through injection but can administer the COVID-19 vaccine. Mo. Rev. Stat. §336.010(4) and Missouri Department of Health and Senior Services Standing Order

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. Mo. Rev. Stat. §336.010, Mo. Rev. Stat. §336.220 and 20 Mo. Code of State Regs. 2210-2.080(6)

A dental hygienist who has practiced at least three years and practices in a public health setting may provide fluoride treatments, teeth cleaning and sealants to Medicaid-eligible children. These services may be performed without the supervision of a dentist and are subject to Medicaid reimbursement. Mo. Rev. Stat. §332.311.2

Statute does not identify dental therapists as an oral health provider.

Missouri allows for the practice of teledentistry. Medicaid allows for reimbursement of teledentistry services through live video and store-and-forward modalities. MO Health Net, Dental Manual, pg. 259

Missouri has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act does allow pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

Missouri does not allow pharmacists to modify prescriptions.

Missouri does not allow pharmacists to prescribe hormonal contraceptives.

A pharmacist must complete a training course in the subject area of tobacco cessation drug therapy and must include instruction in specific content areas. A written protocol for tobacco cessation drug therapy must be approved by the Board of Pharmacy. Mo. Rev. Stat. §338.010

Supervision by a physician required for practice and prescriptive authority.

PA collaborative practice arrangements–refers to written agreements, jointly agreed upon protocols, or standing orders between a collaborating physician and a licensed PA which provide for the delegation of health care services from a collaborating physician to a licensed PA and the review of such services. MO. CODE REGS. ANN. Tit. 20 § 2150-7.135

The scope of practice of a PA shall consist only of the following services and procedures: (1) Taking patient histories; (2) Performing physical examinations of a patient; (3) Performing or assisting in the performance of routine office laboratory and patient screening procedures; (4) Performing routine therapeutic procedures; (5) Recording diagnostic impressions and evaluating situations calling for attention of a physician to institute treatment procedures; (6) Instructing and counseling patients regarding mental and physical health using procedures reviewed and approved by a collaborating physician; (7) Assisting the supervising physician in institutional settings, including reviewing of treatment plans, ordering of tests and diagnostic laboratory and radiological services, and ordering of therapies, using procedures reviewed and approved by a licensed physician; (8) Assisting in surgery; and (9) Performing such other tasks not prohibited by law under the collaborative practice arrangement with a licensed physician as the PA has been trained and is proficient to perform. 3. PAs shall not perform or prescribe abortions. MO. REV. STAT. § 334.735.2,.3

PAs shall not prescribe any drug, medicine, device or therapy unless pursuant to a collaborative practice arrangement in accordance with the law. A PA with a certificate of controlled substance prescriptive authority as provided in this section may prescribe any controlled substance listed in schedule III, IV, or V, and may have restricted authority in Schedule II, when delegated the authority to prescribe controlled substances in a collaborative practice arrangement. MO. REV. STAT. § 334.747

Statue limits the number of PAs a physician may supervise.

No physician shall be designated to serve as a collaborating physician for more than six (6) full-time equivalent licensed PAs, full-time equivalent advanced practice registered nurses, or full-time equivalent assistant physicians, or any combination thereof. MO. REV. STAT. § 334.735.16

Chart co-signatures are required by statute to practice or prescribe as a PA.

The collaborating physician shall complete a review of 10% of the total health care services delivered by the PA. If the PA practice includes the prescribing of controlled substances, the physician shall review a minimum of 20% of the cases in which the PA wrote a prescription for a controlled substance. MO. CODE REGS. ANN. tit. 20 § 2150-7.135(7)

Statute does not allow adaptable proximity.

It is the responsibility of the collaborating physician to determine and document the completion of a one-month period of time during which the licensed PA shall practice with a collaborating physician continuously present before practicing in a setting where a collaborating physician is not continuously present. MO. CODE REGS. ANN. Tit. 20 § 2150-7.135

Collaborative practice arrangements, which shall be in writing, may delegate to a physician assistant the authority to prescribe, administer, or dispense drugs and provide treatment which is within the skill, training, and competence of the physician assistant. Mo. Rev. Stat. §334.735