JEFFERSON CITY — A bill that would allow some nurses to practice independently moved forward Wednesday in the Missouri House.

The House Professional Registration and Licensing Committee heard the bill Wednesday. If passed, it would allow Advanced Practice Registered Nurses to practice independently after practicing for two years in a collaboration agreement with a physician.

APRNs must have at least a master’s degree and be educated in a specific population, according to the National Council of State Boards of Nursing.

The bill’s sponsor, Rep. Hannah Kelly, R-Mountain Grove, said she sponsored the bill to help expand health care access in rural areas.

Kelly said it has been at least five years since a doctor in her hometown has stayed longer than the time it took them to pay off their student loans.

“I need doctors to come to my hometown and stay and build a life,” Kelly said.

She said communities like Mountain Grove need more APRNs in their area until there is a solution for the lack of doctors. Currently, nurse practitioners — one type of APRN — make up a large portion of health care providers in Kelly’s district.

Currently, most APRNs in a collaboration agreement with a physician can only practice within 50 miles of that physician. Rep. Lyle Rowland, R-Cedarcreek, has sponsored a bill to eliminate the 50-mile restriction. That bill passed the House Rules and Administrative Oversight committees on Tuesday.

“The mileage issue is my biggest pet-peeve,” Kelly said.

Though Kelly’s bill does not directly deal with mileage requirements, APRNs who qualify to practice independently under her bill would not be subject to them.

But some in the medical community fear this bill would allow APRNs to practice outside of their current scope.

Elizabeth Mukherjee, a physician, was one who spoke out against the bill at Wednesday’s hearing. She cited her experience an assistant physician after graduating from medical school as her reason to oppose the bill. Mukherjee said she currently works as a part of a collaboration with a doctor while waiting to match in a residency program.

She said that APRNs don’t necessarily have a deep enough education to catch everything a doctor could catch and that the current style of collaboration partnerships are the best solution to expand access to rural health care.

“Are you ok with your family members getting any sort of health care, or would you prefer the standard of practice of health care?” Mukherjee asked.

A representative from the Missouri State Medical Association also testified against the bill.

The bill would not allow APRNs to prescribe, dispense or distribute schedule III, IV or V controlled substances, or schedule II–hydrocodone while practicing independently. They would need to be in a collaboration agreement to do so.

“This bill is about giving checks and balances and allowing people to make sure that they have access,” Kelly said.

The Missouri Board of Nursing would regulate independent APRNs.

Kelly said she would be satisfied if the Board of Nursing and the Missouri Board of Registration for the Healing Arts came up with a non-legislative solution to solve the mileage problem and address barriers to rural health care access.

“Harry Truman said, ‘You get a lot done when you don’t care who gets the credit,’” Kelly said.

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