Legislative Updates

November 2025

Missouri submitted its Rural Health Transformation (RHT) plan to the Centers for Medicare & Medicaid Services (CMS). 

Key elements of Missouri's RHT plan include:

• Improving healthcare access for rural Missourians by connecting providers, pharmacies, public health agencies, at-home resources, and digital health tools through a unified, regional network.
• Expanding access to primary care, behavioral health, and maternity services in rural communities while strengthening specialty and complex care through telehealth and patient-focused technology.
• Enhancing rural provider sustainability by increasing collaboration among local partners to advance technology, operations, and care delivery, and incentivizing better health outcomes through shared savings of avoidable healthcare costs.

In Governor Kehoe's Endorsement for Missouri's Rural Health Transformation Plan (PDF here), he mentions: 

• The state of Missouri commits to joining the Physician Assistant Licensure Compact, through legislation filed in the 2026 state legislative session, with full enactment by December 31, 2027. 
• Additionally, our administration will reassess Missouri’s current scope of practice law and regulations for…Physician Assistants. This re-evaluation will identify reforms to increase the availability of services provided y these professionals in rural areas and enable them to reach rural Missourians who are struggling to access local care.

Prior practice advancements with MOAPA: 

• Clarify that primary and alternate collaborating physicians can fulfill chart review requirements.
• Remove the requirement for 4 hrs per 14 working days of direct supervision.
• Grant PAs the authority to pronounce death and certify a death ( sign a death certificate) from natural causes.
• Allow PAs the authority to prescribe hydrocodone.
• Recognize PAs as MO Medicaid providers.
• Removed the 30-day direct supervision requirement for new collaborative practice arrangements - and won a lawsuit defending this change as of January 2025.