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Missouri academy of physician assistants

Update: 11/18/15

Below is the report Terry Carlise from a recent meeting he attended on our behalf updating all of us on the the process related to the passage of HB618 authorizing PAs to be able to sign death certificates. Please read this and as always, reach out to us with any questions you might have regarding this. Thank you Terry for representing us on this committee.

An update in regards to HB 618 that was recently in acted which gives PAs the authority to pronounce death and certify a death ( sign a death certificate) from natural cause.

Last week the Department of Health and Senior Services Division of Community and Public Health Bureau of Vital records had a quality improvement work group in Jeff City dealing with in proving the death certificate issue, MOevr- Missouri Electronic vital records. The electronic death certificate has had multiple problems with the states in regards to difficult to use ,not users friendly etc... they are trying to fix that and with the new legislation passed now was a perfect time for them to tackle this. The groups invited were the MDs. DO. APRN, PAs, coroners, medical examiners, funeral directors, and embalmers. I was there as the PA representative and they were very glad to have the PAs at the table in discussing this issue. Currently the electronic medical record does not have a" box" for PA but they are working on to correct this missing information. There are still 3 ways in MO to do a death certificate 1) all electronic 2) started by funeral home electronic then finished as paper document . 3) all paper document. I was told by the Chief of the Bureau of vital records (Michelle Zeilman) that they will recognize a PA signature on the form even though the paper forms and electronic media have not been updated that took effect September 26, 2015. Some PAs will need to make sure that their credentials in certain hospitals or healthcare systems need to reflect this additional authority although some may not require this. This is a work in progress and with the new changes the Vital Records division would like to meet with the PAs at different times and set up a work shop on how to sign in to MOEVR,fill out the forms etc.

I have to say one of the biggest supports the PAs had during this and still is the MO Funeral Home Directors ,they made a point of coming over and talking to me telling me how they want to work with the PAs to make this system work the best we can in getting a death certificate to the families for business, banking etc.

Listed below are the current contacts for this process:

Michelle Zeilman Bureau Chief 573-526-0348

Neelie Churchill Deputy state registrar 573-526-1511

Update: 9/23/2015

As promised, I was able to obtain a bit more information regarding the DEA and the issue with PAs prescribing hydrocodone. This information is coming directly from the Missouri BNDD who has been in contact with the DEA about this issue. Here is what I received:

All the mid-level practitioners in Missouri are having the same issue with this.  They are all waiting on the DEA.

I called our Mid-West regional DEA guy and asked him.

Here is what he said:

1.     Missouri copied the DEA on all the laws as they passed;

2.     Missouri updated their laws and rules and have made the change;

3.     The DEA has received our documentation and they are preparing to make the same adjustments….BUT

4.     They are waiting on approval from their DEA attorneys.  Once the DEA legal department approves everything, then DEA will make the amendments.

The hold up is the DEA registrations department is waiting on the DEA legal department.

So the time frame of when this will be resolved appears to still be unknown but we will continue to monitor this and update all of you when more information becomes available. I know this is frustrating, but we will just have to be patient for a while longer. 

Legislative Update: HB 618
September 21, 2015

Click here to access the entire voting record from the recent Veto override session. Please look at both the House Of Rep as well as the Senate and identify your legislators and if they voted in favor of the override, please drop them a brief thank you email for their support. And if they voted against this, consider also emailing them and just reminding them that you are a PA in their district and you are disappointed that they did not support our efforts with this veto override and ask them if they have any questions about your profession that we can answer that would make them feel more comfortable supporting our efforts in the future.

It is important that you inform them that you are an involved, voting member of their district and PA issues are very important to you. This kind of dialogue with your legislators, whether it be a thank you or a note expressing your disappointment, either way it is the on going dialogue that will be vital for future efforts. 

Thank you,


Legislative Update: HB 618
August 14, 2015

1) The bill that will grant PAs the authority to prescribe hydrocodone was signed into law and will become effective August 28, 2015. I have reached out to the BNDD regarding what the process will be for us once this law goes into effect and below is the response I received:

Here are the steps we will be going through:

1. Gov signed the bill into law;

2. The law will go into effect on August 28, 2015;

3. At that time, mid-levels will have C2 authority;

4. Those already registered, can fax or email, or mail a request to BNDD to have Schedule 2 added to their existing registrations.  BNDD will amend and update a registration for no fee.

5. Those who will be re-applying, will have a Schedule 2  box to check on their applications.

Between now and August……BNDD will be working on two things:

1. Updating our paper application to add the Schedule 2 box; and

2. Working with OA-ITSD to have them update our online application by adding a Schedule 2 box.

Once practitioners have updated their Missouri BNDD registration to show schedule 2…..they can go to the DEA website and make a similar request to update their DEA certificate.

Michael R. Boeger, Administrator

Missouri Bureau of Narcotics and Dangerous Drugs

P.O. Box 570

For any specific question(s) you may have about this process that do not seem clear on what they have provided, I would recommend contacting the MO BNDD directly for any clarification you might require. 

2) We have also received an update regarding the MO Medicaid enrollment process for PAs of MO. Here is the language that was most recently sent to me:

The MO HealthNet Division (MHD) is in the process of adding a new Physician Assistant provider type to allow PAs to independently enroll and submit claims for service reimbursement.  This change is targeted for implementation in August 2015.  A provider information bulletin will be released in advance so providers may begin enrolling.

3) As we reported several weeks ago, Governor Nixon vetoed HB618 which contained language giving PAs authority to declare death and sign death certificates. Jorgen has been discussing this issue with the sponsors of the bill as well as other groups who were supporting this bill in hopes that there would be interest from these people and groups to pursue overriding his veto. Therefore, it is time to call the troops into action. We are asking every PA to contact their state representative and state senator and ask them to support the veto override on HB618. We will place some talking points for you to use in the members only section. Don’t feel the need to be bogged down with too many details as the legislators will not ask you pointed detailed questions if you speak with them or in an email response. If you are asked anything that you are unsure of the answer, just tell them that you are not sure but you will find out and get back in contact with them and provide whatever answers they need. Then contact me or your local DAL and we will help you find the answers they are looking for from you.  Feel free to ask your physicians, patients, families or whoever is willing to contact their legislators as well with the same request. If you are unsure who your state legislators currently are, there is a link on our website that will provide that info but have your 9 digit zip code with you as that will be needed. The veto session will be held in September so do not procrastinate with reaching out to these legislators! Remember, we need a 2/3 majority to override a veto so this is by no means a lay-up. 

Legislative Update: SB 716
May 22, 2014

On behalf of the Missouri Academy of Physician Assistants (MOAPA), I have some unhappy news to share. A legislative proposal that we have been monitoring since the start of the legislative session has passed the state legislature. Senate Bill 716 is a comprehensive bill amending several public health laws, including one which has the potential to confuse patients, health systems and other providers. This particular amendment contains language authorizing the Board of Healing Arts to license physicians, unable to find a residency match, as “assistant physicians,” practicing within the confines of a collaboration agreement with a physician, and restricted to providing primary care services in rural and underserved areas. Further, the language within SB 716 contains a provision which states that “An assistant physician shall be considered a physician assistant for purposes of regulations of the Centers for Medicare and Medicaid Services (CMS).” MOAPA worked with our lobbyist, Jorgen Schlemeier, to oppose the “assistant physician” language within this bill. This language was authored by Representative Fredericks, who has been a friend to PAs, and was supported by the Missouri State Medical Association or the Missouri Association of Osteopathic Physicians and Surgeons. You may ask why MOAPA has not previously informed our PA colleagues of this bill. When this provision was initially introduced it was thought to be highly unlikely to pass. The proposal seemed to be in opposition to the high educational standards set for physicians. AAPA staff and our lobbying team continued to monitor activity on the legislation, which inexplicably began to move aggressively in the last week of the legislative session. The language moved from one legislative bill, to several, to finally settle in SB 716, which passed on Friday, May 16. We will be in contact with you within the week to inform you of MOAPA’s next steps and potential efforts to seek a veto on this bill. To complicate the situation, SB 716 contains several positive public health measures such as extending Medicaid benefits to pregnant women and flu immunizations for hospitalized seniors. As a result, MOAPA must tread very carefully, upholding the standards of our profession while also considering the health and well-being of our patients, who may benefit from other positive aspects of this legislation. Please also share this information with your physician colleagues, as they may not be aware of this provision which will negatively impact their profession.

Legislative Update: HB 1213
May 22, 2014 

Missouri PAs had a significant victory during the Missouri States Legislative session as HB 1213 passed which included language to clarify and remove the barriers keeping us from being recognized as Missouri Medicaid providers. I know this is a significant victory for many of our PAs in MO. This bill was passed and is now just awaiting Gov Nixon’s signature. The law will not go into effect until Aug 28, 2014. But the plan will be to begin discussions with Missouri Medicaid Audit and Compliance department as they will be developing the enrollment process for us to receive Medicaid provider numbers. As this process unfolds, we will keep you up to date.

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