A new law passed in Missouri will allow physician assistants (PAs) to practice with more autonomy and mirrors the collaboration requirements for PA-physician teams with those for nurse practitioner-physician teams. The enactment of Senate Bill 514 (SB 514) will replace all references of physician “supervision” with “collaboration.” The bill, signed by Governor Michael Parson on July 11, 2019, will make Missouri the 11th state to use a term other than supervision to describe PA practice.

The legislation will eliminate the requirement that a physician practice at the same facility as the PA for 4 hours every 2 weeks. Any other direct supervision language added through regulation could be met through telemedicine capabilities. Additionally, the legislation will remove the mandate that a PA practice at a location where the collaborating physician routinely sees patients. Finally, the bill eliminates the requirement that a PA practice at the same location as a physician for 30 days before the PA is able to practice in a remote setting. Instead, the decision regarding how much time the PA and physician must practice at the same location before the PA begins working remotely will be made at the practice level.

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“The [Missouri Academy of Physician Assistants] leadership and I are ecstatic about the passage of SB 514,” stated Paul Winter, PA-C, president of the organization. “With the enactment of this legislation PAs will practice under a model that more accurately describes the PA-physician team and moves toward parity for PAs and [nurse practitioners].”

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The passing of the legislation will enhance the PA practice in Missouri as well as increase patient access to care. The law will become effective on August 28, 2019.


American Association of Physician Assistants. Missouri PAs Celebrate Legislation Modernizing PA Practice. AAPA website. https://www.aapa.org/news-central/2019/08/missouri-pas-celebrate-legislation-modernizing-pa-practice/. Published August 7, 2019. Accessed August 13, 2019.