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HB 3298

Creates provisions relating to state-accredited residency programs

2026 Regular Session Introduced by Matthew Overcast

Missouri would allow state-accredited residency programs as an alternative route for physician licensure, overseen by the state board with a pilot and safeguards.

Referred: Emerging Issues(H)
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Bill Summary · HB 3298

Overview

House Bill 3298 proposes the creation of a Missouri State-Sponsored Residency Pathway, establishing state-accredited residency programs as an alternative to traditional nationally accredited (ACGME) programs for physician licensure in Missouri. It sets a framework for approval, supervision, and oversight by the Missouri Board of Registration for the Healing Arts, with a pilot period and ongoing reporting to the General Assembly.

Purpose and intent

  • Expand the pathways through which physicians can complete postgraduate training to qualify for a permanent medical license.
  • Allow health care providers to sponsor state-accredited residency programs that are approved by the board, without requiring national accreditation as a condition of state approval.
  • Ensure licensure standards are consistent regardless of whether a physician completed a nationally accredited program or a state-accredited program.
  • Monitor and study the impact of state-accredited residencies on workforce supply, patient outcomes, and reimbursement.

Key provisions

  • Establishment of the “Missouri State-Sponsored Residency Pathway Act” (sections 334.333–334.354).
  • Definitions:
    • State-accredited residency program: approved by the board under this act.
    • Pilot period: through December 31, 2029, during which the board may limit approval of state-accredited programs.
    • Demonstrated workforce shortage: criteria to identify shortages (peer reports, access metrics, or official findings).
    • Other terms: residency, resident physician, health care provider, etc.
  • Approval process (334.336):
    • The board shall create an approval process for state-accredited programs.
    • Any health care provider may apply to sponsor a state-accredited residency program.
    • During the pilot period, approval may be limited by rule, based on cap or targeted need by specialty/region.
    • The board may issue rules to implement procedures; rules are subject to broader rulemaking controls and sunset provisions if constitutional issues arise.
  • Program requirements (334.339):
    • Minimum training duration and competency standards; shorter durations may be allowed in shortage areas if competency outcomes are equivalent and supervision is enhanced.
    • Supervision by physicians with unrestricted Missouri licenses and relevant competence.
    • Sufficient patient volume and diverse clinical experiences.
    • Written evaluation, remediation, and dismissal procedures.
    • Compliance with state laws on patient safety, quality reporting, and professional conduct.
  • Licensure and staff privileges (334.342, 334.345):
    • No additional postgraduate training beyond the required residency for permanent licensure.
    • Licensure requirements cannot be varied based on accreditation pathway.
    • Hospital staff privileges cannot be denied solely on the basis of the residency’s accreditation pathway.
  • Denial/appeal process (334.348):
    • Denials or revocations must be based on express statutory grounds (pilot period allowances noted).
    • Appeals available to the Administrative Hearing Commission.
  • Limitations and clarifications (334.351, 334.354):
    • Act does not guarantee federal GME funding or require other states to accept state-accredited residencies.
    • Not intended to replace or interfere with nationally accredited residencies.
    • Department of Social Services may seek federal waivers or amendments to maximize reimbursement.
    • Sunset and reporting: not subject to the Missouri sunset act; requires biennial/ten-year reporting beginning before 2037, with data on programs, graduates, workforce outcomes, and reimbursement practices.

Affected parties

  • Health care providers seeking to sponsor state-accredited residency programs.
  • Resident physicians enrolled in state-accredited programs.
  • Hospitals, health systems, federally qualified health centers, and health clinics hosting residencies.
  • The Missouri Board of Registration for the Healing Arts (administrative oversight and rulemaking).
  • Patients and health care markets in Missouri (through potential changes in physician supply and access).

Timelines and procedural notes

  • Pilot period ends December 31, 2029; board may limit approvals during the pilot.
  • Once enacted, the Board must publish rules to implement procedures.
  • Biennial (every ten years) reporting to the General Assembly begins by January 1, 2037 (and every ten years thereafter) with data on program operations, workforce outcomes, and reimbursement practices.

Potential impact

  • Provides an alternative route to physician licensure, potentially expanding the supply of trained physicians in Missouri, especially in shortages.
  • Could affect access to care in underserved regions or specialties if state-accredited programs are targeted to address shortages.
  • Establishes a framework for oversight and quality comparable to nationally accredited programs, while avoiding dependence on national accreditation.
  • Creates ongoing data collection to evaluate effectiveness relative to traditional pathways.

Compiled from official sources — confirm details with the bill’s official record.

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