MO SB1254

Restricts 43 medical titles and specialty designations (including "Physician," "MD," "DO," "Surgeon," and specific specialties like "Cardiologist" or "Psychiatrist") to physicians licensed under Chapter 334, with an exception allowing chiropractors to use "chiropractic physician"

Expands optometrist scope of practice to include injectable pharmaceutical agents (previously excluded) except vaccines, and adds authorized procedures such as removal of embedded foreign bodies, placement of punctal plugs, thermal pulsation therapy, and intranasal stimulator use for dry eye treatment

Requires optometrists to disclose to patients that they are not physicians, inform patients of their option to seek physician care, and obtain informed written consent that must be retained for at least seven years

Establishes a legal framework for surgical comanagement between ophthalmologists and optometrists for pre- and post-operative eye surgery care, requiring written patient consent, established care protocols, and fee arrangements proportional to services provided

Creates a "comanagement safe harbor" protecting eye care providers from disciplinary action when following the established requirements, while prohibiting fee-splitting without services, coercive referral arrangements, and other practices not in patients' best interests