PRINTER'S NO. 1548

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 1253 Session of 2007


        INTRODUCED BY SOLOBAY, SEIP, BELFANTI, CAPPELLI, CREIGHTON,
           DALEY, EACHUS, FREEMAN, GEIST, GRUCELA, JOSEPHS, KIRKLAND,
           MURT, PETRONE, SAYLOR AND SIPTROTH, MAY 10, 2007

        REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, MAY 10, 2007

                                     AN ACT

     1  Amending the act of May 22, 1951 (P.L.317, No.69), entitled, as
     2     amended, "An act relating to the practice of professional
     3     nursing; providing for the licensing of nurses and for the
     4     revocation and suspension of such licenses, subject to
     5     appeal, and for their reinstatement; providing for the
     6     renewal of such licenses; regulating nursing in general;
     7     prescribing penalties and repealing certain laws," further
     8     providing for scope of practice for certified registered
     9     nurse practitioners and for prescriptive authority for
    10     certified registered nurse practitioners; repealing
    11     provisions relating to drug review committee; and providing
    12     for collaborative and written agreements.

    13     The General Assembly of the Commonwealth of Pennsylvania
    14  hereby enacts as follows:
    15     Section 1.  Sections 8.2 and 8.3 of the act of May 22, 1951
    16  (P.L.317, No.69), known as The Professional Nursing Law, amended
    17  December 9, 2002 (P.L.1567, No.206), are amended to read:
    18     Section 8.2.  Scope of Practice for Certified Registered
    19  Nurse Practitioners.--(a)  A certified registered nurse
    20  practitioner while functioning in the expanded role as a
    21  professional nurse shall practice within the scope of practice
    22  of the particular clinical specialty area in which the nurse is


     1  certified by the board.
     2     (b)  A certified registered nurse practitioner may perform
     3  acts of medical diagnosis in collaboration with a physician and
     4  in accordance with regulations promulgated by the board.
     5     (c)  [A] Except as provided in subsection (c.1), a certified
     6  registered nurse practitioner may prescribe medical therapeutic
     7  or corrective measures if the nurse is acting in accordance with
     8  the provisions of section [8.3] 8.3(a).
     9     (c.1)  Except as limited by the scope of an individual's
    10  specialty certification or in a collaborative or written
    11  agreement, and in addition to existing authority, a certified
    12  registered nurse practitioner shall have authority to do all of
    13  the following:
    14     (1)  Order home health and hospice care.
    15     (2)  Order durable medical equipment.
    16     (3)  Issue oral orders under the same conditions and in the
    17  same facilities as physicians are permitted to do.
    18     (4)  Perform and sign workers compensation physicals.
    19     (5)  Perform physical therapy and dietitian referrals.
    20     (6)  Order respiratory or occupational therapy.
    21     (7)  Perform disability assessments for the program providing
    22  Temporary Assistance to Needy Families (TANF).
    23     (8)  Perform and sign methadone treatment evaluations.
    24     (9)  Perform and sign cosmetology license physicals.
    25     (10)  Issue home schooling certifications.
    26     (11)  Take medical histories.
    27     (12)  Perform and sign physical or psychiatric examinations.
    28     (13)  Provide acute illness, minor injury or chronic disease
    29  management care.
    30     (14)  Perform other similar activities.
    20070H1253B1548                  - 2 -     

     1     (15)  Make commitments under the act of July 9, 1976
     2  (P.L.817, No.143), known as the "Mental Health Procedures Act."
     3     (d)  Nothing in this section shall be construed to limit or
     4  prohibit a certified registered nurse practitioner from engaging
     5  in those activities which normally constitute the practice of
     6  nursing as defined in section 2.
     7     Section 8.3.  Prescriptive Authority for Certified Registered
     8  Nurse Practitioners.--(a)  A certified registered nurse
     9  practitioner may prescribe medical therapeutic or corrective
    10  measures if the nurse:
    11     (1)  has successfully completed at least forty-five (45)
    12  hours of coursework specific to advanced pharmacology at a level
    13  above that required by a professional nursing education program;
    14     (2)  is acting in collaboration with a physician as set forth
    15  in a written agreement which shall, at a minimum, identify the
    16  following:
    17     (i)  the area of practice in which the nurse is certified;
    18     (ii)  the categories of drugs from which the nurse may
    19  prescribe or dispense; and
    20     (iii)  the circumstances and how often the collaborating
    21  physician will personally see the patient; and
    22     (3)  is acting in accordance with regulations promulgated by
    23  the board.
    24     [(b)  A certified registered nurse practitioner who satisfies
    25  the requirements of subsection (a) may prescribe and dispense
    26  those categories of drugs that certified registered nurse
    27  practitioners were authorized to prescribe and dispense by board
    28  regulations in effect on the effective date of this section,
    29  subject to the restrictions on certain drug categories imposed
    30  by those regulations. The board shall add to or delete from the
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     1  categories of authorized drugs in accordance with the provisions
     2  of section 8.4.]
     3     (b.1)  A certified registered nurse practitioner shall be
     4  limited by the scope of his specialty certification or in a
     5  collaborative or written agreement when prescribing any drug and
     6  shall comply with the requirements set forth in subsection (a).
     7     (c)  Except as provided in subsection (b), a certified
     8  registered nurse practitioner shall not be limited in
     9  prescribing any drug, including a controlled substance on
    10  Schedules II through V, nor shall there be any limit on the
    11  number of refills or dosages except as may be provided under
    12  Federal law, except that the certified registered nurse
    13  practitioner shall use his own Drug Enforcement Administration
    14  number and not that of any collaborating physician in writing
    15  the prescription.
    16     Section 2.  Section 8.4 of the act, added December 9, 2002
    17  (P.L.1567, No.206), is repealed:
    18     [Section 8.4.  Drug Review Committee.--(a)  The Drug Review
    19  Committee is hereby established and shall consist of seven
    20  members as follows:
    21     (1)  The Secretary of Health or, at the discretion of the
    22  Secretary of Health, the Physician General as his or her
    23  designee, who shall act as chairman.
    24     (2)  Two certified registered nurse practitioners who are
    25  actively engaged in clinical practice, appointed to three-year
    26  terms by the Secretary of Health.
    27     (3)  Two licensed physicians who are actively engaged in
    28  clinical practice, appointed to three-year terms by the
    29  Secretary of Health, at least one of whom shall, at the time of
    30  appointment, be collaborating with one or more certified
    20070H1253B1548                  - 4 -     

     1  registered nurse practitioners in accordance with section
     2  8.3(a)(2).
     3     (4)  Two licensed pharmacists who are actively engaged in the
     4  practice of pharmacy, appointed to three-year terms by the
     5  Secretary of Health.
     6     (b)  (1)  The board shall submit to the Drug Review Committee
     7  any proposed change to the categories of drugs that certified
     8  registered nurse practitioners were authorized to prescribe
     9  pursuant to board regulations in effect on the effective date of
    10  this section. The board shall not change, by addition or
    11  deletion, the categories of authorized drugs without prior
    12  approval of the Drug Review Committee.
    13     (2)  Within sixty (60) days of a submission by the board
    14  under paragraph (1), a majority of the Drug Review Committee
    15  shall vote to approve or disapprove the proposed change.
    16     (3)  If a majority of the Drug Review Committee fails to vote
    17  to approve or disapprove the proposed change within sixty (60)
    18  days of receipt of a submission by the board under paragraph
    19  (1), the Drug Review Committee shall be deemed to have approved
    20  the proposed change.]
    21     Section 3.  The act is amended by adding sections to read:
    22     Section 8.5.  Collaborative and Written Agreements.--(a)
    23  There shall be no limit to the number of certified registered
    24  nurse practitioners with prescriptive authority for whom a
    25  physician has responsibility or supervises under a collaborative
    26  or written agreement at any time.
    27     (b)  Collaborative and written agreements shall not
    28  unreasonably restrict any certified registered nurse
    29  practitioner's ability to practice to the fullest extent
    30  permitted by his scope of practice, clinical education and
    20070H1253B1548                  - 5 -     

     1  experience.
     2     Section 8.6.  Professional Liability.--A certified registered
     3  nurse practitioner practicing in this Commonwealth whose
     4  employer does not provide professional liability coverage shall
     5  maintain a level of professional liability coverage required by
     6  law of a physician providing similar health care services in
     7  this Commonwealth, but shall not be eligible to participate in
     8  the Medical Care Availability and Reduction of Error (Mcare)
     9  Fund.
    10     Section 4.  The State Board of Nursing shall promulgate
    11  regulations to implement the amendment, addition or repeal of
    12  sections 8.2, 8.3, 8.4, 8.5 and 8.6 of the act within 18 months
    13  of the effective date of this section.
    14     Section 5.  This act shall take effect in 60 days.











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