PRINTER'S NO. 1548
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.
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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
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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
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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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