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PRIOR PRINTER'S NO. 715
PRINTER'S NO. 1827
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
717
Session of
2015
INTRODUCED BY VANCE, SCARNATI, BAKER, YUDICHAK, HUTCHINSON,
SCHWANK, HUGHES, BARTOLOTTA, SCAVELLO, LEACH, WOZNIAK,
McGARRIGLE, STEFANO, McILHINNEY, FOLMER, ARGALL, COSTA,
TEPLITZ, TARTAGLIONE, BLAKE, KITCHEN, RESCHENTHALER AND
MENSCH, APRIL 10, 2015
SENATOR TOMLINSON, CONSUMER PROTECTION AND PROFESSIONAL
LICENSURE, AS AMENDED, MAY 18, 2016
AN ACT
Amending the act of May 22, 1951 (P.L.317, No.69), entitled, as
amended, "An act relating to the practice of professional
nursing; providing for the licensing of nurses and for the
revocation and suspension of such licenses, subject to
appeal, and for their reinstatement; providing for the
renewal of such licenses; regulating nursing in general;
prescribing penalties and repealing certain laws," further
providing for definitions; and providing for licensure as a
certified nurse practitioner.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2(1), (10), (13) and (14) of the act of
May 22, 1951 (P.L.317, No.69), known as The Professional Nursing
Law, amended or added June 29, 2002 (P.L.651, No.99) and
December 9, 2002 (P.L.1567, No.206), are amended and the section
is amended by adding paragraphs to read:
Section 2. Definitions.--When used in this act, the
following words and phrases shall have the following meanings
unless the context provides otherwise:
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(1) The "Practice of Professional Nursing" means diagnosing
and treating human responses to actual or potential health
problems through such services as casefinding, health teaching,
health counseling, and provision of care supportive to or
restorative of life and well-being, and executing medical
regimens as prescribed by a licensed physician or dentist. The
foregoing shall not be deemed to include acts of medical
diagnosis or prescription of medical therapeutic or corrective
measures, except as performed by a certified [registered] nurse
practitioner acting in accordance with rules and regulations
promulgated by the Board.
* * *
(10) "Medical nutrition therapy" means the component of
nutrition therapy that concerns determining and recommending
nutrient needs based on nutritional assessment and medical
problems relative to diets prescribed by a licensed physician or
certified nurse practitioner, including:
(i) tube feedings;
(ii) specialized intravenous solutions;
(iii) specialized oral solutions; and
(iv) interactions of prescription drugs with food or
nutrients.
* * *
[(13) "Collaboration" means a process in which a certified
registered nurse practitioner works with one or more physicians
to deliver health care services within the scope of the
certified registered nurse practitioner's expertise. The process
includes all of the following:
(i) Immediate availability of a licensed physician to a
certified registered nurse practitioner through direct
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communications or by radio, telephone or telecommunications.
(ii) A predetermined plan for emergency services.
(iii) A physician available to a certified registered nurse
practitioner on a regularly scheduled basis for referrals,
review of the standards of medical practice incorporating
consultation and chart review, drug and other medical protocols
within the practice setting, periodic updating in medical
diagnosis and therapeutics and cosigning records when necessary
to document accountability by both parties.
[(14) "Drug Review Committee" means the committee
established in section 8.4 whose function is to approve or
disapprove, by addition or deletion, the categories of drugs
that may be prescribed by certified registered nurse
practitioners.]
* * *
(16) "Certified nurse practitioner" or "advanced practice
registered nurse-certified nurse practitioner" means a
registered nurse licensed in this Commonwealth to practice
independently in a particular clinical specialty area or
population focus in which the registered nurse is certified.
(17) "Population focus" means a category of the population
within which a certified nurse practitioner practices, including
family/individual across the lifespan, adult-gerontology,
neonatal, pediatrics, women's health/gender-related,
psychiatric/mental health and any other such categories as
designated by board regulations.
(18) "Controlled substance" means any drug designated as
such under the provisions of the act of April 14, 1972 (P.L.233,
No.64), known as the "Controlled Substance, Drug, Device and
Cosmetic Act."
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(19) "Non-proprietary drug" means a drug containing any
quantity of any controlled substance or any drug which is
required by any applicable Federal or State law to be dispensed
only by prescription.
(20) "Proprietary drug" means a non-prescription, non-
narcotic medicine or drug which may be sold without a
prescription and which is prepackaged for use by the consumer
and labeled in accordance with the requirements of the statutes
and regulations of the Federal Government and this Commonwealth.
(21) "Licensed independent practitioner" means any
practitioner licensed under this act to provide care and
services, without direction or supervision, within the scope of
the practitioner's license.
Section 2. Section 2.1(l) of the act, added December 9, 2002
(P.L.1567, No.206), is amended to read:
Section 2.1. State Board of Nursing.--* * *
(l) Any powers and duties imposed on the State Board of
Medicine or jointly imposed on the State Board of Medicine and
the State Board of Nursing, with respect to certified
[registered] nurse practitioners, by or pursuant to law or
regulation shall, after the effective date of this subsection,
be exercised solely by the State Board of Nursing. This
subsection shall not apply to 49 Pa. Code ยงยง 21.283(4) (relating
to prescribing and dispensing drugs) and 21.321 (relating to
performance of tasks without direction; performance of tasks
without training; other) unless the State Board of Nursing
promulgates a regulation to exercise the duties imposed on the
State Board of Medicine by those sections.
Section 3. Sections 3.1(b) and 7(b) of the act, amended or
added June 29, 2002 (P.L.651, No.99), are amended to read:
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SECTION 3. SECTION 3.1(B) OF THE ACT, AMENDED OR ADDED JUNE
29, 2002 (P.L.651, NO.99), IS AMENDED TO READ:
Section 3.1. Dietitian-Nutritionist License Required.--* * *
(b) Nothing in this section shall be construed to require or
preclude third-party insurance reimbursement. Nothing herein
shall preclude an insurer or other third-party payor from
requiring that a licensed dietitian-nutritionist obtain a
referral from a licensed physician, certified nurse
practitioner, dentist or podiatrist or that a licensed
dietitian-nutritionist file an evaluation and treatment plan
with the insurer or third-party payor as a precondition of
reimbursement.
SECTION 4. SECTION 4.1 OF THE ACT, ADDED DECEMBER 20, 1985
(P.L.409, NO.109), IS AMENDED TO READ:
SECTION 4.1. TEMPORARY PRACTICE PERMIT.--(A) IN ORDER FOR A
PERSON TO PRACTICE PROFESSIONAL NURSING DURING THE ONE (1) YEAR
PERIOD FROM COMPLETION OF HIS OR HER EDUCATION PROGRAM OR THE
ONE (1) YEAR PERIOD FROM THE APPLICATION FOR LICENSURE BY A
PERSON WHO HOLDS A CURRENT LICENSE ISSUED BY ANY OTHER STATE,
TERRITORY OR POSSESSION OF THE UNITED STATES OR THE DOMINION OF
CANADA, THE BOARD MAY ISSUE A TEMPORARY PRACTICE PERMIT WHICH IS
NONRENEWABLE AND VALID FOR A PERIOD OF ONE (1) YEAR AND DURING
SUCH ADDITIONAL PERIOD AS THE BOARD MAY IN EACH CASE ESPECIALLY
PERMIT, EXCEPT THAT THE TEMPORARY PRACTICE PERMIT SHALL EXPIRE
IF SUCH PERSON FAILS THE LICENSING EXAMINATION.
(B) WITHIN 90 DAYS OF THE DATE A TEMPORARY PRACTICE PERMIT
TO PRACTICE AS A CERTIFIED NURSE PRACTITIONER IS ISSUED BY THE
BOARD TO AN INDIVIDUAL WHO WAS LICENSED OR CERTIFIED BY ANOTHER
STATE, TERRITORY OR POSSESSION OF THE UNITED STATES OR A FOREIGN
COUNTRY, THE INDIVIDUAL SHALL COMPLY WITH THE REQUIREMENTS UNDER
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SECTIONS 8.2 AND 8.3 WITH REGARD TO ACTING IN COLLABORATION WITH
A PHYSICIAN AND IN ACCORDANCE WITH A COLLABORATIVE OR WRITTEN
AGREEMENT WITH A PHYSICIAN, UNLESS SUCH INDIVIDUAL QUALIFIES FOR
THE EXCEPTION FROM THE COLLABORATION REQUIREMENT ACCORDING TO
THE BOARD PURSUANT TO SECTION 8.9(C).
SECTION 5. SECTION 7(B) OF THE ACT, AMENDED JUNE 29, 2002
(P.L.651, NO.99), IS AMENDED TO READ:
Section 7. Graduates of Schools of Other States, Territories
or Dominion of Canada.--* * *
(b) The Board may issue a [certification to registered nurse
practitioners who have] license as a certified nurse
practitioner to a registered nurse who has completed a course of
study considered by the Board to be equivalent to that required
in this State at the time such course was completed or who is
licensed or certified by another state, territory or possession
of the United States or a foreign country as deemed equivalent
to Pennsylvania's [certification] licensure requirements in
accordance with the [joint] rules and regulations of the [Boards
of Nursing and Medicine] board.
* * *
Section 4 6. Section 8.1 of the act is amended by adding a
subsection to read:
Section 8.1. Certified Registered Nurse Practitioners;
Qualifications.--* * *
(d) The authority of the board to certify a licensed
registered nurse as a certified registered nurse practitioner
shall expire on the effective date of section 8.8.
Section 5 7. Section 8.2 of the act, amended July 20, 2007
(P.L.318, No.48), is amended to read:
Section 8.2. Scope of Practice for Certified [Registered]
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Nurse Practitioners.--(a) A certified [registered] nurse
practitioner [while functioning in the expanded role as a
professional nurse] shall practice within the scope of practice
of the particular clinical specialty area or population focus
in which the nurse is [certified] licensed by the board.
Notwithstanding any other provision of law, a certified nurse
practitioner is entitled to all of the following:
(1) To practice as a licensed independent practitioner
within the scope of practice of the particular clinical
specialty area or population focus in which the nurse is
licensed by the board.
(2) To be recognized as a primary care provider under
managed care and other health care plans.
(b) [A] EXCEPT AS PROVIDED UNDER SECTION 8.9, A certified
[registered] nurse practitioner may perform acts of medical
diagnosis [in collaboration with a physician and] in accordance
with regulations promulgated by the board.
(c) [Except as provided in subsection (c.1), a] A certified
[registered] nurse practitioner may prescribe medical
therapeutic or corrective measures if the nurse is acting in
accordance with the provisions of section 8.3.
(c.1) [Except as limited by subsection (c.2), and in] In
addition to existing authority, a certified [registered] nurse
practitioner shall have authority to do all of the following,
provided that the certified nurse practitioner is acting within
the scope of [the certified registered nurse practitioner's
collaborative or written agreement with a physician, EXCEPT AS
PROVIDED UNDER SECTION 8.9, and] the certified [registered]
nurse practitioner's [specialty] certification:
(1) Order home health and hospice care.
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(2) Order durable medical equipment.
(3) Issue oral orders [to the extent permitted by the health
care facilities' by-laws, rules, regulations or administrative
policies and guidelines].
(4) Make physical therapy and dietitian referrals.
(5) Make respiratory, speech and occupational therapy
referrals.
(6) Perform disability assessments for the program providing
Temporary Assistance to Needy Families (TANF).
(7) Issue homebound schooling certifications.
(8) Perform and sign the initial assessment of methadone
treatment evaluations[, provided that any] and order [for]
methadone treatment [shall be made only by a physician].
(c.2) [Nothing in this section shall be construed to:
(1) Supersede the authority of the Department of Health and
the Department of Public Welfare to regulate the types of health
care professionals who are eligible for medical staff membership
or clinical privileges.
(2) Restrict the authority of a health care facility to
determine the scope of practice and supervision or other
oversight requirements for health care professionals practicing
within the facility.] Notwithstanding any provision of the act
of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act, that may be to the contrary, no regulation or
order of the Department of Health, the Department of Human
Services or the Insurance Department shall supersede the
decision of the governing body of a health care facility that
the types of health care professionals who are eligible for
medical staff membership or clinical privileges at the facility
include certified nurse practitioners when practicing as
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licensed independent practitioners.
(d) Nothing in this section shall be construed to limit or
prohibit a certified [registered] nurse practitioner from
engaging in those activities which normally constitute the
practice of nursing as defined in section 2.
Section 6 8. Sections 8.3 and 8.4 of the act, added December
9, 2002 (P.L.1567, No.206), are amended to read:
Section 8.3. Prescriptive Authority for Certified
[Registered] Nurse Practitioners.--(a) A certified [registered]
nurse practitioner may prescribe medical therapeutic or
corrective measures if the nurse:
(1) has successfully completed at least forty-five (45)
hours of coursework specific to advanced pharmacology at a level
above that required by a professional nursing education program;
(2) (I) EXCEPT AS PROVIDED UNDER SUBPARAGRAPH (II), is
[acting in collaboration with a physician as set forth in a
written agreement which shall, at a minimum, identify the
following:
[(i)] (A) the area of practice in which the nurse is
certified;
[(ii)] (B) the categories of drugs from which the nurse may
prescribe or dispense; and
[(iii)] (C) the circumstances and how often the
collaborating physician will personally see the patient]; OR
(II) IF THE CERTIFIED NURSE PRACTITIONER QUALIFIES FOR THE
EXCEPTION FROM THE COLLABORATION REQUIREMENT AS PROVIDED UNDER
SECTION 8.9, IS practicing within a clinical specialty area or
population focus in which the nurse is certified ; and
(3) is acting in accordance with regulations promulgated by
the board.
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(b) A certified [registered] nurse practitioner who
satisfies the requirements of subsection (a) may independently
prescribe and dispense [those categories of drugs that certified
registered nurse practitioners were authorized to prescribe and
dispense by board regulations in effect on the effective date of
this section, subject to the restrictions on certain drug
categories imposed by those regulations. The board shall add to
or delete from the categories of authorized drugs in accordance
with the provisions of section 8.4] proprietary and non-
proprietary drugs, subject to any restrictions imposed by board
regulations or by Federal law.
Section 8.4. [Drug Review Committee.--(a) The Drug Review
Committee is hereby established and shall consist of seven
members as follows:
(1) The Secretary of Health or, at the discretion of the
Secretary of Health, the Physician General as his or her
designee, who shall act as chairman.
(2) Two certified registered nurse practitioners who are
actively engaged in clinical practice, appointed to three-year
terms by the Secretary of Health.
(3) Two licensed physicians who are actively engaged in
clinical practice, appointed to three-year terms by the
Secretary of Health, at least one of whom shall, at the time of
appointment, be collaborating with one or more certified
registered nurse practitioners in accordance with section 8.3(a)
(2).
(4) Two licensed pharmacists who are actively engaged in the
practice of pharmacy, appointed to three-year terms by the
Secretary of Health.
(b) (1) The board shall submit to the Drug Review Committee
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any proposed change to the categories of drugs that certified
registered nurse practitioners were authorized to prescribe
pursuant to board regulations in effect on the effective date of
this section. The board shall not change, by addition or
deletion, the categories of authorized drugs without prior
approval of the Drug Review Committee.
(2) Within sixty (60) days of a submission by the board
under paragraph (1), a majority of the Drug Review Committee
shall vote to approve or disapprove the proposed change.
(3) If a majority of the Drug Review Committee fails to vote
to approve or disapprove the proposed change within sixty (60)
days of receipt of a submission by the board under paragraph
(1), the Drug Review Committee shall be deemed to have approved
the proposed change.] (Reserved).
Section 7 9. Section 8.7 of the act, added July 20, 2007
(P.L.318, No.48), is amended to read:
Section 8.7. Professional Liability.--(A) A certified
[registered] nurse practitioner practicing in this Commonwealth
shall maintain a level of professional liability coverage as
required for a nonparticipating health care provider under the
act of March 20, 2002 (P.L.154, No.13), known as the "Medical
Care Availability and Reduction of Error (Mcare) Act," but shall
not be eligible to participate in the Medical Care Availability
and Reduction of Error (Mcare) Fund.
(B) A CERTIFIED NURSE PRACTITIONER WHO QUALIFIES FOR THE
EXCEPTION FROM THE COLLABORATION REQUIREMENT PURSUANT TO SECTION
8.9 AND OPERATES WITHOUT COLLABORATION SHALL SATISFY THE
LIABILITY COVERAGE REQUIREMENT UNDER SUBSECTION (A) BY
MAINTAINING AN INDIVIDUAL POLICY IN THE CERTIFIED NURSE
PRACTITIONER ' S OWN NAME.
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Section 8 10. The act is amended by adding a section
SECTIONS to read:
Section 8.8. Licensure as a Certified Nurse Practitioner.--
(a) A registered nurse who holds current certification by the
board, pursuant to section 8.1, as a certified registered nurse
practitioner in a particular clinical specialty area on the
effective date of this section shall automatically be deemed to
be licensed by the board as a certified nurse practitioner,
either in that specialty area or in the population focus for
which that registered nurse is otherwise qualified. The board
shall issue appropriate written notice of such license as a
certified nurse practitioner, provided that the issuance of that
notice shall not be a condition precedent to practice in
accordance with that license.
(b) Except as provided in subsection (a), a person shall not
qualify for an initial license as a certified nurse practitioner
on or after the effective date of this section unless the person
meets the following criteria:
(1) Holds a current license in this Commonwealth as a
registered nurse.
(2) Is a graduate of an accredited, board-approved master's
or post-master's nurse practitioner program.
(3) Holds current certification as a certified nurse
practitioner from a board-recognized national certification
program which required passing a national certifying examination
in the particular clinical specialty area or population focus in
which the nurse is seeking licensure by the board.
(c) (1) An initial license pursuant to subsection (a) as a
certified nurse practitioner shall expire on the same date as
the nurse's then current license as a registered nurse is
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scheduled to expire. Such license as a certified nurse
practitioner shall thereafter be renewed biennially on the same
date as the nurse's license as a registered nurse.
(2) An initial license pursuant to subsection (b) or section
7(b) as a certified nurse practitioner shall expire on the same
date as the nurse's then current license as a registered nurse
is scheduled to expire. Such license as a certified nurse
practitioner shall thereafter be renewed biennially on the same
date as the nurse's license as a registered nurse.
(3) As a condition for biennial renewal by the board of a
license as a certified nurse practitioner, the nurse must do all
of the following:
(i) Maintain a current license in this Commonwealth as a
registered nurse.
(ii) Maintain current certification through a board-
recognized national certification program in the particular
clinical specialty area or population focus in which the nurse
is licensed as a certified nurse practitioner by the board.
(iii) In the two years prior to renewal, complete at least
thirty (30) hours of continuing education approved by the board.
In the case of a certified nurse practitioner who is prescribing
medical therapeutic or corrective measures pursuant to section
8.3, that continuing education must include at least sixteen
(16) hours in pharmacology in that two-year period.
(d) The board shall establish a procedure by which a license
as a certified nurse practitioner may be amended prior to the
biennial renewal date in order to authorize a nurse to practice
in a particular clinical specialty area or population focus in
which the nurse was not certified on the effective date of this
section or on the date on which the nurse's current license as a
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certified nurse practitioner was issued or renewed. The board
shall authorize a certified nurse practitioner to practice in an
additional clinical specialty area or population focus only if
the nurse holds current certification from a board-recognized
national certification program which required the passing of a
national certifying examination in the additional clinical
specialty area or population focus.
(e) (1) The use of the terms "certified registered nurse
practitioner," "registered nurse practitioner," "certified nurse
practitioner" and "nurse practitioner" in any other act shall be
deemed to include a person licensed as a certified nurse
practitioner pursuant to this section or to section 7(b).
(2) A registered nurse who is licensed by the board as a
certified nurse practitioner in a particular clinical specialty
area or population focus is entitled to use the title "advanced
practice registered nurse-certified nurse practitioner" and the
letters "A.P.R.N.-C.N.P." It shall be unlawful for any other
person to use the title "advanced practice registered nurse-
certified nurse practitioner" or the letters "A.P.R.N.-C.N.P."
(f) (1) A certified nurse practitioner may form a
professional corporation with one or more of the following:
(i) Other registered nurses.
(ii) Other health care practitioners who treat human
ailments and conditions and are licensed to provide health care
services in this Commonwealth without receiving a referral or
supervision from another health care practitioner.
(2) This subsection shall be construed to abrogate the
requirement that the State Board of Medicine and the State Board
of Osteopathic Medicine expressly authorize the combined
practice of certified nurse practitioners with doctors of
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medicine or doctors of osteopathic medicine, respectively, found
in section 2903(d)(1)(ii) of Title 15 of the Pennsylvania
Consolidated Statutes.
SECTION 8.9. ADDITIONAL QUALIFICATIONS.--(A) A CERTIFIED
NURSE PRACTITIONER WHO HAS ENGAGED IN THE PRACTICE OF
PROFESSIONAL NURSING AS A CERTIFIED NURSE PRACTITIONER OR
CERTIFIED REGISTERED NURSE PRACTITIONER IN COLLABORATION WITH A
PHYSICIAN FOR A PERIOD OF NOT LESS THAN THREE (3) YEARS AND NOT
LESS THAN THREE THOUSAND SIX HUNDRED (3,600) HOURS IN ACCORDANCE
WITH A COLLABORATIVE OR WRITTEN AGREEMENT WITH A PHYSICIAN AS
REQUIRED UNDER SECTIONS 8.2 AND 8.3 SHALL NOT BE SUBJECT TO THE
REQUIREMENT THAT THE CERTIFIED NURSE PRACTITIONER ACT IN
COLLABORATION WITH A PHYSICIAN OR IN ACCORDANCE WITH A
COLLABORATIVE OR WRITTEN AGREEMENT WITH A PHYSICIAN AS REQUIRED
UNDER SECTIONS 8.2 AND 8.3.
(B) A CERTIFIED NURSE PRACTITIONER WHO QUALIFIES FOR THE
EXCEPTION FROM THE COLLABORATION REQUIREMENT AS PROVIDED UNDER
THIS SECTION SHALL FILE A FORM WITH THE BOARD ATTESTING TO
HAVING ENGAGED IN THE PRACTICE OF PROFESSIONAL NURSING IN
COLLABORATION WITH A PHYSICIAN FOR A PERIOD OF NOT LESS THAN
THREE (3) YEARS AND NOT LESS THAN THREE THOUSAND SIX HUNDRED
(3,600) HOURS PURSUANT TO SUBSECTION (A). SUCH FORM SHALL BE
DEVELOPED BY THE BOARD BY REGULATION.
(C) A REGISTERED NURSE WHO WAS LICENSED OR CERTIFIED BY
ANOTHER STATE, TERRITORY OR POSSESSION OF THE UNITED STATES OR A
FOREIGN COUNTRY AND RECEIVED A LICENSE AS A CERTIFIED NURSE
PRACTITIONER ISSUED BY THE BOARD OR A TEMPORARY PRACTICE PERMIT
TO PRACTICE AS A CERTIFIED NURSE PRACTITIONER UNDER SECTION 4.1
MAY QUALIFY FOR THE EXCEPTION FROM THE COLLABORATION REQUIREMENT
AS PROVIDED UNDER THIS SECTION IF THE CERTIFIED NURSE
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PRACTITIONER SATISFACTORILY DEMONSTRATES TO THE BOARD THE
COMPLETION OF NO LESS THAN THREE (3) YEARS AND NO LESS THAN
THREE THOUSAND SIX HUNDRED (3,600) HOURS OF PRACTICE IN
COLLABORATION WITH A PHYSICIAN DEEMED EQUIVALENT TO THE
REQUIREMENTS UNDER SUBSECTION (A), WHICH OCCURRED IN
PENNSYLVANIA OR IN ONE OR MORE OTHER STATES, TERRITORIES OR
POSSESSIONS OF THE UNITED STATES OR FOREIGN COUNTRIES WHERE THE
CERTIFIED NURSE PRACTITIONER WAS PREVIOUSLY, OR IS CURRENTLY,
LICENSED.
Section 9 11. Within 90 days after the effective date of
this act, the State Board of Nursing, the Department of Health,
the Department of Human Services and other affected agencies
shall initiate the promulgation of any regulations necessary
because of the amendments made by this act to the act of May 22,
1951 (P.L.317, No.69), known as the Professional Nursing Law,
provided that the promulgation of those regulations shall not be
a condition precedent to the applicability of any such
amendments.
Section 10 12. This act shall take effect in 60 days.
20150SB0717PN1827 - 16 -
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