H0100B1402A07388 AJB:JMT 09/28/20 #90 A07388
AMENDMENTS TO HOUSE BILL NO. 100
Sponsor: REPRESENTATIVE HICKERNELL
Printer's No. 1402
Amend Bill, page 1, lines 7 through 23, by striking out
"further providing for" in line 7 and all of lines 8 through 23
and inserting
providing for Certified Registered Nurse Practitioner Pilot
Program.
Amend Bill, page 1, line 26; pages 2 through 25, lines 1
through 30; page 26, lines 1 through 24; by striking out all of
said lines on said pages and inserting
Section 1. The act of May 22, 1951 (P.L.317, No.69), known
as The Professional Nursing Law, is amended by adding a section
to read:
Section 8.8. Certified Registered Nurse Practitioner Pilot
Program. -- (a) The board shall establish the Certified
Registered Nurse Practitioner Pilot Program to allow an eligible
certified registered nurse practitioner to receive an additional
certification to practice as an independent practitioner in a
health professional shortage area.
(b) A certified registered nurse practitioner shall be
eligible to participate in the program if the certified
registered nurse practitioner meets all of the following
criteria:
(1) The certified registered nurse practitioner holds a
current license to practice in this Commonwealth.
(2) The certified registered nurse practitioner received no
disciplinary action or has no pending disciplinary action within
the five (5) years immediately preceding the date of the
certified registered nurse practitioner's application under
paragraph (4).
(3) The certified registered nurse practitioner 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 in accordance
with a collaborative or written agreement with a physician and
the practice occurred in a primary care setting within the five
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(5) years immediately preceding the date of the certified
registered nurse practitioner's application under paragraph (4).
(4) The certified registered nurse practitioner submits an
application with the board on a form prescribed by the board and
pays a fee established by the board. The application shall
attest that the certified registered nurse practitioner meets
the criteria to participate in the program under paragraph (3)
and shall be signed by a current or former collaborating
physician under paragraph (3). If the certified registered nurse
practitioner is unable to obtain the signature required under
this paragraph, the board may accept any other documentation
attesting that the certified registered nurse practitioner meets
the criteria to participate in the program under paragraph (3).
(c) While practicing in a health professional shortage area
under the program, a certified registered nurse practitioner
may:
(1) practice in accordance with section 8.2 without a
collaborative agreement; and
(2) prescribe medical therapeutic or corrective measures in
accordance with section 8.3 without a collaborative agreement.
(d) In order to continue to participate in the program, a
certified registered nurse practitioner shall be subject to
biennial renewal and shall submit a renewal application on a
form prescribed by the board, pay a fee established by the board
and complete ten (10) hours of continuing education approved by
the board in patient safety and risk management. The renewal
application under this subsection shall attest that the
certified registered nurse practitioner completed the continuing
education required under this subsection. The continuing
education required under this subsection shall be in addition to
the continuing education required under section 8.1(c).
(e) While practicing in a health professional shortage area
under the program, the clinical practice of a certified
registered nurse practitioner shall be limited to primary care,
including family practice, internal medicine, gynecology or
pediatrics. A certified registered nurse practitioner shall
immediately notify the board in writing if the certified
registered nurse practitioner changes practice settings or
provides care in an area that is not a health professional
shortage area. A certified registered nurse practitioner who
fails to provide the notice required under this subsection or
who is found to be practicing outside of the practice settings
or health professional shortage area specified in the notice
shall not be authorized to continue participation in the program
and disciplinary actions may be taken on the certified
registered nurse practitioner's license as deemed necessary by
the board.
(f) While participating in the program in a health
professional shortage area, a certified registered nurse
practitioner shall be accountable to the board, nursing
profession and patients and shall have the following duties:
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(1) The certified registered nurse practitioner shall comply
with the requirements of this act and the standard of care of
advanced nursing care rendered.
(2) The certified registered nurse practitioner shall
recognize the certified registered nurse practitioner's
limitation regarding knowledge and experience.
(3) The certified registered nurse practitioner shall wear a
name identification badge stating the individual's professional
title and shall inform new patients in writing about the
certified registered nurse practitioner's qualifications ,
including a disclosure that the certified registered nurse
practitioner is not a physician, and the nature of the certified
registered nurse practitioner's autonomous practice before or
during the initial patient encounter.
(4) The certified registered nurse practitioner shall plan
for the management of situations beyond the certified registered
nurse practitioner's expertise.
(5) The certified registered nurse practitioner shall
consult with and refer patients to other health care providers,
as appropriate.
(g) The following shall apply:
(1) The board shall be responsible for administering the
program. Within 60 days of the effective date of this
subsection, the board shall establish a subcommittee to assist
the board in administering the program. The subcommittee shall
consist of the following members:
(i) The Secretary of Health or a designee from the
Department of Health, Bureau of Health Planning, that has
experience and expertise in health professional shortage areas ,
who shall serve as chair of the subcommittee .
(ii) Two certified registered nurse practitioners who are
actively engaged in primary care clinical practice. The
certified registered nurse practitioners shall be selected by a
Statewide professional organization representing certified
registered nurse practitioners engaged in primary care clinical
practice. The Statewide professional organization shall submit
the names of the certified registered nurse practitioners
selected under this subparagraph to the board for appointment on
the subcommittee.
(iii) Two licensed physicians, one of whom shall be an
allopathic physician and one of whom shall be an osteopathic
physician, who are actively engaged in primary care clinical
practice. The licensed physicians shall be selected by Statewide
professional organizations representing family medicine,
internal medicine or pediatrics. The Statewide professional
organizations shall submit the names of the licensed physicians
selected under this subparagraph to the board for appointment on
the subcommittee. At the time of appointment under this
subparagraph, the licensed physicians shall meet all of the
following criteria:
(A) The licensed physicians shall be collaborating with a
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certified registered nurse practitioner or shall have
collaborated with a certified registered nurse practitioner
within the preceding three (3) years.
(B) The licensed physicians shall be nationally board
certified in family medicine, internal medicine or pediatrics.
(2) The subcommittee shall have the following duties:
(i) Provide guidance to certified registered nurse
practitioners regarding the qualifications to participate in the
program.
(ii) Approve the temporary regulations promulgated under
subsection (m).
(iii) Review applications for certification to participate
in the program.
(iv) Collaborate with the board to approve, issue, track and
revoke the certification of certified registered nurse
practitioners to participate in the program.
(v) Conduct a preliminary review of a certified registered
nurse practitioner's application to participate in the program.
If the subcommittee determines that the certified registered
nurse practitioner meets the criteria to participate in the
program under subsection (b), the subcommittee shall submit a
notice of preapproval to the board. The board may not issue a
certification to participate in the program to a certified
registered nurse practitioner if the certified registered nurse
practitioner's application has not been preapproved by the
subcommittee under this subparagraph.
(h) While participating in the program in a health
professional shortage area, a certified registered nurse
practitioner shall be recognized as a primary care provider.
(i) A certified registered nurse practitioner who
participates in the program shall be deemed to be a
participating health care provider as defined in section 702 of
the act of March 20, 2002 (P.L.154, No.13), known as the Medical
Care Availability and Reduction of Error (Mcare) Act, shall meet
the requirements under section 711 of t he Medical Care
Availability and Reduction of Error (Mcare) Act, and shall be
assessed under section 712 of the Medical Care Availability and
Reduction of Error (Mcare) Act. Upon receiving an assessment
under section 712 of the Medical Care Availability and Reduction
of Error (Mcare) Act, the certified registered nurse
practitioner who participates in the program shall be eligible
to receive money from claims paid by the Medical Care
Availability and Reduction of Error Fund. For purposes of the
program, the board shall be considered a licensure authority as
defined in section 702 of the Medical Care Availability and
Reduction of Error (Mcare) Act.
(j) If a certified registered nurse practitioner intends to
practice simultaneously under the program, and pursuant to a
collaboration agreement with a physician who is external to the
program, the collaborating physician shall have no legal
responsibility for acts or omissions of the certified registered
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nurse practitioner practicing under the program.
(k) The following shall apply:
(1) Five (5) years after the effective date of this
subsection, the Joint State Government Commission shall conduct
a study on the program and, within six (6) months of commencing
the study, submit the study to the Consumer Protection and
Professional Licensure Committee of the Senate and the
Professional Licensure Committee of the House of Representatives
for the purpose of evaluating the program. The study shall
include, but not be limited to, all of the following
information:
(i) The number of certified registered nurse practitioners
who participated in the program and the health professional
shortage areas where they participated.
(ii) The number of certified registered nurse practitioners
who were rejected from participating in the program and the
reason why they were rejected.
(iii) The number of certified registered nurse practitioners
that left the program and the reason why they left the program.
(iv) The access to patient care, patient outcomes and
emergency room use in the health professional shortage areas
covered under the program as compared to the access to patient
care, patient outcomes and emergency room use in the areas not
covered by the program.
(v) The number of referrals by certified registered nurse
practitioners to emergency hospitals, the severity of illness
experienced by each referred patient and the number of repeat
visits by patients to emergency hospitals.
(vi) A comparison of the use of advanced diagnostic tests
and imaging by certified registered nurse practitioners
participating in the program and the use of advanced diagnostic
tests and imaging by primary care physicians in the same health
professional shortage area.
(vii) The number of complaints filed with the board, the
nature of the complaints and the disciplinary actions that were
taken.
(viii) The number of referrals by certified registered nurse
practitioners to physician specialists as compared to primary
care physicians in the same health professional shortage areas
covered under the program, including the types of specialists
referred to by certified registered nurse practitioners, the
reasons for the referrals and the number of visits with each
certified registered nurse practitioner before the referrals.
(ix) The number of certified registered nurse practitioners
that are employed while participating in the program versus the
number of certified registered nurse practitioners that are
working in private practice under the program.
(x) Any other relevant information to evaluate the program.
(2) The Joint State Government Commission shall obtain
deidentified data from health insurance company claims on
patients receiving care from a certified registered nurse
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practitioner participating in the program for the purpose of
collecting data to complete the study under paragraph (1).
(3) The board shall provide the Joint State Government
Commission, upon request, with all information necessary to
complete the study under paragraph (1).
(l) The department shall notify the board and subcommittee
immediately upon receiving notification of an alleged violation
of this section. The board shall maintain current records of all
reports of alleged violations and periodically review the
records for the purpose of determining that each alleged
violation has been resolved in a timely manner, and if
necessary, forward the reports to the State Board of Medicine or
the State Board of Osteopathic Medicine for informational
purposes.
(m) The board shall promulgate regulations necessary to
implement the program as approved by the subcommittee
established under subsection (g)(1) and with the consideration
of any recommendations made by the Consumer Protection and
Professional Licensure Committee of the Senate and the
Professional Licensure Committee of the House of Representatives
for the purpose of evaluating the program. In order to
facilitate the prompt implementation of the program, regulations
promulgated by the board shall be deemed temporary regulations
which shall not expire for a period of six (6) years following
publication. Temporary regulations promulgated under this
subsection shall not be subject to:
(1) Section 612 of the act of April 9, 1929 (P.L.177,
No.175), known as The Administrative Code of 1929.
(2) Sections 204(b) and 301(10) of the act of October 15,
1980 (P.L.950, No.164), known as the Commonwealth Attorneys Act.
(3) Sections 201, 202, 203, 204 and 205 of the act of July
31, 1968 (P.L.769, No.240), referred to as the Commonwealth
Documents Law.
(4) The act of June 25, 1982 (P.L.633, No.181), known as the
Regulatory Review Act.
(n) Nothing in this section shall be construed to:
(1) permit a certified registered nurse practitioner to
practice under the act of December 20, 1985 (P.L.457, No.112),
known as the Medical Practice Act of 1985, or the act of October
5, 1978 (P.L.1109, No.261), known as the Osteopathic Medical
Practice Act; or
(2) prohibit a certified registered nurse practitioner
certified under the program from consulting with or seeking
information related to patient care from a physician. For the
purpose of this section, no physician-patient relationship shall
be established between a patient and a physician with whom the
certified registered nurse practitioner consults or from whom
clinical information or guidance is sought.
(o) The program shall expire six (6) years after the
effective date of this subsection. Upon the expiration of the
program, the following shall apply:
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(1) A certified registered nurse practitioner shall be
deemed to have retired as a health care practitioner for the
purposes of the Medical Care Availability and Reduction of Error
(Mcare) Act.
(2) A certified registered nurse practitioner may not
practice under the program.
(p) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection:
"Health professional shortage area" shall mean a geographic
or population area in this Commonwealth designated by the United
States Department of Health and Human Services that indicates a
health care professional shortage in primary care.
"Program" shall mean the Certified Registered Nurse Pilot
Program established under subsection (a).
Section 2. This act shall take effect as follows:
(1) Section 8.8(g) and (m) of the act shall take effect
immediately.
(2) The remainder of this act shall take effect in 180
days.
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