PRIOR PRINTER'S NO. 334
PRINTER'S NO. 507
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
25
Session of
2019
INTRODUCED BY BARTOLOTTA, BOSCOLA, SCARNATI, LANGERHOLC, FOLMER,
BREWSTER, FONTANA, HUTCHINSON, STEFANO, SCHWANK, J. WARD,
COLLETT, BLAKE, HAYWOOD, LEACH, SCAVELLO, YUDICHAK, LAUGHLIN,
HUGHES, BAKER, STREET, ARGALL, A. WILLIAMS, FARNESE, MENSCH,
SABATINA, COSTA, L. WILLIAMS, TARTAGLIONE, KEARNEY AND MUTH,
FEBRUARY 27, 2019
SENATOR TOMLINSON, CONSUMER PROTECTION AND PROFESSIONAL
LICENSURE, AS AMENDED, MARCH 27, 2019
AN ACT
Amending the act of May 22, 1951 (P.L.317, No.69), entitled "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
title, for definitions, for State Board of Nursing, for
dietitian-nutritionist license required, for unauthorized
practices and acts not prohibited, for temporary practice
permit, for graduates of schools of other states, territories
or Dominion of Canada, for persons entitled to practice, for
certified registered nurse practitioners and qualifications,
for scope of practice for certified registered nurse
practitioners, for prescriptive authority for certified
registered nurse practitioners, for Drug Review Committee,
for professional liability, for reporting of multiple
licensure, for continuing nursing education, for punishment
for violations, for refusal, suspension or revocation of
license, for reinstatement of license and for injunction or
other process; and providing for the expiration of the State
Board of Nursing's power to license certified registered
nurse practitioners.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The title of the act of May 22, 1951 (P.L.317,
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No.69), known as The Professional Nursing Law, is amended to
read:
AN ACT
Relating to the practice of professional nursing and the
practice of advanced practice registered 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.
Section 2. Section 2(1), (10), (12), (13) and (14) of the
act 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:
(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] an a dvanced practice registered nurse-certified
nurse practitioner acting in accordance with rules and
regulations promulgated by the Board.
* * *
(10) "Medical nutrition therapy" means the component of
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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
an advanced practice registered nurse-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.
* * *
[(12) "Certified registered nurse practitioner" means a
registered nurse licensed in this Commonwealth who is certified
by the board in a particular clinical specialty area.]
(13) "Collaboration" means a process in which [a certified
registered nurse practitioner] an a dvanced practice registered
nurse-certified nurse practitioner works with one or more
physicians to deliver health care services within the scope of
the [certified registered nurse practitioner's] a dvanced
practice registered nurse-certified nurse practitioner 's
expertise. The process includes all of the following:
(i) Immediate availability of a licensed physician to [a
certified registered nurse practitioner] an a dvanced practice
registered nurse-certified nurse practitioner through direct
communications or by radio, telephone or telecommunications.
(ii) A predetermined plan for emergency services.
(iii) A physician available to [a certified registered nurse
practitioner] an a dvanced practice registered nurse-certified
nurse practitioner on a regularly scheduled basis for referrals,
review of the standards of medical practice incorporating
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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) "A dvanced practice registered nurse-certified nurse
practitioner" means a registered nurse licensed in this
Commonwealth to practice independently in a population focus
area in which the registered nurse is certified by a board-
recognized national certification program.
(17) "Population focus area" means a category of patients
for which an advanced practice registered nurse-certified nurse
practitioner has the educational preparation to provide care and
services. The categories of population focus include:
(i) Family and individuals across the lifespan.
(ii) Adult gerontology.
(iii) Neonatal.
(iv) Pediatrics.
(v) Women's health and gender-related health.
(vi) Psychiatric and mental health.
(vii) Any other similar area designated by the board.
(18) "Controlled substance" means a drug designated as a
controlled substance under 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) "Nonproprietary drug" means a drug containing a
quantity of a controlled substance or a drug which is required
by an applicable Federal or State law to be dispensed only by
prescription.
(20) "Proprietary drug" means a nonprescription, 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 the Commonwealth.
(21) "Licensed independent practitioner" means an advanced
practice registered nurse-certified nurse practitioner licensed
under section 8.1(j) or (l) to provide care and services,
without direction or supervision, within the scope of the
practitioner's license.
(22) "Practice of Advanced Practice Registered Nursing"
means the practice of an advanced practice registered nurse-
certified nurse practitioner to assess, diagnose, treat,
prescribe and order, within a population focus AREA approved by
the board of nursing that includes the advanced practice
registered nurse-certified nurse practitioner's scope of
practice. The term shall include, but not be limited to,
performing acts of medical diagnosis or prescription of medical
therapeutic or corrective measures.
Section 3. Sections 2.1(k) and (l), 3.1(b), 4, 4.1, 7(b), 8,
8.1, 8.2, 8.3, 8.4, 8.7, 11.1, 12.1(g)(1), 13(b), 14(a)(1), (2)
and (4) and (b)(6), 15.2 and 15.4 of the act are amended to
read:
Section 2.1. State Board of Nursing.--* * *
(k) The Board shall have the right and duty to establish
rules and regulations for the practice of professional nursing,
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the practice of advanced practice registered nursing, the
practice of dietetics-nutrition and the administration of this
act. Copies of such rules and regulations shall be available for
distribution to the public.
(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] a dvanced practice registered
nurse-certified 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 §§ 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 3.1. 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, an advanced practice
registered nurse-certified nurse practitioner, a 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. Unauthorized Practices; Acts not Prohibited.--
This act confers no authority to practice dentistry, podiatry,
optometry, chiropractic, medicine or surgery, nor does it
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prohibit--
(1) Home care of the sick by friends, domestic servants,
nursemaids, companions, or household aides of any type, so long
as such persons do not represent or hold themselves out to be
licensed nurses, licensed registered nurses, or registered
nurses; or use in connection with their names, any designation
tending to imply that they are licensed to practice under the
provisions of this act nor services rendered by any physicians,
osteopaths, dentists or chiropractors, podiatrists,
optometrists, or any person licensed pursuant to the act of
March 2, 1956 (P.L.1211, No.376), known as the "Practical Nurse
Law."
(2) Care of the sick, with or without compensation or
personal profit, when done solely in connection with the
practice of the religious tenets of any church by adherents
thereof.
(3) The practice of professional nursing or the practice of
advanced practice registered nursing by a person temporarily in
this Commonwealth licensed by another state, territory or
possession of the United States or a foreign country, in
compliance with an engagement made outside of this Commonwealth,
which engagement requires that such person accompany and care
for a patient while temporarily in this Commonwealth: Provided,
however, That said engagement shall not be of more than six (6)
months' duration.
(4) The practice of professional nursing or the practice of
advanced practice registered nursing, pursuant to a temporary
practice permit, by a graduate of an approved program of
professional nursing in Pennsylvania or any other state, working
under qualified supervision, during the period not to exceed one
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(1) year between completion of his or her program and
notification of the results of a licensing examination taken by
such person, and during such additional period as the Board may
in each case especially permit.
(5) The practice of professional nursing or the practice of
advanced practice registered nursing, pursuant to a temporary
practice permit, by a person who holds a current license or
other evidence of the right to practice professional nursing[,
as that term is defined in this act,] or to practice of advanced
practice registered nursing issued by any other state, territory
or possession of the United States or the Dominion of Canada,
during the period that an application filed by such person for
licensure in Pennsylvania is pending before the Board, but not
for a period of more than one (1) year and during such
additional period as the Board may in each case especially
permit.
(6) The practice of professional nursing[, within the
definition of this act] or the practice of advanced practice
registered nursing, by any person when such person is engaged in
the practice [of nursing] as an employee of the United States.
Section 4.1. Temporary Practice Permit.--(a) In order for a
person to practice professional nursing or to practice advanced
practice registered 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
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permit, except that the temporary practice permit shall expire
if such person fails the licensing examination.
(b) Within ninety (90) days of the date a temporary practice
permit to practice as an advanced practice registered nurse-
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
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 the individual qualifies for
the exception from the collaboration requirement according to
the Board under section 8.1(l).
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 an advanced practice
registered nurse-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 8. Persons Entitled to Practice.--(a) The Board
shall issue to each person who meets the professional nursing
licensure requirements of this act, a certificate setting forth
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that such person is licensed to engage in the practice of
professional nursing and entitled to use the title "registered
nurse" and the letters "R.N."
(b) The Board shall issue to each person who meets the
dietitian-nutritionist licensure requirements of this act a
certificate setting forth that such person is licensed as a
dietitian-nutritionist and entitled to use the title "licensed
dietitian-nutritionist" and the letters "L.D.N." A record of
[all persons] each person licensed as [dietitian-nutritionists]
a dietitian-nutritionist in this Commonwealth shall be kept in
the office of the Board and shall be open to public inspection
and copying upon payment of a nominal fee for copying the
record.
(c) The Board shall issue to each person who meets the
a dvanced practice registered nurse-certified nurse practitioner
licensure requirements of this act a certificate setting forth
that such person is licensed as an a dvanced practice registered
nurse-certified nurse practitioner and entitled to use the title
"a dvanced practice registered nurse-certified nurse
practitioner " and the letters "APRN-CNP." A record of each
person licensed as an a dvanced practice registered nurse-
certified nurse practitioner in this Commonwealth shall be kept
in the office of the Board and shall be open to public
inspection and copying upon payment of a nominal fee for copying
the record.
Section 8.1. [Certified Registered Nurse Practitioners;
Qualifications.--(a) The board may certify a licensed
registered nurse as a certified registered nurse practitioner in
a particular clinical specialty area if the nurse satisfies the
requirements established by this act and regulations promulgated
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by the board. Certification of a nurse by the board shall expire
on the same date as the license of that nurse expires.
(b) (1) Beginning on the effective date of this section, a
nurse shall not qualify for initial certification by the board
under subsection (a) unless the nurse:
(i) is a graduate of an accredited, board-approved master's
or post-master's nurse practitioner program; and
(ii) holds certification as a certified registered nurse
practitioner from a board-recognized national certification
organization which required passing of a national certifying
examination in the particular clinical specialty area in which
the nurse is seeking certification by the board.
(2) This subsection shall not apply to a nurse who:
(i) holds certification from the board as a certified
registered nurse practitioner on the effective date of this
subsection; or
(ii) would otherwise qualify for certification as a
certified registered nurse practitioner under section 7(b).
(3) In order to provide a transition period for persons who
completed or were enrolled in an approved educational program on
the effective date of this section and to permit those persons
to apply for certification under the rules in existence
immediately prior to the effective date of this section, the
board shall issue initial certification to any person who,
within two (2) years of the effective date of this section:
(i) submits evidence of having completed or been enrolled in
an approved educational program on the effective date of this
section; and
(ii) fulfills all administrative requirements of the board
and possesses all of the other qualifications for certification
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in effect immediately prior to the effective date of this
section.
(c) As a condition for biennial renewal of certification by
the board, a certified registered nurse practitioner must, in
the two (2) years prior to renewal, complete at least thirty
(30) hours of continuing education approved by the board. In the
case of a certified registered 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.]
Advanced Practice Registered Nurse-Certified Nurse
Practitioner.-- (d) A registered nurse who holds current
certification by the board on the effective date of this
subsection as a certified registered nurse practitioner in a
population focus area on the effective date of this subsection
shall automatically be deemed to be licensed by the board as an
advanced practice registered nurse-certified nurse practitioner
in the population focus area for which the registered nurse is
otherwise qualified. The board shall issue appropriate written
notice of the license as an advanced practice registered nurse-
certified nurse practitioner, except that the issuance of that
notice shall not be a condition precedent to practice in
accordance with the license.
(e) Except as provided in subsection (d), an individual
shall not qualify for an initial license as an advanced practice
registered nurse-certified nurse practitioner on or after the
effective date of this subsection unless the person meets the
following criteria:
(1) Holds a current license in this Commonwealth as a
registered nurse.
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(2) Is a graduate of an accredited, board-approved master's
or post-master's nurse practitioner or doctorate in nursing
program.
(3) Holds current certification as an advanced practice
registered nurse-certified nurse practitioner from a board-
recognized national certification program which required passing
a national certifying examination in a population focus area or
population focus area in which the nurse is seeking licensure by
the board.
(f) (1) An initial license under subsection (d) as an
advanced practice registered nurse-certified nurse practitioner
shall expire on the same date as the nurse's then current
license as a registered nurse is scheduled to expire. The
license as an advanced practice registered nurse-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 under subsection (d) or section 7(b)
as an advanced practice registered nurse-certified nurse
practitioner shall expire on the same date as the nurse's then
current license as a registered nurse is scheduled to expire.
The license as an advanced practice registered nurse-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 an advanced practice registered nurse-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 population
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focus area in which the nurse is licensed as an advanced
practice registered nurse-certified nurse practitioner by the
board.
(iii) In the two (2) years prior to renewal, complete at
least thirty (30) hours of continuing education approved by the
board. For an advanced practice registered nurse-certified nurse
practitioner who is prescribing medical therapeutic or
corrective measures under section 8.3, the continuing education
must include at least sixteen (16) hours in pharmacology in the
two-year period.
(g) The board shall establish a procedure by which a license
as an advanced practice registered nurse-certified nurse
practitioner may be amended prior to the biennial renewal date
in order to authorize a nurse to practice in a population focus
area in which the nurse was not certified on the effective date
of this subsection or on the date on which the nurse's current
license as an advanced practice registered nurse-certified nurse
practitioner was issued or renewed. The board shall authorize an
advanced practice registered nurse-certified nurse practitioner
to practice in an additional population focus area only if the
nurse holds current certification from a board-recognized
national certification program which requires the passing of a
national certifying examination in the additional population
focus area.
(h) (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 under this section or section 7(b).
(2) A registered nurse who is licensed by the board as an
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advanced practice registered nurse-certified nurse practitioner
in a population focus area is entitled to use the title
"advanced practice registered nurse-certified nurse
practitioner" and the letters "APRN-CNP." It shall be unlawful
for any other person to use the title "advanced practice
registered nurse-certified nurse practitioner" or the letters
"APRN-CNP."
(i) (1) An advanced practice registered nurse-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 advanced practice registered nurse-certified nurse
practitioner s with doctors of medicine or doctors of osteopathic
medicine, respectively, found in 15 Pa.C.S. § 2903(d)(1)(ii)
(relating to formation of professional corporations).
(j) An advanced practice registered nurse-certified nurse
practitioner who has 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 shall not be subject to the
requirements under sections 8.2(b) and 8.3(a)(2)(i).
(k) An advanced practice registered nurse-certified nurse
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practitioner who qualifies for the exception under subsection
(j) 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. The form
shall be developed by the board by regulation.
(l) 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 an advanced practice
registered nurse-certified nurse practitioner issued by the
board or a temporary practice permit to practice as an advanced
practice registered nurse-certified nurse practitioner under
section 4.1 may qualify for the exception under subsection (j)
if the advanced practice registered nurse-certified nurse
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 of subsection (j) which occurred in this
Commonwealth or in one or more other states, territories or
possessions of the United States or foreign countries where the
advanced practice registered nurse-certified nurse practitioner
was previously, or is currently, licensed.
(m) The advanced practice registered nurse practitioner is
accountable to patients, the nursing profession and the board
and shall:
(1) comply with the requirements of this chapter and the
quality expectations of advanced nursing care rendered;
(2) recognize limits of knowledge and experience;
(3) plan for the management of situations beyond the
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advanced practice registered nurse-certified nurse
practitioner's expertise; and
(4) consult with or refer patients to other health care
providers, as appropriate.
Section 8.2. Scope of Practice for [Certified Registered
Nurse Practitioners] A dvanced Practice Registered Nurse-
Certified Nurse Practitioners.--(a) [A certified registered
nurse practitioner while functioning in the expanded role as a
professional nurse] An advanced practice registered nurse-
certified nurse practitioner shall practice within the scope of
practice of the [particular clinical specialty] population focus
area in which the nurse is [certified] licensed by the board.
Notwithstanding any other provision of law, an advanced practice
registered nurse-certified nurse practitioner who meets the
requirements under section 8.1(j) or (l) is entitled to all of
the following:
(1) To practice as a licensed independent practitioner
within the scope of practice of a particular population focus
area 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 certified registered] Except as provided under
section 8.1(j) or (l), an advanced practice registered nurse-
certified 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 certified
registered nurse] an advanced practice registered nurse-
certified nurse practitioner may prescribe medical therapeutic
or corrective measures if the nurse is acting in accordance with
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the provisions of section 8.3.
(c.1) [Except as limited by subsection (c.2), and in] Except
as provided for under section 8.1(j) or (l), in addition to
existing authority, [a certified registered nurse] an advanced
practice registered nurse-certified nurse practitioner shall
have authority to do all of the following, provided that the
[certified nurse practitioner] advanced practice registered
nurse-certified nurse practitioner is acting within the scope of
the [certified registered nurse] advanced practice registered
nurse-certified nurse practitioner's collaborative or written
agreement with a physician and the [certified registered nurse]
advanced practice registered nurse-certified nurse
practitioner's [specialty certification] population focus area:
(1) Order home health and hospice care.
(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
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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," 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 advanced practice
registered nurse-certified nurse practitioners when practicing
as licensed independent practitioners.
(d) Nothing in this section shall be construed to limit or
prohibit [a certified registered] an advanced practice
registered nurse-certified nurse practitioner from engaging in
those activities which normally constitute the practice of
professional nursing as defined in section 2.
Section 8.3. Prescriptive Authority for [Certified
Registered] A d vanced Practice Registered Nurse-Certified Nurse
Practitioners.--(a) [A certified registered] An advanced
practice registered nurse-certified 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
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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) is an advanced practice registered nurse-certified
nurse practitioner that qualifies for the exception from
section 8.1(j) or (l) and is practicing within a population
focus area in which the nurse is certified by a board-recognized
national certification program; and
(3) is acting in accordance with regulations promulgated by
the board.
(b) [A certified registered] An advanced practice registered
nurse-certified nurse practitioner who satisfies the
requirements of subsection (a) may 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 nonproprietary 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:
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(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
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).
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Section 8.7. Professional Liability.--[A certified
registered] (a) An advanced practice registered nurse-certified
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) An advanced practice registered nurse-certified nurse
practitioner who qualifies for the exception under section
8.1(j) or (l) and operates without collaboration shall satisfy
the liability coverage requirement under subsection (a) by
maintaining an individual policy in the advanced practice
registered nurse-certified nurse practitioner ' s own name.
Section 11.1. Reporting of Multiple Licensure.--Any licensed
professional nurse or dietitian-nutritionist of this
Commonwealth who is also licensed to practice nursing, advanced
practice registered nursing or dietetics-nutrition in any other
state, territory, possession or country shall report this
information to the Board on the biennial registration
application. Any disciplinary action taken in other states shall
be reported to the Board on the biennial registration
application or within ninety (90) days of final disposition,
whichever is sooner. Multiple licensure shall be noted by the
Board on the licensee's record, and such state, territory,
possession or country shall be notified by the Board of any
disciplinary actions taken against said licensee in this
Commonwealth.
Section 12.1. Continuing Nursing Education.--* * *
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(g) In lieu of meeting the requirements of this section:
(1) [Certified registered] Advanced practice registered
nurse-certified nurse practitioners and dietetics-nutrition
licensees shall fulfill the requirements for continuing
education in accordance with sections 8.1 and 11,
respectively.
* * *
Section 13. Punishment for Violations.--* * *
(b) In addition to any other civil remedy or criminal
penalty provided for in this act, the Board, by a vote of the
majority of the maximum number of the authorized membership of
the Board as provided by law or by a vote of the majority of the
duly qualified and confirmed membership or a minimum of five (5)
members, whichever is greater, may levy a civil penalty of up to
one thousand dollars ($1,000) on any current licensee who
violates any provision of this act or on any person who
practices nursing, practices advanced practice registered
nursing or holds himself or herself forth as a licensed
dietitian-nutritionist without being properly licensed to do so
under this act or on the responsible officers or employes of any
corporation, copartnership, institution or association violating
any of the provisions of this act. The Board shall levy this
penalty only after affording the accused party the opportunity
for a hearing, as provided in Title 2 of the Pennsylvania
Consolidated Statutes (relating to administrative law and
procedure).
Section 14. Refusal, Suspension or Revocation of Licenses.--
(a) The Board may refuse, suspend or revoke any license in any
case where the Board shall find that--
(1) The licensee is on repeated occasions negligent or
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incompetent in the practice of professional nursing, advanced
practice registered nursing or dietetics-nutrition.
(2) The licensee is unable to practice professional nursing
or the practice of advanced practice registered nursing with
reasonable skill and safety to patients by reason of mental or
physical illness or condition or physiological or psychological
dependence upon alcohol, hallucinogenic or narcotic drugs or
other drugs which tend to impair judgment or coordination, so
long as such dependence shall continue. In enforcing this clause
(2), the Board shall, upon probable cause, have authority to
compel a licensee to submit to a mental or physical examination
as designated by it. After notice, hearing, adjudication and
appeal as provided for in section 15, failure of a licensee to
submit to such examination when directed shall constitute an
admission of the allegations against him or her unless failure
is due to circumstances beyond his or her control, consequent
upon which a default and final order may be entered without the
taking of testimony or presentation of evidence. A licensee
affected under this paragraph shall at reasonable intervals be
afforded an opportunity to demonstrate that he or she can resume
a competent practice of professional nursing or the practice of
advanced practice registered nursing with reasonable skill and
safety to patients.
* * *
(4) The licensee has committed fraud or deceit in:
(i) the practice of nursing, the practice of advanced
practice registered nursing or in securing his or her admission
to such practice or nursing school; or
(ii) the practice of dietetics-nutrition or in securing his
or her license as a dietitian-nutritionist.
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* * *
(b) When the Board finds that the license of any nurse or
dietitian-nutritionist may be refused, revoked or suspended
under the terms of subsection (a), the Board may:
* * *
(6) Restore or reissue, in its discretion, a suspended
license to practice professional or practical nursing, advanced
practice registered nursing or dietetics-nutrition and impose
any disciplinary or corrective measure which it might originally
have imposed.
Section 15.2. Reinstatement of License.--Unless ordered to
do so by Commonwealth Court or an appeal therefrom, the Board
shall not reinstate the license of a person to practice nursing,
advanced practice registered nursing or dietetics-nutrition
which has been revoked. Any person whose license has been
revoked may reapply for a license, after a period of at least
five (5) years, but must meet all of the licensing
qualifications of this act for the license applied for, to
include the examination requirement, if he or she desires to
practice at any time after such revocation.
Section 15.4. Injunction or Other Process.--It shall be
unlawful for any person to practice or attempt to offer to
practice nursing, practice advanced practice registered nursing
or hold himself or herself forth as a licensed dietitian-
nutritionist[, as defined in this act,] or an a dvanced practice
registered nurse-certified nurse practitioner without having at
the time of so doing a valid, unexpired, unrevoked and
unsuspended license issued under this act. The unlawful practice
of nursing [as defined in this act] or the unlawful practice of
advanced practice registered nursing may be enjoined by the
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courts on petition of the Board or the Commissioner of
Professional and Occupational Affairs. In any such proceeding,
it shall not be necessary to show that any person is
individually injured by the actions complained of. If it is
determined that the respondent has engaged in the unlawful
practice of nursing or the unlawful practice of advanced
practice registered nursing, the court shall enjoin him or her
from so practicing unless and until he or she has been duly
licensed. Procedure in such cases shall be the same as in any
other injunction suit. The remedy by injunction hereby given is
in addition to any other civil or criminal prosecution and
punishment.
Section 4. The authority of the State Board of Nursing to
certify a licensed registered nurse as an advanced practice
registered nurse-certified nurse practitioner shall expire on
the effective date of this section.
Section 5. Within 90 days after the effective date of this
section, the State Board of Nursing, the Department of Health,
the Department of Human Services and other affected agencies
shall initiate the promulgation of regulations necessary to
carry out the provisions of this act. The promulgation of the
regulations shall not be a condition precedent to the
applicability of this act.
Section 6. This act shall take effect in 60 days.
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