1 STATE OF OKLAHOMA
1
2 2nd Session of the 59th Legislature (2024)
2
3 SENATE BILL 1419 By: Rosino
3
4
4
5
5
6 AS INTRODUCED
6
7 An Act relating to Advanced Unlicensed Assistants;
7 defining term; directing the Oklahoma Health Care
8 Authority to establish certain program subject to
8 certain conditions; stating qualification criteria;
9 limiting skilled tasks performed by certain Advanced
9 Unlicensed Assistants; requiring Registered Nurse or
10 Licensed Practical Nurse to conduct certain home
10 visits; directing certain reimbursement of Advanced
11 Unlicensed Assistant services; requiring certain
11 agencies to coordinate for implementation; directing
12 promulgation of rules; requiring application for
12 certain federal approval; amending 59 O.S. 2021,
13 Section 567.3a, which relates to definitions used in
13 the Oklahoma Nursing Practice Act; broadening certain
14 definition; amending 59 O.S. 2021, Section 567.6a,
14 which relates to Advanced Unlicensed Assistants;
15 requiring the Oklahoma Board of Nursing to count
15 certain training toward completion of prescribed
16 curricula; providing for codification; providing an
16 effective date; and declaring an emergency.
17
17
18
18
19 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
19
20 SECTION 1. NEW LAW A new section of law to be codified
20
21 in the Oklahoma Statutes as Section 5013.2 of Title 63, unless there
21
22 is created a duplication in numbering, reads as follows:
22
23 A. As used in this section, “family member” means a child,
23
24 parent, parent-in-law, sibling, grandparent, grandchild, spouse, or
24
Req. No. 2723 Page 1
 1 any other individual related by blood, and any other individual with
1
2 a close association that is the equivalent of a family relationship.
2
3 B. No later than one year after the effective date of this act
3
4 and subject to receipt of federal approval for the program, the
4
5 Oklahoma Health Care Authority shall establish a program under which
5
6 a family member of a Medicaid enrollee may be certified as an
6
7 Advanced Unlicensed Assistant by the Oklahoma Board of Nursing and,
7
8 after receiving such certification may, under the direction and
8
9 supervision of a Registered Nurse or Licensed Practical Nurse,
9
10 provide Advanced Unlicensed Assistant services to the enrollee
10
11 through a licensed home care agency under the reimbursement rates
11
12 established under subsection E of this section, provided that the
12
13 enrollee qualifies for such services under the state Medicaid
13
14 program.
14
15 C. The program established under this section shall require the
15
16 family member to complete all the training, testing, and other
16
17 qualification criteria required under state and federal law for
17
18 certification as an Advanced Unlicensed Assistant in a home setting
18
19 including, but not limited to, qualification criteria established
19
20 under the Oklahoma Nursing Practice Act.
20
21 D. 1. The skilled tasks performed by an Advanced Unlicensed
21
22 Assistant in a home setting under this section shall be subject to
22
23 the scope of practice established by the Oklahoma Board of Nursing
23
24 for Advanced Unlicensed Assistants in a home setting.
24
Req. No. 2723 Page 2
 1 2. A Registered Nurse or Licensed Practical Nurse shall conduct
1
2 all home visits required by the Oklahoma Health Care Authority at
2
3 the enrollee’s home.
3
4 E. Advanced Unlicensed Assistant services provided by a family
4
5 member of a Medicaid enrollee who becomes certified as an Advanced
5
6 Unlicensed Assistant under the program established under this
6
7 section shall be reimbursed to a home care agency at a rate
7
8 established by the Oklahoma Health Care Authority.
8
9 F. 1. The Authority and the Oklahoma Board of Nursing shall
9
10 coordinate and share information as necessary to implement this
10
11 section.
11
12 2. The Oklahoma Health Care Authority Board and the Oklahoma
12
13 Board of Nursing shall promulgate rules as necessary to implement
13
14 this section.
14
15 3. The Administrator of the Authority shall apply for such
15
16 state plan amendments or waivers as may be necessary to implement
16
17 this section and secure federal financial participation for state
17
18 Medicaid expenditures under the federal Medicaid program.
18
19 SECTION 2. AMENDATORY 59 O.S. 2021, Section 567.3a, is
19
20 amended to read as follows:
20
21 Section 567.3a. As used in the Oklahoma Nursing Practice Act:
21
22 1. “Board” means the Oklahoma Board of Nursing;
22
23 2. “The practice of nursing” means the performance of services
23
24 provided for purposes of nursing diagnosis and treatment of human
24
Req. No. 2723 Page 3
 1 responses to actual or potential health problems consistent with
1
2 educational preparation. Knowledge and skill are the basis for
2
3 assessment, analysis, planning, intervention, and evaluation used in
3
4 the promotion and maintenance of health and nursing management of
4
5 illness, injury, infirmity, restoration or optimal function, or
5
6 death with dignity. Practice is based on understanding the human
6
7 condition across the human lifespan and understanding the
7
8 relationship of the individual within the environment. This
8
9 practice includes execution of the medical regime including the
9
10 administration of medications and treatments prescribed by any
10
11 person authorized by state law to so prescribe;
11
12 3. “Registered nursing” means the practice of the full scope of
12
13 nursing which includes, but is not limited to:
13
14 a. assessing the health status of individuals, families
14
15 and groups,
15
16 b. analyzing assessment data to determine nursing care
16
17 needs,
17
18 c. establishing goals to meet identified health care
18
19 needs,
19
20 d. planning a strategy of care,
20
21 e. establishing priorities of nursing intervention to
21
22 implement the strategy of care,
22
23 f. implementing the strategy of care,
23
24
24
Req. No. 2723 Page 4
 1 g. delegating such tasks as may safely be performed by
1
2 others, consistent with educational preparation and
2
3 that do not conflict with the provisions of the
3
4 Oklahoma Nursing Practice Act,
4
5 h. providing safe and effective nursing care rendered
5
6 directly or indirectly,
6
7 i. evaluating responses to interventions,
7
8 j. teaching the principles and practice of nursing,
8
9 k. managing and supervising the practice of nursing,
9
10 l. collaborating with other health professionals in the
10
11 management of health care,
11
12 m. performing additional nursing functions in accordance
12
13 with knowledge and skills acquired beyond basic
13
14 nursing preparation, and
14
15 n. delegating those nursing tasks as defined in the rules
15
16 of the Board that may be performed by an advanced
16
17 unlicensed assistive person;
17
18 4. “Licensed practical nursing” means the practice of nursing
18
19 under the supervision or direction of a registered nurse, licensed
19
20 physician or dentist. This directed scope of nursing practice
20
21 includes, but is not limited to:
21
22 a. contributing to the assessment of the health status of
22
23 individuals and groups,
23
24
24
Req. No. 2723 Page 5
 1 b. participating in the development and modification of
1
2 the plan of care,
2
3 c. implementing the appropriate aspects of the plan of
3
4 care,
4
5 d. delegating such tasks as may safely be performed by
5
6 others, consistent with educational preparation and
6
7 that do not conflict with the Oklahoma Nursing
7
8 Practice Act,
8
9 e. providing safe and effective nursing care rendered
9
10 directly or indirectly,
10
11 f. participating in the evaluation of responses to
11
12 interventions,
12
13 g. teaching basic nursing skills and related principles,
13
14 h. performing additional nursing procedures in accordance
14
15 with knowledge and skills acquired through education
15
16 beyond nursing preparation, and
16
17 i. delegating those nursing tasks as defined in the rules
17
18 of the Board that may be performed by an advanced
18
19 unlicensed assistive person;
19
20 5. “Advanced Practice Registered Nurse” means a licensed
20
21 Registered Nurse:
21
22 a. who has completed an advanced practice registered
22
23 nursing education program in preparation for one of
23
24
24
Req. No. 2723 Page 6
 1 four recognized advanced practice registered nurse
1
2 roles,
2
3 b. who has passed a national certification examination
3
4 recognized by the Board that measures the advanced
4
5 practice registered nurse role and specialty
5
6 competencies and who maintains recertification in the
6
7 role and specialty through a national certification
7
8 program,
8
9 c. who has acquired advanced clinical knowledge and
9
10 skills in preparation for providing both direct and
10
11 indirect care to patients; however, the defining
11
12 factor for all Advanced Practice Registered Nurses is
12
13 that a significant component of the education and
13
14 practice focuses on direct care of individuals,
14
15 d. whose practice builds on the competencies of
15
16 Registered Nurses by demonstrating a greater depth and
16
17 breadth of knowledge, a greater synthesis of data, and
17
18 increased complexity of skills and interventions, and
18
19 e. who has obtained a license as an Advanced Practice
19
20 Registered Nurse in one of the following roles:
20
21 Certified Registered Nurse Anesthetist, Certified
21
22 Nurse-Midwife, Clinical Nurse Specialist, or Certified
22
23 Nurse Practitioner.
23
24
24
Req. No. 2723 Page 7
 1 Only those persons who hold a license to practice advanced
1
2 practice registered nursing in this state shall have the right to
2
3 use the title “Advanced Practice Registered Nurse” and to use the
3
4 abbreviation “APRN”. Only those persons who have obtained a license
4
5 in the following disciplines shall have the right to fulfill the
5
6 roles and use the applicable titles: Certified Registered Nurse
6
7 Anesthetist and the abbreviation “CRNA”, Certified Nurse-Midwife and
7
8 the abbreviation “CNM”, Clinical Nurse Specialist and the
8
9 abbreviation “CNS”, and Certified Nurse Practitioner and the
9
10 abbreviation “CNP”.
10
11 It shall be unlawful for any person to assume the role or use
11
12 the title Advanced Practice Registered Nurse or use the abbreviation
12
13 “APRN” or use the respective specialty role titles and abbreviations
13
14 or to use any other titles or abbreviations that would reasonably
14
15 lead a person to believe the user is an Advanced Practice Registered
15
16 Nurse, unless permitted by the Oklahoma Nursing Practice Act. Any
16
17 individual doing so shall be guilty of a misdemeanor, which shall be
17
18 punishable, upon conviction, by imprisonment in the county jail for
18
19 not more than one (1) year or by a fine of not less than One Hundred
19
20 Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00), or
20
21 by both such imprisonment and fine for each offense;
21
22 6. “Certified Nurse Practitioner” is an Advanced Practice
22
23 Registered Nurse who performs in an expanded role in the delivery of
23
24 health care:
24
Req. No. 2723 Page 8
 1 a. consistent with advanced educational preparation as a
1
2 Certified Nurse Practitioner in an area of specialty,
2
3 b. functions within the Certified Nurse Practitioner
3
4 scope of practice for the selected area of
4
5 specialization, and
5
6 c. is in accord with the standards for Certified Nurse
6
7 Practitioners as identified by the certifying body and
7
8 approved by the Board.
8
9 A Certified Nurse Practitioner shall be eligible, in accordance
9
10 with the scope of practice of the Certified Nurse Practitioner, to
10
11 obtain recognition as authorized by the Board to prescribe, as
11
12 defined by the rules promulgated by the Board pursuant to this
12
13 section and subject to the medical direction of a supervising
13
14 physician. This authorization shall not include dispensing drugs,
14
15 but shall not preclude, subject to federal regulations, the receipt
15
16 of, the signing for, or the dispensing of professional samples to
16
17 patients.
17
18 The Certified Nurse Practitioner accepts responsibility,
18
19 accountability, and obligation to practice in accordance with usual
19
20 and customary advanced practice registered nursing standards and
20
21 functions as defined by the scope of practice/role definition
21
22 statements for the Certified Nurse Practitioner;
22
23 7. a. “Clinical Nurse Specialist” is an Advanced Practice
23
24 Registered Nurse who holds:
24
Req. No. 2723 Page 9
 1 (1) a master’s degree or higher in nursing with
1
2 clinical specialization preparation to function
2
3 in an expanded role,
3
4 (2) specialty certification from a national
4
5 certifying organization recognized by the Board,
5
6 (3) an Advanced Practice Registered Nurse license
6
7 from the Board, and
7
8 (4) any nurse holding a specialty certification as a
8
9 Clinical Nurse Specialist valid on January 1,
9
10 1994, granted by a national certifying
10
11 organization recognized by the Board, shall be
11
12 deemed to be a Clinical Nurse Specialist under
12
13 the provisions of the Oklahoma Nursing Practice
13
14 Act.
14
15 b. In the expanded role, the Clinical Nurse Specialist
15
16 performs at an advanced practice level which shall
16
17 include, but not be limited to:
17
18 (1) practicing as an expert clinician in the
18
19 provision of direct nursing care to a selected
19
20 population of patients or clients in any setting,
20
21 including private practice,
21
22 (2) managing the care of patients or clients with
22
23 complex nursing problems,
23
24
24
Req. No. 2723 Page 10
 1 (3) enhancing patient or client care by int