PRINTER'S NO. 219
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 25
Session of
2021
INTRODUCED BY BARTOLOTTA, BOSCOLA, LANGERHOLC, J. WARD, STEFANO,
TARTAGLIONE, YAW, BLAKE, COLLETT, SCHWANK, MENSCH, BAKER,
PITTMAN, ARGALL, DiSANTO, SABATINA, HUTCHINSON, SCAVELLO AND
LAUGHLIN, FEBRUARY 22, 2021
REFERRED TO CONSUMER PROTECTION AND PROFESSIONAL LICENSURE,
FEBRUARY 22, 2021
AN ACT
1 Amending the act of May 22, 1951 (P.L.317, No.69), entitled "An
2 act relating to the practice of professional nursing;
3 providing for the licensing of nurses and for the revocation
4 and suspension of such licenses, subject to appeal, and for
5 their reinstatement; providing for the renewal of such
6 licenses; regulating nursing in general; prescribing
7 penalties and repealing certain laws," further providing for
8 title, for definitions, for State Board of Nursing, for
9 dietitian-nutritionist license required, for unauthorized
10 practices and acts not prohibited, for temporary practice
11 permit, for graduates of schools of other states, territories
12 or Dominion of Canada, for persons entitled to practice, for
13 certified registered nurse practitioners and qualifications,
14 for scope of practice for certified registered nurse
15 practitioners, for prescriptive authority for certified
16 registered nurse practitioners, for Drug Review Committee,
17 for professional liability, for reporting of multiple
18 licensure, for continuing nursing education, for punishment
19 for violations, for refusal, suspension or revocation of
20 licenses, for reinstatement of license and for injunction or
21 other process; and providing for the expiration of the State
22 Board of Nursing's power to license certified registered
23 nurse practitioners.
24 The General Assembly of the Commonwealth of Pennsylvania
25 hereby enacts as follows:
26 Section 1. The title of the act of May 22, 1951 (P.L.317,
27 No.69), known as The Professional Nursing Law, is amended to
 1 read:
2 AN ACT
3 Relating to the practice of professional nursing and the
4 practice of advanced practice registered nursing; providing
5 for the licensing of nurses and for the revocation and
6 suspension of such licenses, subject to appeal, and for their
7 reinstatement; providing for the renewal of such licenses;
8 regulating nursing in general; prescribing penalties and
9 repealing certain laws.
10 Section 2. Section 2(1), (10), (12), (13) and (14) of the
11 act are amended and the section is amended by adding paragraphs
12 to read:
13 Section 2. Definitions.--When used in this act, the
14 following words and phrases shall have the following meanings
15 unless the context provides otherwise:
16 (1) The "Practice of Professional Nursing" means diagnosing
17 and treating human responses to actual or potential health
18 problems through such services as casefinding, health teaching,
19 health counseling, and provision of care supportive to or
20 restorative of life and well-being, and executing medical
21 regimens as prescribed by a licensed physician or dentist. The
22 foregoing shall not be deemed to include acts of medical
23 diagnosis or prescription of medical therapeutic or corrective
24 measures, except as performed by [a certified registered nurse
25 practitioner] an advanced practice registered nurse-certified
26 nurse practitioner acting in accordance with rules and
27 regulations promulgated by the Board.
28 * * *
29 (10) "Medical nutrition therapy" means the component of
30 nutrition therapy that concerns determining and recommending
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 1 nutrient needs based on nutritional assessment and medical
2 problems relative to diets prescribed by a licensed physician or
3 an advanced practice registered nurse-certified nurse
4 practitioner, including:
5 (i) tube feedings;
6 (ii) specialized intravenous solutions;
7 (iii) specialized oral solutions; and
8 (iv) interactions of prescription drugs with food or
9 nutrients.
10 * * *
11 [(12) "Certified registered nurse practitioner" means a
12 registered nurse licensed in this Commonwealth who is certified
13 by the board in a particular clinical specialty area.]
14 (13) "Collaboration" means a process in which [a certified
15 registered nurse practitioner] an advanced practice registered
16 nurse-certified nurse practitioner works with one or more
17 physicians to deliver health care services within the scope of
18 the [certified registered nurse practitioner's] advanced
19 practice registered nurse-certified nurse practitioner's
20 expertise. The process includes all of the following:
21 (i) Immediate availability of a licensed physician to [a
22 certified registered nurse practitioner] an advanced practice
23 registered nurse-certified nurse practitioner through direct
24 communications or by radio, telephone or telecommunications.
25 (ii) A predetermined plan for emergency services.
26 (iii) A physician available to [a certified registered nurse
27 practitioner] an advanced practice registered nurse-certified
28 nurse practitioner on a regularly scheduled basis for referrals,
29 review of the standards of medical practice incorporating
30 consultation and chart review, drug and other medical protocols
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 1 within the practice setting, periodic updating in medical
2 diagnosis and therapeutics and cosigning records when necessary
3 to document accountability by both parties.
4 [(14) "Drug Review Committee" means the committee
5 established in section 8.4 whose function is to approve or
6 disapprove, by addition or deletion, the categories of drugs
7 that may be prescribed by certified registered nurse
8 practitioners.]
9 * * *
10 (16) "Advanced practice registered nurse-certified nurse
11 practitioner" means a registered nurse licensed in this
12 Commonwealth to practice independently in a population focus
13 area in which the registered nurse is certified by a Board-
14 recognized national certification program.
15 (17) "Population focus area" means a category of patients
16 for which an advanced practice registered nurse-certified nurse
17 practitioner has the educational preparation to provide care and
18 services. The categories of population focus include:
19 (i) Family and individuals across the lifespan.
20 (ii) Adult gerontology.
21 (iii) Neonatal.
22 (iv) Pediatrics.
23 (v) Women's health and gender-related health.
24 (vi) Psychiatric and mental health.
25 (vii) Any other similar area designated by the Board.
26 (18) "Controlled substance" means a drug designated as a
27 controlled substance under the act of April 14, 1972 (P.L.233,
28 No.64), known as "The Controlled Substance, Drug, Device and
29 Cosmetic Act."
30 (19) "Nonproprietary drug" means a drug containing a
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 1 quantity of a controlled substance or a drug which is required
2 by an applicable Federal or State law to be dispensed only by
3 prescription.
4 (20) "Proprietary drug" means a nonprescription, non-
5 narcotic medicine or drug which may be sold without a
6 prescription and which is prepackaged for use by the consumer
7 and labeled in accordance with the requirements of the statutes
8 and regulations of the Federal Government and the Commonwealth.
9 (21) "Licensed independent practitioner" means an advanced
10 practice registered nurse-certified nurse practitioner licensed
11 under section 8.1(j) or (l) to provide care and services,
12 without direction or supervision, within the scope of the
13 practitioner's license.
14 (22) "Practice of Advanced Practice Registered Nursing"
15 means the practice of an advanced practice registered nurse-
16 certified nurse practitioner to assess, diagnose, treat,
17 prescribe and order, within a population focus approved by the
18 Board of nursing that includes the advanced practice registered
19 nurse-certified nurse practitioner's scope of practice. The term
20 shall include, but not be limited to, performing acts of medical
21 diagnosis or prescription of medical therapeutic or corrective
22 measures.
23 Section 3. Sections 2.1(k) and (l), 3.1(b), 4, 4.1, 7(b), 8,
24 8.1, 8.2, 8.3, 8.4, 8.7, 11.1, 12.1(g)(1), 13(b), 14(a)(1), (2)
25 and (4) and (b)(6), 15.2 and 15.4 of the act are amended to
26 read:
27 Section 2.1. State Board of Nursing.--* * *
28 (k) The Board shall have the right and duty to establish
29 rules and regulations for the practice of professional nursing,
30 the practice of advanced practice registered nursing, the
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 1 practice of dietetics-nutrition and the administration of this
2 act. Copies of such rules and regulations shall be available for
3 distribution to the public.
4 (l) Any powers and duties imposed on the State Board of
5 Medicine or jointly imposed on the State Board of Medicine and
6 the State Board of Nursing, with respect to [certified
7 registered nurse practitioners] advanced practice registered
8 nurse-certified nurse practitioners, by or pursuant to law or
9 regulation shall, after the effective date of this subsection,
10 be exercised solely by the State Board of Nursing. This
11 subsection shall not apply to 49 Pa. Code §§ 21.283(4) (relating
12 to prescribing and dispensing drugs) and 21.321 (relating to
13 performance of tasks without direction; performance of tasks
14 without training; other) unless the State Board of Nursing
15 promulgates a regulation to exercise the duties imposed on the
16 State Board of Medicine by those sections.
17 Section 3.1. Dietitian-Nutritionist License Required.--* * *
18 (b) Nothing in this section shall be construed to require or
19 preclude third-party insurance reimbursement. Nothing herein
20 shall preclude an insurer or other third-party payor from
21 requiring that a licensed dietitian-nutritionist obtain a
22 referral from a licensed physician, an advanced practice
23 registered nurse-certified nurse practitioner, a dentist or
24 podiatrist or that a licensed dietitian-nutritionist file an
25 evaluation and treatment plan with the insurer or third-party
26 payor as a precondition of reimbursement.
27 Section 4. Unauthorized Practices; Acts not Prohibited.--
28 This act confers no authority to practice dentistry, podiatry,
29 optometry, chiropractic, medicine or surgery, nor does it
30 prohibit--
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 1 (1) Home care of the sick by friends, domestic servants,
2 nursemaids, companions, or household aides of any type, so long
3 as such persons do not represent or hold themselves out to be
4 licensed nurses, licensed registered nurses, or registered
5 nurses; or use in connection with their names, any designation
6 tending to imply that they are licensed to practice under the
7 provisions of this act nor services rendered by any physicians,
8 osteopaths, dentists or chiropractors, podiatrists,
9 optometrists, or any person licensed pursuant to the act of
10 March 2, 1956 (P.L.1211, No.376), known as the "Practical Nurse
11 Law."
12 (2) Care of the sick, with or without compensation or
13 personal profit, when done solely in connection with the
14 practice of the religious tenets of any church by adherents
15 thereof.
16 (3) The practice of professional nursing or the practice of
17 advanced practice registered nursing by a person temporarily in
18 this Commonwealth licensed by another state, territory or
19 possession of the United States or a foreign country, in
20 compliance with an engagement made outside of this Commonwealth,
21 which engagement requires that such person accompany and care
22 for a patient while temporarily in this Commonwealth: Provided,
23 however, That said engagement shall not be of more than six (6)
24 months' duration.
25 (4) The practice of professional nursing or the practice of
26 advanced practice registered nursing, pursuant to a temporary
27 practice permit, by a graduate of an approved program of
28 professional nursing in Pennsylvania or any other state, working
29 under qualified supervision, during the period not to exceed one
30 (1) year between completion of his or her program and
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 1 notification of the results of a licensing examination taken by
2 such person, and during such additional period as the Board may
3 in each case especially permit.
4 (5) The practice of professional nursing or the practice of
5 advanced practice registered nursing, pursuant to a temporary
6 practice permit, by a person who holds a current license or
7 other evidence of the right to practice professional nursing, as
8 that term is defined in this act, issued by any other state,
9 territory or possession of the United States or the Dominion of
10 Canada, during the period that an application filed by such
11 person for licensure in Pennsylvania is pending before the
12 Board, but not for a period of more than one (1) year and during
13 such additional period as the Board may in each case especially
14 permit.
15 (6) The practice of professional nursing[, within the
16 definition of this act] or the practice of advanced practice
17 registered nursing, by any person when such person is engaged in
18 the practice [of nursing] as an employee of the United States.
19 Section 4.1. Temporary Practice Permit.--(a) In order for a
20 person to practice professional nursing or to practice advanced
21 practice registered nursing during the one (1) year period from
22 completion of his or her education program or the one (1) year
23 period from the application for licensure by a person who holds
24 a current license issued by any other state, territory or
25 possession of the United States or the Dominion of Canada, the
26 Board may issue a temporary practice permit which is
27 nonrenewable and valid for a period of one (1) year and during
28 such additional period as the Board may in each case especially
29 permit, except that the temporary practice permit shall expire
30 if such person fails the licensing examination.
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 1 (b) Within ninety (90) days of the date a temporary practice
2 permit to practice as an advanced practice registered nurse-
3 certified nurse practitioner is issued by the Board to an
4 individual who was licensed or certified by another state,
5 territory or possession of the United States or a foreign
6 country, the individual shall comply with the requirements under
7 sections 8.2 and 8.3 with regard to acting in collaboration with
8 a physician and in accordance with a collaborative or written
9 agreement with a physician, unless the individual qualifies for
10 the exception from the collaboration requirement according to
11 the Board under section 8.1(l).
12 Section 7. Graduates of Schools of Other States, Territories
13 or Dominion of Canada.--* * *
14 (b) The Board may issue a [certification to registered nurse
15 practitioners who have] license as an advanced practice
16 registered nurse-certified nurse practitioner to a registered
17 nurse who has completed a course of study considered by the
18 Board to be equivalent to that required in this State at the
19 time such course was completed or who is licensed or certified
20 by another state, territory or possession of the United States
21 or a foreign country as deemed equivalent to Pennsylvania's
22 [certification] licensure requirements in accordance with the
23 [joint] rules and regulations of the [Boards of Nursing and
24 Medicine] Board.
25 * * *
26 Section 8. Persons Entitled to Practice.--(a) The Board
27 shall issue to each person who meets the professional nursing
28 licensure requirements of this act, a certificate setting forth
29 that such person is licensed to engage in the practice of
30 professional nursing and entitled to use the title "registered
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 1 nurse" and the letters "R.N."
2 (b) The Board shall issue to each person who meets the
3 dietitian-nutritionist licensure requirements of this act a
4 certificate setting forth that such person is licensed as a
5 dietitian-nutritionist and entitled to use the title "licensed
6 dietitian-nutritionist" and the letters "L.D.N." A record of
7 [all persons] each person licensed as [dietitian-nutritionists]
8 a dietitian-nutritionist in this Commonwealth shall be kept in
9 the office of the Board and shall be open to public inspection
10 and copying upon payment of a nominal fee for copying the
11 record.
12 (c) The Board shall issue to each person who meets the
13 advanced practice registered nurse-certified nurse practitioner
14 licensure requirements of this act a certificate setting forth
15 that such person is licensed as an advanced practice registered
16 nurse-certified nurse practitioner and entitled to use the title
17 "a