PRINTER'S NO. 2494 THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL No. 1825 Session of 2024 INTRODUCED BY GUENST, CABELL, KHAN, MADDEN, NEILSON, HILL-EVANS, HOHENSTEIN, DELLOSO, D. WILLIAMS, DONAHUE, LAWRENCE, WAXMAN, ISAACSON, CONKLIN, KAZEEM, DALEY, CIRESI, BERNSTINE, SMITH- WADE-EL, GIRAL, BELLMON, HANBIDGE, CEPEDA-FREYTIZ, BRENNAN, STRUZZI, MUSTELLO, O'MARA, HOWARD, BOROWSKI, WEBSTER, PROBST, SHUSTERMAN, TOPPER, KINSEY, CERRATO, TOMLINSON, MALAGARI, RIGBY, JAMES AND TWARDZIK, JANUARY 31, 2024 REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, JANUARY 31, 2024 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: 1 Section 1. The title of the act of May 22, 1951 (P.L.317, 2 No.69), known as The Professional Nursing Law, is amended to 3 read: 4 AN ACT 5 Relating to the practice of professional nursing and the 6 practice of advanced practice registered nursing; providing 7 for the licensing of nurses and for the revocation and 8 suspension of such licenses, subject to appeal, and for their 9 reinstatement; providing for the renewal of such licenses; 10 regulating nursing in general; prescribing penalties and 11 repealing certain laws. 12 Section 2. Section 2(1), (10), (12), (13) and (14) of the 13 act are amended and the section is amended by adding paragraphs 14 to read: 15 Section 2. Definitions.--When used in this act, the 16 following words and phrases shall have the following meanings 17 unless the context provides otherwise: 18 (1) The "Practice of Professional Nursing" means diagnosing 19 and treating human responses to actual or potential health 20 problems through such services as casefinding, health teaching, 21 health counseling, and provision of care supportive to or 22 restorative of life and well-being, and executing medical 23 regimens as prescribed by a licensed physician or dentist. The 24 foregoing shall not be deemed to include acts of medical 25 diagnosis or prescription of medical therapeutic or corrective 26 measures, except as performed by [a certified registered nurse 27 practitioner] an APRN-CNP acting in accordance with rules and 28 regulations promulgated by the Board. 29 * * * 30 (10) "Medical nutrition therapy" means the component of 20240HB1825PN2494 - 2 - 1 nutrition therapy that concerns determining and recommending 2 nutrient needs based on nutritional assessment and medical 3 problems relative to diets prescribed by a licensed physician or 4 an APRN-CNP, 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 APRN-CNP who has less than 16 three (3) years and three thousand six hundred (3,600) hours of 17 practice works with one or more physicians to deliver health 18 care services within the scope of [the certified registered 19 nurse practitioner's] an APRN-CNP's expertise. The process 20 includes all of the following: 21 (i) Immediate availability of a licensed physician to [a 22 certified registered nurse practitioner] an APRN-CNP through 23 direct communications or by radio, telephone or 24 telecommunications. 25 (ii) A predetermined plan for emergency services. 26 (iii) A physician available to [a certified registered nurse 27 practitioner] an APRN-CNP on a regularly scheduled basis for 28 referrals, review of the standards of medical practice 29 incorporating consultation and chart review, drug and other 30 medical protocols within the practice setting, periodic updating 20240HB1825PN2494 - 3 - 1 in medical diagnosis and therapeutics and cosigning records when 2 necessary to document accountability by both parties. 3 [(14) "Drug Review Committee" means the committee 4 established in section 8.4 whose function is to approve or 5 disapprove, by addition or deletion, the categories of drugs 6 that may be prescribed by certified registered nurse 7 practitioners.] 8 * * * 9 (18) "Advanced practice registered nurse-certified nurse 10 practitioner" means a registered nurse licensed in this 11 Commonwealth to practice independently in a population focus 12 area in which the registered nurse is certified by a Board- 13 recognized national certification program. 14 (19) "APRN-CNP" means an advanced practice registered nurse- 15 certified nurse practitioner. 16 (20) "Population focus area" means a category of patients 17 for which an APRN-CNP has the educational preparation to provide 18 care and 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 (21) "Controlled substance" means a drug designated as a 26 controlled substance under the act of April 14, 1972 (P.L.233, 27 No.64), known as "The Controlled Substance, Drug, Device and 28 Cosmetic Act." 29 (22) "Nonproprietary drug" means a drug containing a 30 quantity of a controlled substance or a drug which is required 20240HB1825PN2494 - 4 - 1 by an applicable Federal or State law to be dispensed only by 2 prescription. 3 (23) "Proprietary drug" means a nonprescription, non- 4 narcotic medicine or drug which may be sold without a 5 prescription and which is prepackaged for use by the consumer 6 and labeled in accordance with the requirements of the statutes 7 and regulations of the Federal Government and the Commonwealth. 8 (24) "Licensed independent practitioner" means an APRN-CNP 9 licensed to provide care and services within the scope of the 10 practitioner's license. 11 (25) "Practice of Advanced Practice Registered Nursing" 12 means the practice of an APRN-CNP to assess, diagnose, treat, 13 prescribe and order, within a population focus approved by the 14 Board of nursing that includes the APRN-CNP's scope of practice. 15 The term shall include, but not be limited to, performing acts 16 of medical diagnosis or prescription of medical therapeutic or 17 corrective measures. 18 Section 3. Sections 2.1(k) and (l), 3.1(b), 4, 4.1, 7(b), 8, 19 8.1, 8.2, 8.3, 8.4, 8.7, 11.1, 12.1(g)(1), 13(b), 14(a)(1), (2) 20 and (4) and (b)(6), 15.2 and 15.4 of the act are amended to 21 read: 22 Section 2.1. State Board of Nursing.--* * * 23 (k) The Board shall have the right and duty to establish 24 rules and regulations for the practice of professional nursing, 25 the practice of advanced practice registered nursing, the 26 practice of dietetics-nutrition and the administration of this 27 act. Copies of such rules and regulations shall be available for 28 distribution to the public. 29 (l) Any powers and duties imposed on the State Board of 30 Medicine or jointly imposed on the State Board of Medicine and 20240HB1825PN2494 - 5 - 1 the State Board of Nursing, with respect to [certified 2 registered nurse practitioners] APRN-CNPs, by or pursuant to law 3 or regulation shall, after the effective date of this 4 subsection, be exercised solely by the State Board of Nursing. 5 This subsection shall not apply to 49 Pa. Code ยงยง 21.283(4) 6 (relating to prescribing and dispensing drugs) and 21.321 7 (relating to performance of tasks without direction; performance 8 of tasks without training; other) unless the State Board of 9 Nursing promulgates a regulation to exercise the duties imposed 10 on the State Board of Medicine by those sections. 11 Section 3.1. Dietitian-Nutritionist License Required.--* * * 12 (b) Nothing in this section shall be construed to require or 13 preclude third-party insurance reimbursement. Nothing herein 14 shall preclude an insurer or other third-party payor from 15 requiring that a licensed dietitian-nutritionist obtain a 16 referral from a licensed physician, an APRN-CNP, a dentist or 17 podiatrist or that a licensed dietitian-nutritionist file an 18 evaluation and treatment plan with the insurer or third-party 19 payor as a precondition of reimbursement. 20 Section 4. Unauthorized Practices; Acts not Prohibited.-- 21 This act confers no authority to practice dentistry, podiatry, 22 optometry, chiropractic, medicine or surgery, nor does it 23 prohibit-- 24 (1) Home care of the sick by friends, domestic servants, 25 nursemaids, companions, or household aides of any type, so long 26 as such persons do not represent or hold themselves out to be 27 licensed nurses, licensed registered nurses, or registered 28 nurses; or use in connection with their names, any designation 29 tending to imply that they are licensed to practice under the 30 provisions of this act nor services rendered by any physicians, 20240HB1825PN2494 - 6 - 1 osteopaths, dentists or chiropractors, podiatrists, 2 optometrists, or any person licensed pursuant to the act of 3 March 2, 1956 (P.L.1211, No.376), known as the "Practical Nurse 4 Law." 5 (2) Care of the sick, with or without compensation or 6 personal profit, when done solely in connection with the 7 practice of the religious tenets of any church by adherents 8 thereof. 9 (3) The practice of professional nursing or the practice of 10 advanced practice registered nursing by a person temporarily in 11 this Commonwealth licensed by another state, territory or 12 possession of the United States or a foreign country, in 13 compliance with an engagement made outside of this Commonwealth, 14 which engagement requires that such person accompany and care 15 for a patient while temporarily in this Commonwealth: Provided, 16 however, That said engagement shall not be of more than six (6) 17 months' duration. 18 (4) The practice of professional nursing or the practice of 19 advanced practice registered nursing, pursuant to a temporary 20 practice permit, by a graduate of an approved program of 21 professional nursing in Pennsylvania or any other state, working 22 under qualified supervision, during the period not to exceed one 23 (1) year between completion of his or her program and 24 notification of the results of a licensing examination taken by 25 such person, and during such additional period as the Board may 26 in each case especially permit. 27 (5) The practice of professional nursing or the practice of 28 advanced practice registered nursing, pursuant to a temporary 29 practice permit, by a person who holds a current license or 30 other evidence of the right to practice professional nursing, as 20240HB1825PN2494 - 7 - 1 that term is defined in this act, issued by any other state, 2 territory or possession of the United States or the Dominion of 3 Canada, during the period that an application filed by such 4 person for licensure in Pennsylvania is pending before the 5 Board, but not for a period of more than one (1) year and during 6 such additional period as the Board may in each case especially 7 permit. 8 (6) The practice of professional nursing[, within the 9 definition of this act,] or the practice of advanced practice 10 registered nursing by any person when such person is engaged in 11 the practice [of nursing] as an employee of the United States. 12 Section 4.1. Temporary Practice Permit.--(a) In order for a 13 person to practice professional nursing or to practice advanced 14 practice registered nursing during the one (1) year period from 15 completion of his or her education program or the one (1) year 16 period from the application for licensure by a person who holds 17 a current license issued by any other state, territory or 18 possession of the United States or the Dominion of Canada, the 19 Board may issue a temporary practice permit which is 20 nonrenewable and valid for a period of one (1) year and during 21 such additional period as the Board may in each case especially 22 permit, except that the temporary practice permit shall expire 23 if such person fails the licensing examination. 24 (b) Within ninety (90) days of the date a temporary practice 25 permit to practice as an APRN-CNP is issued by the Board to an 26 individual who was licensed or certified by another state, 27 territory or possession of the United States or a foreign 28 country, the individual shall comply with the requirements under 29 sections 8.2 and 8.3 with regard to acting in collaboration with 30 a physician and in accordance with a collaborative or written 20240HB1825PN2494 - 8 - 1 agreement with a physician, unless the individual qualifies for 2 the exception from the collaboration requirement according to 3 the Board under section 8.1(l). 4 Section 7. Graduates of Schools of Other States, Territories 5 or Dominion of Canada.--* * * 6 (b) The Board may issue a [certification to registered nurse 7 practitioners who have] license as an APRN-CNP to a registered 8 nurse who has completed a course of study considered by the 9 Board to be equivalent to that required in this State at the 10 time such course was completed or who is licensed or certified 11 by another state, territory or possession of the United States 12 or a foreign country as deemed equivalent to Pennsylvania's 13 [certification] licensure requirements in accordance with the 14 [joint] rules and regulations of the [Boards of Nursing and 15 Medicine] Board. 16 * * * 17 Section 8. Persons Entitled to Practice.--(a) The Board 18 shall issue to each person who meets the professional nursing 19 licensure requirements of this act, a certificate setting forth 20 that such person is licensed to engage in the practice of 21 professional nursing and entitled to use the title "registered 22 nurse" and the letters "R.N." 23 (b) The Board shall issue to each person who meets the 24 dietitian-nutritionist licensure requirements of this act a 25 certificate setting forth that such person is licensed as a 26 dietitian-nutritionist and entitled to use the title "licensed 27 dietitian-nutritionist" and the letters "L.D.N." A record of 28 [all persons] each person licensed as [dietitian-nutritionists] 29 a dietitian-nutritionist in this Commonwealth shall be kept in 30 the office of the Board and shall be open to public inspection 20240HB1825PN2494 - 9 - 1 and copying upon payment of a nominal fee for copying the 2 record. 3 (c) The Board shall issue to each person who meets the APRN- 4 CNP licensure requirements of this act a certificate stating 5 that such person is licensed as an APRN-CNP and entitled to use 6 the title "advanced practice registered nurse-certified nurse 7 practitioner" and the letters "APRN-CNP." A record of each 8 person licensed as an APRN-CNP in this Commonwealth shall be 9 kept in the office of the Board and posted on the Board's 10 publicly accessible Internet website. 11 Section 8.1. Certified Registered Nurse Practitioners; 12 Qualifications.--[(a) The board may certify a licensed 13 registered nurse as a certified registered nurse practitioner in 14 a particular clinical specialty area if the nurse satisfies the 15 requirements established by this act and regulations promulgated 16 by the board. Certification of a nurse by the board shall expire