2023 - 2024 LEGISLATURE
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2023 ASSEMBLY BILL 154
April 10, 2023 - Introduced by Representatives MAGNAFICI, ARMSTRONG, BEHNKE,
BODDEN, DITTRICH, DONOVAN, GREEN, GUNDRUM, GUSTAFSON, S. JOHNSON,
KITCHENS, KRUG, KURTZ, MACCO, MURPHY, NOVAK, RODRIGUEZ, SCHMIDT,
SCHRAA, SCHUTT, SORTWELL, STEFFEN, TITTL, TUSLER, WICHGERS and NEDWESKI,
cosponsored by Senators TESTIN, CABRAL-GUEVARA, ROYS, BALLWEG, COWLES,
FELZKOWSKI, JACQUE, MARKLEIN, NASS, QUINN, STROEBEL and TAYLOR. Referred
to Committee on Health, Aging and Long-Term Care.
1 AN ACT to repeal 50.01 (1b), 77.54 (14) (f) 3., 118.2925 (1) (b), 146.89 (1) (r) 8.,
2 252.01 (1c), 440.03 (13) (b) 3., 440.03 (13) (b) 42., 440.08 (2) (a) 4m., 440.08 (2)
3 (a) 50., 441.11 (title), 441.11 (1), 441.11 (3), 441.15, 441.16, 441.19, 448.035 (1)
4 (a), 450.01 (1m) and 655.001 (9); to renumber 655.001 (1); to renumber and
5 amend 146.89 (1) (r) 3., 253.13 (1), 255.06 (1) (d), 441.06 (7) and 441.11 (2); to
6 amend 29.193 (1m) (a) 2. (intro.), 29.193 (2) (b) 2., 29.193 (2) (c) 3., 29.193 (2)
7 (cd) 2. b., 29.193 (2) (cd) 2. c., 29.193 (2) (e), 29.193 (3) (a), 45.40 (1g) (a), 46.03
8 (44), 50.08 (2), 50.09 (1) (a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h), 50.09 (1) (k),
9 50.49 (1) (b) (intro.), 51.41 (1d) (b) 4., 70.47 (8) (intro.), 77.54 (14) (f) 4., 97.59,
10 102.13 (1) (a), 102.13 (1) (b) (intro.), 1., 3. and 4., 102.13 (1) (d) 1., 2., 3. and 4.,
11 102.13 (2) (a), 102.13 (2) (b), 102.17 (1) (d) 1. and 2., 102.29 (3), 102.42 (2) (a),
12 106.30 (1), 118.15 (3) (a), 118.25 (1) (a), 118.29 (1) (e), 118.2925 (3), 118.2925 (4)
13 (c), 118.2925 (5), 146.615 (1) (a), 146.82 (3) (a), 146.89 (1) (r) 1., 146.89 (6),
14 154.01 (1g), 252.07 (8) (a) 2., 252.07 (9) (c), 252.10 (7), 252.11 (2), (4), (5) and (7),
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ASSEMBLY BILL 154
1 252.11 (10), 252.15 (3m) (d) 11. b. and 13., (5g) (c), (5m) (d) 2. and (e) 2. and 3.
2 and (7m) (intro.) and (b), 252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 253.07 (4)
3 (d), 253.115 (4), 253.115 (7) (a) (intro.), 253.15 (2), 255.06 (2) (d), 255.07 (1) (d),
4 257.01 (5) (a) and (b), 341.14 (1a), (1e) (a), (1m) and (1q), 343.16 (5) (a), 343.51
5 (1), 343.62 (4) (a) 4., 440.077 (1) (a), 440.077 (2) (c), 440.094 (1) (c) 1., 440.094
6 (2) (a) (intro.), 440.981 (1), 440.982 (1), 440.987 (2), 441.01 (3), 441.01 (4), 441.01
7 (7) (a) (intro.), 441.01 (7) (b), 441.06 (3), 441.06 (4), 441.07 (1g) (intro.), (a), (c)
8 and (e), 441.10 (7), 441.18 (2) (a) (intro.), 441.18 (2) (b), 441.18 (3), 448.03 (2) (a),
9 448.035 (2) to (4), 448.56 (1) and (1m) (b), 448.62 (2m), 448.67 (2), 448.956 (1m),
10 450.01 (16) (h) 2., 450.01 (16) (hr) 2., 450.03 (1) (e), 450.11 (1g) (b), 450.11 (1i)
11 (a) 1., 450.11 (1i) (b) 2. b., 450.11 (7) (b), 450.11 (8) (e), 450.13 (5) (b), 450.135 (7)
12 (b), 462.04, 655.001 (7t), 655.002 (1) (a), 655.002 (1) (b), 655.002 (1) (c), 655.002
13 (1) (d), 655.002 (1) (e), 655.002 (1) (em), 655.002 (2) (a), 655.002 (2) (b), 655.003
14 (1), 655.003 (3), 655.005 (2) (a), 655.005 (2) (b), 655.23 (5m), 655.27 (3) (a) 4.,
15 655.27 (3) (b) 2m., 655.275 (2), 655.275 (5) (b) 2., 961.01 (19) (a) and 961.395;
16 to repeal and recreate 155.01 (1g) (b), 251.01 (1c) and 441.06 (title); and to
17 create 253.115 (1) (f), 253.13 (1) (a), 253.15 (1) (em), 255.06 (1) (f) 2., 440.03 (13)
18 (b) 39m., 440.08 (2) (a) 47r., 441.001 (1c), 441.001 (3c), 441.001 (3g), 441.001
19 (3n), 441.001 (3r), 441.001 (3w), 441.001 (5), 441.01 (7) (c), 441.09, 441.092 and
20 655.001 (1g) of the statutes; relating to: advanced practice registered nurses,
21 extending the time limit for emergency rule procedures, providing an
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ASSEMBLY BILL 154
1 exemption from emergency rule procedures, and granting rule-making
2 authority.
Analysis by the Legislative Reference Bureau
NURSING PRACTICE AND LICENSURE
This bill makes various changes to practice, licensure, and certification
requirements for nurses, which are administered by the Board of Nursing.
Licensure of advanced practice registered nurses
Under current law, a person who wishes to practice professional nursing must
be licensed by the Board of Nursing as a registered nurse (RN). This bill creates an
additional system of licensure for advanced practice registered nurses (APRNs), to
be administered by the board. Under the bill, in order to apply for an APRN license,
a person must 1) hold, or concurrently apply for, an RN license; 2) have completed
an accredited graduate-level or postgraduate-level education program preparing
the person to practice as an APRN in one of four recognized roles and hold a current
national certification approved by the board; 3) possess malpractice liability
insurance as provided in the bill; 4) pay a fee determined by the Department of Safety
and Professional Services; and 5) satisfy certain other criteria specified in the bill.
The bill also allows a person who has not completed an accredited education program
described above to receive an APRN license if the person 1) on January 1, 2024, is
both licensed as an RN in Wisconsin and practicing in one of the four recognized roles;
and 2) satisfies additional practice or education criteria established by the board.
The bill also, however, automatically grants licenses to certain RNs, as further
described below. The four recognized roles, as defined in the bill, are 1) certified
nurse-midwife; 2) certified registered nurse anesthetist; 3) clinical nurse specialist;
and 4) nurse practitioner. The bill requires the board, upon granting a person an
APRN license, to also grant the person one or more specialty designations
corresponding to the recognized role or roles for which the person qualifies.
Under the bill, all APRNs, except APRNs with a certified nurse-midwife
specialty designation, must practice in collaboration with a physician or dentist.
However, under the bill, an APRN may practice without being supervised by a
physician or dentist if the Board of Nursing verifies that the APRN has completed
3,840 clinical hours of advanced practice registered nursing practice in their
recognized role while working with a physician or dentist during those 3,840 hours
of practice. APRNs with a certified nurse-midwife specialty designation are instead
required, if they offer to deliver babies outside of a hospital setting, to file and keep
current with the board a proactive plan for involving a hospital or a physician who
has admitting privileges at a hospital in the treatment of patients with higher acuity
or emergency care needs, as further described below. Additionally, under the bill, an
APRN may provide pain management services only while working in a collaborative
relationship with a physician or, if the APRN has qualified to practice independently,
in a hospital or clinic associated with a hospital.
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ASSEMBLY BILL 154
The holder of an APRN license may append the title “A.P.R.N." to his or her
name, as well as a title corresponding to whichever specialty designations that the
person possesses. The bill prohibits any person from using the title “A.P.R.N.," and
from otherwise indicating that he or she is an APRN, unless the person is licensed
by the board as an APRN. The bill also prohibits the use of titles and abbreviations
corresponding to a recognized role unless the person has a specialty designation for
that role. However, the bill allows an APRN to delegate a task or order to another
clinically trained health care worker if the task or order is within the scope of the
APRN's practice, the APRN is competent to perform the task or issue the order, and
the APRN has reasonable evidence that the health care worker is minimally
competent to perform the task or issue the order under the circumstances. The bill
requires an APRN to adhere to professional standards when managing situations
that are beyond the APRN's expertise.
Under the bill, when an APRN renews his or her APRN license, the board must
grant the person the renewal of both the person's RN license and the person's APRN
license. The bill requires all APRNs to complete continuing education requirements
each biennium in clinical pharmacology or therapeutics relevant to the APRN's area
of practice and to satisfy certain other requirements when renewing a license.
Practice of nurse-midwifery
This bill repeals licensure and practice requirements specific to
nurse-midwives and the practice of nurse-midwifery, including specific
requirements to practice with an obstetrician. Under the bill, “certified
nurse-midwife" is one of the four recognized roles for APRNs, and a person who is
licensed as a nurse-midwife under current law is automatically granted an APRN
license with a certified nurse-midwife specialty designation. The bill otherwise
allows nurse-midwives to be licensed as APRNs if they satisfy the licensure
requirements, except that the bill also requires that a person applying for a certified
nurse-midwife specialty designation be certified by the American Midwifery
Certification Board. The bill also requires an APRN with a specialty designation as
a certified nurse-midwife to file with the board, and obtain the board's approval of,
a plan for ensuring appropriate care or care transitions in treating certain patients
if the APRN offers to deliver babies outside of a hospital setting.
Prescribing authority
Under current law, a person licensed as an RN may apply to the board for a
certificate to issue prescription orders if the person meets certain requirements
established by the board. An RN holding a certificate is subject to various practice
requirements and limitations established by the board and must possess malpractice
liability insurance in an amount determined by the board.
The bill eliminates certificates to issue prescription orders and generally
authorizes APRNs to issue prescription orders. A person who is certified to issue
prescription orders under current law is automatically granted an APRN license
with his or her appropriate specialty designation. RNs who are practicing in a
recognized role on January 1, 2024, but who do not hold a certificate to issue
prescription orders on that date and who are granted an APRN license under the bill
may not issue prescription orders. As under current law, an APRN issuing
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prescription orders is subject to various practice requirements and limitations
established by the board.
The bill repeals a provision concerning the ability of advanced practice nurses
who are certified to issue prescription orders and who are required to work in
collaboration with or under the supervision of a physician to obtain and practice
under a federal waiver to dispense narcotic drugs to individuals for addiction
treatment.
Malpractice liability insurance
The bill requires all APRNs to maintain malpractice liability insurance in
coverage amounts specified under current law for physicians and nurse anesthetists
except for APRNs whose employer has in effect malpractice liability insurance that
provides the same amount of coverage for the APRN. Additionally, the bill requires
APRNs who have qualified to practice independently and who practice outside a
collaborative or employment relationship, but not including those APRNs who only
practice as a certified nurse-midwife, to participate in the Injured Patients and
Families Compensation Fund. The Injured Patients and Families Compensation
Fund provides excess medical malpractice coverage for health care providers who
participate in the fund and meet all other participation requirements, which
includes maintaining malpractice liability insurance in coverage amounts specified
under current law.
OTHER CHANGES
The bill makes numerous other changes throughout the statutes relating to
APRNs, including various terminology changes.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
1 SECTION 1. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:
2 29.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
3 or both arms or one or both hands and fails to meet the minimum standards of any
4 one of the following standard tests, administered under the direction of a licensed
5 physician, a licensed physician assistant, a licensed chiropractor, or a certified
6 licensed advanced practice registered nurse prescriber:
7 SECTION 2. 29.193 (2) (b) 2. of the statutes is amended to read:
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ASSEMBLY BILL 154 SECTION 2
1 29.193 (2) (b) 2. An applicant shall submit an application on a form prepared
2 and furnished by the department, which shall include a written statement or report
3 prepared and signed by a licensed physician, a licensed physician assistant, a
4 licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice
5 registered nurse prescriber prepared no more than 6 months preceding the
6 application and verifying that the applicant is physically disabled.
7 SECTION 3. 29.193 (2) (c) 3. of the statutes is amended to read:
8 29.193 (2) (c) 3. The department may issue a Class B permit to an applicant
9 who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
10 subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
11 applicant and the recommendation of a licensed physician, a licensed physician
12 assistant, a licensed chiropractor, a licensed podiatrist, or a certified licensed
13 advanced practice registered nurse prescriber selected by the applicant from a list
14 of licensed physicians, licensed physician assistants, licensed chiropractors, licensed
15 podiatrists, and certified licensed advanced practice nurse prescribers registered
16 nurses compiled by the department, the department finds that issuance of a permit
17 complies with the intent of this subsection. The use of this review procedure is
18 discretionary with the department and all costs of the review procedure shall be paid
19 by the applicant.
20 SECTION 4. 29.193 (2) (cd) 2. b. of the statutes is amended to read:
21 29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function
22 in one or both arms and fails to meet the minimum standards of the standard upper
23 extremity pinch test, the standard grip test, or the standard nine-hole peg test,
24 administered under the direction of a licensed physician, a licensed physician
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ASSEMBLY BILL 154 SECTION 4
1 assistant, a licensed chiropractor, or a certified licensed advanced practice registered
2 nurse prescriber.
3 SECTION 5. 29.193 (2) (cd) 2. c. of the statutes is amended to read:
4 29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in
5 one or both shoulders and fails to meet the minimum standards of the standard
6 shoulder strength test, administered under the direction of a licensed physician, a
7 licensed physician assistant, a licensed chiropractor, or a certified licensed advanced
8 practice registered nurse prescriber.
9 SECTION 6. 29.193 (2) (e) of the statutes is amended to read:
10 29.193 (2) (e) Review of decisions. An applicant denied a permit under this
11 subsection, except a permit under par. (c) 3., may obtain a review of that decision by
12 a licensed physician, a licensed physician assistant, a licensed chiropractor, a
13 licensed podiatrist, or a certified licensed advanced practice registered nurse
14 prescriber designated by the department and with an office located in the
15 department district in which the applicant resides. The department shall pay for the
16 cost of a review under this paragraph unless the denied application on its face fails
17 to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is
18 the only method of review of a decision to deny a permit under this subsection and
19 is not subject to further review under ch. 227.
20 SECTION 7. 29.193 (3) (a) of the statutes is amended to read:
21 29.193 (3) (a) Produces a certificate from a licensed physician, a licensed
22 physician assistant, a licensed optometrist, or a certified licensed advanced practice
23 registered nurse prescriber stating that his or her sight is impaired to the degree that