Session of 2021
SENATE BILL No. 174
By Committee on Public Health and Welfare
2-8

1 AN ACT concerning advanced practice registered nurses; relating to the
2 board of nursing; definition of practice; prescribing authority; licensure
3 requirements; rules and regulations; amending K.S.A. 65-1130 and
4 K.S.A. 2020 Supp. 40-3401, 65-1113 and 65-4101 and repealing the
5 existing sections.
6
7 Be it enacted by the Legislature of the State of Kansas:
8 Section 1. K.S.A. 2020 Supp. 40-3401 is hereby amended to read as
9 follows: 40-3401. As used in this act:
10 (a) "Applicant" means any healthcare provider.
11 (b) "Basic coverage" means a policy of professional liability
12 insurance required to be maintained by each healthcare provider pursuant
13 to the provisions of K.S.A. 40-3402(a) or (b), and amendments thereto.
14 (c) "Commissioner" means the commissioner of insurance.
15 (d) "Fiscal year" means the year commencing on the effective date of
16 this act and each year, commencing on the first day of July thereafter.
17 (e) "Fund" means the healthcare stabilization fund established
18 pursuant to K.S.A. 40-3403(a), and amendments thereto.
19 (f) (1) "Healthcare provider" means a person licensed to practice any
20 branch of the healing arts by the state board of healing arts, a person who
21 holds a temporary permit to practice any branch of the healing arts issued
22 by the state board of healing arts, a person engaged in a postgraduate
23 training program approved by the state board of healing arts, a medical
24 care facility licensed by the state of Kansas, a podiatrist licensed by the
25 state board of healing arts, a health maintenance organization issued a
26 certificate of authority by the commissioner, an optometrist licensed by the
27 board of examiners in optometry, a pharmacist licensed by the state board
28 of pharmacy, a licensed professional nurse who is authorized to practice as
29 a registered nurse anesthetist, a licensed professional nurse who has been
30 granted a temporary authorization to practice nurse anesthesia under
31 K.S.A. 65-1153, and amendments thereto, a professional corporation
32 organized pursuant to the professional corporation law of Kansas by
33 persons who are authorized by such law to form such a corporation and
34 who are healthcare providers as defined by this subsection, a Kansas
35 limited liability company organized for the purpose of rendering
36 professional services by its members who are healthcare providers as
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1 defined by this subsection and who are legally authorized to render the
2 professional services for which the limited liability company is organized,
3 a partnership of persons who are healthcare providers under this
4 subsection, a Kansas not-for-profit corporation organized for the purpose
5 of rendering professional services by persons who are healthcare providers
6 as defined by this subsection, a nonprofit corporation organized to
7 administer the graduate medical education programs of community
8 hospitals or medical care facilities affiliated with the university of Kansas
9 school of medicine, a dentist certified by the state board of healing arts to
10 administer anesthetics under K.S.A. 65-2899, and amendments thereto, a
11 psychiatric hospital licensed prior to January 1, 1988, and continuously
12 thereafter under K.S.A. 2015 Supp. 75-3307b, prior to its repeal, and
13 K.S.A. 2020 Supp. 39-2001 et seq., and amendments thereto, or a mental
14 health center or mental health clinic licensed by the state of Kansas. On
15 and after January 1, 2015, "healthcare provider" also means, a physician
16 assistant licensed by the state board of healing arts, a licensed advanced
17 practice registered nurse who is authorized by the board of nursing to
18 practice as an advanced practice registered nurse in the classification of a
19 nurse-midwife, a licensed advanced practice registered nurse who has been
20 granted a temporary authorization by the board of nursing to practice as an
21 advanced practice registered nurse in the classification of a nurse-midwife,
22 a nursing facility licensed by the state of Kansas, an assisted living facility
23 licensed by the state of Kansas or, a residential healthcare facility licensed
24 by the state of Kansas or an advanced practice registered nurse licensed
25 by the board of nursing.
26 (2) "Healthcare provider" does not include: (1)(A) Any state
27 institution for people with intellectual disability; (2)(B) any state
28 psychiatric hospital; (3)(C) any person holding an exempt license issued
29 by the state board of healing arts or the board of nursing; (4)(D) any
30 person holding a visiting clinical professor license from the state board of
31 healing arts; (5)(E) any person holding an inactive license issued by the
32 state board of healing arts; (6)(F) any person holding a federally active
33 license issued by the state board of healing arts; (7)(G) an advanced
34 practice registered nurse who is authorized by the board of nursing to
35 practice as an advanced practice registered nurse in the classification of
36 nurse-midwife or nurse anesthetist and who practices solely in the course
37 of employment or active duty in the United States government or any of its
38 departments, bureaus or agencies or who provides professional services as
39 a charitable healthcare provider as defined under K.S.A. 75-6102, and
40 amendments thereto; or (8)(H) a physician assistant licensed by the state
41 board of healing arts who practices solely in the course of employment or
42 active duty in the United States government or any of its departments,
43 bureaus or agencies or who provides professional services as a charitable
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1 healthcare provider as defined under K.S.A. 75-6102, and amendments
2 thereto; or (I) an advanced practice registered nurse: (i) Holding an
3 inactive license issued by the board of nursing; (ii) practicing solely in
4 employment for which the advanced practice registered nurse is covered
5 under the federal tort claims act or the Kansas tort claims act; (iii)
6 practicing solely as a charitable healthcare provider in accordance with
7 K.S.A. 75-6102, and amendments thereto; or (iv) practicing solely while
8 serving on active duty in the military service of the United States.
9 (g) "Inactive healthcare provider" means a person or other entity who
10 purchased basic coverage or qualified as a self-insurer on or subsequent to
11 the effective date of this act but who, at the time a claim is made for
12 personal injury or death arising out of the rendering of or the failure to
13 render professional services by such healthcare provider, does not have
14 basic coverage or self-insurance in effect solely because such person is no
15 longer engaged in rendering professional service as a healthcare provider.
16 (h) "Insurer" means any corporation, association, reciprocal
17 exchange, inter-insurer and any other legal entity authorized to write
18 bodily injury or property damage liability insurance in this state, including
19 workers compensation and automobile liability insurance, pursuant to the
20 provisions of the acts contained in article 9, 11, 12 or 16 of chapter 40 of
21 the Kansas Statutes Annotated, and amendments thereto.
22 (i) "Plan" means the operating and administrative rules and
23 procedures developed by insurers and rating organizations or the
24 commissioner to make professional liability insurance available to
25 healthcare providers.
26 (j) "Professional liability insurance" means insurance providing
27 coverage for legal liability arising out of the performance of professional
28 services rendered or that should have been rendered by a healthcare
29 provider.
30 (k) "Rating organization" means a corporation, an unincorporated
31 association, a partnership or an individual licensed pursuant to K.S.A. 40-
32 956, and amendments thereto, to make rates for professional liability
33 insurance.
34 (l) "Self-insurer" means a healthcare provider who qualifies as a self-
35 insurer pursuant to K.S.A. 40-3414, and amendments thereto.
36 (m) "Medical care facility" means the same when used in the
37 healthcare provider insurance availability act as defined in K.S.A. 65-425,
38 and amendments thereto, except that as used in the healthcare provider
39 insurance availability act such term, as it relates to insurance coverage
40 under the healthcare provider insurance availability act, also includes any
41 director, trustee, officer or administrator of a medical care facility.
42 (n) "Mental health center" means a mental health center licensed by
43 the state of Kansas under K.S.A. 2020 Supp. 39-2001 et seq., and
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1 amendments thereto, except that as used in the healthcare provider
2 insurance availability act such term, as it relates to insurance coverage
3 under the healthcare provider insurance availability act, also includes any
4 director, trustee, officer or administrator of a mental health center.
5 (o) "Mental health clinic" means a mental health clinic licensed by
6 the state of Kansas under K.S.A. 2020 Supp. 39-2001 et seq., and
7 amendments thereto, except that as used in the healthcare provider
8 insurance availability act such term, as it relates to insurance coverage
9 under the healthcare provider insurance availability act, also includes any
10 director, trustee, officer or administrator of a mental health clinic.
11 (p) "State institution for people with intellectual disability" means
12 Winfield state hospital and training center, Parsons state hospital and
13 training center and the Kansas neurological institute.
14 (q) "State psychiatric hospital" means Larned state hospital,
15 Osawatomie state hospital and Rainbow mental health facility.
16 (r) "Person engaged in residency training" means:
17 (1) A person engaged in a postgraduate training program approved by
18 the state board of healing arts who is employed by and is studying at the
19 university of Kansas medical center only when such person is engaged in
20 medical activities that do not include extracurricular, extra-institutional
21 medical service for which such person receives extra compensation and
22 that have not been approved by the dean of the school of medicine and the
23 executive vice-chancellor of the university of Kansas medical center.
24 Persons engaged in residency training shall be considered resident
25 healthcare providers for purposes of K.S.A. 40-3401 et seq., and
26 amendments thereto; and
27 (2) a person engaged in a postgraduate training program approved by
28 the state board of healing arts who is employed by a nonprofit corporation
29 organized to administer the graduate medical education programs of
30 community hospitals or medical care facilities affiliated with the university
31 of Kansas school of medicine or who is employed by an affiliate of the
32 university of Kansas school of medicine as defined in K.S.A. 76-367, and
33 amendments thereto, only when such person is engaged in medical
34 activities that do not include extracurricular, extra-institutional medical
35 service for which such person receives extra compensation and that have
36 not been approved by the chief operating officer of the nonprofit
37 corporation or the chief operating officer of the affiliate and the executive
38 vice-chancellor of the university of Kansas medical center.
39 (s) "Full-time physician faculty employed by the university of Kansas
40 medical center" means a person licensed to practice medicine and surgery
41 who holds a full-time appointment at the university of Kansas medical
42 center when such person is providing healthcare. A person licensed to
43 practice medicine and surgery who holds a full-time appointment at the
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1 university of Kansas medical center may also be employed part-time by
2 the United States department of veterans affairs if such employment is
3 approved by the executive vice-chancellor of the university of Kansas
4 medical center.
5 (t) "Sexual act" or "sexual activity" means that sexual conduct that
6 constitutes a criminal or tortious act under the laws of the state of Kansas.
7 (u) "Board" means the board of governors created by K.S.A. 40-3403,
8 and amendments thereto.
9 (v) "Board of directors" means the governing board created by K.S.A.
10 40-3413, and amendments thereto.
11 (w) "Locum tenens contract" means a temporary agreement not
12 exceeding 182 days per calendar year that employs a healthcare provider
13 to actively render professional services in this state.
14 (x) "Professional services" means patient care or other services
15 authorized under the act governing licensure of a healthcare provider.
16 (y) "Healthcare facility" means a nursing facility, an assisted living
17 facility or a residential healthcare facility as all such terms are defined in
18 K.S.A. 39-923, and amendments thereto.
19 (z) "Charitable healthcare provider" means the same as defined in
20 K.S.A. 75-6102, and amendments thereto.
21 Sec. 2. K.S.A. 2020 Supp. 65-1113 is hereby amended to read as
22 follows: 65-1113. When used in this act and the act of which this section is
23 amendatoryAs used in the Kansas nurse practice act:
24 (a) "Board" means the board of nursing.
25 (b) "Diagnosis" in the context of nursing practice, for licensed
26 practical nurses and registered nurses, means that the identification of and
27 discrimination between physical and psychosocial signs and symptoms
28 essential to effective execution and management of the nursing regimen
29 and shall be construed as distinct from a medical diagnosis nursing
30 regimen. Advanced practice registered nurses are educated and trained in
31 using diagnoses and may develop primary and differential diagnoses
32 within the advanced practice registered nurse scope of practice.
33 (c) "Treatment" means the selection and performance of those
34 therapeutic measures essential to effective execution implementation and
35 management of the nursing regimen, and any prescribed medical regimen
36 patient's healthcare, determined by the nurse's level of education.
37 (d) Practice of nursing. (1) The practice of professional nursing as
38 performed by a registered professional nurse for compensation or
39 gratuitously, except as permitted by K.S.A. 65-1124, and amendments
40 thereto, means the process in which substantial specialized knowledge
41 derived from the biological, physical, and behavioral sciences is applied
42 to: the care, diagnosis, treatment, counsel and health teaching of persons
43 who are experiencing changes in the normal health processes or who
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1 require assistance in the maintenance of health or the prevention or
2 management of illness, injury or infirmity; administration, supervision or
3 teaching of the process as defined in this section; and the execution of the
4 medical treatment regimen as prescribed by a person licensed to practice
5 medicine and surgery or a person licensed to practice dentistry or an
6 individual licensed to practice advanced practice registered nursing.
7 (2) The practice of nursing as a licensed practical nurse means the
8 performance for compensation or gratuitously, except as permitted by
9 K.S.A. 65-1124, and any amendments thereto, of tasks and responsibilities
10 defined in paragraph (1), which tasks and responsibilities that are based on
11 acceptable educational preparation within the framework of supportive and
12 restorative care under the direction of a registered professional nurse, a
13 person licensed to practice medicine and surgery or a person licensed to
14 practice dentistry.
15 (3) The practice of professional nursing as an advanced practice
16 registered nurse as defined in subsection (g) within the APRN role means,
17 in addition to the practice and responsibilities of professional nursing as
18 defined in paragraph (1): Conducting an advanced assessment; ordering
19 and interpreting diagnostic procedures; establishing primary and
20 differential diagnoses; prescribing, ordering, administering and furnishing
21 therapeutic measures as set forth by the board; delegating and assigning
22 therapeutic measures to assistive personnel; collaborating and consulting
23 with physicians and other healthcare providers; providing referrals to
24 healthcare providers, agencies and community resources; and other acts
25 that require education and training consistent with the professional
26 standards and commensurate with the APRN's education, certification,
27 demonstrated competencies and experience.
28 (e) A "professional nurse" means a person who is licensed to practice
29 professional nursing as defined in subsection (d)(1).
30 (f) A "practical nurse" means a person who is licensed to practice
31 practical nursing as defined in subsection (d)(2).
32 (g) "Advanced practice registered nurse" or "APRN" means a
33 professional nurse who holds a license from the board to function practice
34 advanced practice registered nursing as defined in subsection (d)(3) as a
35 professional nurse in an advanced role, and this advanced role shall may be
36 further defined by rules and regulations consistent with the Kansas nurse
37 practice act adopted by the board in accordance with K.S.A. 65-1130, and
38 amendments thereto.
39 (h) "Continuing nursing education" means learning experiences
40 intended to build upon the educational and experiential bases of the
41 registered professional and l