Bill Summary – FastDemocracy

PRINTER'S NO.   387
                     THE GENERAL ASSEMBLY OF PENNSYLVANIA
                        SENATE BILL
                        No. 25
                                               Session of
                                                 2023
     INTRODUCED BY BARTOLOTTA, BOSCOLA, LAUGHLIN, FLYNN, LANGERHOLC,
        SCHWANK, COLLETT, KANE, STEFANO, TARTAGLIONE, COSTA,
        CAPPELLETTI, HUTCHINSON, J. WARD, COMITTA, DiSANTO, HAYWOOD,
        ROTHMAN, BAKER, YAW, ARGALL AND KEARNEY, MARCH 3, 2023
     REFERRED TO CONSUMER PROTECTION AND PROFESSIONAL LICENSURE,
        MARCH 3, 2023
                                    AN ACT
 Amending the act of May 22, 1951 (P.L.317, No.69), entitled "An
    act relating to the practice of professional nursing;
    providing for the licensing of nurses and for the revocation
    and suspension of such licenses, subject to appeal, and for
    their reinstatement; providing for the renewal of such
    licenses; regulating nursing in general; prescribing
    penalties and repealing certain laws," further providing for
    title, for definitions, for State Board of Nursing, for
    dietitian-nutritionist license required, for unauthorized
    practices and acts not prohibited, for temporary practice
    permit, for graduates of schools of other states, territories
    or Dominion of Canada, for persons entitled to practice, for
    certified registered nurse practitioners and qualifications,
    for scope of practice for certified registered nurse
    practitioners, for prescriptive authority for certified
    registered nurse practitioners, for Drug Review Committee,
    for professional liability, for reporting of multiple
    licensure, for continuing nursing education, for punishment
    for violations, for refusal, suspension or revocation of
    licenses, for reinstatement of license and for injunction or
    other process; and providing for the expiration of the State
    Board of Nursing's power to license certified registered
    nurse practitioners.
    The General Assembly of the Commonwealth of Pennsylvania
 hereby enacts as follows:
    Section 1.    The title of the act of May 22, 1951 (P.L.317,
 No.69), known as The Professional Nursing Law, is amended to
 read:
                                 AN ACT
 Relating to the practice of professional nursing and the
    practice of advanced practice registered nursing; providing
    for the licensing of nurses and for the revocation and
    suspension of such licenses, subject to appeal, and for their
    reinstatement; providing for the renewal of such licenses;
    regulating nursing in general; prescribing penalties and
    repealing certain laws.
    Section 2.    Section 2(1), (10), (12), (13) and (14) of the
 act are amended and the section is amended by adding paragraphs
 to read:
    Section 2.    Definitions.--When used in this act, the
 following words and phrases shall have the following meanings
 unless the context provides otherwise:
    (1)     The "Practice of Professional Nursing" means diagnosing
 and treating human responses to actual or potential health
 problems through such services as casefinding, health teaching,
 health counseling, and provision of care supportive to or
 restorative of life and well-being, and executing medical
 regimens as prescribed by a licensed physician or dentist. The
 foregoing shall not be deemed to include acts of medical
 diagnosis or prescription of medical therapeutic or corrective
 measures, except as performed by [a certified registered nurse
 practitioner] an APRN-CNP acting in accordance with rules and
 regulations promulgated by the Board.
    * * *
    (10)    "Medical nutrition therapy" means the component of
 nutrition therapy that concerns determining and recommending
 nutrient needs based on nutritional assessment and medical
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 problems relative to diets prescribed by a licensed physician or
 an APRN-CNP, including:
    (i)    tube feedings;
    (ii)    specialized intravenous solutions;
    (iii)     specialized oral solutions; and
    (iv)    interactions of prescription drugs with food or
 nutrients.
    * * *
    [(12)     "Certified registered nurse practitioner" means a
 registered nurse licensed in this Commonwealth who is certified
 by the board in a particular clinical specialty area.]
    (13)    "Collaboration" means a process in which [a certified
 registered nurse practitioner] an APRN-CNP works with one or
 more physicians to deliver health care services within the scope
 of [the certified registered nurse practitioner's] an APRN-CNP's
 expertise. The process includes all of the following:
    (i)    Immediate availability of a licensed physician to [a
 certified registered nurse practitioner] an APRN-CNP through
 direct communications or by radio, telephone or
 telecommunications.
    (ii)    A predetermined plan for emergency services.
    (iii)     A physician available to [a certified registered nurse
 practitioner] an APRN-CNP on a regularly scheduled basis for
 referrals, review of the standards of medical practice
 incorporating consultation and chart review, drug and other
 medical protocols within the practice setting, periodic updating
 in medical diagnosis and therapeutics and cosigning records when
 necessary to document accountability by both parties.
    (iv)    In the case of an APRN-CNP practicing under section
 8.2(c.1), a written collaborative agreement with a physician.
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    [(14)    "Drug Review Committee" means the committee
 established in section 8.4 whose function is to approve or
 disapprove, by addition or deletion, the categories of drugs
 that may be prescribed by certified registered nurse
 practitioners.]
    * * *
    (18)    "Advanced practice registered nurse-certified nurse
 practitioner" means a registered nurse licensed in this
 Commonwealth to practice independently in a population focus
 area in which the registered nurse is certified by a Board-
 recognized national certification program.
    (19)    "APRN-CNP" means an advanced practice registered nurse-
 certified nurse practitioner.
    (20)    "Population focus area" means a category of patients
 for which an APRN-CNP has the educational preparation to provide
 care and services. The categories of population focus include:
    (i)    Family and individuals across the lifespan.
    (ii)    Adult Gerontology.
    (iii)    Neonatal.
    (iv)    Pediatrics.
    (v)    Women's health and gender-related health.
    (vi)    Psychiatric and mental health.
    (21)    "Controlled substance" means a drug designated as a
 controlled substance under the act of April 14, 1972 (P.L.233,
 No.64), known as "The Controlled Substance, Drug, Device and
 Cosmetic Act."
    (22)    "Nonproprietary drug" means a drug containing a
 quantity of a controlled substance or a drug which is required
 by an applicable Federal or State law to be dispensed only by
 prescription.
20230SB0025PN0387                    - 4 -
    (23)    "Proprietary drug" means a nonprescription, non-
 narcotic medicine or drug which may be sold without a
 prescription and which is prepackaged for use by the consumer
 and labeled in accordance with the requirements of the statutes
 and regulations of the Federal Government and the Commonwealth.
    (24)    "Licensed independent practitioner" means an APRN-CNP
 licensed under section 8.1(j) or (l) to provide care and
 services, without direction or supervision, within the scope of
 the practitioner's license.
    (25)    "Practice of Advanced Practice Registered Nursing"
 means the practice of an APRN-CNP to assess, diagnose, treat,
 prescribe and order, within a population focus approved by the
 Board of nursing that includes the APRN-CNP's scope of practice.
 The term shall include, but not be limited to, performing acts
 of medical diagnosis or prescription of medical therapeutic or
 corrective measures.
    Section 3.    Sections 2.1(k) and (l), 3.1(b), 4, 4.1, 7(b), 8,
 8.1, 8.2, 8.3, 8.4, 8.7, 11.1, 12.1(g)(1), 13(b), 14(a)(1), (2)
 and (4) and (b)(6), 15.2 and 15.4 of the act are amended to
 read:
    Section 2.1.    State Board of Nursing.--* * *
    (k)    The Board shall have the right and duty to establish
 rules and regulations for the practice of professional nursing,
 the practice of advanced practice registered nursing, the
 practice of dietetics-nutrition and the administration of this
 act. Copies of such rules and regulations shall be available for
 distribution to the public.
    (l)    Any powers and duties imposed on the State Board of
 Medicine or jointly imposed on the State Board of Medicine and
 the State Board of Nursing, with respect to [certified
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 registered nurse practitioners] APRN-CNPs, by or pursuant to law
 or regulation shall, after the effective date of this
 subsection, be exercised solely by the State Board of Nursing.
 This subsection shall not apply to 49 Pa. Code §§ 21.283(4)
 (relating to prescribing and dispensing drugs) and 21.321
 (relating to performance of tasks without direction; performance
 of tasks without training; other) unless the State Board of
 Nursing promulgates a regulation to exercise the duties imposed
 on the State Board of Medicine by those sections.
    Section 3.1.   Dietitian-Nutritionist License Required.--* * *
    (b)   Nothing in this section shall be construed to require or
 preclude third-party insurance reimbursement. Nothing herein
 shall preclude an insurer or other third-party payor from
 requiring that a licensed dietitian-nutritionist obtain a
 referral from a licensed physician, an APRN-CNP, a dentist or
 podiatrist or that a licensed dietitian-nutritionist file an
 evaluation and treatment plan with the insurer or third-party
 payor as a precondition of reimbursement.
    Section 4.   Unauthorized Practices; Acts not Prohibited.--
 This act confers no authority to practice dentistry, podiatry,
 optometry, chiropractic, medicine or surgery, nor does it
 prohibit--
    (1)   Home care of the sick by friends, domestic servants,
 nursemaids, companions, or household aides of any type, so long
 as such persons do not represent or hold themselves out to be
 licensed nurses, licensed registered nurses, or registered
 nurses; or use in connection with their names, any designation
 tending to imply that they are licensed to practice under the
 provisions of this act nor services rendered by any physicians,
 osteopaths, dentists or chiropractors, podiatrists,
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 optometrists, or any person licensed pursuant to the act of
 March 2, 1956 (P.L.1211, No.376), known as the "Practical Nurse
 Law."
    (2)     Care of the sick, with or without compensation or
 personal profit, when done solely in connection with the
 practice of the religious tenets of any church by adherents
 thereof.
    (3)     The practice of professional nursing or the practice of
 advanced practice registered nursing by a person temporarily in
 this Commonwealth licensed by another state, territory or
 possession of the United States or a foreign country, in
 compliance with an engagement made outside of this Commonwealth,
 which engagement requires that such person accompany and care
 for a patient while temporarily in this Commonwealth: Provided,
 however, That said engagement shall not be of more than six (6)
 months' duration.
    (4)     The practice of professional nursing or the practice of
 advanced practice registered nursing, pursuant to a temporary
 practice permit, by a graduate of an approved program of
 professional nursing in Pennsylvania or any other state, working
 under qualified supervision, during the period not to exceed one
 (1) year between completion of his or her program and
 notification of the results of a licensing examination taken by
 such person, and during such additional period as the Board may
 in each case especially permit.
    (5)     The practice of professional nursing or the practice of
 advanced practice registered nursing, pursuant to a temporary
 practice permit, by a person who holds a current license or
 other evidence of the right to practice professional nursing, as
 that term is defined in this act, issued by any other state,
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 territory or possession of the United States or the Dominion of
 Canada, during the period that an application filed by such
 person for licensure in Pennsylvania is pending before the
 Board, but not for a period of more than one (1) year and during
 such additional period as the Board may in each case especially
 permit.
    (6)    The practice of professional nursing[, within the
 definition of this act,] or the practice of advanced practice
 registered nursing by any person when such person is engaged in
 the practice [of nursing] as an employee of the United States.
    Section 4.1.   Temporary Practice Permit.--(a)   In order for a
 person to practice professional nursing or to practice advanced
 practice registered nursing during the one (1) year period from
 completion of his or her education program or the one (1) year
 period from the application for licensure by a person who holds
 a current license issued by any other state, territory or
 possession of the United States or the Dominion of Canada, the
 Board may issue a temporary practice permit which is
 nonrenewable and valid for a period of one (1) year and during
 such additional period as the Board may in each case especially
 permit, except that the temporary practice permit shall expire
 if such person fails the licensing examination.
    (b)    Within ninety (90) days of the date a temporary practice
 permit to practice as an APRN-CNP is issued by the Board to an
 individual who was licensed or certified by another state,
 territory or possession of the United States or a foreign
 country, the individual shall comply with the requirements under
 sections 8.2 and 8.3 with regard to acting in collaboration with
 a physician and in accordance with a collaborative or written
 agreement with a physician, unless the individual qualifies for
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 the exception from the collaboration requirement according to
 the Board under section 8.1(l).
    Section 7.   Graduates of Schools of Other States, Territories
 or Dominion of Canada.--* * *
    (b)   The Board may issue a [certification to registered nurse
 practitioners who have] license as an APRN-CNP to a registered
 nurse who has completed a course of study considered by the
 Board to be equivalent to that required in this State at the
 time such course was completed or who is licensed or certified
 by another state, territory or possession of the United States
 or a foreign country as deemed equivalent to Pennsylvania's
 [certification] licensure requirements in accordance with the
 [joint] rules and regulations of the [Boards of Nursing and
 Medicine] Board.
    * * *
    Section 8.   Persons Entitled to Practice.--(a)   The Board
 shall issue to each person who meets the professional nursing
 licensure requirements of this act, a certificate setting forth
 that such person is licensed to engage in the practice of
 professional nursing and entitled to use the title "registered
 nurse" and the letters "R.N."
    (b)   The Board shall issue to each person who meets the
 dietitian-nutritionist licensure requirements of this act a
 certificate setting forth that such person is licensed as a
 dietitian-nutritionist and entitled to use the title "licensed
 dietitian-nutritionist" and the letters "L.D.N." A record of
 [all persons] each person licensed as [dietitian-nutritionists]
 a dietitian-nutritionist in this Commonwealth shall be kept in
 the office of the Board and shall be open to public inspection
 and copying upon payment of a nominal fee for copying the
20230SB0025PN0387                    - 9 -
 record.
    (c)    The Board shall issue to each person who meets the APRN-
 CNP licensure requirements of this act a certificate stating
 that such person is licensed as an APRN-CNP and entitled to use
 the title "advanced practice registered nurse-certified nurse
 practitioner" and the letters "APRN-CNP." A record of each
 person licensed as an APRN-CNP in this Commonwealth shall be
 kept in the office of the Board and posted on the Board's
 publicly accessible Internet website.
    Section 8.1.    Certified Registered Nurse Practitioners;
 Qualifications.--[(a)    The board may certify a licensed
 registered nurse as a certified registered nurse practitioner in
 a particular clinical specialty area if the nurse satisfies the
 requirements established by this act and regulations promulgated
 by the board. Certification of a nurse by the board shall expire
 on the same date as the license of that nurse expires.
    (b)    (1)