2021 - 2022 LEGISLATURE
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2021 ASSEMBLY BILL 396
June 14, 2021 - Introduced by Representatives CABRAL-GUEVARA, MAGNAFICI,
BRANDTJEN, BROOKS, CALLAHAN, GUNDRUM, KITCHENS, KNODL, KRUG,
KUGLITSCH, KURTZ, MACCO, MURPHY, PETERSEN, J. RODRIGUEZ, ROZAR,
SKOWRONSKI, SNYDER, TAUCHEN, TITTL, TUSLER, WICHGERS, RIEMER and
DITTRICH, cosponsored by Senators TESTIN, FELZKOWSKI, MARKLEIN, STROEBEL
and JACQUE. Referred to Committee on Health.
1 AN ACT to repeal 50.01 (1b), 77.54 (14) (f) 3., 118.2925 (1) (b), 146.89 (1) (r) 3.,
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) and 450.01 (1m); to renumber and amend 253.13 (1), 255.06 (1) (d), 441.06
5 (7) and 441.11 (2); to amend 14.87 (title), 29.193 (1m) (a) 2. (intro.), 29.193 (2)
6 (b) 2., 29.193 (2) (c) 3., 29.193 (2) (cd) 2. b., 29.193 (2) (cd) 2. c., 29.193 (2) (e),
7 29.193 (3) (a), 45.40 (1g) (a), 46.03 (44), 50.08 (2), 50.09 (1) (a) (intro.), 50.09 (1)
8 (f) 1., 50.09 (1) (h), 50.09 (1) (k), 50.49 (1) (b) (intro.), 51.41 (1d) (b) 4., 70.47 (8)
9 (intro.), 77.54 (14) (f) 4., 97.59, 102.13 (1) (a), 102.13 (1) (b) (intro.), 1., 3. and 4.,
10 102.13 (1) (d) 1., 2., 3. and 4., 102.13 (2) (a), 102.13 (2) (b), 102.17 (1) (d) 1. and
11 2., 102.29 (3), 102.42 (2) (a), 106.30 (1), 118.15 (3) (a), 118.25 (1) (a), 118.29 (1)
12 (e), 118.2925 (3), 118.2925 (4) (c), 118.2925 (5), 146.343 (1) (c), 146.82 (3) (a),
13 146.89 (1) (r) 1., 146.89 (1) (r) 8., 146.89 (6), 154.01 (1g), 252.07 (8) (a) 2., 252.07
14 (9) (c), 252.10 (7), 252.11 (2), (4), (5), (7) and (10), 252.15 (3m) (d) 11. b. and 13.,
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ASSEMBLY BILL 396
1 (5g) (c), (5m) (d) 2. and (e) 2. and 3. and (7m) (intro.) and (b), 252.16 (3) (c)
2 (intro.), 252.17 (3) (c) (intro.), 253.07 (4) (d), 253.115 (4), 253.115 (7) (a) (intro.),
3 253.15 (2), 255.06 (2) (d), 255.07 (1) (d), 257.01 (5) (a) and (b), 341.14 (1a), (1e)
4 (a), (1m) and (1q), 343.16 (5) (a), 343.51 (1), 343.62 (4) (a) 4., 440.094 (1) (c) 1.,
5 440.094 (2) (a) (intro.), 440.981 (1), 440.982 (1), 440.987 (2), 441.01 (3), 441.01
6 (4), 441.01 (7) (a) (intro.), 441.01 (7) (b), 441.06 (3), 441.06 (4), 441.07 (1g)
7 (intro.), (a), (c) and (e), 441.10 (7), 441.18 (2) (a) (intro.), 441.18 (2) (b), 441.18
8 (3), subchapter II (title) of chapter 441 [precedes 441.51], 441.51 (title), 448.03
9 (2) (a), 448.035 (2), (3) and (4), 448.56 (1) and (1m) (b), 448.62 (2m), 448.67 (2),
10 448.956 (1m), 450.01 (16) (h) 2., 450.01 (16) (hr) 2., 450.03 (1) (e), 450.11 (1g) (b),
11 450.11 (1i) (a) 1., 450.11 (1i) (b) 2. b., 450.11 (7) (b), 450.11 (8) (e), 450.13 (5) (b),
12 450.135 (7) (b), 462.04, 655.001 (7t), 655.001 (9), 655.005 (2) (a), 961.01 (19) (a)
13 and 961.395; to repeal and recreate 46.03 (44), 50.08 (2), 70.47 (8) (intro.),
14 146.82 (3) (a), 146.89 (1) (r) 1., 155.01 (1g) (b), 255.07 (1) (d), 343.16 (5) (a),
15 441.06 (title), 448.03 (2) (a), 448.035 (2), (3) and (4), 448.956 (1m), 450.11 (1g)
16 (b), 450.11 (1i) (a) 1., 462.04 and 961.01 (19) (a); and to create 253.115 (1) (f),
17 253.13 (1) (a), 253.15 (1) (em), 255.06 (1) (f) 2., 440.03 (13) (b) 39m., 440.08 (2)
18 (a) 47., 441.001 (1c), 441.001 (1m), 441.001 (3c), 441.001 (3g), 441.001 (3n),
19 441.001 (3r), 441.001 (3w), 441.001 (5), 441.01 (7) (c), 441.09 and 441.092 of the
20 statutes; relating to: advanced practice registered nurses, extending the time
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ASSEMBLY BILL 396
1 limit for emergency rule procedures, providing an exemption from emergency
2 rule procedures, and granting rule-making 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 in an amount determined 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, 2019, was 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.
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.
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ASSEMBLY BILL 396
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 APRNs with a specialty designation as a
certified nurse-midwife to file and keep current with DSPS a plan for involving a
hospital or physician in treating certain patients if the APRN practices outside of a
hospital.
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 were practicing in a
recognized role on January 1, 2019, but who did 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
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.
OTHER CHANGES
The bill makes numerous other changes throughout the statutes relating to
APRNs, including various terminology changes and technical changes relating to the
Nurse Licensure Compact.
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ASSEMBLY BILL 396
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. 14.87 (title) of the statutes is amended to read:
2 14.87 (title) Enhanced nurse Nurse licensure compact.
3 SECTION 2. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:
4 29.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
5 or both arms or one or both hands and fails to meet the minimum standards of any
6 one of the following standard tests, administered under the direction of a licensed
7 physician, a licensed physician assistant, a licensed chiropractor, or a certified
8 licensed advanced practice registered nurse prescriber:
9 SECTION 3. 29.193 (2) (b) 2. of the statutes is amended to read:
10 29.193 (2) (b) 2. An applicant shall submit an application on a form prepared
11 and furnished by the department, which shall include a written statement or report
12 prepared and signed by a licensed physician, a licensed physician assistant, a
13 licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice
14 registered nurse prescriber prepared no more than 6 months preceding the
15 application and verifying that the applicant is physically disabled.
16 SECTION 4. 29.193 (2) (c) 3. of the statutes is amended to read:
17 29.193 (2) (c) 3. The department may issue a Class B permit to an applicant
18 who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
19 subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
20 applicant and the recommendation of a licensed physician, a licensed physician
21 assistant, a licensed chiropractor, a licensed podiatrist, or a certified licensed
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1 advanced practice registered nurse prescriber selected by the applicant from a list
2 of licensed physicians, licensed physician assistants, licensed chiropractors, licensed
3 podiatrists, and certified licensed advanced practice nurse prescribers registered
4 nurses compiled by the department, the department finds that issuance of a permit
5 complies with the intent of this subsection. The use of this review procedure is
6 discretionary with the department and all costs of the review procedure shall be paid
7 by the applicant.
8 SECTION 5. 29.193 (2) (cd) 2. b. of the statutes is amended to read:
9 29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function
10 in one or both arms and fails to meet the minimum standards of the standard upper
11 extremity pinch test, the standard grip test, or the standard nine-hole peg test,
12 administered under the direction of a licensed physician, a licensed physician
13 assistant, a licensed chiropractor, or a certified licensed advanced practice registered
14 nurse prescriber.
15 SECTION 6. 29.193 (2) (cd) 2. c. of the statutes is amended to read:
16 29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in
17 one or both shoulders and fails to meet the minimum standards of the standard
18 shoulder strength test, administered under the direction of a licensed physician, a
19 licensed physician assistant, a licensed chiropractor, or a certified licensed advanced
20 practice registered nurse prescriber.
21 SECTION 7. 29.193 (2) (e) of the statutes is amended to read:
22 29.193 (2) (e) Review of decisions. An applicant denied a permit under this
23 subsection, except a permit under par. (c) 3., may obtain a review of that decision by
24 a licensed physician, a licensed physician assistant, a licensed chiropractor, a
25 licensed podiatrist, or a certified licensed advanced practice registered nurse
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ASSEMBLY BILL 396 SECTION 7
1 prescriber designated by the department and with an office located in the
2 department district in which the applicant resides. The department shall pay for the
3 cost of a review under this paragraph unless the denied application on its face fails
4 to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is
5 the only method of review of a decision to deny a permit under this subsection and
6 is not subject to further review under ch. 227.
7 SECTION 8. 29.193 (3) (a) of the statutes is amended to read:
8 29.193 (3) (a) Produces a certificate from a licensed physician, a licensed
9 physician assistant, a licensed optometrist, or a certified licensed advanced practice
10 registered nurse prescriber stating that his or her sight is impaired to the degree that
11 he or she cannot read ordinary newspaper print with or without corrective glasses.
12 SECTION 9. 45.40 (1g) (a) of the statutes is amended to read:
13 45.40 (1g) (a) “Health care provider" means an advanced practice registered
14 nurse prescriber certified who may issue prescription orders under s. 441.16 441.09
15 (2), an audiologist licensed under ch. 459, a dentist licensed under ch. 447, an
16 optometrist licensed under ch. 449, a physician licensed under s. 448.02, or a
17 podiatrist licensed under s. 448.63.
18 SECTION 10. 46.03 (44) of the statutes is amended to read:
19 46.03 (44) SEXUALLY TRANSMITTED DISEASE TREATMENT INFORMATION. Prepare and
20 keep current an information sheet to be distributed to a patient by a physician, a
21 physician assistant, or certified an advanced practice registered nurse prescriber
22 who may issue prescription orders under s. 441.09 (2) providing expedited partner
23 therapy to that patient under s. 441.092 or 448.035. The information sheet shall
24 include information about sexually transmitted diseases and their treatment and
25 about the risk of drug allergies. The information sheet shall also include a statement
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1 advising a person with questions about the information to contact his or her
2 physician, pharmacist, or local health department, as defined in s. 250.01 (4).
3 SECTION 11. 46.03 (44) of the statutes, as affected by 2021 Wisconsin Acts 23
4 and .... (this act), is repealed and recreated to read:
5 46.03 (44) SEXUALLY TRANSMITTED DISEASE TREATMENT INFORMATION. Prepare and
6 keep current an information sheet to be distributed to a patient by a physician,
7 physician assistant, or an advanced practice registered nurse who may issue
8 prescription orders under s. 441.09 (2