1Amending the act of May 22, 1951 (P.L.317, No.69), entitled, as
2amended, "An act relating to the practice of professional
3nursing; providing for the licensing of nurses and for the
4revocation and suspension of such licenses, subject to
5appeal, and for their reinstatement; providing for the
6renewal of such licenses; regulating nursing in general;
7prescribing penalties and repealing certain laws," further
8providing for definitions; and providing for licensure as a
9certified nurse practitioner.

10The General Assembly of the Commonwealth of Pennsylvania
11hereby enacts as follows:

12Section 1. Section 2(1), (10), (13) and (14) of the act of
13May 22, 1951 (P.L.317, No.69), known as The Professional Nursing
14Law, amended or added June 29, 2002 (P.L.651, No.99) and
15December 9, 2002 (P.L.1567, No.206), are amended and the section
16is amended by adding paragraphs to read:

17Section 2. Definitions.--When used in this act, the
18following words and phrases shall have the following meanings
19unless the context provides otherwise:

20(1) The "Practice of Professional Nursing" means diagnosing

1and treating human responses to actual or potential health
2problems through such services as casefinding, health teaching,
3health counseling, and provision of care supportive to or
4restorative of life and well-being, and executing medical
5regimens as prescribed by a licensed physician or dentist. The
6foregoing shall not be deemed to include acts of medical
7diagnosis or prescription of medical therapeutic or corrective
8measures, except as performed by a certified [registered] nurse
9practitioner acting in accordance with rules and regulations
10promulgated by the Board.

11* * *

12(10) "Medical nutrition therapy" means the component of
13nutrition therapy that concerns determining and recommending
14nutrient needs based on nutritional assessment and medical
15problems relative to diets prescribed by a licensed physician or 
16certified nurse practitioner, including:

17(i) tube feedings;

18(ii) specialized intravenous solutions;

19(iii) specialized oral solutions; and

20(iv) interactions of prescription drugs with food or
21nutrients.

22* * *

23[(13) "Collaboration" means a process in which a certified
24registered nurse practitioner works with one or more physicians
25to deliver health care services within the scope of the
26certified registered nurse practitioner's expertise. The process
27includes all of the following:

28(i) Immediate availability of a licensed physician to a
29certified registered nurse practitioner through direct
30communications or by radio, telephone or telecommunications.

1(ii) A predetermined plan for emergency services.

2(iii) A physician available to a certified registered nurse
3practitioner on a regularly scheduled basis for referrals,
4review of the standards of medical practice incorporating
5consultation and chart review, drug and other medical protocols
6within the practice setting, periodic updating in medical
7diagnosis and therapeutics and cosigning records when necessary
8to document accountability by both parties.

9(14) "Drug Review Committee" means the committee established
10in section 8.4 whose function is to approve or disapprove, by
11addition or deletion, the categories of drugs that may be
12prescribed by certified registered nurse practitioners.]

13* * *

14(16) "Certified nurse practitioner" or "advanced practice
15registered nurse-certified nurse practitioner" means a
16registered nurse licensed in this Commonwealth to practice
17independently in a particular clinical specialty area or
18population focus in which the registered nurse is certified.

19(17) "Population focus" means a category of the population
20within which a certified nurse practitioner practices, including
21family/individual across the lifespan, adult-gerontology,
22neonatal, pediatrics, women's health/gender-related,
23psychiatric/mental health and any other such categories as
24designated by board regulations.

25(18) "Controlled substance" means any drug designated as
26such under the provisions of the act of April 14, 1972 (P.L.233,
27No.64), known as the "Controlled Substance, Drug, Device and
28Cosmetic Act."

29(19) "Non-proprietary drug" means a drug containing any
30quantity of any controlled substance or any drug which is

1required by any applicable Federal or State law to be dispensed
2only by prescription.

3(20) "Proprietary drug" means a non-prescription, non-
4narcotic medicine or drug which may be sold without a
5prescription and which is prepackaged for use by the consumer
6and labeled in accordance with the requirements of the statutes
7and regulations of the Federal Government and this Commonwealth.

8(21) "Licensed independent practitioner" means any
9practitioner licensed under this act to provide care and
10services, without direction or supervision, within the scope of
11the practitioner's license.

12Section 2. Section 2.1(l) of the act, added December 9, 2002
13(P.L.1567, No.206), is amended to read:

14Section 2.1. State Board of Nursing.--* * *

15(l) Any powers and duties imposed on the State Board of
16Medicine or jointly imposed on the State Board of Medicine and
17the State Board of Nursing, with respect to certified
18[registered] nurse practitioners, by or pursuant to law or
19regulation shall, after the effective date of this subsection,
20be exercised solely by the State Board of Nursing. This
21subsection shall not apply to 49 Pa. Code §§ 21.283(4) (relating
22to prescribing and dispensing drugs) and 21.321 (relating to
23performance of tasks without direction; performance of tasks
24without training; other) unless the State Board of Nursing
25promulgates a regulation to exercise the duties imposed on the
26State Board of Medicine by those sections.

27Section 3. Sections 3.1(b) and 7(b) of the act, amended or
28added June 29, 2002 (P.L.651, No.99), are amended to read:

29Section 3.1. Dietitian-Nutritionist License Required.--* * *

30(b) Nothing in this section shall be construed to require or

1preclude third-party insurance reimbursement. Nothing herein
2shall preclude an insurer or other third-party payor from
3requiring that a licensed dietitian-nutritionist obtain a
4referral from a licensed physician, certified nurse 
5practitioner, dentist or podiatrist or that a licensed
6dietitian-nutritionist file an evaluation and treatment plan
7with the insurer or third-party payor as a precondition of
8reimbursement.

9Section 7. Graduates of Schools of Other States, Territories
10or Dominion of Canada.--* * *

11(b) The Board may issue a [certification to registered nurse
12practitioners who have] license as a certified nurse 
13practitioner to a registered nurse who has completed a course of
14study considered by the Board to be equivalent to that required
15in this State at the time such course was completed or who is
16licensed or certified by another state, territory or possession
17of the United States or a foreign country as deemed equivalent
18to Pennsylvania's [certification] licensure requirements in
19accordance with the [joint] rules and regulations of the [Boards
20of Nursing and Medicine] board.

21* * *

22Section 4. Section 8.1 of the act is amended by adding a
23subsection to read:

24Section 8.1. Certified Registered Nurse Practitioners;
25Qualifications.--* * *

26(d) The authority of the board to certify a licensed
27registered nurse as a certified registered nurse practitioner
28shall expire on the effective date of section 8.8.

29Section 5. Section 8.2 of the act, amended July 20, 2007
30(P.L.318, No.48), is amended to read:

1Section 8.2. Scope of Practice for Certified [Registered]
2Nurse Practitioners.--(a) A certified [registered] nurse
3practitioner [while functioning in the expanded role as a
4professional nurse] shall practice within the scope of practice
5of the particular clinical specialty area or population focus
6in which the nurse is [certified] licensed by the board.
7Notwithstanding any other provision of law, a certified nurse
8practitioner is entitled to all of the following:

9(1) To practice as a licensed independent practitioner
10within the scope of practice of the particular clinical
11specialty area or population focus in which the nurse is
12licensed by the board.

13(2) To be recognized as a primary care provider under
14managed care and other health care plans.

15(3) To be reimbursed directly by insurers and other
16third-party payors.

17(b) A certified [registered] nurse practitioner may perform
18acts of medical diagnosis [in collaboration with a physician
19and] in accordance with regulations promulgated by the board.

20(c) [Except as provided in subsection (c.1), a] A certified
21[registered] nurse practitioner may prescribe medical
22therapeutic or corrective measures if the nurse is acting in
23accordance with the provisions of section 8.3.

24(c.1) [Except as limited by subsection (c.2), and in] In
25addition to existing authority, a certified [registered] nurse
26practitioner shall have authority to do all of the following,
27provided that the certified nurse practitioner is acting within
28the scope of [the certified registered nurse practitioner's
29collaborative or written agreement with a physician and] the
30certified [registered] nurse practitioner's [specialty]

1certification:

2(1) Order home health and hospice care.

3(2) Order durable medical equipment.

4(3) Issue oral orders [to the extent permitted by the health
5care facilities' by-laws, rules, regulations or administrative
6policies and guidelines].

7(4) Make physical therapy and dietitian referrals.

8(5) Make respiratory, speech and occupational therapy
9referrals.

10(6) Perform disability assessments for the program providing
11Temporary Assistance to Needy Families (TANF).

12(7) Issue homebound schooling certifications.

13(8) Perform and sign the initial assessment of methadone
14treatment evaluations[, provided that any] and order [for]
15methadone treatment [shall be made only by a physician].

16(c.2) [Nothing in this section shall be construed to:

17(1) Supersede the authority of the Department of Health and
18the Department of Public Welfare to regulate the types of health
19care professionals who are eligible for medical staff membership
20or clinical privileges.

21(2) Restrict the authority of a health care facility to
22determine the scope of practice and supervision or other
23oversight requirements for health care professionals practicing
24within the facility.] (Reserved).

25(d) Nothing in this section shall be construed to limit or
26prohibit a certified [registered] nurse practitioner from
27engaging in those activities which normally constitute the
28practice of nursing as defined in section 2.

29Section 6. Sections 8.3 and 8.4 of the act, added December
309, 2002 (P.L.1567, No.206), are amended to read:

1Section 8.3. Prescriptive Authority for Certified
2[Registered] Nurse Practitioners.--(a) A certified [registered]
3nurse practitioner may prescribe medical therapeutic or
4corrective measures if the nurse:

5(1) has successfully completed at least forty-five (45)
6hours of coursework specific to advanced pharmacology at a level
7above that required by a professional nursing education program;

8(2) is [acting in collaboration with a physician as set
9forth in a written agreement which shall, at a minimum, identify
10the following:

11(i) the area of practice in which the nurse is certified;

12(ii) the categories of drugs from which the nurse may
13prescribe or dispense; and

14(iii) the circumstances and how often the collaborating
15physician will personally see the patient] practicing within a
16clinical specialty area or population focus in which the nurse
17is certified; and

18(3) is acting in accordance with regulations promulgated by
19the board.

20(b) A certified [registered] nurse practitioner who
21satisfies the requirements of subsection (a) may independently
22prescribe and dispense [those categories of drugs that certified
23registered nurse practitioners were authorized to prescribe and
24dispense by board regulations in effect on the effective date of
25this section, subject to the restrictions on certain drug
26categories imposed by those regulations. The board shall add to
27or delete from the categories of authorized drugs in accordance
28with the provisions of section 8.4] proprietary and non-
29proprietary drugs, subject to any restrictions imposed by board
30regulations or by Federal law.

1Section 8.4. [Drug Review Committee.--(a) The Drug Review
2Committee is hereby established and shall consist of seven
3members as follows:

4(1) The Secretary of Health or, at the discretion of the
5Secretary of Health, the Physician General as his or her
6designee, who shall act as chairman.

7(2) Two certified registered nurse practitioners who are
8actively engaged in clinical practice, appointed to three-year
9terms by the Secretary of Health.

10(3) Two licensed physicians who are actively engaged in
11clinical practice, appointed to three-year terms by the
12Secretary of Health, at least one of whom shall, at the time of
13appointment, be collaborating with one or more certified
14registered nurse practitioners in accordance with section 8.3(a)
15(2).

16(4) Two licensed pharmacists who are actively engaged in the
17practice of pharmacy, appointed to three-year terms by the
18Secretary of Health.

19(b) (1) The board shall submit to the Drug Review Committee
20any proposed change to the categories of drugs that certified
21registered nurse practitioners were authorized to prescribe
22pursuant to board regulations in effect on the effective date of
23this section. The board shall not change, by addition or
24deletion, the categories of authorized drugs without prior
25approval of the Drug Review Committee.

26(2) Within sixty (60) days of a submission by the board
27under paragraph (1), a majority of the Drug Review Committee
28shall vote to approve or disapprove the proposed change.

29(3) If a majority of the Drug Review Committee fails to vote
30to approve or disapprove the proposed change within sixty (60)

1days of receipt of a submission by the board under paragraph
2(1), the Drug Review Committee shall be deemed to have approved
3the proposed change.] (Reserved).

4Section 7. Section 8.7 of the act, added July 20, 2007
5(P.L.318, No.48), is amended to read:

6Section 8.7. Professional Liability.--A certified
7[registered] nurse practitioner practicing in this Commonwealth
8shall maintain a level of professional liability coverage as
9required for a nonparticipating health care provider under the
10act of March 20, 2002 (P.L.154, No.13), known as the "Medical
11Care Availability and Reduction of Error (Mcare) Act," but shall
12not be eligible to participate in the Medical Care Availability
13and Reduction of Error (Mcare) Fund.

14Section 8. The act is amended by adding a section to read:

15Section 8.8. Licensure as a Certified Nurse Practitioner.--
16(a) A registered nurse who holds current certification by the
17board, pursuant to section 8.1, as a certified registered nurse
18practitioner in a particular clinical specialty area on the
19effective date of this section shall automatically be deemed to
20be licensed by the board as a certified nurse practitioner,
21either in that specialty area or in the population focus for
22which that registered nurse is otherwise qualified. The board
23shall issue appropriate written notice of such license as a
24certified nurse practitioner, provided that the issuance of that
25notice shall not be a condition precedent to practice in
26accordance with that license.

27(b) Except as provided in subsection (a), a person shall not
28qualify for an initial license as a certified nurse practitioner
29on or after the effective date of this section unless the person
30meets the following criteria:

1(1) Holds a current license in this Commonwealth as a
2registered nurse.

3(2) Is a graduate of an accredited, board-approved master's
4or post master's nurse practitioner program.

5(3) Holds current certification as a certified nurse
6practitioner from a board-recognized national certification
7program which required passing a national certifying examination
8in the particular clinical specialty area or population focus in
9which the nurse is seeking licensure by the board.

10(c) (1) An initial license pursuant to subsection (a) as a
11certified nurse practitioner shall expire on the same date as
12the nurse's then-current license as a registered nurse is
13scheduled to expire. Such license as a certified nurse
14practitioner shall thereafter be renewed biennially on the same
15date as the nurse's license as a registered nurse.

16(2) An initial license pursuant to subsection (b) or section
177(b) as a certified nurse practitioner shall expire on the same
18date as the nurse's then-current license as a registered nurse
19is scheduled to expire. Such license as a certified nurse
20practitioner shall thereafter be renewed biennially on the same
21date as the nurse's license as a registered nurse.

22(3) As a condition for biennial renewal by the board of a
23license as a certified nurse practitioner, the nurse must do all
24of the following:

25(i) Maintain a current license in this Commonwealth as a
26registered nurse.

27(ii) Maintain current certification through a board-
28recognized national certification program in the particular
29clinical specialty area or population focus in which the nurse
30is licensed as a certified nurse practitioner by the board.

1(iii) In the two years prior to renewal, complete at least
2thirty (30) hours of continuing education approved by the board.
3In the case of a certified nurse practitioner who is prescribing
4medical therapeutic or corrective measures pursuant to section
58.3, that continuing education must include at least sixteen
6(16) hours in pharmacology in that two-year period.

7(d) The board shall establish a procedure by which a license
8as a certified nurse practitioner may be amended prior to the
9biennial renewal date in order to authorize a nurse to practice
10in a particular clinical specialty area or population focus in
11which the nurse was not certified on the effective date of this
12section or on the date on which the nurse's current license as a
13certified nurse practitioner was issued or renewed. The board
14shall authorize a certified nurse practitioner to practice in an
15additional clinical specialty area or population focus only if
16the nurse holds current certification from a board-recognized
17national certification program which required the passing of a
18national certifying examination in the additional clinical
19specialty area or population focus.

20(e) (1) The use of the terms "certified registered nurse
21practitioner," "registered nurse practitioner," "certified nurse
22practitioner" and "nurse practitioner" in any other act shall be
23deemed to include a person licensed as a certified nurse
24practitioner pursuant to this section or to section 7(b).

25(2) A registered nurse who is licensed by the board as a
26certified nurse practitioner in a particular clinical specialty
27area or population focus is entitled to use the title "advanced
28practice registered nurse-certified nurse practitioner" and the
29letters "A.P.R.N.-C.N.P." It shall be unlawful for any other
30person to use the title "advanced practice registered nurse-

1certified nurse practitioner" or the letters "A.P.R.N.-C.N.P."

2(f) (1) A certified nurse practitioner may form a
3professional corporation with one or more of the following:

4(i) Other registered nurses.

5(ii) Other health care practitioners who treat human
6ailments and conditions and are licensed to provide health care
7services in this Commonwealth without receiving a referral or
8supervision from another health care practitioner.

9(2) This subsection shall be construed to abrogate the
10requirement that the State Board of Medicine and the State Board
11of Osteopathic Medicine expressly authorize the combined
12practice of certified nurse practitioners with doctors of
13medicine or doctors of osteopathic medicine, respectively, found
14in section 2903(d)(1)(ii) of Title 15 of the Pennsylvania
15Consolidated Statutes.

16Section 9. Within 90 days after the effective date of this
17act, the State Board of Nursing shall initiate the promulgation
18of any regulations necessary because of the amendments made by
19this act to the act of May 22, 1951 (P.L.317, No.69), known as
20the Professional Nursing Law, provided that the promulgation of
21those regulations shall not be a condition precedent to the
22applicability of any such amendments.

23Section 10. This act shall take effect in 60 days.