S0025B0387A05357 MSP:MAC 07/01/24 #90 A05357
AMENDMENTS TO SENATE BILL NO. 25
Sponsor: SENATOR PENNYCUICK
Printer's No. 387
Amend Bill, page 1, lines 1 through 23, by striking out all
of said lines and inserting
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
definitions; and providing for the Rural Certified Registered
Nurse Practitioner Health Care Access Program.
Amend Bill, page 1, lines 26 and 27; pages 2 through 24,
lines 1 through 30; page 25, lines 1 through 9; by striking out
all of said lines on said pages and inserting
Section 1. Section 2 of the act of May 22, 1951 (P.L.317,
No.69), known as The Professional Nursing Law, is amended by
adding clauses 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:
* * *
(18) "Primary health care practitioner" means a certified
registered nurse practitioner providing medical services in any
of the following specialty areas:
(i) Family.
(ii) Adult.
(iii) Adult gerontology.
(iv) General pediatrics.
(v) Women's health.
(vi) Mental health.
(19) "Program" means the Rural Certified Registered Nurse
Practitioner Health Care Access Program established under
section 9(a).
(20) "Rural area" means:
(i) A county where the total population of a specific county
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divided by the total number of square land miles yields a
population density fewer than 291 people per square mile based
on 2020 Federal decennial census figures.
(ii) A county designated under section 9(m).
(21) "Rural certified registered nurse practitioner" means a
certified registered nurse practitioner licensed in this
Commonwealth to practice in a rural area of this Commonwealth as
a primary health care practitioner.
Section 2. The act is amended by adding a section to read:
Section 9. Rural Certified Registered Nurse Practitioner
Health Care Access Program.--(a) The board shall establish the
Rural Certified Registered Nurse Practitioner Health Care Access
Program to allow an eligible rural certified registered nurse
practitioner to practice as an independent practitioner without
a written or collaborative agreement with a physician in a rural
area.
(b) A certified registered nurse practitioner may
participate in the program if the certified registered nurse
practitioner meets all of the following:
(1) Holds a current license to practice as a certified
registered nurse practitioner in this Commonwealth.
(2) Received no disciplinary action or has no pending
disciplinary action within the five (5) years immediately
preceding the date of the application under paragraph (4).
(3) Engaged in the practice of professional nursing pursuant
to a collaborative or written agreement with a physician for a
period of not less than three (3) years and not less than three
thousand six hundred (3,600) hours and the practice occurred
within the five (5) years immediately preceding the date of the
certified registered nurse practitioner's application under
paragraph (4).
(4) Submits an application to the board on a form prescribed
by the board and pays a fee established by the board.
(5) Submits an attestation that the certified registered
nurse practitioner meets the criteria to become a rural
certified registered nurse practitioner to participate in the
program.
(b.1) The following shall apply:
(1) The application under subsection (b)(4) shall be issued
no later than thirty (30) days after the effective date of this
section.
(2) Upon approval of the application by the board, the
certified registered nurse practitioner shall be deemed a rural
certified registered nurse practitioner for practice in rural
areas under the program.
(c) While practicing under the program, a rural certified
registered nurse practitioner may do all of the following:
(1) Practice in accordance with section 8.2 without a
written or collaborative agreement.
(2) Prescribe medical therapeutic or corrective measures in
accordance with section 8.3 without a written or collaborative
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agreement.
(d) In order to continue to participate in the program, a
rural certified registered nurse practitioner shall be subject
to biennial renewal and shall submit a renewal application on a
form prescribed by the board, pay a fee established by the board
and complete at least ten (10) hours of continuing education
approved by the board in patient safety and risk management. The
renewal application under this subsection shall contain an
attestation that the rural certified registered nurse
practitioner completed the continuing education required under
this subsection. The continuing education required under this
subsection shall be in addition to the continuing education
required under section 8.1(c).
(e) While practicing in a rural area under the program, the
rural certified registered nurse practitioner shall act solely
as a primary health care practitioner. A rural certified
registered nurse practitioner shall immediately notify the board
in writing if there are changes in practice or location outside
a rural area. A rural certified registered nurse practitioner
who fails to provide the notice required under this subsection
or who is found to be practicing outside of the rural area
specified may not continue to practice in the program.
(f) While participating in the program in a rural area, a
rural certified registered nurse practitioner shall be
accountable to the board, nursing profession and patients and
shall have the following duties:
(1) To comply with the requirements of this act and the
standard of care of advanced nursing care rendered.
(2) To recognize any limitations regarding knowledge and
experience.
(3) To wear a name identification badge stating the rural
certified registered nurse practitioner's professional title and
inform new patients about the rural certified registered nurse
practitioner's title before or during the initial patient
encounter. Signage and advertisements must contain the rural
certified registered nurse practitioner's professional title.
(4) To plan for the management of situations beyond the
rural certified registered nurse practitioner's expertise.
(5) To consult with and refer patients to other health care
providers as appropriate.
(g) The board shall be responsible for administering the
program and shall issue regulations as may be necessary to carry
out the provisions of this section. The promulgation of
regulations shall not be a condition precedent to the
applicability of this section.
(h) If a rural certified registered nurse practitioner
intends to practice simultaneously under the program and
pursuant to a written or collaborative agreement with a
physician who is external to the program, the collaborating
physician shall have no legal responsibility for acts or
omissions of the rural certified registered nurse practitioner
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practicing under the program.
(i) Nothing in this section shall be construed to do any of
the following:
(1) Permit a rural certified registered nurse practitioner
to practice under the act of December 20, 1985 (P.L.457,
No.112), known as the "Medical Practice Act of 1985," or the act
of October 5, 1978 (P.L.1109, No.261), known as the "Osteopathic
Medical Practice Act."
(2) Prohibit a rural certified registered nurse practitioner
from consulting with or seeking information related to patient
care from a physician. For the purpose of this section, no
physician-patient relationship shall be established between a
patient and a physician with whom the rural certified registered
nurse practitioner consults or from whom clinical information or
guidance is sought.
(j) Notwithstanding any other provision of law, a rural
certified registered nurse practitioner participating in the
program shall be authorized to practice as a licensed
independent practitioner within the scope of practice for which
the rural certified registered nurse practitioner practices as a
primary health care practitioner practices and to be recognized
as a primary care provider under managed care and other health
care plans.
(k) The following shall apply:
(1) A rural certified registered nurse practitioner
participating in the program may form a professional corporation
with one or more of the following:
(i) Registered nurses.
(ii) Practitioners who treat human ailments and conditions
and are licensed to provide health care services in this
Commonwealth without receiving a referral or supervision from
another practitioner.
(2) Notwithstanding 15 Pa.C.S. ยง 2903(d)(1)(ii) (relating to
formation of professional corporations), rural certified
registered nurse practitioners participating in the program and
practicing in a rural area shall not be required to have express
authorization by the State Board of Medicine and the State Board
of Osteopathic Medicine for the combined practice of rural
certified registered nurse practitioners with doctors of
medicine and doctors of osteopathic medicine, respectively.
(l) A rural certified registered nurse practitioner who
participates in the program must satisfy the liability coverage
requirement under section 8.7 by maintaining an individual
policy in the rural certified registered nurse practitioner's
own name and by providing proof of current coverage to the board
in conjunction with the initial application for participation in
the program and the issuance or renewal of the rural certified
registered nurse practitioner's license.
(m) On an annual basis, the Center for Rural Pennsylvania
shall add to the rural area designation based on any necessary
recalculation of population density in this Commonwealth and
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provide the information to the board for use in determining the
scope of the program. The board shall transmit a list of any
counties added under this subsection to the Legislative
Reference Bureau for publication in the next available issue of
the Pennsylvania Bulletin.
Section 3. This act shall take effect in 60 days.
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