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
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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) "A dvanced 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.
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(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
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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 "a dvanced 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) Beginning on the effective date of this section, a
nurse shall not qualify for initial certification by the board
under subsection (a) unless the nurse:
(i) is a graduate of an accredited, board-approved master's
or post-master's nurse practitioner program; and
(ii) holds certification as a certified registered nurse
practitioner from a board-recognized national certification
organization which required passing of a national certifying
examination in the particular clinical specialty area in which
the nurse is seeking certification by the board.
(2) This subsection shall not apply to a nurse who:
(i) holds certification from the board as a certified
registered nurse practitioner on the effective date of this
subsection; or
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(ii) would otherwise qualify for certification as a
certified registered nurse practitioner under section 7(b).
(3) In order to provide a transition period for persons who
completed or were enrolled in an approved educational program on
the effective date of this section and to permit those persons
to apply for certification under the rules in existence
immediately prior to the effective date of this section, the
board shall issue initial certification to any person who,
within two (2) years of the effective date of this section:
(i) submits evidence of having completed or been enrolled in
an approved educational program on the effective date of this
section; and
(ii) fulfills all administrative requirements of the board
and possesses all of the other qualifications for certification
in effect immediately prior to the effective date of this
section.
(c) As a condition for biennial renewal of certification by
the board, a certified registered nurse practitioner must, in
the two (2) years prior to renewal, complete at least thirty
(30) hours of continuing education approved by the board. In the
case of a certified registered nurse practitioner who is
prescribing medical therapeutic or corrective measures pursuant
to section 8.3, that continuing education must include at least
sixteen (16) hours in pharmacology in that two-year period.]
Advanced Practice Registered Nurse-Certified Nurse
Practitioner.--
(d) A registered nurse who holds current certification by
the Board on the effective date of this subsection as a
certified registered nurse practitioner in a population focus
area shall automatically be deemed to be licensed by the Board
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as an APRN-CNP in the population focus area for which the
registered nurse is certified. The Board shall issue appropriate
written notice of the license as an APRN-CNP, except that the
issuance of that notice shall not be a condition precedent to
practice in accordance with the license.
(e) Except as provided in subsection (d), an individual
shall not qualify for an initial license as an APRN-CNP on or
after the effective date of this subsection unless the person
meets the following criteria:
(1) Holds a current license in this Commonwealth as a
registered nurse.
(2) Is a graduate of an accredited, Board-approved nurse
practitioner program at the master's, post-master's or doctoral
level.
(3) Holds current certification as an APRN-CNP from a Board-
recognized national certification program that requires passage
of a national certifying examination in a population focus area
for which the registered nurse is certified and is seeking
licensure by the Board.
(f) (1) An initial license under subsection (d) as an APRN-
CNP shall expire on the same date as the registered nurse's then
current license as a registered nurse is scheduled to expire.
The license as an APRN-CNP shall thereafter be renewed
biennially on the same date as the nurse's license as a
registered nurse.
(2) An initial license under subsection (e) or section 7(b)
as an APRN-CNP shall expire on the same date as the registered
nurse's then current license as a registered nurse is scheduled
to expire. The license as an APRN-CNP shall thereafter be
renewed biennially on the same date as the nurse's license as a
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registered nurse.
(3) As a condition for biennial renewal by the Board of a
license as an APRN-CNP , the nurse must do all of the following:
(i) Maintain a current license in this Commonwealth as a
registered nurse.
(ii) Maintain current certification through a Board-
recognized national certification program in the population
focus area in which the registered nurse is licensed as an APRN-
CNP by the Board.
(iii) In the two (2) years prior to renewal, complete at
least thirty (30) hours of continuing education approved by the
Board. For an APRN-CNP who is prescribing medical therapeutic or
corrective measures under section 8.3, the continuing education
shall include at least sixteen (16) hours in pharmacology in the
two-year period.
(g) The Board shall establish a procedure by which a license
as an APRN-CNP may be amended prior to the biennial renewal date
in order to authorize a registered nurse to practice in a
population focus area in which the nurse was not certified on
the effective date of this subsection or on the date on which
the nurse's current license as an APRN-CNP was issued or
renewed. The Board shall authorize an APRN-CNP to practice in an
additional population focus area only if the nurse holds current
certification from a Board-recognized national certification
program that requires passage of a national certifying
examination in the additional population focus area.
(h) (1) The use of the terms "certified registered nurse
practitioner," "registered nurse practitioner," "certified nurse
practitioner" and "nurse practitioner" in any other act shall be
deemed to include a person licensed as an APRN-CNP under this
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section or section 7(b) and shall be entitled to practice in
accordance with this act, notwithstanding any other provision of
law.
(2) A registered nurse who is licensed by the Board as an
APRN-CNP in a population focus area is entitled to use the title
"advanced practice registered nurse-certified nurse
practitioner" and the letters "APRN-CNP." It shall be unlawful
for any other person to use the title "advanced practice
registered nurse-certified nurse practitioner" or the letters
"APRN-CNP."
(i) (1) An APRN-CNP may form a professional corporation
with one or more of the following:
(i) Other registered nurses.
(ii) Other health care 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 health care practitioner.
(2) This subsection shall be construed to abrogate the
requirement that the State Board of Medicine and the State Board
of Osteopathic Medicine expressly authorize the combined
practice of APRN-CNPs with doctors of medicine or doctors of
osteopathic medicine, respectively, found in 15 Pa.C.S. §
2903(d)(1)(ii) (relating to formation of professional
corporations).
(j) An APRN-CNP who has engaged in the practice of
professional nursing in collaboration with a physician for a
period of not less than three (3) years and not less than three
thousand six hundred (3,600) hours in accordance with a written
collaborative agreement with a physician shall not be subject to
the requirements under sections 8.2(b) and 8.3(a)(2)(i).
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(k) An APRN-CNP who qualifies for the exception under
subsection (j) shall file a form with the Board attesting to
having engaged in the practice of professional nursing in
collaboration with a physician for a period of not less than
three (3) years and not less than three thousand six hundred
(3,600) hours pursuant to a written collaborative agreement. The
form shall be developed by the Board.
(l) A registered nurse who was licensed or certified by
another state, territory or possession of the United States or a
foreign country and received a license as an APRN-CNP issued by
the Board or a temporary practice permit to practice as an APRN-
CNP under section 4.1 may qualify for the exception under
subsection (j) if the APRN-CNP satisfactorily demonstrates to
the Board the completion of no less than three (3) years and no
less than three thousand six hundred (3,600) hours of practice
in collaboration with a physician deemed equivalent to the
requirements of subsection (j) which occurred in this
Commonwealth or in one or more other states, territories or
possessions of the United States or foreign countries where the
APRN-CNP was previously, or is currently, licensed.
(m) The APRN-CNP shall be accountable to patients, the
nursing profession and the Board and shall:
(1) Comply with the requirements of this chapter and the
quality expectations of advanced nursing care rendered.
(2) Recognize limits of knowledge and experience.
(3) Plan for the management of situations beyond the APRN-
CNP's expertise.
(4) Consult with or refer patients to other health care
providers, as appropriate.
Section 8.2. Scope of Practice for [Certified Registered
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Nurse Practitioners] A dvanced Practice Registered Nurse-
Certified Nurse Practitioners.--(a) A [certified registered
nurse practitioner while functioning in the expanded role as a
professional nurse] An APRN-CNP shall practice within the scope
of practice of the [particular clinical specialty] population
focus area in which the nurse is [certified] licensed by the
board. Notwithstanding any other provision of law, an APRN-CNP
who meets the requirements under section 8.1(j) or (l) is
entitled to all of the following:
(1) To practice as a licensed independent practitioner
within the scope of practice of a particular population focus
area.
(2) To be recognized as a primary care provider under
managed care and other health care plans.
(b) [A certified registered nurse practitioner] Except as
provided under section 8.1(j) or (l), an APRN-CNP may perform
acts of medical diagnosis [in collaboration] pursuant to a
written collaboration agreement with a physician and in
accordance with regulations promulgated by the board.
(c) Except as provided in subsection (c.1), [a certified
registered nurse practitioner] an APRN-CNP may prescribe medical
therapeutic or corrective measures if the nurse is acting in
accordance with the provisions of section 8.3.
(c.1) [Except as limited by subsection (c.2), and in] An
APRN-CNP who has not met the three-year or 3600-hour requirement
under section 8.1(j) or (l), in addition to existing authority,
[a certified registered nurse practitioner] shall have authority
to do all of the following, provided that the [certified nurse
practitioner] APRN-CNP is acting within the scope of the
[certified registered nurse practitioner's] APRN-CNP's written
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collaborative [or written] agreement with a physician and the
[certified registered nurse practitioner's specialty
certification] APRN-CNP's population focus area:
(1) Order home health and hospice care.
(2) Order durable medical equipment.
(3) Issue oral orders [to the extent permitted by the health
care facilities' by-laws, rules, regulations or administrative
policies and guidelines].
(4) Make physical therapy and dietitian referrals.
(5) Make respiratory, speech and occupational therapy
referrals.
(6) Perform disability assessments for the program providing
Temporary Assistance to Needy Families (TANF).
(7) Issue homebound schooling certifications.
(8) Perform and sign the initial assessment of methadone
treatment evaluations[, provided that any] and order [for]
methadone treatment [shall be made only by a physician].
(c.2) [Nothing in this section shall be construed to:
(1) Supersede the authority of the Department of Health and
the Department of Public Welfare to regulate the types of health
care professionals who are eligible for medical staff membership
or clinical privileges.
(2) Restrict the authority of a health care facility to
determine the scope of practice and supervision or other
oversight requirements for health care professionals practicing
within the facility.] Notwithstanding any provision of the act
of July 19, 1979 (P.L.130, No.48), known as the "Health Care
Facilities Act," no regulation or order of the Department of
Health, the Department of Human Services or the Insurance
Department shall preclude the decision of the governing body of
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a health care facility that the types of health care
professionals who are eligible for medical staff membership or
clinical privileges at the facility include APRN-CNPs when
practicing as licensed independent practitioners.
(d) Nothing in this section shall be construed to limit or
prohibit [a certified registered nurse practitioner] an APRN-CNP
from engaging in those activities which normally constitute the
practice of professional nursing as defined in section 2.
Section 8.3. Prescriptive Authority for [Certified
Registered] Advanced Practice Registered Nurse-Certified Nurse
Practitioners.--(a) [A certified registered nurse practitioner]
An APRN-CNP may prescribe medical therapeutic or corrective
measures if the nurse:
(1) has successfully completed at least forty-five (45)
hours of coursework specific to advanced pharmacology at a level
above that required by a professional nursing education program;
(2) (i) except as provided under subparagraph (ii), is
acting [in collaboration with a physician as set forth in a]
within the scope of a written collaborative agreement with a
physician which shall, at a minimum, identify the following:
[(i)] (A) the area of practice in which the nurse is
certified;
[(ii)] (B) the categories of drugs from which the nurse may
prescribe or dispense; and
[(iii)] (C) the circumstances and how often the
collaborating physician will personally see the patient; [and]
or
(ii) is an APRN-CNP that qualifies for the exception under
section 8.1(j) or (l) and is practicing within a population
focus area in which the nurse is certified by a Board-recognized
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national certification program ; and
(3) is acting in accordance with regulations promulgated by
the board.
(b) [A certified registered nurse practitioner] An APRN-CNP
who satisfies the requirements of subsection (a) may prescribe
and dispense [those categories of drugs that certified
registered nurse practitioners were authorized to prescribe and
dispense by board regulations in effect on the effective date of
this section, subject to the restrictions on certain drug
categories imposed by those regulations. The board shall add to
or delete from the categories of authorized drugs in accordance
with the provisions of section 8.4] proprietary and
nonproprietary drugs, subject to any restrictions imposed by
Board regulations or by Federal law.
Section 8.4. [Drug Review Committee.--(a) The Drug Review
Committee is hereby established and shall consist of seven
members as follows:
(1) The Secretary of Health or, at the discretion of the
Secretary of Health, the Physician General as his or her
designee, who shall act as chairman.
(2) Two certified registered nurse practitioners who are
actively engaged in clinical practice, appointed to three-year
terms by the Secretary of Health.
(3) Two licensed physicians who are actively engaged in
clinical practice, appointed to three-year terms by the
Secretary of Health, at least one of whom shall, at the time of
appointment, be collaborating with one or more certified
registered nurse practitioners in accordance with section 8.3(a)
(2).
(4) Two licensed pharmacists who are actively engaged in the
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practice of pharmacy, appointed to three-year terms by the
Secretary of Health.
(b) (1) The board shall submit to the Drug Review Committee
any proposed change to the categories of drugs that certified
registered nurse practitioners were authorized to prescribe
pursuant to board regulations in effect on the effective date of
this section. The board shall not change, by addition or
deletion, the categories of authorized drugs without prior
approval of the Drug Review Committee.
(2) Within sixty (60) days of a submission by the board
under paragraph (1), a majority of the Drug Review Committee
shall vote to approve or disapprove the proposed change.
(3) If a majority of the Drug Review Committee fails to vote
to approve or disapprove the proposed change within sixty (60)
days of receipt of a submission by the board under paragraph
(1), the Drug Review Committee shall be deemed to have approved
the proposed change.] (Reserved).
Section 8.7. Professional Liability.--[A certified
registered nurse practitioner] An APRN-CNP practicing in this
Commonwealth shall maintain a level of professional liability
coverage as required for a nonparticipating health care provider
under the act of March 20, 2002 (P.L.154, No.13), known as the
"Medical Care Availability and Reduction of Error (Mcare) Act,"
but shall not be eligible to participate in the Medical Care
Availability and Reduction of Error (Mcare) Fund.
(b) An APRN-CNP who qualifies for the exception under
section 8.1(j) or (l) and practices without the need for a
written collaborative agreement with a physician shall satisfy
the liability coverage requirement under subsection (a) by
maintaining an individual policy in the APRN-CNP ' s own name .
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Section 11.1. Reporting of Multiple Licensure.--Any licensed
professional nurse or dietitian-nutritionist of this
Commonwealth who is also licensed to practice nursing, advanced
practice registered nursing or dietetics-nutrition in any other
state, territory, possession or country shall report this
information to the Board on the biennial registration
application. Any disciplinary action taken in other states shall
be reported to the Board on the biennial registration
application or within ninety (90) days of final disposition,
whichever is sooner. Multiple licensure shall be noted by the
Board on the licensee's record, and such state, territory,
possession or country shall be notified by the Board of any
disciplinary actions taken against said licensee in this
Commonwealth.
Section 12.1. Continuing Nursing Education.--* * *
(g) In lieu of meeting the requirements of this section:
(1) [Certified registered nurse practitioners] APRN-CNPs
and dietetics-nutrition licensees shall fulfill the
requirements for continuing education in accordance with
sections 8.1 and 11, respectively.
* * *
Section 13. Punishment for Violations.--* * *
(b) In addition to any other civil remedy or criminal
penalty provided for in this act, the Board, by a vote of the
majority of the maximum number of the authorized membership of
the Board as provided by law or by a vote of the majority of the
duly qualified and confirmed membership or a minimum of five (5)
members, whichever is greater, may levy a civil penalty of up to
one thousand dollars ($1,000) on any current licensee who
violates any provision of this act or on any person who
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practices nursing, practices advanced practice registered
nursing or holds himself or herself forth as a licensed
dietitian-nutritionist without being properly licensed to do so
under this act or on the responsible officers or employes of any
corporation, copartnership, institution or association violating
any of the provisions of this act. The Board shall levy this
penalty only after affording the accused party the opportunity
for a hearing, as provided in Title 2 of the Pennsylvania
Consolidated Statutes (relating to administrative law and
procedure).
Section 14. Refusal, Suspension or Revocation of Licenses.--
(a) The Board may refuse, suspend or revoke any license in any
case where the Board shall find that--
(1) The licensee is on repeated occasions negligent or
incompetent in the practice of professional nursing, advanced
practice registered nursing or dietetics-nutrition.
(2) The licensee is unable to practice professional nursing
or the practice of advanced practice registered nursing with
reasonable skill and safety to patients by reason of mental or
physical illness or condition or physiological or psychological
dependence upon alcohol, hallucinogenic or narcotic drugs or
other drugs which tend to impair judgment or coordination, so
long as such dependence shall continue. In enforcing this clause
(2), the Board shall, upon probable cause, have authority to
compel a licensee to submit to a mental or physical examination
as designated by it. After notice, hearing, adjudication and
appeal as provided for in section 15, failure of a licensee to
submit to such examination when directed shall constitute an
admission of the allegations against him or her unless failure
is due to circumstances beyond his or her control, consequent
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upon which a default and final order may be entered without the
taking of testimony or presentation of evidence. A licensee
affected under this paragraph shall at reasonable intervals be
afforded an opportunity to demonstrate that he or she can resume
a competent practice of professional nursing or the practice of
advanced practice registered nursing with reasonable skill and
safety to patients.
* * *
(4) The licensee has committed fraud or deceit in:
(i) the practice of nursing, the practice of advanced
practice registered nursing or in securing his or her admission
to such practice or nursing school; or
(ii) the practice of dietetics-nutrition or in securing his
or her license as a dietitian-nutritionist.
* * *
(b) When the Board finds that the license of any nurse or
dietitian-nutritionist may be refused, revoked or suspended
under the terms of subsection (a), the Board may:
* * *
(6) Restore or reissue, in its discretion, a suspended
license to practice professional or practical nursing, advanced
practice registered nursing or dietetics-nutrition and impose
any disciplinary or corrective measure which it might originally
have imposed.
Section 15.2. Reinstatement of License.--Unless ordered to
do so by Commonwealth Court or an appeal therefrom, the Board
shall not reinstate the license of a person to practice nursing,
advanced practice registered nursing or dietetics-nutrition
which has been revoked. Any person whose license has been
revoked may reapply for a license, after a period of at least
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five (5) years, but must meet all of the licensing
qualifications of this act for the license applied for, to
include the examination requirement, if he or she desires to
practice at any time after such revocation.
Section 15.4. Injunction or Other Process.--It shall be
unlawful for any person to practice or attempt to offer to
practice nursing, practice advanced practice registered nursing
or hold himself or herself forth as a licensed dietitian-
nutritionist[, as defined in this act,] or an APRN-CNP without
having at the time of so doing a valid, unexpired, unrevoked and
unsuspended license issued under this act. The unlawful practice
of nursing [as defined in this act] or unlawful practice of
advanced practice registered nursing may be enjoined by the
courts on petition of the Board or the Commissioner of
Professional and Occupational Affairs. In any such proceeding,
it shall not be necessary to show that any person is
individually injured by the actions complained of. If it is
determined that the respondent has engaged in the unlawful
practice of nursing or the unlawful practice of advanced
practice registered nursing, the court shall enjoin him or her
from so practicing unless and until he or she has been duly
licensed. Procedure in such cases shall be the same as in any
other injunction suit. The remedy by injunction hereby given is
in addition to any other civil or criminal prosecution and
punishment.
Section 4. The authority of the State Board of Nursing to
certify a licensed registered nurse as an advanced practice
registered nurse-certified nurse practitioner shall expire on
the effective date of this section.
Section 5. Within 90 days after the effective date of this
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section, the State Board of Nursing, the Department of Health,
the Department of Human Services and other affected agencies
shall initiate the promulgation of regulations necessary to
carry out the provisions of this act. The promulgation of the
regulations shall not be a condition precedent to the
applicability of this act.
Section 6. All other acts and parts of acts are repealed
insofar as they are inconsistent with this act.
Section 7. This act shall take effect in 60 days.
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