Report Title:

Health Care; Advanced Practice Registered Nurse; Primary Care Provider; Prescriptive Authority

 

Description:

Requires insurers, mutual and fraternal benefit societies, and health maintenance organizations to recognize advanced practice registered nurses as primary care providers.  Grants global signature authority and prescriptive rights.  Amends definition of advanced practice registered nurse.  (SD1)

 

THE SENATE	S.B. NO.	1045
TWENTY-FIFTH LEGISLATURE, 2009		S.D. 1
STATE OF HAWAII

A BILL FOR AN ACT

 

 

RELATING TO ADVANCED PRACTICE REGISTERED NURSES.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§431:10A-    Primary care provider; advanced practice registered nurse.  (a)  Each policy of accident and health or sickness insurance delivered or issued for delivery in this State shall recognize advanced practice registered nurses as defined under section 457-8.5 as participating providers and shall include coverage for care provided by participating advanced practice registered nurses practicing within the scope of their licenses for purposes of health maintenance, diagnosis or treatment to the extent that the policy provides benefits for identical services rendered by another health care provider.

     (b)  Notwithstanding any other law to the contrary, an insurer shall provide its insured with an opportunity to select a participating advanced practice registered nurse as a primary care provider, if the insured's policy requires the selection of a primary care provider, and shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers."

     SECTION 2.  Chapter 432, article 1, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§432:1-    Primary care provider; advanced practice registered nurse.  (a)  Each policy of insurance delivered or issued for delivery in this State by a mutual benefit society shall recognize advanced practice registered nurses as defined under section 457-8.5 as participating providers and shall include coverage for care provided by participating advanced practice registered nurses practicing within the scope of their licenses for purposes of health maintenance, diagnosis or treatment to the extent that the policy provides benefits for identical services rendered by another health care provider.

     (b)  Notwithstanding any other law to the contrary, mutual benefit societies shall provide their members with an opportunity to select a participating advanced practice registered nurse as a primary care provider, if the member's policy requires the selection of a primary care provider, and shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers."

     SECTION 3.  Chapter 432, article 2, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§432:2-    Primary care provider; advanced practice registered nurse.  (a)  Each policy of insurance delivered or issued for delivery in this State by a fraternal benefit society shall recognize advanced practice registered nurses as defined under section 457-8.5 as participating providers and shall include coverage for care provided by participating advanced practice registered nurses practicing within the scope of their licenses for purposes of health maintenance, diagnosis or treatment to the extent that the policy provides benefits for identical services rendered by another health care provider.

     (b)  Notwithstanding any other law to the contrary, fraternal benefit societies shall provide their members with an opportunity to select a participating advanced practice registered nurse as a primary care provider, if the member's policy requires the selection of a primary care provider, and shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers."

     SECTION 4.  Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§432D-    Primary care provider; advanced practice registered nurse.  (a)  Each policy of insurance delivered or issued for delivery in this State by a health maintenance organization shall recognize advanced practice registered nurses as defined under section 457-8.5 as participating providers and shall include coverage for care provided by participating advanced practice registered nurses practicing within the scope of their licenses for purposes of health maintenance, diagnosis or treatment to the extent that the policy provides benefits for identical services rendered by another health care provider.

     (b)  Notwithstanding any other law to the contrary, health maintenance organizations shall provide their members with an opportunity to select a participating advanced practice registered nurse as a primary care provider, if the member's policy requires the selection of a primary care provider, and shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers."

     SECTION 5.  Chapter 457, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§457-    Global signature authority.  Notwithstanding any law to the contrary, advanced practice registered nurses shall be authorized to sign, certify, or endorse all documents relating to health care for their patients, including but not limited to workers' compensation verification documents, verification and evaluation forms of the department of human services, verification and evaluation forms of the department of education, verification and authorization forms from the department of health, and physical examination forms; provided that nothing in this section shall be construed to expand the scope of practice of advanced practice registered nurses."

     SECTION 6.  Section 457-2, Hawaii Revised Statutes, is amended by amending the definition of "advanced practice registered nurse" to read as follows:

     ""Advanced practice registered nurse" means a registered nurse who has met the qualifications for advanced practice registered nurse set forth in this chapter and through rules of the board, which shall include [educational requirements.] the following:

     (1)  Has completed an accredited graduate-level education program leading to a degree or certification as a certified registered nurse anesthetist, a certified nurse midwife, a clinical nurse specialist, or a certified nurse practitioner; or has passed a national certification examination that measures role and population-focused competencies;

     (2)  Maintains continued competencies through recertification in role and population competencies through the national certification program;

     (3)  Has acquired advanced clinical knowledge and skills preparing the nurse to provide direct care to patients through a significant educational and practical concentration on the direct care of patients;

     (4)  Demonstrates a greater breadth of knowledge, a greater synthesis of data, greater complexity of skills and interventions, and greater role autonomy than demonstrated by a registered nurse;

     (5)  Has been educationally prepared to assume responsibility and accountability for health promotion and maintenance and to assess, diagnose, and manage patient problems through the use and prescription of pharmacologic and non-pharmacologic interventions; and

     (6)  Has clinical experience of sufficient depth and breadth to reflect the intended license."

     SECTION 7.  Section 457-8.6, Hawaii Revised Statutes, is amended to read as follows:

     "§457-8.6  Prescriptive authority for advanced practice registered nurses.  (a)  The board shall grant prescriptive authority to qualified and currently recognized advanced practice registered nurses and shall designate the requirements for advanced nursing practice related to prescriptive authority. [The Hawaii medical board shall submit an annual report of all amendments made to the formularies to the board.

     (b)  The department of commerce and consumer affairs shall establish a joint formulary advisory committee composed of:

     (1)  Two persons licensed as advanced practice registered nurses and appointed by the board;

     (2)  Two persons licensed in medicine by the Hawaii medical board and appointed by the Hawaii medical board;

     (3)  Three persons licensed as pharmacists and appointed by the board of pharmacy;

     (4)  One representative of the John A. Burns school of medicine appointed by the dean of the University of Hawaii school of medicine; and

     (5)  One representative from a school of nursing with an advanced practice registered nurse program.

The joint formulary advisory committee shall recommend the applicable formulary for persons recognized under this section.  The Hawaii medical board shall consider the recommendations of the joint formulary advisory committee in adopting the formulary.  The appropriate working relationship with licensed physicians shall be reflected in rules adopted by the board in accordance with chapter 91.]

     The board shall establish nursing requirements for education, experience, and national certification pursuant to rules adopted in accordance with chapter 91.

     (b)  Qualified or currently recognized advanced practice registered nurses shall be authorized to diagnose, prescribe, and institute therapy or referrals of patients, within their practice specialty, to health care agencies, health care providers, and community resources and may:

     (1)  Prescribe, procure, administer, and dispense over the counter, legend, and controlled substances;

     (2)  Prescribe, order, and dispense medical devices and equipment; and

     (3)  Plan and initiate a therapeutic regimen that includes nutritional, diagnostic, and supportive services including home health care, hospice, and physical and occupational therapy."

     SECTION 8.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 9.  This Act shall take effect on July 1, 2050.