Bill Text: HI SB1045 | 2010 | Regular Session | Amended
Bill Title: Health Care; Advanced Practice Registered Nurse; Primary Care Provider; Prescriptive Authority
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Engrossed - Dead) 2009-05-11 - Carried over to 2010 Regular Session. [SB1045 Detail]
Download: Hawaii-2010-SB1045-Amended.html
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. (SD2)
|
THE SENATE |
S.B. NO. |
1045 |
|
TWENTY-FIFTH LEGISLATURE, 2009 |
S.D. 2 |
|
|
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. The legislature finds that there is a need for more access to healthcare professionals, particularly in rural areas. Studies show that appropriately trained advanced practice registered nurses can provide high quality health care and achieve positive outcomes for patients. Advanced practice registered nurses are capable of providing primary health care and play an important role in meeting the growing demand for primary health care, particularly in underserved areas.
The legislature further finds that the disciplines of medicine and nursing and the roles of physicians and advanced practice registered nurses are complementary. Ultimately, the interests of patients are well served when advanced practice registered nurses are included as an essential component of the primary health care team.
The purpose of this Act is to recognize advanced practice registered nurses as participating primary health care providers for insurance coverage purposes, to permit advanced practice registered nurses to sign documents relating to health care for their patients, to clarify educational and other requirements for advanced practice registered nurses, and to update the authority for advanced practice registered nurses to write prescriptions including for controlled substance, medical equipment, and therapeutic regimens in accordance with their scope of practice.
SECTION 2. 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. "Participating advanced practice registered nurses" are defined as advanced practice registered nurses who have contracted with the insurer to provide healthcare services to its insureds.
(b) Notwithstanding any other law to the contrary, an insurer may recognize a participating advanced practice registered nurse as a primary care provider, if the insured's policy requires the selection of a primary care provider. The insurer shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers. The insurer retains the right to determine the contracting criteria for a participating primary care provider."
SECTION 3. 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. "Participating advanced practice registered nurses" are defined as advanced practice registered nurses who have contracted with the insurer to provide healthcare services to its insureds.
(b) Notwithstanding any other law to the contrary, an insurer may recognize a participating advanced practice registered nurse as a primary care provider, if the insured's policy requires the selection of a primary care provider. The insurer shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers. The insurer retains the right to determine the contracting criteria for a participating primary care provider."
SECTION 4. 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. "Participating advanced practice registered nurses" are defined as advanced practice registered nurses who have contracted with the insurer to provide healthcare services to its insureds.
(b) Notwithstanding any other law to the contrary, an insurer may recognize a participating advanced practice registered nurse as a primary care provider, if the insured's policy requires the selection of a primary care provider. The insurer shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers. The insurer retains the right to determine the contracting criteria for a participating primary care provider."
SECTION 5. 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. "Participating advanced practice registered nurses" are defined as advanced practice registered nurses who have contracted with the insurer to provide healthcare services to its insureds.
(b) Notwithstanding any other law to the contrary, an insurer may recognize a participating advanced practice registered nurse as a primary care provider, if the insured's policy requires the selection of a primary care provider. The insurer shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers. The insurer retains the right to determine the contracting criteria for a participating primary care provider."
SECTION 6. 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. (a) Notwithstanding any law to the contrary, advanced practice registered nurses shall be authorized to sign, certify, or endorse all documents relating to health care within their scope of practice provided 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.
(b) This section shall not apply to a certificate of disability that may be used to obtain parking privileges for disabled persons pursuant to part III of chapter 291."
SECTION 7. Section 457-8.5, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
"(a) [The] Effective October 1,
2009, the board shall grant recognition as an advanced practice registered
nurse[; provided the] to a nurse who has:
(1) A current, unencumbered license as a registered nurse in this State;
(2) An unencumbered license as a registered nurse in all other states in which the nurse has a current and active license;
(3) An unencumbered recognition as an advanced practice registered nurse or similar designation in all other states in which the nurse has a current and active recognition as an advanced practice registered nurse;
(4) [A master's degree in nursing as specified in
rules adopted by the board or a current certification for specialized and
advanced nursing practice from a national certifying body recognized by the
board; provided that certified nurse midwives shall maintain current
certification from a national certifying body recognized by the board; and
(5)] An accredited graduate-level education
program leading to a master’s degree as a certified registered nurse
anesthetist, a nurse midwife, a clinical nurse specialist, or a nurse
practitioner;
(5) A current, unencumbered certification of having passed a national certification examination that measures role and population-focused competencies and is recognized by the board;
(6) Maintained continued competencies through recertification in role and population competencies through a national certification program recognized by the board;
(7) 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;
(8) Demonstrated 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;
(9) 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;
(10) Acquired clinical experience of sufficient depth and breadth to reflect the intended license; and
(11) Paid the appropriate fees.
(b) [The board shall require certified nurse
midwives to meet the requirements of subsection (a) in order to obtain
recognition and maintain recognition as advanced practice registered nurses.]
Any person recognized as an advanced practice registered nurse prior to
October 1, 2009 whose recognition was granted based on a master’s degree in
nursing or a current certification for specialized and advanced nursing
practice from a national certifying body recognized by the board shall be eligible
to renew that recognition as an advanced practice registered nurse; provided
that all nurse licenses, recognitions and prescriptive authorities or similar
designations held by the person in any jurisdiction are unencumbered."
SECTION 8. 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 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.] The
board shall determine the exclusionary formulary for qualified advanced
practice registered nurses who are granted prescriptive authority.
(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 University of Hawaii John A. Burns school of medicine appointed by the dean of the University of Hawaii John A. Burns 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.
(c) The board shall establish nursing requirements for education, experience, and national certification pursuant to rules adopted in accordance with chapter 91.
(d) Advanced practice registered nurses shall be considered qualified if they have met the requirements of section 457-8.5, and have met the advanced pharmacology requirements for initial prescriptive authority pursuant to rules adopted by the board. Only qualified advanced practice registered nurses authorized to diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources and, only as appropriate to the practice specialty in which the advanced practice nurse is qualified, 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 9. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 10. This Act shall take effect upon approval.
