Bill Text: VA HB981 | 2023 | Regular Session | Prefiled
Bill Title: Health professions, certain; licensure by endorsement.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2022-11-22 - Left in Health, Welfare and Institutions [HB981 Detail]
Download: Virginia-2023-HB981-Prefiled.html
Be it enacted by the General Assembly of Virginia:
1. That §§54.1-2709, 54.1-2722, 54.1-2927, 54.1-2951.1, 54.1-2957, as it is currently effective and as it shall become effective, 54.1-2957.04, 54.1-3018, 54.1-3021, and 54.1-3024 of the Code of Virginia are amended and reenacted and that the Code of Virginia is amended by adding a section numbered 54.1-3042.1 as follows:
§54.1-2709. License; application; qualifications; examinations.
A. No person shall practice dentistry unless he possesses a current valid license from the Board of Dentistry.
B. An application for such license shall be made to the Board in writing and shall be accompanied by satisfactory proof that the applicant (i) is of good moral character; (ii) is a graduate of an accredited dental school or college, or dental department of an institution of higher education; (iii) has passed all parts of the examination given by the Joint Commission on National Dental Examinations; (iv) has successfully completed a clinical examination acceptable to the Board; and (v) has met other qualifications as determined in regulations promulgated by the Board.
C. The Board may shall grant a license to
practice dentistry to an applicant licensed to practice in another jurisdiction
if he (i) meets the requirements of subsection B; (ii) holds a current,
unrestricted license to practice dentistry in another jurisdiction in the
United States and is certified to be in good standing by each jurisdiction in
which he currently holds or has held a license; (iii) has not committed any act
that would constitute grounds for denial as set forth in §54.1-2706; and (iv)
has been in continuous clinical practice for five out of the six years
immediately preceding application for licensure pursuant to this section.
Active patient care in the dental corps of the United States Armed Forces,
volunteer practice in a public health clinic, or practice in an intern or
residency program may be accepted by the Board to satisfy this requirement.
D. The Board shall provide for an inactive license for those dentists who hold a current, unrestricted dental license in the Commonwealth at the time of application for an inactive license and who do not wish to practice in Virginia. The Board shall promulgate such regulations as may be necessary to carry out the provisions of this section, including requirements for remedial education to activate a license.
E. The Board shall promulgate regulations requiring continuing education for any dental license renewal or reinstatement. The Board may grant extensions or exemptions from these continuing education requirements.
§54.1-2722. License; application; qualifications; practice of dental hygiene; report.
A. No person shall practice dental hygiene unless he possesses a current, active, and valid license from the Board of Dentistry. The licensee shall have the right to practice dental hygiene in the Commonwealth for the period of his license as set by the Board, under the direction of any licensed dentist.
B. An application for such license shall be made to the Board in writing and shall be accompanied by satisfactory proof that the applicant (i) is of good moral character, (ii) is a graduate of a dental hygiene program accredited by the Commission on Dental Accreditation and offered by an accredited institution of higher education, (iii) has passed the dental hygiene examination given by the Joint Commission on National Dental Examinations, and (iv) has successfully completed a clinical examination acceptable to the Board.
C. The Board may shall grant a license to
practice dental hygiene to an applicant licensed to practice in another jurisdiction
if he (i) meets the requirements of subsection B; (ii) holds a current,
unrestricted license to practice dental hygiene in another jurisdiction in the
United States; (iii) has not committed any act that would constitute grounds
for denial as set forth in §54.1-2706; and (iv) meets other qualifications as
determined in regulations promulgated by the Board.
D. A licensed dental hygienist may, under the direction or general supervision of a licensed dentist and subject to the regulations of the Board, perform services that are educational, diagnostic, therapeutic, or preventive. These services shall not include the establishment of a final diagnosis or treatment plan for a dental patient. Pursuant to subsection V of § 54.1-3408, a licensed dental hygienist may administer topical oral fluorides under an oral or written order or a standing protocol issued by a dentist or a doctor of medicine or osteopathic medicine.
A dentist may also authorize a dental hygienist under his direction to administer Schedule VI nitrous oxide and oxygen inhalation analgesia and, to persons 18 years of age or older, Schedule VI local anesthesia. In its regulations, the Board of Dentistry shall establish the education and training requirements for dental hygienists to administer such controlled substances under a dentist's direction.
For the purposes of this section, "general supervision" means that a dentist has evaluated the patient and prescribed authorized services to be provided by a dental hygienist; however, the dentist need not be present in the facility while the authorized services are being provided.
The Board shall provide for an inactive license for those dental hygienists who hold a current, unrestricted license to practice in the Commonwealth at the time of application for an inactive license and who do not wish to practice in Virginia. The Board shall promulgate such regulations as may be necessary to carry out the provisions of this section, including requirements for remedial education to activate a license.
E. For the purposes of this subsection, "remote supervision" means that a public health dentist has regular, periodic communications with a public health dental hygienist regarding patient treatment, but such dentist may not have conducted an initial examination of the patients who are to be seen and treated by the dental hygienist and may not be present with the dental hygienist when dental hygiene services are being provided.
Notwithstanding any provision of law, a dental hygienist employed by the Virginia Department of Health or the Department of Behavioral Health and Developmental Services who holds a license issued by the Board of Dentistry may provide educational and preventative dental care in the Commonwealth under the remote supervision of a dentist employed by the Department of Health or the Department of Behavioral Health and Developmental Services. A dental hygienist providing such services shall practice pursuant to protocols developed jointly by the Department of Health and the Department of Behavioral Health and Developmental Services for each agency, in consultation with the Virginia Dental Association and the Virginia Dental Hygienists' Association. Such protocols shall be adopted by the Board as regulations.
A report of services provided by dental hygienists employed by the Virginia Department of Health pursuant to such protocol, including their impact upon the oral health of the citizens of the Commonwealth, shall be prepared and submitted annually to the Secretary of Health and Human Resources by the Department of Health, and a report of services provided by dental hygienists employed by the Department of Behavioral Health and Developmental Services shall be prepared and submitted annually to the Secretary of Health and Human Resources by the Department of Behavioral Health and Developmental Services. Nothing in this section shall be construed to authorize or establish the independent practice of dental hygiene.
F. For the purposes of this subsection, "remote supervision" means that a supervising dentist is accessible and available for communication and consultation with a dental hygienist during the delivery of dental hygiene services, but such dentist may not have conducted an initial examination of the patients who are to be seen and treated by the dental hygienist and may not be present with the dental hygienist when dental hygiene services are being provided.
Notwithstanding any other provision of law, a dental hygienist may practice dental hygiene under the remote supervision of a dentist who holds an active license by the Board and who has a dental practice physically located in the Commonwealth. No dental hygienist shall practice under remote supervision unless he has (i) completed a continuing education course designed to develop the competencies needed to provide care under remote supervision offered by an accredited dental education program or from a continuing education provider approved by the Board and (ii) at least two years of clinical experience, consisting of at least 2,500 hours of clinical experience. A dental hygienist practicing under remote supervision shall have professional liability insurance with policy limits acceptable to the supervising dentist. A dental hygienist shall only practice under remote supervision at a federally qualified health center; charitable safety net facility; free clinic; long-term care facility; elementary or secondary school; Head Start program; mobile dentistry program for adults with developmental disabilities operated by the Department of Behavioral Health and Developmental Services' Office of Integrated Health; or women, infants, and children (WIC) program.
A dental hygienist practicing under remote supervision may (a) obtain a patient's treatment history and consent, (b) perform an oral assessment, (c) perform scaling and polishing, (d) perform all educational and preventative services, (e) take X-rays as ordered by the supervising dentist or consistent with a standing order, (f) maintain appropriate documentation in the patient's chart, (g) administer topical oral fluorides, topical oral anesthetics, topical and directly applied antimicrobial agents for treatment of periodontal pocket lesions, and any other Schedule VI topical drug approved by the Board of Dentistry under an oral or written order or a standing protocol issued by a dentist or a doctor of medicine or osteopathic medicine pursuant to subsection V of §54.1-3408, and (h) perform any other service ordered by the supervising dentist or required by statute or Board regulation. No dental hygienist practicing under remote supervision shall administer local anesthetic or nitrous oxide.
Prior to providing a patient dental hygiene services, a dental hygienist practicing under remote supervision shall obtain (1) the patient's or the patient's legal representative's signature on a statement disclosing that the delivery of dental hygiene services under remote supervision is not a substitute for the need for regular dental examinations by a dentist and (2) verbal confirmation from the patient that he does not have a dentist of record whom he is seeing regularly.
After conducting an initial oral assessment of a patient, a dental hygienist practicing under remote supervision may provide further dental hygiene services following a written practice protocol developed and provided by the supervising dentist. Such written practice protocol shall consider, at a minimum, the medical complexity of the patient and the presenting signs and symptoms of oral disease.
A dental hygienist practicing under remote supervision shall inform the supervising dentist of all findings for a patient. A dental hygienist practicing under remote supervision may continue to treat a patient for 90 days. After such 90-day period, the supervising dentist, absent emergent circumstances, shall either conduct an examination of the patient or refer the patient to another dentist to conduct an examination. The supervising dentist shall develop a diagnosis and treatment plan for the patient, and either the supervising dentist or the dental hygienist shall provide the treatment plan to the patient. The supervising dentist shall review a patient's records at least once every 10 months.
Nothing in this subsection shall prevent a dental hygienist from practicing dental hygiene under general supervision whether as an employee or as a volunteer.
§54.1-2927. Applicants from other states without reciprocity; temporary licenses or certificates for certain practitioners of the healing arts.
A. The Board, in its discretion,
may shall issue certificates or licenses a license or certificate by endorsement
to applicants an
applicant who holds a valid, unrestricted license or certificate under the laws
of another state, the District of Columbia, or a United States territory or
possession with which the Commonwealth has not established a reciprocal
relationship upon endorsement by
boards the appropriate
board or other appropriate
authorities authority
of such other
states or territories or
state, the District of Columbia
with which reciprocal relations have not been established if, or United States territory or possession and a
determination by the Board that the
applicant's
credentials of such applicants
are satisfactory to the Board
and the examinations and passing grades required by such other boards
board or other appropriate authority are fully equal to
those required by the Virginia
Board.
B. The
Board may issue certificates or licenses licenses or certificates to
applicants holding certificates from the national boards of their respective branches
of the healing arts if their credentials, schools of graduation, and national board
examinations and results are acceptable to the Board. The Board shall
promulgate regulations in order to carry out the provisions of this section.
C. The Board of Medicine shall prioritize applicants for licensure as a doctor of medicine or osteopathic medicine, a physician assistant, or a nurse practitioner from such states that are contiguous with the Commonwealth in processing their applications for licensure by endorsement through a streamlined process, with a final determination regarding qualification to be made within 20 days of the receipt of a completed application.
B. D. The Board may issue
authorization to practice valid for a period not to exceed three months to a
practitioner of the healing arts licensed or certified and in good standing
with the applicable regulatory agency in the state, District of Columbia, or
Canada where the practitioner resides when the practitioner is in Virginia
temporarily to practice the healing arts (i) in a summer camp or in conjunction
with patients who are participating in recreational activities, (ii) in
continuing education programs, or (iii) by rendering at any site any health
care services within the limits of his license or certificate, voluntarily and
without compensation, to any patient of any clinic that is organized in whole
or in part for the delivery of health care services without charge as provided
in §54.1-106. A fee not to exceed $25 may be charged by the Board for the
issuance of authorization to practice pursuant to the provisions of this
subsection.
§54.1-2951.1. Requirements for licensure and practice as a physician assistant; licensure by endorsement.
A. The Board shall promulgate regulations establishing requirements for licensure as a physician assistant that shall include the following:
1. Successful completion of a physician assistant program or surgical physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant;
2. Passage of the certifying examination administered by the National Commission on Certification of Physician Assistants; and
3. Documentation that the applicant for licensure has not had his license or certification as a physician assistant suspended or revoked and is not the subject of any disciplinary proceedings in another jurisdiction.
B. The Board may issue
a license by endorsement to an applicant for licensure as a physician assistant
if the applicant (i) is the spouse of an active duty member of the Armed Forces
of the United States or the Commonwealth, (ii) holds current certification from
the National Commission on Certification of Physician Assistants, and (iii)
holds a license as a physician assistant that is in good standing, or that is
eligible for reinstatement if lapsed, under the laws of another state.
C.
Every physician assistant shall practice as part of a patient care team and
shall provide care in accordance with a written or electronic practice
agreement with one or more patient care team physicians or patient care team
podiatrists.
A practice agreement shall include acts pursuant to § 54.1-2952, provisions for the periodic review of patient charts or electronic health records, guidelines for collaboration and consultation among the parties to the agreement and the patient, periodic joint evaluation of the services delivered, and provisions for appropriate physician input in complex clinical cases, in patient emergencies, and for referrals.
A practice agreement may include provisions for periodic site visits by a patient care team physician or patient care team podiatrist who is part of the patient care team at a location other than where the licensee regularly practices. Such visits shall be in the manner and at the frequency as determined by the patient care team physician or patient care team podiatrist who is part of the patient care team.
D. C. Evidence of a practice
agreement shall be maintained by the physician assistant and provided to the
Board upon request. The practice agreement may be maintained in writing or
electronically and may be a part of credentialing documents, practice
protocols, or procedures.
§54.1-2957. (Effective until July 1, 2022) Licensure and practice of nurse practitioners.
A. As used in this section, "clinical experience" means the postgraduate delivery of health care directly to patients pursuant to a practice agreement with a patient care team physician.
B. The Board of Medicine and the Board of Nursing shall jointly prescribe the regulations governing the licensure of nurse practitioners. It is unlawful for a person to practice as a nurse practitioner in the Commonwealth unless he holds such a joint license.
C. Every nurse practitioner other than a certified nurse midwife, certified registered nurse anesthetist, or clinical nurse specialist or a nurse practitioner who meets the requirements of subsection I shall maintain appropriate collaboration and consultation, as evidenced in a written or electronic practice agreement, with at least one patient care team physician. A nurse practitioner who meets the requirements of subsection I may practice without a written or electronic practice agreement. A certified nurse midwife shall practice pursuant to subsection H. A nurse practitioner who is licensed by the Boards of Medicine and Nursing as a clinical nurse specialist shall practice pursuant to subsection J. A certified registered nurse anesthetist shall practice under the supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry. A nurse practitioner who is appointed as a medical examiner pursuant to §32.1-282 shall practice in collaboration with a licensed doctor of medicine or osteopathic medicine who has been appointed to serve as a medical examiner pursuant to §32.1-282. Collaboration and consultation among nurse practitioners and patient care team physicians may be provided through telemedicine as described in §38.2-3418.16.
Physicians on patient care teams may require that a nurse practitioner be covered by a professional liability insurance policy with limits equal to the current limitation on damages set forth in §8.01-581.15.
Service on a patient care team by a patient care team member shall not, by the existence of such service alone, establish or create liability for the actions or inactions of other team members.
D. The Boards of Medicine and Nursing shall jointly promulgate regulations specifying collaboration and consultation among physicians and nurse practitioners working as part of patient care teams that shall include the development of, and periodic review and revision of, a written or electronic practice agreement; guidelines for availability and ongoing communications that define consultation among the collaborating parties and the patient; and periodic joint evaluation of the services delivered. Practice agreements shall include provisions for (i) periodic review of health records, which may include visits to the site where health care is delivered, in the manner and at the frequency determined by the nurse practitioner and the patient care team physician and (ii) input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. Evidence of a practice agreement shall be maintained by a nurse practitioner and provided to the Boards upon request. For nurse practitioners providing care to patients within a hospital or health care system, the practice agreement may be included as part of documents delineating the nurse practitioner's clinical privileges or the electronic or written delineation of duties and responsibilities in collaboration and consultation with a patient care team physician.
E. The Boards of Medicine and Nursing
may shall issue a license by endorsement
to an applicant to practice as a nurse practitioner if the applicant has been
licensed as a nurse practitioner under the laws of another state and, pursuant
to regulations of the Boards, the applicant meets the qualifications for
licensure required of nurse practitioners in the Commonwealth. A nurse
practitioner to whom a license is issued by endorsement may practice without a
practice agreement with a patient care team physician pursuant to subsection I
if such application provides an attestation to the Boards of
Medicine and Nursing that the applicant has completed the
equivalent of at least two years of full-time clinical experience, as
determined by the Boards, in accordance with the laws of the state in which the
nurse practitioner was licensed.
F. Pending the outcome of the next National Specialty Examination, the Boards may jointly grant temporary licensure to nurse practitioners.
G. In the event a physician who is serving as a patient care team physician dies, becomes disabled, retires from active practice, surrenders his license or has it suspended or revoked by the Board, or relocates his practice such that he is no longer able to serve, and a nurse practitioner is unable to enter into a new practice agreement with another patient care team physician, the nurse practitioner may continue to practice upon notification to the designee or his alternate of the Boards and receipt of such notification. Such nurse practitioner may continue to treat patients without a patient care team physician for an initial period not to exceed 60 days, provided the nurse practitioner continues to prescribe only those drugs previously authorized by the practice agreement with such physician and to have access to appropriate input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. The designee or his alternate of the Boards shall grant permission for the nurse practitioner to continue practice under this subsection for another 60 days, provided the nurse practitioner provides evidence of efforts made to secure another patient care team physician and of access to physician input.
H. Every certified nurse midwife shall practice in accordance with regulations adopted by the Boards and consistent with the Standards for the Practice of Midwifery set by the American College of Nurse-Midwives governing such practice. A certified nurse midwife who has practiced fewer than 1,000 hours shall practice in consultation with a certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or a licensed physician, in accordance with a practice agreement. Such practice agreement shall address the availability of the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician for routine and urgent consultation on patient care. Evidence of the practice agreement shall be maintained by the certified nurse midwife and provided to the Boards upon request. A certified nurse midwife who has completed 1,000 hours of practice as a certified nurse midwife may practice without a practice agreement upon receipt by the certified nurse midwife of an attestation from the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician with whom the certified nurse midwife has entered into a practice agreement stating (i) that such certified nurse midwife or licensed physician has provided consultation to the certified nurse midwife pursuant to a practice agreement meeting the requirements of this section and (ii) the period of time for which such certified nurse midwife or licensed physician practiced in collaboration and consultation with the certified nurse midwife pursuant to the practice agreement. A certified nurse midwife authorized to practice without a practice agreement shall consult and collaborate with and refer patients to such other health care providers as may be appropriate for the care of the patient.
I. A nurse practitioner, other than a nurse practitioner licensed by the Boards of Medicine and Nursing in the category of certified nurse midwife, certified registered nurse anesthetist, or clinical nurse specialist, who has completed the equivalent of at least two years of full-time clinical experience as a licensed nurse practitioner, as determined by the Boards, may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement upon receipt by the nurse practitioner of an attestation from the patient care team physician stating (i) that the patient care team physician has served as a patient care team physician on a patient care team with the nurse practitioner pursuant to a practice agreement meeting the requirements of this section and §54.1-2957.01; (ii) that while a party to such practice agreement, the patient care team physician routinely practiced with a patient population and in a practice area included within the category for which the nurse practitioner was certified and licensed; and (iii) the period of time for which the patient care team physician practiced with the nurse practitioner under such a practice agreement. A copy of such attestation shall be submitted to the Boards together with a fee established by the Boards. Upon receipt of such attestation and verification that a nurse practitioner satisfies the requirements of this subsection, the Boards shall issue to the nurse practitioner a new license that includes a designation indicating that the nurse practitioner is authorized to practice without a practice agreement. In the event that a nurse practitioner is unable to obtain the attestation required by this subsection, the Boards may accept other evidence demonstrating that the applicant has met the requirements of this subsection in accordance with regulations adopted by the Boards.
A nurse practitioner authorized to practice without a practice agreement pursuant to this subsection shall (a) only practice within the scope of his clinical and professional training and limits of his knowledge and experience and consistent with the applicable standards of care, (b) consult and collaborate with other health care providers based on the clinical conditions of the patient to whom health care is provided, and (c) establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.
A nurse practitioner practicing without a practice agreement pursuant to this subsection shall obtain and maintain coverage by or shall be named insured on a professional liability insurance policy with limits equal to the current limitation on damages set forth in §8.01-581.15.
J. Nurse practitioners licensed by the Boards of Medicine and Nursing in the category of clinical nurse specialist shall practice in consultation with a licensed physician in accordance with a practice agreement between the nurse practitioner and the licensed physician. Such practice agreement shall address the availability of the physician for routine and urgent consultation on patient care. Evidence of a practice agreement shall be maintained by a nurse practitioner and provided to the Boards upon request. The practice of clinical nurse specialists shall be consistent with the standards of care for the profession and with applicable laws and regulations.
§54.1-2957. (Effective July 1, 2022) Licensure and practice of nurse practitioners.
A. As used in this section, "clinical experience" means the postgraduate delivery of health care directly to patients pursuant to a practice agreement with a patient care team physician.
B. The Board of Medicine and the Board of Nursing shall jointly prescribe the regulations governing the licensure of nurse practitioners. It is unlawful for a person to practice as a nurse practitioner in the Commonwealth unless he holds such a joint license.
C. Every nurse practitioner other than a certified nurse midwife, certified registered nurse anesthetist, or clinical nurse specialist or a nurse practitioner who meets the requirements of subsection I shall maintain appropriate collaboration and consultation, as evidenced in a written or electronic practice agreement, with at least one patient care team physician. A nurse practitioner who meets the requirements of subsection I may practice without a written or electronic practice agreement. A certified nurse midwife shall practice pursuant to subsection H. A nurse practitioner who is licensed by the Boards of Medicine and Nursing as a clinical nurse specialist shall practice pursuant to subsection J. A certified registered nurse anesthetist shall practice under the supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry. A nurse practitioner who is appointed as a medical examiner pursuant to §32.1-282 shall practice in collaboration with a licensed doctor of medicine or osteopathic medicine who has been appointed to serve as a medical examiner pursuant to §32.1-282. Collaboration and consultation among nurse practitioners and patient care team physicians may be provided through telemedicine as described in §38.2-3418.16.
Physicians on patient care teams may require that a nurse practitioner be covered by a professional liability insurance policy with limits equal to the current limitation on damages set forth in §8.01-581.15.
Service on a patient care team by a patient care team member shall not, by the existence of such service alone, establish or create liability for the actions or inactions of other team members.
D. The Boards of Medicine and Nursing shall jointly promulgate regulations specifying collaboration and consultation among physicians and nurse practitioners working as part of patient care teams that shall include the development of, and periodic review and revision of, a written or electronic practice agreement; guidelines for availability and ongoing communications that define consultation among the collaborating parties and the patient; and periodic joint evaluation of the services delivered. Practice agreements shall include provisions for (i) periodic review of health records, which may include visits to the site where health care is delivered, in the manner and at the frequency determined by the nurse practitioner and the patient care team physician and (ii) input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. Evidence of a practice agreement shall be maintained by a nurse practitioner and provided to the Boards upon request. For nurse practitioners providing care to patients within a hospital or health care system, the practice agreement may be included as part of documents delineating the nurse practitioner's clinical privileges or the electronic or written delineation of duties and responsibilities in collaboration and consultation with a patient care team physician.
E. The Boards of Medicine and Nursing
may shall issue a license by endorsement
to an applicant to practice as a nurse practitioner if the applicant has been
licensed as a nurse practitioner under the laws of another state and, pursuant
to regulations of the Boards, the applicant meets the qualifications for
licensure required of nurse practitioners in the Commonwealth. A nurse
practitioner to whom a license is issued by endorsement may practice without a
practice agreement with a patient care team physician pursuant to subsection I
if such application provides an attestation to the Boards of
Medicine and Nursing that the applicant has completed the
equivalent of at least five years of full-time clinical experience, as
determined by the Boards, in accordance with the laws of the state in which the
nurse practitioner was licensed.
F. Pending the outcome of the next National Specialty Examination, the Boards may jointly grant temporary licensure to nurse practitioners.
G. In the event a physician who is serving as a patient care team physician dies, becomes disabled, retires from active practice, surrenders his license or has it suspended or revoked by the Board, or relocates his practice such that he is no longer able to serve, and a nurse practitioner is unable to enter into a new practice agreement with another patient care team physician, the nurse practitioner may continue to practice upon notification to the designee or his alternate of the Boards and receipt of such notification. Such nurse practitioner may continue to treat patients without a patient care team physician for an initial period not to exceed 60 days, provided the nurse practitioner continues to prescribe only those drugs previously authorized by the practice agreement with such physician and to have access to appropriate input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals. The designee or his alternate of the Boards shall grant permission for the nurse practitioner to continue practice under this subsection for another 60 days, provided the nurse practitioner provides evidence of efforts made to secure another patient care team physician and of access to physician input.
H. Every certified nurse midwife shall practice in accordance with regulations adopted by the Boards and consistent with the Standards for the Practice of Midwifery set by the American College of Nurse-Midwives governing such practice. A certified nurse midwife who has practiced fewer than 1,000 hours shall practice in consultation with a certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or a licensed physician, in accordance with a practice agreement. Such practice agreement shall address the availability of the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician for routine and urgent consultation on patient care. Evidence of the practice agreement shall be maintained by the certified nurse midwife and provided to the Boards upon request. A certified nurse midwife who has completed 1,000 hours of practice as a certified nurse midwife may practice without a practice agreement upon receipt by the certified nurse midwife of an attestation from the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician with whom the certified nurse midwife has entered into a practice agreement stating (i) that such certified nurse midwife or licensed physician has provided consultation to the certified nurse midwife pursuant to a practice agreement meeting the requirements of this section and (ii) the period of time for which such certified nurse midwife or licensed physician practiced in collaboration and consultation with the certified nurse midwife pursuant to the practice agreement. A certified nurse midwife authorized to practice without a practice agreement shall consult and collaborate with and refer patients to such other health care providers as may be appropriate for the care of the patient.
I. A nurse practitioner, other than a nurse practitioner licensed by the Boards of Medicine and Nursing in the category of certified nurse midwife, certified registered nurse anesthetist, or clinical nurse specialist, who has completed the equivalent of at least five years of full-time clinical experience as a licensed nurse practitioner, as determined by the Boards, may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement upon receipt by the nurse practitioner of an attestation from the patient care team physician stating (i) that the patient care team physician has served as a patient care team physician on a patient care team with the nurse practitioner pursuant to a practice agreement meeting the requirements of this section and §54.1-2957.01; (ii) that while a party to such practice agreement, the patient care team physician routinely practiced with a patient population and in a practice area included within the category for which the nurse practitioner was certified and licensed; and (iii) the period of time for which the patient care team physician practiced with the nurse practitioner under such a practice agreement. A copy of such attestation shall be submitted to the Boards together with a fee established by the Boards. Upon receipt of such attestation and verification that a nurse practitioner satisfies the requirements of this subsection, the Boards shall issue to the nurse practitioner a new license that includes a designation indicating that the nurse practitioner is authorized to practice without a practice agreement. In the event that a nurse practitioner is unable to obtain the attestation required by this subsection, the Boards may accept other evidence demonstrating that the applicant has met the requirements of this subsection in accordance with regulations adopted by the Boards.
A nurse practitioner authorized to practice without a practice agreement pursuant to this subsection shall (a) only practice within the scope of his clinical and professional training and limits of his knowledge and experience and consistent with the applicable standards of care, (b) consult and collaborate with other health care providers based on the clinical conditions of the patient to whom health care is provided, and (c) establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.
A nurse practitioner practicing without a practice agreement pursuant to this subsection shall obtain and maintain coverage by or shall be named insured on a professional liability insurance policy with limits equal to the current limitation on damages set forth in §8.01-581.15.
J. Nurse practitioners licensed by the Boards of Medicine and Nursing in the category of clinical nurse specialist shall practice in consultation with a licensed physician in accordance with a practice agreement between the nurse practitioner and the licensed physician. Such practice agreement shall address the availability of the physician for routine and urgent consultation on patient care. Evidence of a practice agreement shall be maintained by a nurse practitioner and provided to the Boards upon request. The practice of clinical nurse specialists shall be consistent with the standards of care for the profession and with applicable laws and regulations.
§54.1-2957.04. Licensure as a licensed certified midwife; practice as a licensed certified midwife; use of title; required disclosures.
A. It shall be unlawful for any person to practice or to hold himself out as practicing as a licensed certified midwife or use in connection with his name the words "Licensed Certified Midwife" unless he holds a license as such issued jointly by the Boards of Medicine and Nursing.
B. The Boards of Medicine and Nursing shall jointly adopt regulations for the licensure of licensed certified midwives, which shall include criteria for licensure and renewal of a license as a certified midwife that shall include a requirement that the applicant provide evidence satisfactory to the Boards of current certification as a certified midwife by the American Midwifery Certification Board and that shall be consistent with the requirements for certification as a certified midwife established by the American Midwifery Certification Board.
C. The Boards of
Medicine and Nursing may issue a license by endorsement to an applicant to
practice as a licensed certified midwife if the applicant has been licensed as
a certified midwife under the laws of another state and, pursuant to
regulations of the Boards, the applicant meets the qualifications for licensure
as a licensed certified midwife in the Commonwealth.
D. C. Licensed certified midwives
shall practice in consultation with a licensed physician in accordance with a
practice agreement between the licensed certified midwife and the licensed
physician. Such practice agreement shall address the availability of the
physician for routine and urgent consultation on patient care. Evidence of a
practice agreement shall be maintained by the licensed certified midwife and
provided to the Board upon request. The Board shall adopt regulations for the
practice of licensed certified midwives, which shall be in accordance with
regulations jointly adopted by the Boards of Medicine and Nursing, which shall
be consistent with the Standards for the Practice of Midwifery set by the
American College of Nurse-Midwives governing the practice of midwifery.
E. D. Notwithstanding any
provision of law or regulation to the contrary, a licensed certified midwife
may prescribe Schedules II through VI controlled substances in accordance with
regulations of the Boards of Medicine and Nursing.
F. E. A licensed certified midwife
who provides health care services to a patient outside of a hospital or
birthing center shall disclose to that patient, when appropriate, information
on health risks associated with births outside of a hospital or birthing
center, including but not limited to risks associated with vaginal births after
a prior cesarean section, breech births, births by women experiencing high-risk
pregnancies, and births involving multiple gestation. As used in this
subsection, "birthing center" shall have the same meaning as in §
54.1-2957.03.
G. F. A licensed certified midwife
who provides health care to a patient shall be liable for the midwife's
negligent, grossly negligent, or willful and wanton acts or omissions. Except
as otherwise provided by law, any (i) doctor of medicine or osteopathy who did
not collaborate or consult with the midwife regarding the patient and who has
not previously treated the patient for this pregnancy, (ii) physician
assistant, (iii) nurse practitioner, (iv) prehospital emergency medical
personnel, or (v) hospital as defined in §32.1-123, or any employee of, person
providing services pursuant to a contract with, or agent of such hospital, that
provides screening and stabilization health care services to a patient as a result
of a licensed certified midwife's negligent, grossly negligent, or willful and
wanton acts or omissions shall be immune from liability for acts or omissions
constituting ordinary negligence.
§54.1-3018. Registered nurse's license by endorsement.
A. The Board may shall issue a license by
endorsement to an applicant to practice professional nursing if the applicant
has been licensed as a professional or registered nurse under the laws of
another state, the District of Columbia, or a United States possession
or territory or possession,
and, in the opinion of the Board, the applicant meets the qualifications
required of registered nurses in this Commonwealth.
B. The Board shall also endorse for licensure nurses who hold an unrestricted license in Canada and whose training was obtained in a nursing school in Canada where English was the primary language and who have passed the Canadian Registered Nurses Examination (CRNE).
§54.1-3021. Practical nurse's license by endorsement.
The Board may shall issue a license by
endorsement to any applicant to practice as a licensed practical nurse if the
applicant has been licensed as a practical nurse or a person entitled to
perform similar services under laws of another state, the District of Columbia, or a United States possession or territory or possession and, in the
opinion of the Board, the applicant meets the requirements for licensed
practical nurses in this Commonwealth.
§54.1-3024. Application for certification by endorsement.
A. Every
applicant for certification by endorsement shall pay the required application
fee,
and shall submit the information such evidence as may be
required by the Board in the manner and form specified by the Board, and shall submit written evidence that the applicant.
B. The Board shall certify as a nurse aide every applicant for certification by endorsement who:
1. Is certified to practice as a nurse aide by another state or territory of, the
District of Columbia, or a United States (with
territory or possession that has established requirements for certification that are
essentially similar to the requirements for certification set out in this
article) and
that such whose
certification is in good standing;
2. Has not committed any act or omission that would be grounds for discipline or denial of certification under this article; and
3. Has no record of abuse, negligent practice, or misappropriation of a patient's or resident's property or any disciplinary action taken or pending in any other state or territory against such certification.
§54.1-3042.1. Registration by endorsement.
The Board shall register as a medication aide every applicant for registration by endorsement who:
1. Is registered to practice as a medication aide by another state, the District of Columbia, or a United States territory or possession and, in the opinion of the Board, the applicant meets the qualifications required for registration as a medication aide in this Commonwealth; and
2. Has not committed any act that would be grounds for discipline or denial of registration under this article.
