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 participating providers and allow recognition as primary care providers.  Grants increased signature authority and prescriptive rights.  Sets new standards for board recognition of advanced practice registered nurses effective 10/1/09.  (HB1378 HD2)

 


HOUSE OF REPRESENTATIVES

H.B. NO.

1378

TWENTY-FIFTH LEGISLATURE, 2009

H.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 health care professionals, particularly in rural areas.  Studies show that appropriately trained advanced practice registered nurses can provide high quality care and achieve good health outcomes for patients.  Also, advanced practice registered nurses are capable of providing critical access to primary care and can play an important role in meeting the growing demand for primary care in underserved areas.  The disciplines of medicine and nursing, and the roles of physicians and advanced practice registered nurses, are complementary.  The interests of consumers are well-served when advanced practice registered nurses function as an essential component of the primary health care team.

     The purpose of this Act is to:

     (1)  Recognize advanced practice registered nurses as participating primary care providers for insurance purposes;

     (2)  Permit advanced practice registered nurses to sign documents relating to health care for patients;

     (3)  Clarify the educational requirements for advanced practice registered nurses; and

     (4)  Update the authority for advanced practice registered nurses to prescribe pharmaceuticals including controlled substances, medical equipment, and therapeutic regimes in accordance with the scope of their practice specialty.

     SECTION 2.  Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding a new section to part VI 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 pursuant to 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 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 shall retain the right to determine the contracting criteria for the participating provider.

     (c)  For the purposes of this section, "participating advanced practice registered nurse" means an advanced practice registered nurse who contracts with an insurer to provide health care services to insureds."

     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 individual and group hospital or medical service plan contract delivered or issued for delivery in this state by a mutual benefit society shall recognize advanced practice registered nurses pursuant to 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 medical service plan contract provides benefits for identical services rendered by another health care provider.  (b)  Notwithstanding any other law to the contrary, mutual benefit societies may recognize a participating advanced practice registered nurse as a primary care provider, if the member's medical service plan contract requires the selection of a primary care provider.  The mutual benefit society shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers.  The mutual benefit society shall retain the right to determine the contracting criteria for the participating provider.

     (c)  For the purposes of this section, "participating advanced practice registered nurse" means an advanced practice registered nurse who contracts with a mutual benefit society to provide health care services to members."

     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 benefit contract delivered or issued for delivery in this state by a fraternal benefit society shall recognize advanced practice registered nurses pursuant to 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 benefit contract provides benefits for identical services rendered by another health care provider.  (b)  Notwithstanding any other law to the contrary, fraternal benefit societies may recognize a participating advanced practice registered nurse as a primary care provider, if the member's benefit contract requires the selection of a primary care provider.  The fraternal benefit society shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers.  The fraternal benefit society shall retain the right to determine the contracting criteria for the participating provider.

     (c)  For the purposes of this section, "participating advanced practice registered nurse" means an advanced practice registered nurse who contracts with a fraternal benefit society to provide health care services to members."

     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 individual and group contract delivered or issued for delivery in this state by a health maintenance organization shall recognize advanced practice registered nurses pursuant to 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 contract provides benefits for identical services rendered by another health care provider. 

     (b)  Notwithstanding any other law to the contrary, health maintenance organizations may recognize a participating advanced practice registered nurse as a primary care provider, if the enrollee's contract requires the selection of a primary care provider.  The health maintenance organization shall include participating advanced practice registered nurses on any publicly available list of participating primary care providers.  The health maintenance organization shall retain the right to determine the contracting criteria for the participating provider.

     (c)  For the purposes of this section, a "participating advanced practice registered nurse" means an advanced practice registered nurse who contracts with a health maintenance organization to provide health care services to enrollees."

     SECTION 6.  Chapter 457, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§457-    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 within the scope of their practice, including workers' compensation verification and evaluation forms of the department of human services, verification and evaluation forms of the department of education, verification and authorization forms of the department of health, and physical examination forms; provided that:

(1)  Nothing in this section shall be construed to expand the scope of practice of advanced practice registered nurses; and

(2)  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] to the nurse who has:

     (1)  A current, unencumbered license as a registered nurse in this [State;] 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]

     (4)  A master's degree from an accredited graduate-level education program as a certified registered nurse anesthetist, a nurse midwife, a clinical nurse specialist, or a certified nurse practitioner;

     (5)  A current, unencumbered certification, 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 the 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 nonpharmacologic interventions;

    (10)  Clinical experience of sufficient depth and breadth to reflect the intended license; and

    [(5)](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, and whose recognition was granted based upon 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; provided that no nurse license, recognition, or prescriptive authority, or similar designation held by the person in this state or any other state or territory of the Unites States, shall be encumbered."

     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 or 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 considered qualified if they meet the requirements of section 457-8.5(a) and the advanced pharmacology requirements for the initial prescriptive authority as designated by the board's rules.  Only qualified advanced practice registered nurses shall be authorized to diagnose, prescribe, and institute therapy or referrals of patients 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 9.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 10.  This Act shall take effect on July 1, 2020.