senate Bill S4611A

Amended

Establishes the nurse practitioners modernization act

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 15 / Apr / 2013
    • REFERRED TO HIGHER EDUCATION
  • 11 / Jun / 2013
    • AMEND AND RECOMMIT TO HIGHER EDUCATION
  • 11 / Jun / 2013
    • PRINT NUMBER 4611A
  • 08 / Jan / 2014
    • REFERRED TO HIGHER EDUCATION
  • 29 / Jan / 2014
    • AMEND AND RECOMMIT TO HIGHER EDUCATION
  • 29 / Jan / 2014
    • PRINT NUMBER 4611B
  • 28 / Apr / 2014
    • RECOMMIT, ENACTING CLAUSE STRICKEN

Summary

Establishes the nurse practitioners modernization act which allows the practice of registered professional nursing by a certified nurse practitioner to include diagnosis and performance without collaboration of a licensed physician.

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Bill Details

See Assembly Version of this Bill:
A4846A
Versions:
S4611
S4611A
S4611B
Legislative Cycle:
2013-2014
Current Committee:
Senate Higher Education
Law Section:
Education Law
Laws Affected:
Amd ยง6902, Ed L
Versions Introduced in Previous Legislative Cycles:
2011-2012: A5308A, A5308A
2009-2010: A765B, A765B
2007-2008: A10829, A10829

Sponsor Memo

BILL NUMBER:S4611A

TITLE OF BILL: An act to amend the education law, in relation to
establishing the nurse practitioners modernization act; and providing
for the repeal of such provisions upon the expiration thereof

PURPOSE OR GENERAL IDEA OF BILL:

Enacts the "nurse practitioners modernization act," thereby limiting
the need for a written practice agreement, while continuing to respect
the relationship between nurse practitioners, physicians, and other
healthcare practitioners.

SUMMARY OF SPECIFIC PROVISIONS:

The bill amends the nurse practice act in Education law to limit the
requirements for written collaboration agreements and practice
protocols between nurse practitioners (NPs) and physicians to NPs who
axe practicing for less than 3,600 hours with exceptions for good
cause approved by the Education Department. Under the exceptions
allowed, a collaborating physician may be substituted by a
collaborating NP who is past his or her written-collaboration term and
is qualified to collaborate in the specialty involved.

NPs who have successfully practiced for more than 3,600 hours shall
not be required to have a written practice agreement with a physician.
These NPs will, however, continue to collaborate with physicians or
Article 28 hospitals, in addition to other healthcare providers.
Additionally, these NPs will be required to complete and execute a
form to be created by the State Education Department that will
include, among other things, a summary of the NP's written practice
protocols and the manner in which the NP will collaborate with other
providers. Although this form does not need, to be filed with SED, it
will be subject to review of the Department. Failure to comply with
this requirement will be considered misconduct.

Finally, the bill will require the Commissioner of Education, in
consultation with the Commissioner of Health, to issue a report
summarizing the implementation of this law, and any recommendations
for further revisions to the NP's statute. The report shall be
submitted to the legislature by September 1, 2017.

JUSTIFICATION:

Nurse Practitioners practice in a variety of primary and specialty
care settings including ambulatory, acute, long term care, and primary
care. Nurse practitioners are licensed and certified by the State
Education Department to diagnose illness and physical conditions and
perform therapeutic and corrective measures, order tests, prescribe
medications, medical devices and immunizing agents and, when
appropriate, refer patients to other health care providers, without
direct supervision. In addition to their advance certification by the
Nursing Board, many NPs are certified by national accrediting agencies
in one or more practice specialty.

Currently, New York mandates that NPs maintain a signed written
collaborative agreement with MD. That relationship can be as narrow or


as broad as the MD is willing. Elsewhere, NPs practice with complete
independence in 18 states (AK, AZ, CO, HI, ID, IA, ME, MD, MT, ND, NH,
NM, OR, RI, UT, VT, WA, WY) and the District of Columbia. Given the
education, training and advanced certification of NPs, statutorily
mandated collaborative agreements no longer serve a clinical purpose.
Instead, the signed written practice agreement serves as a barrier to
practice and a disincentive to advanced certification, and it
restricts access to primary health care for individuals and families
in underserved areas of the state.

PRIOR LEGISLATIVE HISTORY:

Similar to S.3289: referred to Higher Education in 2011 and 2012.
A.:5308-A passed the Assembly in 2012.

FISCAL IMPLICATIONS:;

Reduces administrative costs for the State Education Department.

EFFECTIVE DATE:

This act shall take effect on the first day of January after it shall
have become a law and shall expire June 30 of the sixth year after it
shall have become a law, when upon such date the provisions of this
act shall be deemed repealed; provided, however, that effective
immediately, the addition, amendment and/or repeal of any rule or
regulation necessary for the implementation of this act on its
effective date is authorized and directed to be made and completed on
or before such effective date.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4611--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             April 15, 2013
                               ___________

Introduced  by  Sens.  YOUNG,  AVELLA,  ESPAILLAT,  MONTGOMERY,  PARKER,
  RITCHIE, ROBACH, SAVINO -- read twice and ordered  printed,  and  when
  printed  to  be  committed  to  the  Committee  on Higher Education --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted to said committee

AN ACT to amend the education law, in relation to establishing the nurse
  practitioners  modernization act; and providing for the repeal of such
  provisions upon the expiration thereof

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Short  title. This act shall be known and may be cited as
the "nurse practitioners modernization act".
  S 2. Subdivision 3 of section 6902 of the education law, as  added  by
chapter 257 of the laws of 1988, is amended to read as follows:
  3.  (a) (I) The practice of registered professional nursing by a nurse
practitioner, certified under section six thousand nine hundred  ten  of
this  article,  may include the diagnosis of illness and physical condi-
tions and the performance of therapeutic and corrective measures  within
a specialty area of practice, in collaboration with a licensed physician
qualified  to  collaborate  in  the  specialty  involved,  provided such
services are performed in accordance with a written  practice  agreement
and  written  practice protocols EXCEPT AS PERMITTED BY PARAGRAPH (B) OF
THIS SUBDIVISION.  The written practice agreement shall include explicit
provisions for the resolution of any disagreement  between  the  collab-
orating physician and the nurse practitioner regarding a matter of diag-
nosis  or treatment that is within the scope of practice of both. To the
extent the practice agreement does not so provide, then the  collaborat-
ing physician's diagnosis or treatment shall prevail.
  (II) IN THE EVENT THAT (A) AN EXISTING WRITTEN PRACTICE AGREEMENT WITH
A  COLLABORATING  PHYSICIAN TERMINATES AS A RESULT OF: THE COLLABORATING
PHYSICIAN MOVING, RETIRING, NO LONGER NEEDING THE SERVICES OF THE  NURSE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10172-02-3

S. 4611--A                          2

PRACTITIONER,  NO  LONGER  BEING  QUALIFIED  TO PRACTICE; OR THE WRITTEN
PRACTICE AGREEMENT TERMINATING DUE TO NO FAULT ON THE PART OF THE  NURSE
PRACTITIONER; AND (B) THE NURSE PRACTITIONER DEMONSTRATES THAT HE OR SHE
HAS MADE A GOOD FAITH EFFORT TO ENTER INTO A NEW WRITTEN PRACTICE AGREE-
MENT  WITH  A COLLABORATING PHYSICIAN AND HAS BEEN UNABLE TO DO SO, THEN
UPON APPROVAL BY THE DEPARTMENT, SUCH NURSE PRACTITIONER MAY CONTINUE TO
PRACTICE PURSUANT TO THIS PARAGRAPH WITHIN A SPECIALTY AREA OF  PRACTICE
FOR  A PERIOD OF UP TO SIX MONTHS, IN COLLABORATION WITH A NURSE PRACTI-
TIONER WHO HAS BEEN CERTIFIED UNDER SECTION SIX  THOUSAND  NINE  HUNDRED
TEN  OF  THIS ARTICLE, WHO HAS BEEN PRACTICING FOR MORE THAN THREE THOU-
SAND SIX HUNDRED HOURS AND  WHO  IS  QUALIFIED  TO  COLLABORATE  IN  THE
SPECIALTY  INVOLVED,  PROVIDED THAT SERVICES ARE PERFORMED IN ACCORDANCE
WITH A WRITTEN PRACTICE AGREEMENT AND WRITTEN PRACTICE  PROTOCOLS;  SUCH
SIX  MONTH TIME PERIOD FOR COLLABORATION BETWEEN NURSE PRACTITIONERS MAY
BE EXTENDED FOR A PERIOD OF TIME NOT TO EXCEED AN ADDITIONAL SIX  MONTHS
UPON A SHOWING OF GOOD CAUSE SUBJECT TO THE APPROVAL OF THE DEPARTMENT.
  [(b)] (III) Prescriptions for drugs, devices and immunizing agents may
be  issued  by  a nurse practitioner, under this [subdivision] PARAGRAPH
and section six thousand nine hundred ten of this article, in accordance
with the practice agreement and practice protocols EXCEPT  AS  PERMITTED
BY  PARAGRAPH  (B)  OF  THIS SUBDIVISION.   The nurse practitioner shall
obtain a certificate from the department upon successfully completing  a
program  including  an appropriate pharmacology component, or its equiv-
alent, as  established  by  the  commissioner's  regulations,  prior  to
prescribing  under  this [subdivision] PARAGRAPH. The certificate issued
under section six thousand nine hundred ten of this article shall  state
whether the nurse practitioner has successfully completed such a program
or  equivalent  and  is authorized to prescribe under this [subdivision]
PARAGRAPH.
  [(c)] (IV) Each practice agreement shall provide for  patient  records
review  by the collaborating physician OR, WHERE APPLICABLE, THE COLLAB-
ORATING NURSE PRACTITIONER, in a timely fashion but  in  no  event  less
often  than  every three months. The names of the nurse practitioner and
the collaborating physician  OR,  WHERE  APPLICABLE,  THE  COLLABORATING
NURSE  PRACTITIONER  shall  be clearly posted in the practice setting of
the nurse practitioner.
  [(d)] (V) The practice protocol shall reflect current accepted medical
and nursing practice, OR FOR COLLABORATING WITH  ANOTHER  NURSE  PRACTI-
TIONER  PURSUANT  TO  SUBPARAGRAPH  (II)  OF THIS PARAGRAPH, THE CURRENT
ACCEPTED NURSING PRACTICE.   The  protocols  shall  be  filed  with  the
department  within  ninety  days of the commencement of the practice and
may be updated periodically. The  commissioner  shall  make  regulations
establishing  the procedure for the review of protocols and the disposi-
tion of any issues arising from such review.
  [(e)] (VI) No physician  OR,  WHERE  APPLICABLE,  NURSE  PRACTITIONER,
shall  enter  into practice agreements with more than four nurse practi-
tioners who are not located on the same physical premises as the collab-
orating physician OR COLLABORATING NURSE PRACTITIONER.
  [(f)] (B) NOTWITHSTANDING SUBPARAGRAPH (I) OF PARAGRAPH  (A)  OF  THIS
SUBDIVISION,  A  NURSE  PRACTITIONER, CERTIFIED UNDER SECTION SIXTY-NINE
HUNDRED TEN OF THIS ARTICLE AND PRACTICING FOR MORE THAN THREE  THOUSAND
SIX  HUNDRED  HOURS  MAY COMPLY WITH THIS PARAGRAPH IN LIEU OF COMPLYING
WITH THE REQUIREMENTS OF PARAGRAPH (A) OF THIS SUBDIVISION  RELATING  TO
COLLABORATION WITH A PHYSICIAN, A WRITTEN PRACTICE AGREEMENT AND WRITTEN
PRACTICE  PROTOCOLS.  A NURSE PRACTITIONER COMPLYING WITH THIS PARAGRAPH
SHALL HAVE COLLABORATIVE RELATIONSHIPS WITH ONE OR MORE LICENSED  PHYSI-

S. 4611--A                          3

CIANS  QUALIFIED TO COLLABORATE IN THE SPECIALTY INVOLVED OR A HOSPITAL,
LICENSED UNDER ARTICLE TWENTY-EIGHT  OF  THE  PUBLIC  HEALTH  LAW,  THAT
PROVIDES  SERVICES  THROUGH LICENSED PHYSICIANS QUALIFIED TO COLLABORATE
IN  THE SPECIALTY INVOLVED AND HAVING PRIVILEGES AT SUCH INSTITUTION. AS
EVIDENCE THAT THE NURSE PRACTITIONER MAINTAINS  COLLABORATIVE  RELATION-
SHIPS,  THE  NURSE  PRACTITIONER  SHALL  COMPLETE  AND  MAINTAIN A FORM,
CREATED BY THE DEPARTMENT, WHICH THE NURSE PRACTITIONER SHALL ATTEST TO,
THAT IDENTIFIES WRITTEN PRACTICE PROTOCOLS AND THE METHODS BY WHICH  THE
NURSE  PRACTITIONER  WILL  COLLABORATE  SUCH AS: THE CRITERIA TO BE USED
REGARDING CONSULTATION, INCLUDING METHODS AND FREQUENCY OF HOW CONSULTA-
TION SHALL BE PROVIDED; COLLABORATIVE MANAGEMENT AND REFERRAL; AND EMER-
GENCY REFERRAL PLANS. SUCH FORMS SHALL BE UPDATED AS NEEDED AND  MAY  BE
SUBJECT  TO  REVIEW BY THE DEPARTMENT. THE NURSE PRACTITIONER SHALL MAKE
INFORMATION CONTAINED IN THIS FORM AVAILABLE TO HIS OR HER PATIENTS UPON
REQUEST. FAILURE TO COMPLY WITH THE REQUIREMENTS FOUND IN THIS PARAGRAPH
BY A NURSE PRACTITIONER WHO IS NOT COMPLYING  WITH  SUCH  PROVISIONS  OF
PARAGRAPH  (A)  OF  THIS  SUBDIVISION,  SHALL BE SUBJECT TO PROFESSIONAL
MISCONDUCT PROVISIONS AS SET FORTH IN ARTICLE ONE HUNDRED THIRTY OF THIS
TITLE.
  (C) Nothing in this subdivision shall be deemed to limit  or  diminish
the  practice  of the profession of nursing as a registered professional
nurse under this article or any other law, rule, regulation  or  certif-
ication,  nor  to deny any registered professional nurse the right to do
any act or engage in any practice authorized  by  this  article  or  any
other law, rule, regulation or certification.
  [(g)]  (D)  The  provisions of this subdivision shall not apply to any
activity authorized, pursuant to statute,  rule  or  regulation,  to  be
performed by a registered professional nurse in a hospital as defined in
article twenty-eight of the public health law.
  (E) THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH,
SHALL  ISSUE  A  REPORT  ON THE IMPLEMENTATION OF THE PROVISIONS OF THIS
SECTION, ALONG WITH INFORMATION THAT INCLUDES, BUT IS  NOT  LIMITED  TO:
THE  NUMBER OF NURSE PRACTITIONERS PRACTICING FOR FEWER THAN THREE THOU-
SAND SIX HUNDRED HOURS THAT PRACTICE  PURSUANT  TO  A  WRITTEN  PRACTICE
AGREEMENT WITH A PHYSICIAN; THE NUMBER OF NURSE PRACTITIONERS THAT PRAC-
TICE  PURSUANT TO A WRITTEN PRACTICE AGREEMENT WITH A NURSE PRACTITIONER
FOR SIX MONTHS AND THE NUMBER OF THESE NURSE PRACTITIONERS THAT EXTEND A
WRITTEN PRACTICE AGREEMENT FOR AN ADDITIONAL SIX MONTHS UPON  A  SHOWING
OF  GOOD  CAUSE SUBJECT TO THE APPROVAL OF THE DEPARTMENT; THE NUMBER OF
NURSE PRACTITIONERS THAT PRACTICE PURSUANT  TO  COLLABORATIVE  RELATION-
SHIPS  WITH PHYSICIANS; AND OTHER INFORMATION THE DEPARTMENT DEEMS RELE-
VANT, INCLUDING BUT NOT LIMITED TO, ANY RECOMMENDATIONS FOR THE  CONTIN-
UATION  OF  OR  AMENDMENTS TO THE PROVISIONS OF THIS SECTION RELATING TO
WRITTEN PRACTICE AGREEMENTS OR COLLABORATIVE RELATIONSHIPS. THE  COMMIS-
SIONER  SHALL  SUBMIT  THIS  REPORT  TO THE GOVERNOR, THE SPEAKER OF THE
ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE CHAIRS  OF  THE
ASSEMBLY  AND SENATE HIGHER EDUCATION COMMITTEES BY SEPTEMBER FIRST, TWO
THOUSAND SEVENTEEN.
  S 3. This act shall take effect on the first day of January  after  it
shall have become a law and shall expire June 30 of the sixth year after
it  shall  have become a law, when upon such date the provisions of this
act shall be deemed repealed; provided, however,  that  effective  imme-
diately, the addition, amendment and/or repeal of any rule or regulation
necessary  for  the  implementation of this act on its effective date is
authorized and directed to be made  and  completed  on  or  before  such
effective date.

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