Senate Bill S2948

2009-2010 Legislative Session

Allows certified nurse practitioners to practice without collaboration of a licensed physician and provides coverage for services performed by a nurse practitioner

download bill text pdf

Archive: Last Bill Status - In Senate Committee Higher Education Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 21, 2010	print number 2948b
Jun 21, 2010	amend (t) and recommit to higher education
Apr 16, 2010	print number 2948a
Apr 16, 2010	amend and recommit to higher education
Jan 06, 2010	referred to higher education
Mar 06, 2009	referred to higher education

Bill Amendments

Original

B (Active)

co-Sponsors

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2009-S2948 - Details

See Assembly Version of this Bill:: A765
Current Committee:: Senate Higher Education
Law Section:: Education Law
Laws Affected:: Amd §6902, add §6911, Ed L; amd §§3216, 3221, 4235 & 4303, Ins L; amd §4403, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2011-2012: S324, A5308
2013-2014: S2309, A4846

2009-S2948 - Summary

Allows the practice of registered professional nursing by a certified nurse practitioner to include diagnosis and performance without collaboration of a licensed physician.

2009-S2948 - Sponsor Memo

                                 BILL NUMBER:  S2948

 TITLE OF BILL :
An act to amend the education law, the insurance law and the public
health law, in relation to services performed by nurse practitioners


 PURPOSE OR GENERAL IDEA OF BILL :
To end the requirement of a collaboration agreement between a nurse
practitioner and a physician as a condition for practice, and provide
third party coverage for nurse practitioner services.

 SUMMARY OF SPECIFIC PROVISIONS :
Section 1 of the bill amends the nurse practice act in Education law
to delete the requirements for a collaboration agreements and practice
protocols between nurse practitioners and physicians.
Section 2 establishes a nurse practitioner advisory panel, appointed
by the Regents. Sections 4, 5, 6, and 7 mandate that major medical,
comprehensive-type insurance benefits, as well as managed care
policies, extend coverage to nurse practitioners, including those
working in independent settings.

 JUSTIFICATION :
Nurse Practitioners (NPs) 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
requires a mandatory collaboration relationship between a NP and a MD.
That relationship is defined by a written practice agreement which can
be as narrow or as broad as the MD is willing, Elsewhere, NPs practice
with complete independence in 13 states (AL, AZ, DC, IA, ID, ME, MT,
NH, NM, OR, UT, WA, WY). Given the education, training and advanced
certification of NPs, mandatory collaboration no longer serves a
clinical purpose. Instead, mandatory collaboration 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 :
2008: A10829 - Referred to Higher Education Committee.

 FISCAL IMPLICATIONS :
Reduces administrative costs for the State Education Department.

 EFFECTIVE DATE :
180 days after the date of enactment, except for section 2, which is
effective immediately.

2009-S2948 - Bill Text download pdf

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

                                  2948

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              March 6, 2009
                               ___________

Introduced  by  Sens.  MONTGOMERY, HASSELL-THOMPSON, OPPENHEIMER -- read
  twice and ordered printed, and when printed to  be  committed  to  the
  Committee on Higher Education

AN  ACT  to  amend  the  education law, the insurance law and the public
  health law, in relation to services performed by nurse practitioners

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

  Section  1.  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) 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  physi-
cian  qualified  to collaborate in the specialty involved, provided such
services are performed in accordance with a written  practice  agreement
and  written  practice  protocols.  The written practice agreement shall
include explicit provisions  for  the  resolution  of  any  disagreement
between the collaborating physician and the nurse practitioner regarding
a  matter of diagnosis or treatment that is within the scope of practice
of both. To the extent the practice agreement does not so provide,  then
the collaborating physician's diagnosis or treatment shall prevail].
  (b)  Prescriptions  for  drugs,  devices  and immunizing agents may be
issued by a nurse practitioner, under this subdivision and  section  six
thousand nine hundred ten of this article[, in accordance with the prac-
tice  agreement  and  practice  protocols]. 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. The certificate issued under section
six  thousand  nine  hundred ten of this article shall state whether the

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00773-01-9

S. 2948                             2

nurse practitioner has successfully completed such a program  or  equiv-
alent and is authorized to prescribe under this subdivision.
  (c)  [Each practice agreement shall provide for patient records review
by the collaborating physician in a timely fashion but in no event  less
often  than  every three months. The names of the nurse practitioner and
the collaborating physician shall be  clearly  posted  in  the  practice
setting of the nurse practitioner.
  (d)  The  practice protocol shall reflect current accepted medical and
nursing practice. The protocols shall be filed with the department with-
in 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 disposition of any  issues
arising from such review.
  (e)  No  physician shall enter into practice agreements with more than
four nurse practitioners who are not located on the same physical  prem-
ises as the collaborating physician.
  (f)]  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.
  S 2. The education law is amended by adding a new section 6911 to read
as follows:
  S 6911. NURSE PRACTITIONER ADVISORY PANEL. A NINE MEMBER NURSE PRACTI-
TIONER ADVISORY PANEL SHALL BE APPOINTED BY  THE  BOARD  OF  REGENTS  ON
RECOMMENDATION  OF  THE  COMMISSIONER  FOR  THE PURPOSE OF ASSISTING THE
BOARD OF REGENTS, THE BOARD FOR NURSING, AND THE COMMISSIONER ON MATTERS
RELATED TO THE PRACTICE OF REGISTERED NURSING AS A  NURSE  PRACTITIONER.
THE PANEL SHALL BE COMPOSED OF AT LEAST SIX LICENSED AND CERTIFIED NURSE
PRACTITIONERS,  AND  AT  LEAST  TWO  PERSONS  TO REPRESENT CONSUMERS AND
PATIENT GROUPS.
  S 3. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 26 to read as follows:
  (26) EVERY POLICY WHICH PROVIDES COVERAGE FOR PHYSICIAN SERVICES IN  A
PHYSICIAN'S  OFFICE,  AND  EVERY  POLICY WHICH PROVIDES MAJOR MEDICAL OR
SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE THE SAME COVERAGE  FOR
SUCH  SERVICES WHEN PERFORMED BY A NURSE PRACTITIONER, INCLUDING A NURSE
PRACTITIONER PRACTICING INDEPENDENTLY, ACTING WITHIN THE LAWFUL SCOPE OF
HIS OR HER PRACTICE AND CERTIFIED PURSUANT TO ARTICLE ONE HUNDRED  THIR-
TY-NINE  OF  THE  EDUCATION  LAW. SUCH COVERAGE MAY BE SUBJECT TO ANNUAL
DEDUCTIBLES AND COINSURANCE AS MAY BE  DEEMED  APPROPRIATE  AND  AS  ARE
CONSISTENT WITH OTHER BENEFITS COVERED UNDER THE POLICY.
  S 4. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 15 to read as follows:
  (15)  EVERY POLICY WHICH PROVIDES COVERAGE FOR PHYSICIAN SERVICES IN A
PHYSICIAN'S OFFICE, AND EVERY POLICY WHICH  PROVIDES  MAJOR  MEDICAL  OR
SIMILAR  COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE THE SAME COVERAGE FOR
SUCH SERVICES WHEN PERFORMED BY A NURSE PRACTITIONER, INCLUDING A  NURSE
PRACTITIONER PRACTICING INDEPENDENTLY, ACTING WITHIN THE LAWFUL SCOPE OF
HIS  OR HER PRACTICE AND CERTIFIED PURSUANT TO ARTICLE ONE HUNDRED THIR-
TY-NINE OF THE EDUCATION LAW. SUCH COVERAGE MAY  BE  SUBJECT  TO  ANNUAL

S. 2948                             3

DEDUCTIBLES  AND  COINSURANCE  AS  MAY  BE DEEMED APPROPRIATE AND AS ARE
CONSISTENT WITH OTHER BENEFITS COVERED UNDER THE POLICY.
  S  5.  Subparagraphs  (G)  and (H) of paragraph 4 of subsection (f) of
section 4235 of the insurance law, as relettered by chapter 456  of  the
laws of 1993, are amended and a new subparagraph (I) is added to read as
follows:
  (G)  psychiatric  or  psychological  services or for the diagnosis and
treatment of mental, nervous, or emotional disorders or ailments, howev-
er defined in such policy, a subscriber to such policy shall be entitled
to reimbursement for such psychiatric or psychological services or diag-
nosis or treatment whether performed by a physician, psychiatrist  or  a
certified  and  registered  psychologist  when the services rendered are
within the lawful scope of their practice, and when such policy  or  any
certificate  issued thereunder is delivered or issued for delivery with-
out this state by an authorized insurer,  covered  persons  residing  in
this  state  shall  be  entitled to reimbursement for such diagnosis and
treatment by a physician, psychiatrist or  a  certified  and  registered
psychologist as hereinabove provided; [and]
  (H)  any  service  which  is  within the lawful scope of practice of a
licensed chiropractor, a subscriber to such policy shall be entitled  to
reimbursement  for  such  service  when  such  service is performed by a
licensed chiropractor[.]; AND
  (I) ANY SERVICE WHICH IS WITHIN THE LAWFUL  SCOPE  OF  PRACTICE  OF  A
CERTIFIED NURSE PRACTITIONER, A SUBSCRIBER TO SUCH POLICY SHALL BE ENTI-
TLED TO REIMBURSEMENT FOR SUCH SERVICE WHEN SAID SERVICE IS PERFORMED BY
A  CERTIFIED NURSE PRACTITIONER, INCLUDING A NURSE PRACTITIONER PRACTIC-
ING INDEPENDENTLY, ACTING WITHIN THE LAWFUL SCOPE OF HIS OR HER PRACTICE
AND CERTIFIED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF THE  EDUCA-
TION LAW.
  S  6.  Section  4303  of  the insurance law is amended by adding a new
subsection (ff) to read as follows:
  (FF) EVERY CONTRACT ISSUED  BY  A  HEALTH  SERVICE  CORPORATION  OR  A
MEDICAL EXPENSE INDEMNITY CORPORATION WHICH PROVIDES COVERAGE FOR PHYSI-
CIAN SERVICES IN A PHYSICIAN'S OFFICE, AND EVERY CONTRACT WHICH PROVIDES
MAJOR  MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE, SHALL PROVIDE THE
SAME COVERAGE FOR SUCH SERVICES WHEN PERFORMED BY A NURSE  PRACTITIONER,
INCLUDING  A  NURSE PRACTITIONER PRACTICING INDEPENDENTLY, ACTING WITHIN
THE LAWFUL SCOPE OF HIS OR HER PRACTICE AND CERTIFIED PURSUANT TO  ARTI-
CLE  ONE  HUNDRED THIRTY-NINE OF THE EDUCATION LAW. SUCH COVERAGE MAY BE
SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPROPRI-
ATE AND AS ARE CONSISTENT WITH OTHER BENEFITS COVERED UNDER THE POLICY.
  S 7. Paragraph (a) of subdivision 5 of  section  4403  of  the  public
health law, as amended by chapter 586 of the laws of 1998, is amended to
read as follows:
  (a) The commissioner, at the time of initial licensure, at least every
three  years  thereafter,  and upon application for expansion of service
area, shall ensure that the health maintenance organization maintains  a
network  of  health  care  providers  adequate to meet the comprehensive
health needs of its enrollees and to provide an  appropriate  choice  of
providers   sufficient   to  provide  the  services  covered  under  its
enrollee's contracts by determining that  (i)  there  are  a  sufficient
number  of geographically accessible participating providers; (ii) there
are opportunities to select from at least three primary  care  providers
pursuant  to  travel  and  distance  time standards, providing that such
standards account for the conditions of  accessing  providers  in  rural
areas;  (iii)  there  are sufficient providers in each area of specialty

S. 2948                             4

practice to meet the needs of the enrollment population; (iv)  there  is
no  exclusion of any appropriately licensed type of provider as a class,
INCLUDING  NURSE  PRACTITIONERS  PRACTICING   INDEPENDENTLY;   and   (v)
contracts  entered  into  with  health  care  providers neither transfer
financial  risk  to  providers,  in  a  manner  inconsistent  with   the
provisions  of  paragraph  (c)  of  subdivision one of this section, nor
penalize providers for unfavorable case mix  so  as  to  jeopardize  the
quality  of  or  enrollees'  appropriate  access  to medically necessary
services; provided, however, that payment at less  than  prevailing  fee
for  service  rates  or capitation shall not be deemed or presumed prima
facie to jeopardize quality or access.
  S 8. This act shall take effect immediately; provided,  however,  that
sections  one,  three,  four, five, six and seven of this act shall take
effect on the one hundred eightieth day after it  shall  have  become  a
law;  and  provided,  further, 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 are authorized and
directed to be made and completed on or before such effective date.

co-Sponsors

View additional co-sponsors

2009-S2948A - Details

See Assembly Version of this Bill:: A765
Current Committee:: Senate Higher Education
Law Section:: Education Law
Laws Affected:: Amd §6902, add §6911, Ed L; amd §§3216, 3221, 4235 & 4303, Ins L; amd §4403, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2011-2012: S324, A5308
2013-2014: S2309, A4846

2009-S2948A - Summary

Allows the practice of registered professional nursing by a certified nurse practitioner to include diagnosis and performance without collaboration of a licensed physician.

2009-S2948A - Sponsor Memo

                                 BILL NUMBER:  S2948A

 TITLE OF BILL :
An act to amend the education law, the insurance law and the public
health law, in relation to services performed by nurse practitioners


 PURPOSE OR GENERAL IDEA OF BILL :
To end the requirement of a collaboration agreement between a nurse
practitioner and a physician as a condition for practice, and provide
third party coverage for nurse practitioner services.

 SUMMARY OF SPECIFIC PROVISIONS :
Section 1 of the bill amends the nurse practice act in Education law
to delete the requirements for a collaboration agreements and practice
protocols between nurse practitioners and physicians.  Section 2
establishes a nurse practitioner advisory panel, appointed by the
Regents. Sections 4, 5, 6, and 7 mandate that major medical,
comprehensive-type insurance benefits, as well as managed care
policies, extend coverage to nurse practitioners, including those
working in independent settings.

 JUSTIFICATION :
Nurse Practitioners (NPs) 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
requires a mandatory collaboration relationship between a NP and a MD.
That relationship is defined by a written practice agreement which can
be as narrow or as broad as the MD is willing, Elsewhere, NPs practice
with complete independence in 13 states (AL, AZ, DC, IA, ID, ME, MT,
NH, NM, OR, UT, WA, WY). Given the education, training and advanced
certification of NPs, mandatory collaboration no longer serves a
clinical purpose. Instead, mandatory collaboration 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 :
2008: A.10829 - Referred to Higher Education Committee.

 FISCAL IMPLICATIONS :
Reduces administrative costs for the State Education Department.

 EFFECTIVE DATE :
180 days after the date of enactment, except for section 2, which is
effective immediately.

2009-S2948A - Bill Text download pdf

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

                                 2948--A

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              March 6, 2009
                               ___________

Introduced by Sens. MONTGOMERY, FOLEY, HASSELL-THOMPSON, HUNTLEY, KLEIN,
  OPPENHEIMER,  PERKINS  --  read  twice  and  ordered printed, and when
  printed to be committed to the Committee on Higher Education -- recom-
  mitted to the Committee on Higher Education in accordance with  Senate
  Rule  6,  sec.  8  --  committee  discharged,  bill  amended,  ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the education law, the  insurance  law  and  the  public
  health law, in relation to services performed by nurse practitioners

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

  Section 1. 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)  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 physi-
cian qualified to collaborate in the specialty involved,  provided  such
services  are  performed in accordance with a written practice agreement
and written practice protocols. The  written  practice  agreement  shall
include  explicit  provisions  for  the  resolution  of any disagreement
between the collaborating physician and the nurse practitioner regarding
a matter of diagnosis or treatment that is within the scope of  practice
of  both. To the extent the practice agreement does not so provide, then
the collaborating physician's diagnosis or treatment shall prevail].
  (b) Prescriptions for drugs, devices  and  immunizing  agents  may  be
issued  by  a nurse practitioner, under this subdivision and section six
thousand nine hundred ten of this article[, in accordance with the prac-
tice agreement and practice protocols].  The  nurse  practitioner  shall
obtain  a certificate from the department upon successfully completing a
program including an appropriate pharmacology component, or  its  equiv-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00773-03-0

S. 2948--A                          2

alent,  as  established  by  the  commissioner's  regulations,  prior to
prescribing under this subdivision. 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 equiv-
alent and is authorized to prescribe under this subdivision.
  (c) [Each practice agreement shall provide for patient records  review
by  the collaborating physician in a timely fashion but in no event less
often than every three months. The names of the nurse  practitioner  and
the  collaborating  physician  shall  be  clearly posted in the practice
setting of the nurse practitioner.
  (d) The practice protocol shall reflect current accepted  medical  and
nursing practice. The protocols shall be filed with the department with-
in  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 disposition of any issues
arising from such review.
  (e) No physician shall enter into practice agreements with  more  than
four  nurse practitioners who are not located on the same physical prem-
ises as the collaborating physician.
  (f)] 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.
  S 2. The education law is amended by adding a new section 6911 to read
as follows:
  S 6911. NURSE PRACTITIONER ADVISORY PANEL. A NINE MEMBER NURSE PRACTI-
TIONER  ADVISORY  PANEL  SHALL  BE  APPOINTED BY THE BOARD OF REGENTS ON
RECOMMENDATION OF THE COMMISSIONER FOR  THE  PURPOSE  OF  ASSISTING  THE
BOARD OF REGENTS, THE BOARD FOR NURSING, AND THE COMMISSIONER ON MATTERS
RELATED  TO  THE PRACTICE OF REGISTERED NURSING AS A NURSE PRACTITIONER.
THE PANEL SHALL BE COMPOSED OF AT LEAST SIX LICENSED AND CERTIFIED NURSE
PRACTITIONERS, AND AT LEAST  TWO  PERSONS  TO  REPRESENT  CONSUMERS  AND
PATIENT GROUPS.
  S 3. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 27 to read as follows:
  (27)  EVERY POLICY WHICH PROVIDES COVERAGE FOR PHYSICIAN SERVICES IN A
PHYSICIAN'S OFFICE, AND EVERY POLICY WHICH  PROVIDES  MAJOR  MEDICAL  OR
SIMILAR  COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE THE SAME COVERAGE FOR
SUCH SERVICES WHEN PERFORMED BY A NURSE PRACTITIONER, INCLUDING A  NURSE
PRACTITIONER PRACTICING INDEPENDENTLY, ACTING WITHIN THE LAWFUL SCOPE OF
HIS  OR HER PRACTICE AND CERTIFIED PURSUANT TO ARTICLE ONE HUNDRED THIR-
TY-NINE OF THE EDUCATION LAW. SUCH COVERAGE MAY  BE  SUBJECT  TO  ANNUAL
DEDUCTIBLES  AND  COINSURANCE  AS  MAY  BE DEEMED APPROPRIATE AND AS ARE
CONSISTENT WITH OTHER BENEFITS COVERED UNDER THE POLICY.
  S 4. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 16 to read as follows:
  (16) EVERY POLICY WHICH PROVIDES COVERAGE FOR PHYSICIAN SERVICES IN  A
PHYSICIAN'S  OFFICE,  AND  EVERY  POLICY WHICH PROVIDES MAJOR MEDICAL OR
SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE THE SAME COVERAGE  FOR
SUCH  SERVICES WHEN PERFORMED BY A NURSE PRACTITIONER, INCLUDING A NURSE

S. 2948--A                          3

PRACTITIONER PRACTICING INDEPENDENTLY, ACTING WITHIN THE LAWFUL SCOPE OF
HIS OR HER PRACTICE AND CERTIFIED PURSUANT TO ARTICLE ONE HUNDRED  THIR-
TY-NINE  OF  THE  EDUCATION  LAW. SUCH COVERAGE MAY BE SUBJECT TO ANNUAL
DEDUCTIBLES  AND  COINSURANCE  AS  MAY  BE DEEMED APPROPRIATE AND AS ARE
CONSISTENT WITH OTHER BENEFITS COVERED UNDER THE POLICY.
  S 5. Subparagraphs (G) and (H) of paragraph 4  of  subsection  (f)  of
section  4235  of the insurance law, as relettered by chapter 456 of the
laws of 1993, are amended and a new subparagraph (I) is added to read as
follows:
  (G) psychiatric or psychological services or  for  the  diagnosis  and
treatment of mental, nervous, or emotional disorders or ailments, howev-
er defined in such policy, a subscriber to such policy shall be entitled
to reimbursement for such psychiatric or psychological services or diag-
nosis  or  treatment whether performed by a physician, psychiatrist or a
certified and registered psychologist when  the  services  rendered  are
within  the  lawful scope of their practice, and when such policy or any
certificate issued thereunder is delivered or issued for delivery  with-
out  this  state  by  an authorized insurer, covered persons residing in
this state shall be entitled to reimbursement  for  such  diagnosis  and
treatment  by  a  physician,  psychiatrist or a certified and registered
psychologist as hereinabove provided; [and]
  (H) any service which is within the lawful  scope  of  practice  of  a
licensed  chiropractor, a subscriber to such policy shall be entitled to
reimbursement for such service when  such  service  is  performed  by  a
licensed chiropractor[.]; AND
  (I)  ANY  SERVICE  WHICH  IS  WITHIN THE LAWFUL SCOPE OF PRACTICE OF A
CERTIFIED NURSE PRACTITIONER, A SUBSCRIBER TO SUCH POLICY SHALL BE ENTI-
TLED TO REIMBURSEMENT FOR SUCH SERVICE WHEN SAID SERVICE IS PERFORMED BY
A CERTIFIED NURSE PRACTITIONER, INCLUDING A NURSE PRACTITIONER  PRACTIC-
ING INDEPENDENTLY, ACTING WITHIN THE LAWFUL SCOPE OF HIS OR HER PRACTICE
AND  CERTIFIED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF THE EDUCA-
TION LAW.
  S 6. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (gg) to read as follows:
  (GG)  EVERY  CONTRACT  ISSUED  BY  A  HEALTH  SERVICE CORPORATION OR A
MEDICAL EXPENSE INDEMNITY CORPORATION WHICH PROVIDES COVERAGE FOR PHYSI-
CIAN SERVICES IN A PHYSICIAN'S OFFICE, AND EVERY CONTRACT WHICH PROVIDES
MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE, SHALL PROVIDE  THE
SAME  COVERAGE FOR SUCH SERVICES WHEN PERFORMED BY A NURSE PRACTITIONER,
INCLUDING A NURSE PRACTITIONER PRACTICING INDEPENDENTLY,  ACTING  WITHIN
THE  LAWFUL SCOPE OF HIS OR HER PRACTICE AND CERTIFIED PURSUANT TO ARTI-
CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW. SUCH COVERAGE  MAY  BE
SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPROPRI-
ATE AND AS ARE CONSISTENT WITH OTHER BENEFITS COVERED UNDER THE POLICY.
  S  7.  Paragraph  (a)  of  subdivision 5 of section 4403 of the public
health law, as amended by chapter 586 of the laws of 1998, is amended to
read as follows:
  (a) The commissioner, at the time of initial licensure, at least every
three years thereafter, and upon application for  expansion  of  service
area,  shall ensure that the health maintenance organization maintains a
network of health care providers  adequate  to  meet  the  comprehensive
health  needs  of  its enrollees and to provide an appropriate choice of
providers  sufficient  to  provide  the  services  covered   under   its
enrollee's  contracts  by  determining  that  (i) there are a sufficient
number of geographically accessible participating providers; (ii)  there
are  opportunities  to select from at least three primary care providers

S. 2948--A                          4

pursuant to travel and distance  time  standards,  providing  that  such
standards  account  for  the  conditions of accessing providers in rural
areas; (iii) there are sufficient providers in each  area  of  specialty
practice  to  meet the needs of the enrollment population; (iv) there is
no exclusion of any appropriately licensed type of provider as a  class,
INCLUDING   NURSE   PRACTITIONERS   PRACTICING  INDEPENDENTLY;  and  (v)
contracts entered into  with  health  care  providers  neither  transfer
financial   risk  to  providers,  in  a  manner  inconsistent  with  the
provisions of paragraph (c) of subdivision  one  of  this  section,  nor
penalize  providers  for  unfavorable  case  mix so as to jeopardize the
quality of or  enrollees'  appropriate  access  to  medically  necessary
services;  provided,  however,  that payment at less than prevailing fee
for service rates or capitation shall not be deemed  or  presumed  prima
facie to jeopardize quality or access.
  S  8.  This act shall take effect immediately; provided, however, that
sections one, three, four, five, six and seven of this  act  shall  take
effect  on  the  one  hundred eightieth day after it shall have become a
law; and provided, further, 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  are  authorized  and
directed to be made and completed on or before such effective date.

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2009-S2948B (ACTIVE) - Details

See Assembly Version of this Bill:: A765
Current Committee:: Senate Higher Education
Law Section:: Education Law
Laws Affected:: Amd §6902, add §6911, Ed L; amd §§3216, 3221, 4235 & 4303, Ins L; amd §4403, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2011-2012: S324, A5308
2013-2014: S2309, A4846

2009-S2948B (ACTIVE) - Summary

Allows the practice of registered professional nursing by a certified nurse practitioner to include diagnosis and performance without collaboration of a licensed physician.

2009-S2948B (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S2948B

TITLE OF BILL:
An act to amend the education law, in relation to services performed
by nurse practitioners

PURPOSE OR GENERAL IDEA OF BILL:
To end the requirement of a collaboration agreement between a nurse
practitioner and a physician as a condition for practice, and provide
third party coverage for nurse practitioner services.

SUMMARY OF SPECIFIC PROVISIONS:
Section 1 of the bill amends the nurse practice act in Education law
to delete the requirements for a collaboration agreements and practice
protocols between nurse practitioners and physicians. Section 2
establishes a nurse practitioner advisory panel, appointed by the
Regents.

Sections 4, 5, 6, and 7 mandate that major medical, comprehensive-type
insurance benefits, as well as managed care policies, extend coverage
to nurse practitioners, including those working in independent
settings.

JUSTIFICATION:
Nurse practitioners (NPs) 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 requires a mandatory collaboration relationship
between a NP and a MD. That relationship is defined by a written
practice agreement which can be as narrow or as broad as the MD is
willing, Elsewhere, NPs practice with complete independence in 13
states (AL, AZ, DC, IA, ID, ME, MT, NH, NM, OR, UT, WA, WY). Given the
education, training and advanced certification of NPS, mandatory
collaboration no longer serves a clinical purpose. Instead, mandatory
collaboration 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 under served areas of the state.

PRIOR LEGISLATIVE HISTORY:
2008: A.10829 - Referred to Higher Education Committee.

FISCAL IMPLICATIONS:
Reduces administrative costs for the State Education Department.

EFFECTIVE DATE:
180 days after the date of enactment, except for section 2, which is
effective immediately.

2009-S2948B (ACTIVE) - Bill Text download pdf

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

                                 2948--B

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              March 6, 2009
                               ___________

Introduced by Sens. MONTGOMERY, FOLEY, HASSELL-THOMPSON, HUNTLEY, KLEIN,
  OPPENHEIMER,  PERKINS  --  read  twice  and  ordered printed, and when
  printed to be committed to the Committee on Higher Education -- recom-
  mitted to the Committee on Higher Education in accordance with  Senate
  Rule  6,  sec.  8  --  committee  discharged,  bill  amended,  ordered
  reprinted as amended and recommitted to said  committee  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN  ACT to amend the education law, in relation to services performed by
  nurse practitioners

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

  Section  1.  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) 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  physi-
cian  qualified  to collaborate in the specialty involved, provided such
services are performed in accordance with a written  practice  agreement
and  written  practice  protocols.  The written practice agreement shall
include explicit provisions  for  the  resolution  of  any  disagreement
between the collaborating physician and the nurse practitioner regarding
a  matter of diagnosis or treatment that is within the scope of practice
of both. To the extent the practice agreement does not so provide,  then
the collaborating physician's diagnosis or treatment shall prevail].
  (b)  Prescriptions  for  drugs,  devices  and immunizing agents may be
issued by a nurse practitioner, under this subdivision and  section  six
thousand nine hundred ten of this article[, in accordance with the prac-
tice  agreement  and  practice  protocols]. The nurse practitioner shall

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00773-06-0

S. 2948--B                          2

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. 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  equiv-
alent and is authorized to prescribe under this subdivision.
  (c)  [Each practice agreement shall provide for patient records review
by the collaborating physician in a timely fashion but in no event  less
often  than  every three months. The names of the nurse practitioner and
the collaborating physician shall be  clearly  posted  in  the  practice
setting of the nurse practitioner.
  (d)  The  practice protocol shall reflect current accepted medical and
nursing practice. The protocols shall be filed with the department with-
in 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 disposition of any  issues
arising from such review.
  (e)  No  physician shall enter into practice agreements with more than
four nurse practitioners who are not located on the same physical  prem-
ises as the collaborating physician.
  (f)]  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.
  S 2. The education law is amended by adding a new section 6911 to read
as follows:
  S 6911. NURSE PRACTITIONER ADVISORY PANEL. A NINE MEMBER NURSE PRACTI-
TIONER ADVISORY PANEL SHALL BE APPOINTED BY  THE  BOARD  OF  REGENTS  ON
RECOMMENDATION  OF  THE  COMMISSIONER  FOR  THE PURPOSE OF ASSISTING THE
BOARD OF REGENTS, THE BOARD FOR NURSING, AND THE COMMISSIONER ON MATTERS
RELATED TO THE PRACTICE OF REGISTERED NURSING AS A  NURSE  PRACTITIONER.
THE PANEL SHALL BE COMPOSED OF AT LEAST SIX LICENSED AND CERTIFIED NURSE
PRACTITIONERS,  AND  AT  LEAST  TWO  PERSONS  TO REPRESENT CONSUMERS AND
PATIENT GROUPS.
  S 3. This act shall take effect immediately; provided,  however,  that
section  one  of this act shall take effect on the one hundred eightieth
day after it shall have become a law; and provided, further, that effec-
tive immediately, the addition, amendment and/or repeal of any  rule  or
regulation necessary for the implementation of this act on its effective
date  are  authorized and directed to be made and completed on or before
such effective date.

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