S T A T E O F N E W Y O R K
________________________________________________________________________
5308--A
2011-2012 Regular Sessions
I N A S S E M B L Y
February 15, 2011
___________
Introduced by M. of A. GOTTFRIED, GUNTHER, PAULIN, LIFTON, LUPARDO,
ENGLEBRIGHT, GABRYSZAK, HOOPER, N. RIVERA, JAFFEE, SCARBOROUGH, ROSEN-
THAL, CAHILL, PRETLOW, ORTIZ, BENEDETTO, CASTRO, GIBSON, BRONSON,
RUSSELL, BRINDISI -- Multi-Sponsored by -- M. of A. BRENNAN, CROUCH,
CUSICK, GALEF, HEVESI, LATIMER, LAVINE, LENTOL, PEOPLES-STOKES, REILLY
-- read once and referred to the Committee on Higher Education --
reported and referred to the Committee on Rules -- Rules Committee
discharged, bill amended, ordered reprinted as amended and recommitted
to the Committee on Rules
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 AND PRACTICING FOR FEWER THAN THIRTY-SIX MONTHS AND THREE
THOUSAND SIX HUNDRED HOURS, may include the diagnosis of illness and
physical conditions 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 prac-
tice 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 practi-
tioner regarding a matter of diagnosis or treatment that is within the
scope of practice of both. To the extent the practice agreement does not
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01405-03-2
A. 5308--A 2
so provide, then the collaborating physician's diagnosis or treatment
shall prevail. IN THE EVENT THAT (I) 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 PRACTITIONER, NO LONGER BEING QUALIFIED TO PRACTICE OR UPON
HIS OR HER DEATH AND THE NURSE PRACTITIONER IS UNABLE TO ENTER INTO A
NEW WRITTEN PRACTICE AGREEMENT WITH ANOTHER COLLABORATING PHYSICIAN; OR
IF (II) A NURSE PRACTITIONER OBTAINS APPROVAL BY THE DEPARTMENT BASED ON
A DEMONSTRATION TO THE DEPARTMENT THAT AN EXISTING WRITTEN PRACTICE
AGREEMENT WAS TERMINATED DUE TO NO FAULT ON THE PART OF THE NURSE PRAC-
TITIONER, AND THAT THE NURSE PRACTITIONER IS UNABLE TO ENTER INTO A NEW
WRITTEN PRACTICE AGREEMENT WITHIN ANOTHER COLLABORATING PHYSICIAN
FOLLOWING A SHOWING OF GOOD FAITH EFFORT; THEN: 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 PRACTITIONER WHO HAS BEEN CERTIFIED UNDER SECTION SIX THOUSAND
NINE HUNDRED TEN OF THIS ARTICLE, WHO HAS BEEN PRACTICING FOR MORE THAN
THIRTY-SIX MONTHS AND THREE THOUSAND SIX HUNDRED HOURS AND WHO IS QUALI-
FIED TO COLLABORATE IN THE SPECIALTY INVOLVED, PROVIDED THAT SERVICES
ARE PERFORMED IN ACCORDANCE WITH A WRITTEN PRACTICE AGREEMENT AND WRIT-
TEN 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)] (II) 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. The nurse practi-
tioner shall obtain a certificate from the department upon successfully
completing a program including an appropriate pharmacology component, or
its equivalent, 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 [subdi-
vision] PARAGRAPH.
[(c)] (III) 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)] (IV) The practice protocol shall reflect current accepted
medical and nursing practice, OR WHERE APPLICABLE 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 establish-
ing the procedure for the review of protocols and the disposition of any
issues arising from such review.
[(e)] (V) No physician OR, WHERE APPLICABLE, NURSE PRACTITIONER, shall
enter into practice agreements with more than four nurse practitioners
who are not located on the same physical premises as the collaborating
physician OR COLLABORATING NURSE PRACTITIONER.
(B) (I) THE PRACTICE OF REGISTERED PROFESSIONAL NURSING BY A NURSE
PRACTITIONER, CERTIFIED UNDER SECTION SIX THOUSAND NINE HUNDRED TEN OF
A. 5308--A 3
THIS ARTICLE AND PRACTICING FOR MORE THAN THIRTY-SIX MONTHS AND THREE
THOUSAND SIX HUNDRED HOURS, MAY INCLUDE THE DIAGNOSIS OF ILLNESS AND
PHYSICAL CONDITIONS AND THE PERFORMANCE OF THERAPEUTIC AND CORRECTIVE
MEASURES WITHIN A SPECIALTY AREA OF PRACTICE.
(II) PRESCRIPTIONS FOR DRUGS, DEVICES AND IMMUNIZING AGENTS MAY BE
ISSUED BY A NURSE PRACTITIONER, UNDER THIS PARAGRAPH AND SECTION SIX
THOUSAND NINE HUNDRED TEN OF THIS ARTICLE. 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 PARAGRAPH; PROVIDED THAT ANY CERTIFICATE ISSUED
PURSUANT TO SUBPARAGRAPH (II) OF PARAGRAPH (A) OF THIS SUBDIVISION SHALL
ALSO SATISFY THE REQUIREMENTS OF THIS SUBPARAGRAPH. 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 PARA-
GRAPH.
(III) A NURSE PRACTITIONER, CERTIFIED UNDER SECTION SIX THOUSAND NINE
HUNDRED TEN OF THIS ARTICLE AND PRACTICING FOR MORE THAN THIRTY-SIX
MONTHS AND THREE THOUSAND SIX HUNDRED HOURS, SHALL EITHER HAVE A WRITTEN
PRACTICE AGREEMENT AND WRITTEN PRACTICE PROTOCOLS WITH A LICENSED PHYSI-
CIAN IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN PARAGRAPH (A) OF
THIS SUBDIVISION OR SHALL HAVE COLLABORATIVE RELATIONSHIPS WITH ONE OR
MORE LICENSED PHYSICIANS 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
HAVING PRIVILEGES AT SUCH INSTITUTION AND QUALIFIED TO COLLABORATE IN
THE SPECIALTY INVOLVED. SUCH COLLABORATIVE RELATIONSHIP SHALL INCLUDE
WRITTEN GUIDELINES FOR PRACTICE THAT PROVIDE FOR THE CRITERIA TO BE USED
REGARDING CONSULTATION, INCLUDING METHODS AND FREQUENCY OF HOW CONSULTA-
TION SHALL BE PROVIDED, COLLABORATIVE MANAGEMENT AND REFERRAL, INCLUDING
EMERGENCY REFERRAL PLANS, TO ADDRESS THE HEALTH STATUS AND RISKS OF
PATIENTS. DOCUMENTATION OF SUCH COLLABORATIVE RELATIONSHIPS SHALL BE
MAINTAINED BY THE NURSE PRACTITIONER AND THE NURSE PRACTITIONER SHALL
MAKE INFORMATION ABOUT SUCH COLLABORATIVE RELATIONSHIPS AVAILABLE TO HIS
OR HER PATIENTS UPON REQUEST. FAILURE TO COMPLY WITH THE REQUIREMENTS
FOUND IN THIS SUBPARAGRAPH SHALL BE SUBJECT TO PROFESSIONAL MISCONDUCT
PROVISIONS AS SET FORTH IN ARTICLE ONE HUNDRED THIRTY OF THIS TITLE.
(IV) THE WRITTEN GUIDELINES FOR PRACTICE SHALL REFLECT CURRENT
ACCEPTED MEDICAL AND NURSING PRACTICE AND SHALL BE FILED WITH THE
DEPARTMENT, ALONG WITH AN ATTESTATION BY THE NURSE PRACTITIONER IDENTI-
FYING THE PHYSICIAN, PHYSICIANS, OR HOSPITAL THAT HAVE AGREED TO PARTIC-
IPATE IN THE COLLABORATIVE RELATIONSHIP PURSUANT TO SUCH WRITTEN GUIDE-
LINES, WITHIN NINETY DAYS OF THE COMMENCEMENT OF THE PRACTICE AND MAY BE
UPDATED PERIODICALLY. THE COMMISSIONER SHALL MAKE REGULATIONS ESTABLISH-
ING THE PROCEDURES FOR THE REVIEW OF WRITTEN GUIDELINES AND THE DISPOSI-
TION OF ANY ISSUES ARISING FROM SUCH REVIEW.
[(f)] (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 certification, 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
A. 5308--A 4
performed by a registered professional nurse in a hospital as defined in
article twenty-eight of the public health law.
(E) THE DEPARTMENT SHALL REVIEW THE COMPONENTS COMMONLY FOUND IN THE
WRITTEN GUIDELINES FOR PRACTICE FILED WITH THE DEPARTMENT AND SHALL ALSO
ESTABLISH A SURVEY FORM, WHICH SHALL BE MADE AVAILABLE TO PHYSICIANS AND
NURSE PRACTITIONERS LICENSED IN THE STATE, IN ORDER TO SOLICIT COMMENTS
REGARDING THE PRACTICAL IMPLEMENTATION AND FUNCTIONALITY OF COLLABORA-
TIVE AGREEMENTS BETWEEN NURSE PRACTITIONERS AND COLLABORATIVE RELATION-
SHIPS BETWEEN A NURSE PRACTITIONER AND A PHYSICIAN AND THE IMPACT OF
SUCH AGREEMENTS AND RELATIONSHIPS TO THE PROVISION OF HEALTH CARE
SERVICES WITHIN THE STATE. THE COMMISSIONER, IN CONSULTATION WITH THE
COMMISSIONER OF HEALTH, SHALL ISSUE A REPORT THAT SUMMARIZES THE COMPO-
NENTS COMMONLY FOUND IN THE WRITTEN GUIDELINES FOR PRACTICE AND THE
COMMENTS RECEIVED RELATING TO COLLABORATIVE AGREEMENTS AND COLLABORATIVE
RELATIONSHIPS ALONG WITH INFORMATION THAT INCLUDES, BUT IS NOT LIMITED
TO: THE NUMBER OF NURSE PRACTITIONERS PRACTICING FOR FEWER THAN THIRTY-
SIX MONTHS AND THREE THOUSAND SIX HUNDRED HOURS THAT PRACTICE PURSUANT
TO A COLLABORATIVE AGREEMENT WITH A PHYSICIAN; THE NUMBER OF NURSE PRAC-
TITIONERS PRACTICING FOR FEWER THAN THIRTY-SIX MONTHS AND THREE THOUSAND
SIX HUNDRED HOURS THAT PRACTICE PURSUANT TO A COLLABORATIVE AGREEMENT
WITH A NURSE PRACTITIONER FOR SIX MONTHS AND THE NUMBER OF THESE NURSE
PRACTITIONERS THAT EXTEND A COLLABORATIVE AGREEMENT FOR AN ADDITIONAL
SIX MONTHS UPON A SHOWING OF GOOD CAUSE SUBJECT TO THE APPROVAL OF THE
DEPARTMENT; THE NUMBER OF NURSE PRACTITIONERS PRACTICING FOR MORE THAN
THIRTY-SIX MONTHS AND THREE THOUSAND SIX HUNDRED HOURS THAT PRACTICE
PURSUANT TO A COLLABORATIVE RELATIONSHIP WITH A PHYSICIAN; OTHER INFOR-
MATION THE DEPARTMENT DEEMS RELEVANT, INCLUDING BUT NOT LIMITED TO, ANY
RECOMMENDATIONS FOR THE CONTINUATION OR AMENDMENTS TO THE PROVISIONS OF
THIS SECTION RELATING TO COLLABORATIVE AGREEMENTS OR COLLABORATIVE
RELATIONSHIPS. THE COMMISSIONER SHALL SUBMIT THIS REPORT TO THE GOVER-
NOR, 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 SIXTEEN.
S 3. This act shall take effect on the one hundred eightieth day after
it shall have become a law and shall expire June 30, 2018 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.