NY State Senate Bill 2013-S4611A

Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 28, 2014	recommit, enacting clause stricken
Jan 29, 2014	print number 4611b
Jan 29, 2014	amend and recommit to higher education
Jan 08, 2014	referred to higher education
Jun 11, 2013	print number 4611a
Jun 11, 2013	amend and recommit to higher education
Apr 15, 2013	referred to higher education

co-Sponsors

View additional co-sponsors

2013-S4611 - Details

See Assembly Version of this Bill:: A4846
Law Section:: Education Law
Laws Affected:: Amd §6902, Ed L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A765
2011-2012: A5308

2013-S4611 - 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.

2013-S4611 - Sponsor Memo

                                BILL NUMBER:S4611

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"

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
are practicing for less than 36 months and 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 36 months and 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, the manner in which the NP will collaborate and
refer 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 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 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 collaboration no longer serves a clinical
purpose. Instead, mandatory collaboration and the 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:

180 days after the date of enactment.

2013-S4611 - Bill Text download pdf

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

                                  4611

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             April 15, 2013
                               ___________

Introduced  by  Sens.  YOUNG,  AVELLA,  ESPAILLAT,  MONTGOMERY, RITCHIE,
  ROBACH, SAVINO -- read twice and ordered printed, and when printed  to
  be committed to the Committee on Higher Education

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]  SIXTY-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  collab-
oration  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. 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 diag-
nosis or treatment shall prevail. 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 PRACTITIONER, NO LONGER BEING QUALI-
FIED TO PRACTICE OR UPON HIS OR HER DEATH AND THE NURSE PRACTITIONER  IS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10172-01-3

S. 4611                             2

UNABLE  TO  ENTER  INTO  A  NEW  WRITTEN PRACTICE AGREEMENT WITH ANOTHER
COLLABORATING PHYSICIAN; OR IF (B) 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 PRACTITIONER, AND THAT THE NURSE  PRACTITIONER  IS
UNABLE  TO  ENTER  INTO  A  NEW  WRITTEN PRACTICE AGREEMENT WITH ANOTHER
COLLABORATING PHYSICIAN FOLLOWING A SHOWING OF GOOD FAITH EFFORT;  THEN:
SUCH  NURSE PRACTITIONER MAY CONTINUE TO PRACTICE PURSUANT TO THIS PARA-
GRAPH WITHIN A SPECIALTY AREA OF PRACTICE FOR A  PERIOD  OF  UP  TO  SIX
MONTHS,  IN  COLLABORATION WITH A NURSE PRACTITIONER WHO HAS BEEN CERTI-
FIED UNDER SECTION SIXTY-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  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)]  (II) Prescriptions for drugs, devices and immunizing agents may
be issued by a nurse practitioner, under  this  [subdivision]  PARAGRAPH
and  section [six thousand nine] SIXTY-NINE hundred ten of this article,
in accordance with the practice 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 equivalent, as established by the commissioner's regu-
lations,  prior  to  prescribing under this [subdivision] PARAGRAPH. The
certificate issued under section [six thousand nine] SIXTY-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)] (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.
  [(f)] (B) (I) THE PRACTICE OF REGISTERED  PROFESSIONAL  NURSING  BY  A
NURSE  PRACTITIONER,  CERTIFIED  UNDER SECTION SIXTY-NINE HUNDRED TEN OF
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  SIXTY-

S. 4611                             3

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 EQUIVALENT, 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 SATIS-
FY  THE REQUIREMENTS OF THIS SUBPARAGRAPH.  THE CERTIFICATE ISSUED UNDER
SECTION SIXTY-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 PARAGRAPH.
  (III) A NURSE PRACTITIONER, CERTIFIED UNDER SECTION SIXTY-NINE HUNDRED
TEN OF THIS ARTICLE AND PRACTICING FOR MORE THAN THIRTY-SIX  MONTHS  AND
THREE THOUSAND SIX HUNDRED HOURS, 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  PHYSI-
CIANS  QUALIFIED  TO  COLLABORATE  IN  THE SPECIALTY INVOLVED AND HAVING
PRIVILEGES AT SUCH INSTITUTION BUT SHALL NOT BE REQUIRED TO HAVE A WRIT-
TEN PRACTICE AGREEMENT, PROVIDED  THAT  SUCH  NURSE  PRACTITIONER  SHALL
COMPLETE  AND  MAINTAIN  A  FORM, CREATED BY THE DEPARTMENT, WHICH NURSE
PRACTITIONER SHALL ATTEST TO, THAT SUMMARIZES  WRITTEN  PRACTICE  PROTO-
COLS, PROVIDES THE CRITERIA TO BE USED REGARDING CONSULTATION, INCLUDING
METHODS  AND FREQUENCY OF HOW CONSULTATION SHALL BE PROVIDED, COLLABORA-
TIVE MANAGEMENT AND REFERRAL, AND EMERGENCY REFERRAL PLANS,  TO  ADDRESS
THE  HEALTH  STATUS AND RISK OF PATIENTS. SUCH FORMS SHALL BE UPDATED AS
NEEDED AND MAY BE SUBJECT TO REVIEW BY THE DEPARTMENT. THE NURSE PRACTI-
TIONER SHALL MAKE CURRENT INFORMATION CONTAINED IN THIS  FORM  AVAILABLE
TO  HIS  OR HER PATIENTS UPON REQUEST.  DOCUMENTATION OF SUCH COLLABORA-
TIVE RELATIONSHIPS SHALL BE MAINTAINED BY THE NURSE PRACTITIONER AND MAY
BE SUBJECT TO REVIEW BY THE DEPARTMENT.   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.
  (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 THIRTY-SIX
MONTHS AND THREE THOUSAND SIX HUNDRED HOURS THAT PRACTICE PURSUANT TO  A
COLLABORATIVE  AGREEMENT  WITH  A PHYSICIAN; THE NUMBER OF NURSE PRACTI-
TIONERS 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

S. 4611                             4

PURSUANT  TO COLLABORATIVE RELATIONSHIPS WITH PHYSICIANS; OTHER INFORMA-
TION 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 SEVENTEEN.
  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, 2019 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.

co-Sponsors

View additional co-sponsors

2013-S4611A - Details

See Assembly Version of this Bill:: A4846
Law Section:: Education Law
Laws Affected:: Amd §6902, Ed L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A765
2011-2012: A5308

2013-S4611A - 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.

2013-S4611A - 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.

2013-S4611A - Bill Text download pdf

                            
                    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.

co-Sponsors

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2013-S4611B (ACTIVE) - Details

See Assembly Version of this Bill:: A4846
Law Section:: Education Law
Laws Affected:: Amd §6902, Ed L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A765
2011-2012: A5308

2013-S4611B (ACTIVE) - 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.

2013-S4611B (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S4611B

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"

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 are practicing for less
than 36 months and 3,600 hours with exceptions for good cause approved
by the State Education Department (SED). 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.

If a written practice agreement were to terminate because the
collaborating physician moves, retires, or dies, and the nurse
practitioner is unable to enter into a new written practice agreement
with a physician, the nurse Practitioner may enter into one with an
experienced nurse practitioner in order to continue to practice for up
to six months. The six month period may be extended for up to another
six months upon showing of good cause subject to the approval of SED.

NPs who have successfully practiced for more than 36 months and 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, the manner in which the NP will collaborate and
refer 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, 2018. The bill includes a
sunset provision for these changes in June 2020.

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
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 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 collaboration no longer serves a clinical
purpose. Instead, mandatory collaboration and the 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 undeserved areas 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.

2013-S4611B (ACTIVE) - Bill Text download pdf

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

                                 4611--B

                       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 -- recommitted to the Committee on High-
  er  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, 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.
                                                           LBD10172-03-4

S. 4611--B                          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--B                          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 EIGHTEEN.
  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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