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A04846 Summary:

BILL NO    A04846B

SAME AS    SAME AS S04611-B

SPONSOR    Gottfried (MS)

COSPNSR    Gunther, Paulin, Lifton, Lupardo, Englebright, Hooper, Jaffee,
           Scarborough, Rosenthal, Cahill, Pretlow, Ortiz, Benedetto, Russell,
           Brindisi, Rivera

MLTSPNSR   Abinanti, Brennan, Crouch, Cusick, Galef, Hevesi, Lavine, Lentol,
           Millman, Peoples-Stokes, Perry

Amd S6902, Ed L

Establishes the nurse practitioners modernization act which allows the practice
of registered professional nursing by a certified nurse practitioner to include
diagnosis and performance without collaboration of a licensed physician.
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A04846 Text:

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

                                        4846--B

                              2013-2014 Regular Sessions

                                 I N  A S S E M B L Y

                                   February 11, 2013
                                      ___________

       Introduced  by  M.  of  A.  GOTTFRIED, GUNTHER, PAULIN, LIFTON, LUPARDO,
         ENGLEBRIGHT, HOOPER, JAFFEE, SCARBOROUGH, ROSENTHAL, CAHILL,  PRETLOW,
         ORTIZ,  BENEDETTO,  RUSSELL, BRINDISI, RIVERA -- Multi-Sponsored by --
         M. of A.  ABINANTI, BOYLAND, BRENNAN, CROUCH, CUSICK,  GALEF,  HEVESI,
         LAVINE,  LENTOL,  MILLMAN,  PEOPLES-STOKES,  PERRY  --  read  once and
         referred to the Committee on Higher Education -- committee discharged,
         bill amended, ordered reprinted as amended  and  recommitted  to  said
         committee  --  recommitted  to  the  Committee  on Higher Education in
         accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
         amended,  ordered reprinted as amended and recommitted to said commit-
         tee

       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:

    1    Section 1. Short title. This act shall be known and may  be  cited  as
    2  the "nurse practitioners modernization act".
    3    S  2.  Subdivision 3 of section 6902 of the education law, as added by
    4  chapter 257 of the laws of 1988, is amended to read as follows:
    5    3. (a) (I) The practice of registered professional nursing by a  nurse
    6  practitioner,  certified  under section six thousand nine hundred ten of
    7  this article, may include the diagnosis of illness and  physical  condi-
    8  tions  and the performance of therapeutic and corrective measures within
    9  a specialty area of practice, in collaboration with a licensed physician
   10  qualified to  collaborate  in  the  specialty  involved,  provided  such
   11  services  are  performed in accordance with a written practice agreement
   12  and written practice protocols EXCEPT AS PERMITTED BY PARAGRAPH  (B)  OF
   13  THIS SUBDIVISION.  The written practice agreement shall include explicit
   14  provisions  for  the  resolution of any disagreement between the collab-
   15  orating physician and the nurse practitioner regarding a matter of diag-

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06944-06-4
       A. 4846--B                          2

    1  nosis or treatment that is within the scope of practice of both. To  the
    2  extent  the practice agreement does not so provide, then the collaborat-
    3  ing physician's diagnosis or treatment shall prevail.
    4    (II) IN THE EVENT THAT (A) AN EXISTING WRITTEN PRACTICE AGREEMENT WITH
    5  A  COLLABORATING  PHYSICIAN TERMINATES AS A RESULT OF: THE COLLABORATING
    6  PHYSICIAN MOVING, RETIRING, NO LONGER NEEDING THE SERVICES OF THE  NURSE
    7  PRACTITIONER,  NO  LONGER  BEING  QUALIFIED  TO PRACTICE; OR THE WRITTEN
    8  PRACTICE AGREEMENT TERMINATING DUE TO NO FAULT ON THE PART OF THE  NURSE
    9  PRACTITIONER; AND (B) THE NURSE PRACTITIONER DEMONSTRATES THAT HE OR SHE
   10  HAS MADE A GOOD FAITH EFFORT TO ENTER INTO A NEW WRITTEN PRACTICE AGREE-
   11  MENT  WITH  A COLLABORATING PHYSICIAN AND HAS BEEN UNABLE TO DO SO, THEN
   12  UPON APPROVAL BY THE DEPARTMENT, SUCH NURSE PRACTITIONER MAY CONTINUE TO
   13  PRACTICE PURSUANT TO THIS PARAGRAPH WITHIN A SPECIALTY AREA OF  PRACTICE
   14  FOR  A PERIOD OF UP TO SIX MONTHS, IN COLLABORATION WITH A NURSE PRACTI-
   15  TIONER WHO HAS BEEN CERTIFIED UNDER SECTION SIX  THOUSAND  NINE  HUNDRED
   16  TEN  OF  THIS ARTICLE, WHO HAS BEEN PRACTICING FOR MORE THAN THREE THOU-
   17  SAND SIX HUNDRED HOURS AND  WHO  IS  QUALIFIED  TO  COLLABORATE  IN  THE
   18  SPECIALTY  INVOLVED,  PROVIDED THAT SERVICES ARE PERFORMED IN ACCORDANCE
   19  WITH A WRITTEN PRACTICE AGREEMENT AND WRITTEN PRACTICE  PROTOCOLS;  SUCH
   20  SIX  MONTH TIME PERIOD FOR COLLABORATION BETWEEN NURSE PRACTITIONERS MAY
   21  BE EXTENDED FOR A PERIOD OF TIME NOT TO EXCEED AN ADDITIONAL SIX  MONTHS
   22  UPON A SHOWING OF GOOD CAUSE SUBJECT TO THE APPROVAL OF THE DEPARTMENT.
   23    [(b)] (III) Prescriptions for drugs, devices and immunizing agents may
   24  be  issued  by  a nurse practitioner, under this [subdivision] PARAGRAPH
   25  and section six thousand nine hundred ten of this article, in accordance
   26  with the practice agreement and practice protocols EXCEPT  AS  PERMITTED
   27  BY  PARAGRAPH  (B)  OF  THIS SUBDIVISION.   The nurse practitioner shall
   28  obtain a certificate from the department upon successfully completing  a
   29  program  including  an appropriate pharmacology component, or its equiv-
   30  alent, as  established  by  the  commissioner's  regulations,  prior  to
   31  prescribing  under  this [subdivision] PARAGRAPH. The certificate issued
   32  under section six thousand nine hundred ten of this article shall  state
   33  whether the nurse practitioner has successfully completed such a program
   34  or  equivalent  and  is authorized to prescribe under this [subdivision]
   35  PARAGRAPH.
   36    [(c)] (IV) Each practice agreement shall provide for  patient  records
   37  review  by the collaborating physician OR, WHERE APPLICABLE, THE COLLAB-
   38  ORATING NURSE PRACTITIONER, in a timely fashion but  in  no  event  less
   39  often  than  every three months. The names of the nurse practitioner and
   40  the collaborating physician  OR,  WHERE  APPLICABLE,  THE  COLLABORATING
   41  NURSE  PRACTITIONER  shall  be clearly posted in the practice setting of
   42  the nurse practitioner.
   43    [(d)] (V) The practice protocol shall reflect current accepted medical
   44  and nursing practice, OR FOR COLLABORATING WITH  ANOTHER  NURSE  PRACTI-
   45  TIONER  PURSUANT  TO  SUBPARAGRAPH  (II)  OF THIS PARAGRAPH, THE CURRENT
   46  ACCEPTED NURSING PRACTICE.   The  protocols  shall  be  filed  with  the
   47  department  within  ninety  days of the commencement of the practice and
   48  may be updated periodically. The  commissioner  shall  make  regulations
   49  establishing  the procedure for the review of protocols and the disposi-
   50  tion of any issues arising from such review.
   51    [(e)] (VI) No physician  OR,  WHERE  APPLICABLE,  NURSE  PRACTITIONER,
   52  shall  enter  into practice agreements with more than four nurse practi-
   53  tioners who are not located on the same physical premises as the collab-
   54  orating physician OR COLLABORATING NURSE PRACTITIONER.
   55    [(f)] (B) NOTWITHSTANDING SUBPARAGRAPH (I) OF PARAGRAPH  (A)  OF  THIS
   56  SUBDIVISION,  A  NURSE  PRACTITIONER, CERTIFIED UNDER SECTION SIXTY-NINE
       A. 4846--B                          3

    1  HUNDRED TEN OF THIS ARTICLE AND PRACTICING FOR MORE THAN THREE  THOUSAND
    2  SIX  HUNDRED  HOURS  MAY COMPLY WITH THIS PARAGRAPH IN LIEU OF COMPLYING
    3  WITH THE REQUIREMENTS OF PARAGRAPH (A) OF THIS SUBDIVISION  RELATING  TO
    4  COLLABORATION WITH A PHYSICIAN, A WRITTEN PRACTICE AGREEMENT AND WRITTEN
    5  PRACTICE  PROTOCOLS.  A NURSE PRACTITIONER COMPLYING WITH THIS PARAGRAPH
    6  SHALL HAVE COLLABORATIVE RELATIONSHIPS WITH ONE OR MORE LICENSED  PHYSI-
    7  CIANS  QUALIFIED TO COLLABORATE IN THE SPECIALTY INVOLVED OR A HOSPITAL,
    8  LICENSED UNDER ARTICLE TWENTY-EIGHT  OF  THE  PUBLIC  HEALTH  LAW,  THAT
    9  PROVIDES  SERVICES  THROUGH LICENSED PHYSICIANS QUALIFIED TO COLLABORATE
   10  IN THE SPECIALTY INVOLVED AND HAVING PRIVILEGES AT SUCH INSTITUTION.  AS
   11  EVIDENCE  THAT  THE NURSE PRACTITIONER MAINTAINS COLLABORATIVE RELATION-
   12  SHIPS, THE NURSE  PRACTITIONER  SHALL  COMPLETE  AND  MAINTAIN  A  FORM,
   13  CREATED BY THE DEPARTMENT, WHICH THE NURSE PRACTITIONER SHALL ATTEST TO,
   14  THAT  IDENTIFIES WRITTEN PRACTICE PROTOCOLS AND THE METHODS BY WHICH THE
   15  NURSE PRACTITIONER WILL COLLABORATE SUCH AS: THE  CRITERIA  TO  BE  USED
   16  REGARDING CONSULTATION, INCLUDING METHODS AND FREQUENCY OF HOW CONSULTA-
   17  TION SHALL BE PROVIDED; COLLABORATIVE MANAGEMENT AND REFERRAL; AND EMER-
   18  GENCY  REFERRAL  PLANS. SUCH FORMS SHALL BE UPDATED AS NEEDED AND MAY BE
   19  SUBJECT TO REVIEW BY THE DEPARTMENT. THE NURSE PRACTITIONER  SHALL  MAKE
   20  INFORMATION CONTAINED IN THIS FORM AVAILABLE TO HIS OR HER PATIENTS UPON
   21  REQUEST. FAILURE TO COMPLY WITH THE REQUIREMENTS FOUND IN THIS PARAGRAPH
   22  BY  A  NURSE  PRACTITIONER  WHO IS NOT COMPLYING WITH SUCH PROVISIONS OF
   23  PARAGRAPH (A) OF THIS SUBDIVISION,  SHALL  BE  SUBJECT  TO  PROFESSIONAL
   24  MISCONDUCT PROVISIONS AS SET FORTH IN ARTICLE ONE HUNDRED THIRTY OF THIS
   25  TITLE.
   26    (C)  Nothing  in this subdivision shall be deemed to limit or diminish
   27  the practice of the profession of nursing as a  registered  professional
   28  nurse  under  this article or any other law, rule, regulation or certif-
   29  ication, nor to deny any registered professional nurse the right  to  do
   30  any  act  or  engage  in  any practice authorized by this article or any
   31  other law, rule, regulation or certification.
   32    [(g)] (D) The provisions of this subdivision shall not  apply  to  any
   33  activity  authorized,  pursuant  to  statute,  rule or regulation, to be
   34  performed by a registered professional nurse in a hospital as defined in
   35  article twenty-eight of the public health law.
   36    (E) THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH,
   37  SHALL ISSUE A REPORT ON THE IMPLEMENTATION OF  THE  PROVISIONS  OF  THIS
   38  SECTION,  ALONG  WITH  INFORMATION THAT INCLUDES, BUT IS NOT LIMITED TO:
   39  THE NUMBER OF NURSE PRACTITIONERS PRACTICING FOR FEWER THAN THREE  THOU-
   40  SAND  SIX  HUNDRED  HOURS  THAT  PRACTICE PURSUANT TO A WRITTEN PRACTICE
   41  AGREEMENT WITH A PHYSICIAN; THE NUMBER OF NURSE PRACTITIONERS THAT PRAC-
   42  TICE PURSUANT TO A WRITTEN PRACTICE AGREEMENT WITH A NURSE  PRACTITIONER
   43  FOR SIX MONTHS AND THE NUMBER OF THESE NURSE PRACTITIONERS THAT EXTEND A
   44  WRITTEN  PRACTICE  AGREEMENT FOR AN ADDITIONAL SIX MONTHS UPON A SHOWING
   45  OF GOOD CAUSE SUBJECT TO THE APPROVAL OF THE DEPARTMENT; THE  NUMBER  OF
   46  NURSE  PRACTITIONERS  THAT  PRACTICE PURSUANT TO COLLABORATIVE RELATION-
   47  SHIPS WITH PHYSICIANS; AND OTHER INFORMATION THE DEPARTMENT DEEMS  RELE-
   48  VANT,  INCLUDING BUT NOT LIMITED TO, ANY RECOMMENDATIONS FOR THE CONTIN-
   49  UATION OF OR AMENDMENTS TO THE PROVISIONS OF THIS  SECTION  RELATING  TO
   50  WRITTEN  PRACTICE AGREEMENTS OR COLLABORATIVE RELATIONSHIPS. THE COMMIS-
   51  SIONER SHALL SUBMIT THIS REPORT TO THE  GOVERNOR,  THE  SPEAKER  OF  THE
   52  ASSEMBLY,  THE  TEMPORARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE
   53  ASSEMBLY AND SENATE HIGHER EDUCATION COMMITTEES BY SEPTEMBER FIRST,  TWO
   54  THOUSAND EIGHTEEN.
   55    S  3.  This act shall take effect on the first day of January after it
   56  shall have become a law and shall expire June 30 of the sixth year after
       A. 4846--B                          4

    1  it shall have become a law, when upon such date the provisions  of  this
    2  act  shall  be  deemed repealed; provided, however, that effective imme-
    3  diately, the addition, amendment and/or repeal of any rule or regulation
    4  necessary  for  the  implementation of this act on its effective date is
    5  authorized and directed to be made  and  completed  on  or  before  such
    6  effective date.
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