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A04846 Summary:

SPONSORGottfried (MS)
COSPNSRGunther, Paulin, Lifton, Lupardo, Englebright, Hooper, Jaffee, Scarborough, Rosenthal, Cahill, Pretlow, Ortiz, Benedetto, Russell, Brindisi, Rivera
MLTSPNSRAbinanti, 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:

                STATE OF NEW YORK
                               2013-2014 Regular Sessions
                   IN ASSEMBLY
                                    February 11, 2013
        Introduced  by  M.  of  A.  GOTTFRIED, GUNTHER, PAULIN, LIFTON, LUPARDO,
          ORTIZ,  BENEDETTO,  RUSSELL, BRINDISI, RIVERA -- Multi-Sponsored by --
          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-
        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    §  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.

        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    §  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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