S3289A-2011 Actions

• Jun 13, 2012: PRINT NUMBER 3289A
• Jun 13, 2012: AMEND (T) AND RECOMMIT TO HIGHER EDUCATION
• Jan 4, 2012: REFERRED TO HIGHER EDUCATION
• Feb 15, 2011: REFERRED TO HIGHER EDUCATION

S3289A-2011 Memo

BILL NUMBER:S3289A

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:

To limit the requirement of a collaboration agreement between a nurse
practitioner and a physician as a condition for practice.

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 passed the written-collaboration term successfully will
still be required to maintain "collaborative relationships" with
physicians or Article 28 hospitals with written guidelines covering
consultation and emergency referral plans. The written guidelines
must be filed with the department and failure to do so will
constitute misconduct.

The department will survey physicians and NPs on their experience with
the new requirements and report their findings and recommendations to
the legislature by September 1, 2016.

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 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:

Based on
2008:    A.10829 - Referred to Higher Education Committee
2009-10: A.765-B - Referred to Higher Education Committee

FISCAL IMPLICATIONS:

Reduces administrative costs for the State Education Department.

EFFECTIVE DATE:

180 days after the date of enactment.

S3289A-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 3289--A
 2011-2012 Regular Sessions
 I N  SENATE
 February 15, 2011
 
 Introduced  by  Sens. YOUNG, AVELLA, ESPAILLAT, MONTGOMERY, OPPENHEIMER,
 RITCHIE, ROBACH -- read twice and ordered printed, and when printed to
 be committed to the Committee on Higher Education  --  recommitted  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, 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
 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
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD01405-04-2
 
       S. 3289--A                          2
 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
 THIS ARTICLE AND PRACTICING FOR MORE THAN THIRTY-SIX  MONTHS  AND  THREE
 THOUSAND  SIX  HUNDRED  HOURS,  MAY INCLUDE THE DIAGNOSIS OF ILLNESS AND
 
       S. 3289--A                          3
 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
 performed by a registered professional nurse in a hospital as defined in
 article twenty-eight of the public health law.
 
       S. 3289--A                          4
 (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.

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