Bill S324-2011

Allows certified nurse practitioners to practice without collaboration of a licensed physician

Allows the practice of registered professional nursing by a certified nurse practitioner to include diagnosis and performance without collaboration of a licensed physician.






TITLE OF BILL: An act to amend the education law, in relation to services performed by nurse practitioners

PURPOSE OR GENERAL IDEA OF BILL: To end the requirement of a collaboration agreement between a nurse practitioner and a physician as a condition for practice, and provide coverage for nurse practitioner services.

SUMMARY OF SPECIFIC PROVISIONS: Section 1 of the bill amends the nurse practice act in Education Law to delete the requirements for a collaboration agreement and practice protocols between nurse practitioners and physicians. Section 2 establishes a nurse practitioner advisory panel, appointed by the Regents.

Sections 4, 5, 6, and 7 mandate that major medical, comprehensive-type insurance benefits, as well as managed care policies, extend coverage to nurse practitioners, including those working in independent settings.

JUSTIFICATION: Nurse practitioners (NPs) practice in a variety of primary and specialty care settings including ambulatory, acute, long term 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 written practice agreement which can be as narrow or as broad as the MD is willing. Elsewhere, NP's 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: 2008: Referred to and died in Higher Education Committee; 2009-10: Referred to and died in Higher Education Committee.

FISCAL IMPLICATIONS: Reduces administrative costs for the State Education Department.


Immediately, with provisions.


STATE OF NEW YORK ________________________________________________________________________ 324 2011-2012 Regular Sessions IN SENATE (PREFILED) January 5, 2011 ___________
Introduced by Sens. MONTGOMERY, HASSELL-THOMPSON, HUNTLEY, KLEIN, OPPEN- HEIMER, PERKINS -- 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 services performed by nurse practitioners THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. 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) 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 physi- cian 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 diagnosis or treatment shall prevail]. (b) Prescriptions for drugs, devices and immunizing agents may be issued by a nurse practitioner, under this subdivision and section six thousand nine hundred ten of this article[, in accordance with the prac- tice 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 equiv- alent, as established by the commissioner's regulations, prior to prescribing under this subdivision. 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 equiv- alent and is authorized to prescribe under this subdivision. (c) [Each practice agreement shall provide for patient records review by the collaborating physician in a timely fashion but in no event less often than every three months. The names of the nurse practitioner and the collaborating physician shall be clearly posted in the practice setting of the nurse practitioner. (d) The practice protocol shall reflect current accepted medical and nursing practice. The protocols shall be filed with the department with- in 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 disposition of any issues arising from such review. (e) No physician shall enter into practice agreements with more than four nurse practitioners who are not located on the same physical prem- ises as the collaborating physician. (f)] 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. S 2. The education law is amended by adding a new section 6911 to read as follows: S 6911. NURSE PRACTITIONER ADVISORY PANEL. A NINE MEMBER NURSE PRACTI- TIONER ADVISORY PANEL SHALL BE APPOINTED BY THE BOARD OF REGENTS ON RECOMMENDATION OF THE COMMISSIONER FOR THE PURPOSE OF ASSISTING THE BOARD OF REGENTS, THE BOARD FOR NURSING, AND THE COMMISSIONER ON MATTERS RELATED TO THE PRACTICE OF REGISTERED NURSING AS A NURSE PRACTITIONER. THE PANEL SHALL BE COMPOSED OF AT LEAST SIX LICENSED AND CERTIFIED NURSE PRACTITIONERS, AND AT LEAST TWO PERSONS TO REPRESENT CONSUMERS AND PATIENT GROUPS. S 3. This act shall take effect immediately; provided, however, that section one of this act shall take effect on the one hundred eightieth day after it shall have become a law; and provided, further, that effec- tive immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized and directed to be made and completed on or before such effective date.


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