Minnesota Legislature
HF 2803
as introduced - 88th Legislature (2013 - 2014) Posted on 03/06/2014 01:53pm
Bill Text Versions
| Engrossments | ||
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| Introduction | Posted on 03/06/2014 |
Current Version - as introduced
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A bill for an act
relating to health; changing provisions for certain licensed health professions;
amending Minnesota Statutes 2012, sections 147.081, subdivision 3; 148.171,
subdivisions 3, 5, 6, 10, 11, 13, 16, 21, by adding subdivisions; 148.211, by
adding subdivisions; 148.235, subdivisions 2, 2a, 4, 4a, 4b, 6; 148.261, by adding
subdivisions; Minnesota Statutes 2013 Supplement, section 147.012.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2013 Supplement, section 147.012, is amended to read:
147.012 OVERSIGHT OF ALLIED HEALTH PROFESSIONS.
new text begin (a) new text end The board has responsibility for the oversight of the following allied health
professions: physician assistants under chapter 147A; acupuncture practitioners under
chapter 147B; respiratory care practitioners under chapter 147C; traditional midwives
under chapter 147D; registered naturopathic doctors under chapter 147E; deleted text begin anddeleted text end athletic
trainers under sections 148.7801 to 148.7815new text begin ; and advanced practice nurses under section
148.211, subdivisions 1a and 1bnew text end .
new text begin
(b) The board shall appoint physicians who work with advanced practice registered
nurses to the joint subcommittee established under section 148.261, subdivision 6, to
investigate complaints against advanced practice registered nurses licensed under chapter
148. The joint subcommittee shall make recommendations for any discipline to the
Board of Nursing.
new text end
Sec. 2.
Minnesota Statutes 2012, section 147.081, subdivision 3, is amended to read:
Subd. 3.
Practice of medicine defined.
new text begin (a) new text end For purposes of this chapter, a person
not exempted under section 147.09 is "practicing medicine" or engaged in the "practice of
medicine" if the person does any of the following:
(1) advertises, holds out to the public, or represents in any manner that the person is
authorized to practice medicine in this state;
(2) offers or undertakes to prescribe, give, or administer any drug or medicine for
the use of another;
(3) offers or undertakes to prevent or to diagnose, correct, or treat in any manner or
by any means, methods, devices, or instrumentalities, any disease, illness, pain, wound,
fracture, infirmity, deformity or defect of any person;
(4) offers or undertakes to perform any surgical operation including any invasive
or noninvasive procedures involving the use of a laser or laser assisted device, upon
any person;
(5) offers to undertake to use hypnosis for the treatment or relief of any wound,
fracture, or bodily injury, infirmity, or disease; deleted text begin or
deleted text end
(6) uses in the conduct of any occupation or profession pertaining to the diagnosis
of human disease or conditions, the designation "doctor of medicine," "medical doctor,"
"doctor of osteopathy," "osteopath," "osteopathic physician," "physician," "surgeon,"
"M.D.," "D.O.," or any combination of these designationsdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(7) performs the following interventions in the course of diagnosing or treating pain
which is chronic, persistent and intractable, or occurs outside of a surgical, obstetrical,
or postoperative course of care:
new text end
new text begin
(i) ablation of targeted nerves;
new text end
new text begin
(ii) percutaneous precision needle placement within or adjacent to the spinal column
with injection of contrast materials or drugs such as local anesthetics, steroids, and
analgesics using fluoroscopy, computed tomography, ultrasound, or other image-guidance
modalities; or
new text end
new text begin
(iii) laser or endoscopic discectomy, the surgical placement of intrathecal infusion
pumps, or spinal cord stimulators.
new text end
new text begin
(b) Nothing in this section shall be construed to prohibit or restrict the performance
of surgical or obstetrical anesthesia services or postoperative pain control by a certified
registered nurse anesthetist performed perioperatively in a hospital as defined in section
144.50 or outpatient surgical centers as defined in section 144.55.
new text end
Sec. 3.
Minnesota Statutes 2012, section 148.171, subdivision 3, is amended to read:
Subd. 3.
Advanced practice registered nurse.
"Advanced practice registered
nurse," abbreviated APRN, means an individual licensed as deleted text begin adeleted text end new text begin an advanced practice
new text end registered nurse by the board and certified by a national nurse certification organization
acceptable to the board to practice as a clinical nurse specialist, nurse anesthetist,
nurse-midwife, or nurse practitioner.
Sec. 4.
Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Board of Medical Practice. new text end
new text begin
"Board of Medical Practice" means the
Board of Medical Practice that is established in chapter 147.
new text end
Sec. 5.
Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
to read:
new text begin Subd. 4b. new text end
new text begin Joint subcommittee. new text end
new text begin
"Joint subcommittee" means the subcommittee
composed of an equal number of advanced practice registered nurses appointed by
the Board of Nursing and physicians who work with advanced practice registered
nurses appointed by the Board of Medical Practice with the responsibility to review
investigations and recommend disciplinary action to the Board of Nursing for advanced
practice registered nurses.
new text end
Sec. 6.
Minnesota Statutes 2012, section 148.171, subdivision 5, is amended to read:
Subd. 5.
Clinical nurse specialist practice.
"Clinical nurse specialist practice"
means the provision of patient care in a particular specialty or subspecialty of advanced
practice registered nursing deleted text begin within the context of collaborative management,deleted text end and includes:
(1) diagnosing illness and disease;
(2) providing deleted text begin nonpharmacologicdeleted text end new text begin limited pharmacologicnew text end treatmentdeleted text begin , includingdeleted text end new text begin in
accordance with section 148.235;
new text end
new text begin (3) providingnew text end psychotherapy;
deleted text begin (3)deleted text end new text begin (4)new text end promoting wellness; deleted text begin and
deleted text end
deleted text begin (4)deleted text end new text begin (5)new text end preventing illness and diseasenew text begin ; and
new text end
new text begin (6) collaborating with, consulting with, and referring to physicians and other health
care providers when needed for optimal patient carenew text end .
The certified clinical nurse specialist is certified for advanced practice registered
nursing in a specific field of clinical nurse specialist practice.
Sec. 7.
Minnesota Statutes 2012, section 148.171, subdivision 6, is amended to read:
Subd. 6.
deleted text begin Collaborative managementdeleted text end new text begin Collaborationnew text end .
deleted text begin
"Collaborative management"
is a mutually agreed-upon plan between an advanced practice registered nurse and
one or more physicians or surgeons licensed under chapter 147 that designates the
scope of collaboration necessary to manage the care of patients. The advanced practice
registered nurse and the one or more physicians must have experience in providing care to
patients with the same or similar medical problems, except that certified registered nurse
anesthetists may continue to provide anesthesia in collaboration with physicians, including
surgeons, podiatrists licensed under chapter 153, and dentists licensed under chapter
150A. Certified registered nurse anesthetists must provide anesthesia services at the same
hospital, clinic, or health care setting as the physician, surgeon, podiatrist, or dentist.
deleted text end
new text begin
"Collaboration" means a mutually agreed upon process in which health professionals
jointly contribute to the health care provided to a patient with each collaborator performing
actions that the professional is licensed, certified, or otherwise authorized to perform.
Collaboration includes the systematic formal planning and evaluation in a patient's care,
including but not limited to the care that is best for the patient, emergency backup plans,
and referral arrangements to other health care professionals.
new text end
Sec. 8.
Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
to read:
new text begin Subd. 7c. new text end
new text begin Integrated clinical setting. new text end
new text begin
"Integrated clinical setting" means a place
of practice where an advanced practice registered nurse works with physicians and other
practitioners in the same location.
new text end
Sec. 9.
Minnesota Statutes 2012, section 148.171, subdivision 10, is amended to read:
Subd. 10.
Nurse-midwife practice.
"Nurse-midwife practice" means the
management of women's primary health care, focusing on pregnancy, childbirth, the
postpartum period, care of the newbornnew text begin partner care management relating to sexual healthnew text end ,
and the family planning and gynecological needs of women and includes diagnosing
deleted text begin anddeleted text end new text begin ,new text end providing deleted text begin nonpharmacologicdeleted text end new text begin limited pharmacologicnew text end treatment deleted text begin within a system that
provides for consultation, collaborative management, and referral as indicated by the
health status of patientsdeleted text end new text begin in accordance with section 148.235 and collaborating with,
consulting with, and referring to physicians and other health care providers when needed
for optimal patient carenew text end .
Sec. 10.
Minnesota Statutes 2012, section 148.171, subdivision 11, is amended to read:
Subd. 11.
Nurse practitioner practice.
"Nurse practitioner practice" meansdeleted text begin , within
the context of collaborative managementdeleted text end new text begin the provision of patient care in a particular
specialty or subspecialty of advanced practice registered nursing and includesnew text end : (1)
diagnosing, directly managing, and preventing acute and chronic illness and disease; deleted text begin and
deleted text end (2) promoting wellness, including new text begin health assessment and screening activities; (3) health
promotion, disease prevention, health education, and patient counseling; (4) new text end providing
new text begin limited pharmacologic and new text end nonpharmacologic treatmentnew text begin in accordance with section
148.235; and (5) collaborating with, consulting with, and referring to physicians and
other health care providers when needed for optimal patient carenew text end . The certified nurse
practitioner is certified for advanced registered nurse practice in a specific field of nurse
practitioner practice.
Sec. 11.
Minnesota Statutes 2012, section 148.171, subdivision 13, is amended to read:
Subd. 13.
Practice of advanced practice registered nursing.
The "practice of
advanced practice registered nursing" means the performance of clinical nurse specialist
practice, nurse-midwife practice, nurse practitioner practice, or registered nurse anesthetist
practice as defined in subdivisions 5, 10, 11, and 21. The practice includes functioning as
a direct care provider, case manager, consultant, educator, and researcher. The practice of
advanced practice registered nursing also includes accepting referrals from, consulting
with, cooperating with, or referring to all other types of health care providers, including
but not limited to physicians, chiropractors, podiatrists, and dentists, provided that the
advanced practice registered nurse and the other provider are practicing within their
scopes of practice as defined in state law. The advanced practice registered nurse must
practice within a health care deleted text begin systemdeleted text end new text begin settingnew text end that provides for consultation, deleted text begin collaborative
managementdeleted text end new text begin collaborationnew text end , and referral as indicated by the health status of the patient.
new text begin
An advanced practice registered nurse who is practicing in a setting that is not a
hospital licensed under chapter 144 or a clinic where there are one or more physicians
practicing on site must make available to patients:
new text end
new text begin
(1) the designation of a physician, physician clinic, or other health care group
practice with whom the advanced practice registered nurse has a preestablished
relationship for consultation, collaboration, and referral;
new text end
new text begin
(2) the designation of a physician, physician clinic, or other health care group
practice with whom the advanced practice registered nurse has a preestablished
arrangement to accept the transfer of care if the advanced practice registered nurse is
without admitting privileges or has to transfer care to another provider;
new text end
new text begin
(3) the designation of hospitals or other inpatient facilities where patients requiring
admission will be referred; and
new text end
new text begin
(4) the plan for transfer of or access to health records.
new text end
Sec. 12.
Minnesota Statutes 2012, section 148.171, subdivision 16, is amended to read:
Subd. 16.
Prescribing.
"Prescribing" means the act of generating a prescription for
the preparation of, use of, or manner of using a drug or therapeutic device in accordance
with the provisions of section 148.235. Prescribing does not include recommending the
use of a drug or therapeutic device which is not required by the federal Food and Drug
Administration to meet the labeling requirements for prescription drugs and devices.
Prescribing also does not include recommending or administering a drug or therapeutic
device deleted text begin perioperativelydeleted text end new text begin for surgical or obstetrical anesthesia or for postoperative pain
controlnew text end by a certified registered nurse anesthetist.
Sec. 13.
Minnesota Statutes 2012, section 148.171, subdivision 21, is amended to read:
Subd. 21.
Registered nurse anesthetist practice.
"Registered nurse anesthetist
practice" means the provision of anesthesia care and related services deleted text begin within the context of
collaborative managementdeleted text end , including selecting, obtaining, and administering drugs and
therapeutic devices to facilitate diagnostic, therapeutic, and surgical procedures upon
request, assignment, or referral by a patient's physician, dentist, or podiatrist.new text begin A registered
nurse anesthetist shall be prohibited from performing any procedures constituting the
practice of interventional or invasive pain management as defined in section 147.081,
subdivision 3, clause (7).
new text end
Sec. 14.
Minnesota Statutes 2012, section 148.211, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Initial advanced practice registered nurse licensure. new text end
new text begin
(a) An applicant
for a license to practice as an advanced practice registered nurse (APRN) shall apply to
the board for a license in a format prescribed by the board and pay a fee in an amount
determined by statute. In no case may fees be refunded. In addition, an APRN must also
register with the Board of Medical Practice.
new text end
new text begin
(b) To be eligible for licensure:
new text end
new text begin
(1) the applicant must hold a current Minnesota professional nursing license or
demonstrate eligibility for licensure as a registered nurse in this jurisdiction;
new text end
new text begin
(2) the applicant shall not hold an encumbered license as a registered nurse in any
state or territory;
new text end
new text begin
(3) the applicant must have completed a graduate-level APRN program accredited
by a nursing or nursing-related accrediting body that is recognized by the United States
Secretary of Education or the Council for Higher Education Accreditation as acceptable
to the board. The education must be in one of the four APRN roles and at least one
population focus;
new text end
new text begin
(4) the applicant must be currently certified by a national certifying body recognized
by the board in the APRN role appropriate to educational preparation;
new text end
new text begin
(5) the applicant must report any criminal conviction, nolo contendere plea, Alford
plea, or other plea arrangement in lieu of conviction; and
new text end
new text begin
(6) the applicant must have committed no acts or omissions which are grounds
for disciplinary action in another jurisdiction or, if such acts have been committed and
would be grounds for disciplinary action under section 148.261, the board has found after
investigation that sufficient restitution has been made.
new text end
new text begin
(c) After December 31, 2015, all new graduates applying for advanced practice
registered nurse licensure must meet the licensure requirements in this chapter.
new text end
Sec. 15.
Minnesota Statutes 2012, section 148.211, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin Advanced practice registered nurse grandfather provision. new text end
new text begin
Any
advanced practice registered nurse with authority to practice as an advanced practice
registered nurse in this state that is valid on December 31, 2015, shall be eligible to apply
for licensure with the board and apply for registration with the Board of Medical Practice
as an advanced practice registered nurse under the provisions of this chapter with current
privileges and shall be eligible for license renewal under the conditions and standards
prescribed in this chapter.
new text end
Sec. 16.
Minnesota Statutes 2012, section 148.235, subdivision 2, is amended to read:
Subd. 2.
Certified nurse practitioners.
new text begin (a) new text end A certified nurse practitioner who has
deleted text begin a written agreement with a physician based on standards established by the Minnesota
Nurses Association and the Minnesota Medical Association that defines the delegated
responsibilities related to the prescription of drugs and therapeutic devices,deleted text end new text begin successfully
completed no less than 30 hours of formal study from a college, university, or university
health care institution which included instruction in health assessment, medication
classifications, indications, dosages, contraindications, and side effects; supervised
practice; and competence evaluation including evidence of the application of knowledge
pertaining to prescribing for and therapeutic management of the clinical type of patients
in the certified nurse practitioner's practice application, and who has practiced in an
integrated clinical setting for at least three years,new text end may prescribe and administer drugs and
therapeutic devicesnew text begin , excluding schedule II controlled substances,new text end within the scope of deleted text begin the
written agreement and withindeleted text end practice as a certified nurse practitioner.
new text begin (b) A certified nurse practitioner who has practiced fewer than three years in an
integrated clinical setting or a certified nurse practitioner who wants to prescribe and
administer schedule II controlled substances must have a written agreement with a
physician based on standards established by the Minnesota Nurses Association and the
Minnesota Medical Association that defines the delegated responsibilities related to the
prescription of drugs and therapeutic devices. The agreement must include processes
for appropriate review of prescribing practices by the physician to assist with quality
improvement and to ensure patient safety.new text end The written agreement required under this
subdivision shall be based on standards established by the Minnesota Nurses Association
and the Minnesota Medical Association as of January 1, 1996, unless both associations
agree to revisions.new text begin Written prescribing agreements shall be mutually reviewed between all
parties to the agreement on at least an annual basis.
new text end
Sec. 17.
Minnesota Statutes 2012, section 148.235, subdivision 2a, is amended to read:
Subd. 2a.
Certified registered nurse anesthetists.
A certified registered nurse
anesthetist who has a written agreement with a physician based on standards established
by the Minnesota Nurses Association and the Minnesota Medical Association that defines
the delegated responsibilities related to the prescription of drugs and therapeutic devices,
may prescribe and administer drugs and therapeutic devices within the scope of the
written agreement and within practice as a certified registered nurse anesthetist.new text begin Nothing
in this section shall permit the performance of procedures constituting the practice of
interventional or invasive pain management as defined in section 147.081, subdivision
3, clause (7).
new text end
Sec. 18.
Minnesota Statutes 2012, section 148.235, subdivision 4, is amended to read:
Subd. 4.
Certified clinical nurse specialists in psychiatric and mental health
nursing.
new text begin (a) new text end A certified clinical nurse specialist who deleted text begin (1)deleted text end has successfully completed no
less than 30 hours of formal study in the prescribing of psychotropic medications and
medications to treat their side effects which included instruction in health assessment,
psychotropic classifications, psychopharmacology, indications, dosages, contraindications,
side effects, and evidence of applicationdeleted text begin ; and (2) hasdeleted text end new text begin and who has practiced in an
integrated clinical setting for at lest three years may prescribe and administer drugs
used to treat psychiatric and behavioral disorders and the side effects of those drugs,
excluding schedule II controlled substances, within the scope of practice as a certified
clinical nurse specialist in psychiatric and mental health nursing. A certified clinical
nurse specialist who has practiced fewer than three years in an integrated clinical setting
or a certified clinical nurse specialist who wants to prescribe and administer schedule II
controlled substances must havenew text end a written agreement with a psychiatrist or other physician
based on standards established by the Minnesota Nurses Association and the Minnesota
Psychiatric Association that specifies and defines the delegated responsibilities related to
the prescription of drugs in relationship to the diagnosis, may prescribe and administer
drugs used to treat psychiatric and behavioral disorders and the side effects of those drugs
within the scope of the written agreement and within practice as a certified clinical
nurse specialist in psychiatric and mental health nursing. new text begin The agreement must include
processes for appropriate review of prescribing practices by the physician to assist with
quality improvement and ensure patient safety. new text end The written agreement required under this
subdivision shall be based on standards established by the Minnesota Nurses Association
and the Minnesota Psychiatric Association as of January 1, 1996, unless both associations
agree to revisions.new text begin Written prescribing agreements shall be mutually reviewed between all
parties to the agreement on at least an annual basis.
new text end
new text begin (b) new text end Nothing in this subdivision removes or limits the legal professional liability of
the treating psychiatrist, certified clinical nurse specialist, mental health clinic or hospital
for the prescription and administration of drugs by a certified clinical nurse specialist in
accordance with this subdivision.
Sec. 19.
Minnesota Statutes 2012, section 148.235, subdivision 4a, is amended to read:
Subd. 4a.
Other certified clinical nurse specialists.
A certified clinical nurse
specialist whodeleted text begin : (1)deleted text end has successfully completed no less than 30 hours of formal study from
a college, university, or university health care institution, which included the following:
instruction in health assessment, medication classifications, indications, dosages,
contraindications, and side effects; supervised practice; and competence evaluation,
including evidence of the application of knowledge pertaining to prescribing for and
therapeutic management of the clinical type of patients in the certified clinical nurse
specialist's practicedeleted text begin ; and (2) hasdeleted text end new text begin , and who has practiced in an integrated clinical setting for
at least three years, may prescribe and administer drugs and therapeutic devices, excluding
schedule II controlled substances, within the scope of practice as a certified clinical nurse
specialist. A certified clinical nurse specialist who practiced fewer than three years in an
integrated clinical setting or a certified clinical nurse specialist who wants to prescribe
and administer schedule II controlled substances must havenew text end a written agreement with a
physician based on standards established by the Minnesota Nurses Association and the
Minnesota Medical Association that defines the delegated responsibilities related to the
prescription of drugs and therapeutic devices, may prescribe and administer drugs and
therapeutic devices within the scope of the written agreement and within practice as a
certified clinical nurse specialist.new text begin The agreement must include processes for appropriate
review of prescribing practices by the physician to assist with quality improvement and to
ensure patient safety. Written prescribing agreements shall be mutually reviewed between
all parties to the agreement on at least an annual basis.
new text end
Sec. 20.
Minnesota Statutes 2012, section 148.235, subdivision 4b, is amended to read:
Subd. 4b.
Dispensing authority.
An advanced practice registered nurse who is
authorized under this section to prescribe drugs is authorized to dispense drugs subject to
the same requirements established for the prescribing of drugs. deleted text begin This authority to dispense
extends only to those drugs described in the written agreement entered into under this
section.deleted text end The authority to dispense includes, but is not limited to, the authority to receive
and dispense sample drugs.
Sec. 21.
Minnesota Statutes 2012, section 148.235, subdivision 6, is amended to read:
Subd. 6.
Standards for written agreements; review and filing.
Written
agreements required under this section shall be maintained at the primary practice site of
the advanced practice registered nurse and of the collaborating physician. The written
agreement does not need to be filed with the Board of Nursing or the Board of Medical
Practicenew text begin but must be reviewed on an annual basis by the parties to the agreementnew text end .
Sec. 22.
Minnesota Statutes 2012, section 148.261, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Actions against an APRN. new text end
new text begin
The joint subcommittee comprised of an equal
number of advanced practice nurses appointed by the Board of Nursing and physicians
who work with advanced practice registered nurses appointed by the Board of Medical
Practice shall review complaints against an advanced practice registered nurse that are
in violation of chapter 147 or 148 and recommend disciplinary action as described in
sections 148.261 or 148.262 to the Board of Nursing.
new text end
Sec. 23.
Minnesota Statutes 2012, section 148.261, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Standard of care. new text end
new text begin
An advanced practice registered nurse licensed under
this chapter who is diagnosing, treating, or prescribing under chapter 148 shall be held
to the same standard of care as that of a physician licensed under chapter 147 by the
state of Minnesota.
new text end