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Minnesota Legislature

Office of the Revisor of Statutes

HF 1668

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:53am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to health occupations; modifying practice requirements for advanced
practice registered nurses; amending Minnesota Statutes 2008, sections 148.171,
subdivisions 5, 10, 11, 13, 21; 148.235, subdivisions 2a, 4a, 4b; 151.01,
subdivisions 23, 27; 151.37, subdivision 2; repealing Minnesota Statutes 2008,
sections 148.171, subdivision 6; 148.235, subdivisions 1, 2, 4, 6.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2008, 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 beginwithin the context of collaborative management,deleted text end and includes:
(1) diagnosing illness and disease; (2) deleted text beginprovidingdeleted text endnew text begin prescribing pharmacological andnew text end
nonpharmacologic treatmentdeleted text begin, includingdeleted text endnew text begin; (3) providing new text endpsychotherapy; deleted text begin(3)deleted text endnew text begin (4)new text end promoting
wellness; and deleted text begin(4)deleted text endnew text begin (5)new text end preventing illness and disease. The certified clinical nurse specialist
is certified for advanced practice registered nursing in a specific field of clinical nurse
specialist practice.

Sec. 2.

Minnesota Statutes 2008, 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 newborn, and the family planning and gynecological
needs of women and includes diagnosing and deleted text beginprovidingdeleted text endnew text begin prescribing pharmacologic andnew text end
nonpharmacologic treatment deleted text beginwithin a system that provides for consultation, collaborative
management, and referral as indicated by the health status of patients
deleted text end.

Sec. 3.

Minnesota Statutes 2008, 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 management
deleted text end: (1) diagnosing, directly managing, and
preventing acute and chronic illness and disease; deleted text beginanddeleted text end (2) promoting wellnessdeleted text begin, including
providing
deleted text endnew text begin; and (3) prescribing pharmacological and new text end nonpharmacologic treatment. The
certified nurse practitioner is certified for advanced registered nurse practice in a specific
field of nurse practitioner practice.

Sec. 4.

Minnesota Statutes 2008, section 148.171, subdivision 13, is amended to read:


Subd. 13.

Practice of advanced practice registered nursing.

new text begin(a) new text endThe "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.

new text begin (b) The advanced practice registered nurse is accountable for:
new text end

new text begin (1) the quality of advanced nursing care rendered;
new text end

new text begin (2) planning for the management of situations beyond the advanced practice
registered nurse's scope of practice; and
new text end

new text begin (3) consulting with, or referring patients to, other health care providers as
appropriate.
new text end

new text begin (c) new text endThe advanced practice registered nurse must practice within a health care
system that provides for new text beginpatient-centered interdisciplinary new text endconsultation, deleted text begincollaborative
management
deleted text endnew text begin collaborationnew text end, and referral as indicated by the health statusnew text begin and preferencesnew text end
of the patientnew text begin and the scope of practice of the advanced practice registered nursenew text end.

new text begin (d) An advanced practice registered nurse who is practicing in a health care setting
or group practice that does not include a physician, podiatrist, dentist, or a requirement
to be credentialed by a hospital as defined in section 144.50, a health plan as defined in
section 62A.011, or a health maintenance organization as defined in section 62D.02,
must make available to patients:
new text end

new text begin (1) the designation of a physician practice group, physician, 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 practice group, physician, and other health
care providers 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 transferred 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. 5.

Minnesota Statutes 2008, 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 beginwithin the context
of collaborative management,
deleted text end including selecting, obtaining, and administering drugs
and therapeutic devices to facilitate diagnostic, therapeutic, and surgical procedures
upon request, assignment, or referral by deleted text begina patient's physician, dentist, or podiatristdeleted text endnew text begin other
health care providers, including physicians, podiatrists, dentists, and advanced practice
registered nurses
new text end.

Sec. 6.

Minnesota Statutes 2008, section 148.235, subdivision 2a, is amended to read:


Subd. 2a.

Certified registered nurse anesthetists.

A certified registered nurse
anesthetist deleted text beginwho 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,
deleted text end
may prescribe and administer drugs and therapeutic devices deleted text beginwithin the scope of the written
agreement and
deleted text end within practice as a certified registered nurse anesthetist.

Sec. 7.

Minnesota Statutes 2008, section 148.235, subdivision 4a, is amended to read:


Subd. 4a.

deleted text beginOtherdeleted text end 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) 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,
deleted text end may prescribe and administer drugs and therapeutic devices
deleted text begin within the scope of the written agreement anddeleted text end within new text beginthe scope of new text endpractice as a certified
clinical nurse specialist.

Sec. 8.

Minnesota Statutes 2008, 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 beginThis 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. 9.

Minnesota Statutes 2008, section 151.01, subdivision 23, is amended to read:


Subd. 23.

Practitioner.

"Practitioner" means a licensed doctor of medicine,
licensed doctor of osteopathy duly licensed to practice medicine, licensed doctor of
dentistry, licensed doctor of optometry, licensed podiatrist, new text beginlicensed advanced practice
registered nurse,
new text endor licensed veterinarian. For purposes of sections 151.15, subdivision 4,
151.37, subdivision 2, paragraphs (b), (e), and (f), and 151.461, "practitioner" also means
a physician assistant authorized to prescribe, dispense, and administer under chapter
147Adeleted text begin, or an advanced practice nurse authorized to prescribe, dispense, and administer
under section 148.235
deleted text end.

Sec. 10.

Minnesota Statutes 2008, section 151.01, subdivision 27, is amended to read:


Subd. 27.

Practice of pharmacy.

"Practice of pharmacy" means:

(1) interpretation and evaluation of prescription drug orders;

(2) compounding, labeling, and dispensing drugs and devices (except labeling by
a manufacturer or packager of nonprescription drugs or commercially packaged legend
drugs and devices);

(3) participation in clinical interpretations and monitoring of drug therapy for
assurance of safe and effective use of drugs;

(4) participation in drug and therapeutic device selection; drug administration for
first dosage and medical emergencies; drug regimen reviews; and drug or drug-related
research;

(5) participation in administration of influenza vaccines to all eligible individuals
over ten years of age and all other vaccines to patients 18 years of age and older under
standing orders from a physician licensed under chapter 147 or by written protocol with a
physician provided that:

(i) the pharmacist is trained in a program approved by the American Council of
Pharmaceutical Education for the administration of immunizations or graduated from a
college of pharmacy in 2001 or thereafter; and

(ii) the pharmacist reports the administration of the immunization to the patient's
primary physician or clinic;

(6) participation in the practice of managing drug therapy and modifying drug
therapy, according to section 151.21, subdivision 1, according to a written protocol
between the specific pharmacist and the individual dentist, optometrist, physician,
podiatrist, new text beginadvanced practice registered nurse, new text endor veterinarian who is responsible for the
patient's care and authorized to independently prescribe drugs. Any significant changes in
drug therapy must be reported by the pharmacist to the patient's medical record;

(7) participation in the storage of drugs and the maintenance of records;

(8) responsibility for participation in patient counseling on therapeutic values,
content, hazards, and uses of drugs and devices; and

(9) offering or performing those acts, services, operations, or transactions necessary
in the conduct, operation, management, and control of a pharmacy.

Sec. 11.

Minnesota Statutes 2008, section 151.37, subdivision 2, is amended to read:


Subd. 2.

Prescribing and filing.

(a) A licensed practitioner in the course of
professional practice only, may prescribe, administer, and dispense a legend drug, and
may cause the same to be administered by a nurse, a physician assistant, or medical
student or resident under the practitioner's direction and supervision, and may cause a
person who is an appropriately certified, registered, or licensed health care professional
to prescribe, dispense, and administer the same within the expressed legal scope of the
person's practice as defined in Minnesota Statutes. A licensed practitioner may prescribe
a legend drug, without reference to a specific patient, by directing a nurse, pursuant to
section 148.235, subdivisions 8 and 9, physician assistant, new text beginpharmacist, new text endor medical student
or resident to adhere to a particular practice guideline or protocol when treating patients
whose condition falls within such guideline or protocol, and when such guideline or
protocol specifies the circumstances under which the legend drug is to be prescribed
and administered. An individual who verbally, electronically, or otherwise transmits a
written, oral, or electronic order, as an agent of a prescriber, shall not be deemed to have
prescribed the legend drug. This paragraph applies to a physician assistant only if the
physician assistant meets the requirements of section 147A.18.

(b) A licensed practitioner that dispenses for profit a legend drug that is to be
administered orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must
file with the practitioner's licensing board a statement indicating that the practitioner
dispenses legend drugs for profit, the general circumstances under which the practitioner
dispenses for profit, and the types of legend drugs generally dispensed. It is unlawful to
dispense legend drugs for profit after July 31, 1990, unless the statement has been filed
with the appropriate licensing board. For purposes of this paragraph, "profit" means (1)
any amount received by the practitioner in excess of the acquisition cost of a legend drug
for legend drugs that are purchased in prepackaged form, or (2) any amount received
by the practitioner in excess of the acquisition cost of a legend drug plus the cost of
making the drug available if the legend drug requires compounding, packaging, or other
treatment. The statement filed under this paragraph is public data under section 13.03.
This paragraph does not apply to a licensed doctor of veterinary medicine or a registered
pharmacist. Any person other than a licensed practitioner with the authority to prescribe,
dispense, and administer a legend drug under paragraph (a) shall not dispense for profit.
To dispense for profit does not include dispensing by a community health clinic when the
profit from dispensing is used to meet operating expenses.

(c) A prescription or drug order for the following drugs is not valid, unless it can be
established that the prescription or order was based on a documented patient evaluation,
including an examination, adequate to establish a diagnosis and identify underlying
conditions and contraindications to treatment:

(1) controlled substance drugs listed in section 152.02, subdivisions 3 to 5;

(2) drugs defined by the Board of Pharmacy as controlled substances under section
152.02, subdivisions 7, 8, and 12;

(3) muscle relaxants;

(4) centrally acting analgesics with opioid activity;

(5) drugs containing butalbital; or

(6) phoshodiesterase type 5 inhibitors when used to treat erectile dysfunction.

(d) For the purposes of paragraph (c), the requirement for an examination shall be
met if an in-person examination has been completed in any of the following circumstances:

(1) the prescribing practitioner examines the patient at the time the prescription
or drug order is issued;

(2) the prescribing practitioner has performed a prior examination of the patient;

(3) another prescribing practitioner practicing within the same group or clinic as the
prescribing practitioner has examined the patient;

(4) a consulting practitioner to whom the prescribing practitioner has referred the
patient has examined the patient; or

(5) the referring practitioner has performed an examination in the case of a
consultant practitioner issuing a prescription or drug order when providing services by
means of telemedicine.

(e) Nothing in paragraph (c) or (d) prohibits a licensed practitioner from prescribing
a drug through the use of a guideline or protocol pursuant to paragraph (a).

(f) Nothing in this chapter prohibits a licensed practitioner from issuing a
prescription or dispensing a legend drug in accordance with the Expedited Partner Therapy
in the Management of Sexually Transmitted Diseases guidance document issued by the
United States Centers for Disease Control.

(g) Nothing in paragraph (c) or (d) limits prescription, administration, or dispensing
of legend drugs through a public health clinic or other distribution mechanism approved
by the commissioner of health or a board of health in order to prevent, mitigate, or treat
a pandemic illness, infectious disease outbreak, or intentional or accidental release of a
biological, chemical, or radiological agent.

(h) No pharmacist employed by, under contract to, or working for a pharmacy
licensed under section 151.19, subdivision 1, may dispense a legend drug based on a
prescription that the pharmacist knows, or would reasonably be expected to know, is not
valid under paragraph (c).

(i) No pharmacist employed by, under contract to, or working for a pharmacy
licensed under section 151.19, subdivision 2, may dispense a legend drug to a resident
of this state based on a prescription that the pharmacist knows, or would reasonably be
expected to know, is not valid under paragraph (c).

Sec. 12. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, sections 148.171, subdivision 6; and 148.235, subdivisions
1, 2, 4, and 6,
new text end new text begin are repealed.
new text end