Governor's Bill No. 36
February Session, 2014
LCO No. 249
Referred to Committee on PUBLIC HEALTH
SEN. WILLIAMS, 29th Dist.
SEN. LOONEY, 11th Dist.
REP. SHARKEY, 88th Dist.
REP. ARESIMOWICZ, 30th Dist.
AN ACT CONCERNING THE GOVERNOR'S RECOMMENDATIONS TO IMPROVE ACCESS TO HEALTH CARE.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Subsection (b) of section 20-87a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2014):
(b) (1) Advanced nursing practice is defined as the performance of advanced level nursing practice activities that, by virtue of [postbasic] post-basic specialized education and experience, are appropriate to and may be performed by an advanced practice registered nurse. The advanced practice registered nurse performs acts of diagnosis and treatment of alterations in health status, as described in subsection (a) of this section. [, and shall]
(2) An advanced practice registered nurse having been issued a license pursuant to section 20-94a shall, for the first three years after having been issued such license, collaborate with a physician licensed to practice medicine in this state. In all settings, [the] such advanced practice registered nurse may, in collaboration with a physician licensed to practice medicine in this state, prescribe, dispense and administer medical therapeutics and corrective measures and may request, sign for, receive and dispense drugs in the form of professional samples in accordance with sections 20-14c to 20-14e, inclusive, except [that an] such advanced practice registered nurse licensed pursuant to section 20-94a and maintaining current certification from the American Association of Nurse Anesthetists who is prescribing and administrating medical therapeutics during surgery may only do so if the physician who is medically directing the prescriptive activity is physically present in the institution, clinic or other setting where the surgery is being performed. For purposes of this [subsection] subdivision, "collaboration" means a mutually agreed upon relationship between [an] such advanced practice registered nurse and a physician who is educated, trained or has relevant experience that is related to the work of such advanced practice registered nurse. The collaboration shall address a reasonable and appropriate level of consultation and referral, coverage for the patient in the absence of [the] such advanced practice registered nurse, a method to review patient outcomes and a method of disclosure of the relationship to the patient. Relative to the exercise of prescriptive authority, the collaboration between [an] such advanced practice registered nurse and a physician shall be in writing and shall address the level of schedule II and III controlled substances that [the] such advanced practice registered nurse may prescribe and provide a method to review patient outcomes, including, but not limited to, the review of medical therapeutics, corrective measures, laboratory tests and other diagnostic procedures that [the] such advanced practice registered nurse may prescribe, dispense and administer.
(3) An advanced practice registered nurse having been issued a license pursuant to section 20-94a and having maintained such license for a period of not less than three years in accordance with the provisions of subdivision (2) of this subsection may thereafter, alone or in collaboration with a physician or another health care provider licensed to practice in this state: (A) Perform the acts of diagnosis and treatment of alterations in health status, as described in subsection (a) of this section; and (B) prescribe, dispense and administer medical therapeutics and corrective measures and dispense drugs in the form of professional samples as described in subdivision (2) of this subsection in all settings.
(4) An advanced practice registered nurse licensed under the provisions of this chapter may make the determination and pronouncement of death of a patient, provided the advanced practice registered nurse attests to such pronouncement on the certificate of death and signs the certificate of death [no] not later than twenty-four hours after the pronouncement.
Sec. 2. Subsection (b) of section 20-9 of the 2014 supplement to the general statutes, as amended by section 138 of public act 13-234, is repealed and the following is substituted in lieu thereof (Effective July 1, 2014):
(b) The provisions of this chapter shall not apply to:
(1) Dentists while practicing dentistry only;
(2) Any person in the employ of the United States government while acting in the scope of his employment;
(3) Any person who furnishes medical or surgical assistance in cases of sudden emergency;
(4) Any person residing out of this state who is employed to come into this state to render temporary assistance to or consult with any physician or surgeon who has been licensed in conformity with the provisions of this chapter;
(5) Any physician or surgeon residing out of this state who holds a current license in good standing in another state and who is employed to come into this state to treat, operate or prescribe for any injury, deformity, ailment or disease from which the person who employed such physician, or the person on behalf of whom such physician is employed, is suffering at the time when such nonresident physician or surgeon is so employed, provided such physician or surgeon may practice in this state without a Connecticut license for a period not to exceed thirty consecutive days;
(6) Any person rendering service as (A) an advanced practice registered nurse if such service is rendered in [collaboration with a licensed physician] accordance with section 20-87a, as amended by this act, or (B) an advanced practice registered nurse maintaining classification from the American Association of Nurse Anesthetists if such service is under the direction of a licensed physician;
(7) Any nurse-midwife practicing nurse-midwifery in accordance with the provisions of chapter 377;
(8) Any podiatrist licensed in accordance with the provisions of chapter 375;
(9) Any Christian Science practitioner who does not use or prescribe in his practice any drugs, poisons, medicines, chemicals, nostrums or surgery;
(10) Any person licensed to practice any of the healing arts named in section 20-1, who does not use or prescribe in his practice any drugs, medicines, poisons, chemicals, nostrums or surgery;
(11) Any graduate of any school or institution giving instruction in the healing arts who has been issued a permit in accordance with subsection (a) of section 20-11a and who is serving as an intern, resident or medical officer candidate in a hospital;
(12) Any student participating in a clinical clerkship program who has the qualifications specified in subsection (b) of section 20-11a;
(13) Any person, otherwise qualified to practice medicine in this state except that he is a graduate of a medical school located outside of the United States or the Dominion of Canada which school is recognized by the American Medical Association or the World Health Organization, to whom the Connecticut Medical Examining Board, subject to such regulations as the Commissioner of Public Health, with advice and assistance from the board, prescribes, has issued a permit to serve as an intern or resident in a hospital in this state for the purpose of extending his education;
(14) Any person rendering service as a physician assistant licensed pursuant to section 20-12b, a registered nurse, a licensed practical nurse or a paramedic, as defined in subdivision (15) of section 19a-175, acting within the scope of regulations adopted pursuant to section 19a-179, if such service is rendered under the supervision, control and responsibility of a licensed physician;
(15) Any student enrolled in an accredited physician assistant program or paramedic program approved in accordance with regulations adopted pursuant to section 19a-179, who is performing such work as is incidental to his course of study;
(16) Any person who, on June 1, 1993, has worked continuously in this state since 1979 performing diagnostic radiology services and who, as of October 31, 1997, continued to render such services under the supervision, control and responsibility of a licensed physician solely within the setting where such person was employed on June 1, 1993;
(17) Any person practicing athletic training, as defined in section 20-65f;
(18) When deemed by the Connecticut Medical Examining Board to be in the public's interest, based on such considerations as academic attainments, specialty board certification and years of experience, to a foreign physician or surgeon whose professional activities shall be confined within the confines of a recognized medical school;
(19) Any technician engaging in tattooing in accordance with the provisions of section 20-266o or 20-266p and any regulations adopted thereunder;
(20) Any person practicing perfusion, as defined in section 20-162aa; or
(21) Any foreign physician or surgeon (A) participating in supervised clinical training under the direct supervision and control of a physician or surgeon licensed in accordance with the provisions of this chapter, and (B) whose professional activities are confined to a licensed hospital that has a residency program accredited by the Accreditation Council for Graduate Medical Education or that is a primary affiliated teaching hospital of a medical school accredited by the Liaison Committee on Medical Education. Such hospital shall verify that the foreign physician or surgeon holds a current valid license in another country.
This act shall take effect as follows and shall amend the following sections:
July 1, 2014
July 1, 2014
Statement of Purpose:
To implement the Governor's recommendations concerning advanced nursing practice.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]