OLR Bill Analysis

sSB 67

AN ACT CONCERNING THE AUTHORITY AND RESPONSIBILITIES OF ADVANCED PRACTICE REGISTERED NURSES.

SUMMARY:

This bill allows advanced practice registered nurses (APRNs) to certify, sign, or otherwise document medical information in several situations that currently require a physician's signature, certification, or documentation. Examples include:

1. certifying a patient for medical marijuana use (except for glaucoma),

2. issuing “do not resuscitate” orders,

3. certifying a disability to cancel a health club contract, and

4. certifying a disability or illness for continuing education waivers or extensions for various health professions.

In a few situations not involving written documentation, the bill similarly extends to APRNs authority or responsibility that currently applies only to physicians (e.g., notification to specified people before removal of life support).

The bill also extends certain reporting requirements to APRNs regarding specified types of patients or conditions (e.g., reporting to the Department of Rehabilitation Services when a vision-impaired person comes under the APRN's care).

The bill also makes technical and conforming changes.

EFFECTIVE DATE: October 1, 2016

APRN CERTIFICATION OF MEDICAL INFORMATION AND RELATED AUTHORITY

The bill allows APRNs to certify, sign, or otherwise document medical information in several situations. It also extends authority to APRNs in certain other contexts. Under current law, almost all of these provisions apply only to physicians. (In a few cases, the provisions also apply to other specified providers.)

The bill's provisions are grouped below by categories of authority extended to APRNs, as shown in the following tables.

Table 1: Certification or Other Documentation Authority Extended to APRNs Related to Employment

Bill

Statute

Description

4

5-248a

Certification of a serious illness or an organ or bone marrow donation to qualify state employees for family and medical leave

5

10-183b

Statement of health for a disability benefit application through the teachers' retirement system

9

14-44

Certification that an applicant for certain public passenger driver's licenses controls with medication a condition that would otherwise deem the applicant medically unqualified

10

14-73

Certification of an applicant's fitness for a driving instructor's license based on a recent medical examination

16

19a-12e

Written statement of findings after examining an impaired health care professional under investigation for possible impairment

30 - 42

Various provisions in Title 20

Certification of a disability or illness for a continuing education waiver or extension for the following professions: 

naturopaths

physical therapists

radiographers

dentists

dental hygienists

optometrists

respiratory care practitioners

psychologists

veterinarians

acupuncturists

audiologists

hearing instrument specialists

speech and language pathologists

57

29-143t 

Certification that a boxer or mixed martial arts fighter has been examined and is physically fit to compete and related requirements

Table 2:  Certification or Other Documentation Authority Extended to APRNs for Medication or Care Approval

Bill

Statute

Description

6

10-212a

Order for administration by a qualified school employee of (1) glucagon using injectable equipment or (2) antiepileptic medication

26

20-14m

Documentation in a medical record if prescribing, administering, or dispensing long-term antibiotic therapy for Lyme disease (Department of Public Health or the licensing board may not initiate a disciplinary action solely for such actions as documented in the record)

27

20-162n

Written protocols for respiratory care and direction over such care

29

20-206jj 

Written protocols or standing orders for paramedics to administer controlled substances and written or oral authorization for paramedics to administer other drugs

45 & 46

21a-246 & 21a-253

License to possess and supply marijuana to treat side effects of chemotherapy (bill also makes clarifying change regarding APRNs' general authority to dispense and administer controlled substances)

47 – to 52

Various provisions in Chapter 420f

Certification for a patient's use of medical marijuana. This includes, among other things:

diagnosing a patient's qualifying debilitating condition, except the bill does not authorize APRNs to certify marijuana use for glaucoma;

issuing a written certification for medical marijuana use after (1) making this diagnosis, (2) explaining the potential risks and benefits to the patient and parent or guardian of a patient lacking legal capacity, and (3) meeting other criteria; and

extending to APRNs the same protections from civil, criminal, and disciplinary liability that currently apply to physicians under the medical marijuana law.

53

22a-616 

Prescription for mercury fever thermometers

Table 3: Certification or Approval Authority Extended to APRNs for Insurance Purposes

Bill

Statute

Description

59 & 64

38a-489 &

38a-515

Certification of inability for self-sustaining employment because of mental or physical disability for continuation of coverage when child reaches limiting age (applies to individual and group policies)

60 & 65

38a-492m & 38a-518l  

Need for renewal of prescription eye drops for insurance coverage purposes (applies to individual and group policies)

61 & 66

38a-493 & 38a-520 

Various provisions concerning insurance coverage for home health care, such as approval of a care plan; diagnosis of a patient's terminal illness in some circumstances; and supervision of home health agency services (applies to individual and group policies)

62 & 67

38a-495 & 38a-522 

Certification of medical necessity of home health aide services, or recommendation of additional mammograms beyond once a year, for Medicare supplement policy coverage (applies to individual and group policies)

63 & 69

38a-496 & 38a-524 

Approval and certification of an occupational therapy care plan for insurance coverage purposes (applies to individual and group policies)

68

38a-523 

Approval of a care plan at a comprehensive rehabilitation facility for insurance coverage purposes (applies to group policies)

Table 4: Certification or Other Documentation Authority Extended to APRNs in Other Contexts

Bill

Statute

Description

2

3-39j

Copy of an individual's diagnosis of impairment or vision impairment for purposes of disability certification for Achieving a Better Life Experience (ABLE) program

3

3-123aa 

Certification of a service need for withdrawals from Connecticut Home Care Trust Fund

7

10-220j

Order stating a child's need for, and capability of, performing blood glucose self-testing at school

11

14-100a 

Statement of an individual's inability to wear a seat belt for exemption from seat belt requirements

12

14-286 

Certification of an individual's disability and capability of riding a motor-driven cycle for a special permit

13

14-314c 

Certification that a child is hearing impaired to require traffic authorities to erect a sign in the child's neighborhood alerting to the child's presence

14

17b-261p 

Certification of a Medicaid applicant's inability to care for self or manage affairs, when a nursing home, on a patient's behalf, seeks an extension to claim undue hardship

18

19a-535

Documentation in the medical record of the basis for a patient's transfer or discharge from a nursing facility, and related requirement to develop discharge plan in certain situations

22

19a-582 

Certification that criteria are met for court-ordered HIV testing if a health care provider or other worker had significant exposure to HIV from a patient (the APRN or physician must first seek the patient's voluntary consent for testing)

Certification that criteria are met to require HIV testing of a prison inmate if there is no reasonable alternative and testing is needed (1) for diagnostic, treatment, or related reasons or (2) because the inmate's behavior poses a significant risk of transmission or has led to significant exposure to another inmate

43 & 44

21a-217 & 21a-218

Certification of an individual's disability or physical examination to cancel a health club contract

54

26-29a

Certification of an individual's intellectual disability to receive a free lifetime sport fishing license

55

26-29b 

Certification of an individual's disability to receive a free lifetime hunting, sport fishing, or trapping license

70

42-282 

Letter indicating that continuation of a diet program is adverse to a an individual's health to cancel a diet company contract

71

47-88b 

Statement of a tenant's blindness or disability for laws limiting eviction in conversion condominiums under the Condominium Act

72

47a-23c 

Statement of a tenant's blindness or disability for laws limiting eviction

73

51-217 

Letter stating an individual's disability for permanent exemption from jury duty

74

54-204 

Report of treatment or examination, as part of an application for victim compensation

Table 5:  Miscellaneous Provisions Extending Authority to APRNs

Bill

Statute

Description

1

1-350i

Determination of an agent's incapacity, under the Uniform Power of Attorney Act (must be made by two physicians, two APRNs, or one APRN and one physician, and the two providers must be independent)

19

19a-550

Various provisions in the patients' bill of rights for nursing homes, residential care homes, and chronic disease hospitals, such as:

documenting in the medical record when a general right is medically contraindicated for that patient, including the rights to be fully informed of his or her medical condition, communicate with persons of the patient's choice, participate in social and similar activities, use his or her own clothing and possessions, and share a room with his or her spouse;

authority to order the administration of psychopharmacologic drugs or the use of restraints under certain circumstances; and

inclusion of the patient's physician or APRN during the consultative process for certain room transfers in nursing homes or rest homes with nursing supervision.

The bill also specifies that such a patient in these facilities has the right to choose his or her own physician or APRN, not just physician

20

19a-571

Immunity from civil and criminal liability for withholding or causing the removal of a life support system under specified conditions, including that the APRN:

based the decision on the provider's best medical judgment according to medical standards;

deemed the patient to be in a terminal condition or, in consultation with a neurologist or other qualified physician, deemed the patient to be permanently unconscious; and

considered the patient's wishes, including in a living will or similar document.

If the patient is an infant, additional provisions apply pursuant to federal regulations.

21

19a-580d 

Issuance of “do not resuscitate” orders (reference to required regulations)

23

19a-592

Decision to treat a minor for HIV or AIDS without notifying the parent, after determining that (1) such notification will result in denial of treatment or (2) the minor will not pursue treatment if the parents are notified and the minor requests they not be notified (the APRN must document the reasons in the medical record)

24

20-7h 

Disclosure to personal injury patients as to whether the APRN or physician will provide services on the basis of a letter of protection issued by an attorney

25

19a-580

Responsibility to notify the patient's next of kin or other specified persons within a reasonable time before withholding or causing the removal of life support for a patient

28

20-206q 

Countersigning a diet order, for a patient being treated by a dietitian-nutritionist in an institution

APRN REPORTING REQUIREMENTS

The bill extends to APRNs certain existing requirements for physicians to report about particular types of patients or conditions, as shown in Table 6.

Table 6:  Reporting Requirements Extended to APRNs

Bill

Statute

Description

8

10-305 

Report to the Department of Rehabilitation Services on vision-impaired patients coming into their care (existing law also requires optometrists to report)

15

18-94 

Report to a correctional facility warden or superintendent that an inmate with venereal disease may be released without danger to public health

17

19a-262 

Report to the Department of Public Health and the local health director on patients with, or suspected to have, tuberculosis

56

27-140ee

Report to the Department of Veterans' Affairs, upon patient's request, on veteran's possible exposure to Vietnam herbicides

58

31-40a 

Report to the Labor Department on persons with certain occupational diseases (e.g., lead poisoning)

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute

Yea

27

Nay

0

(03/16/2016)