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ACNM Policy Update - 4/7/2016

State Issues

1. Victory for WV CNMs – Passage of HB 4334 in March 2016!

2. An Important Step Forward -- Florida CNMs Gain Ability to Prescribe Controlled Substances!

3. Celebrating Virginia’s Step toward Full Practice Authority

4. Reminder about ACNM State Policy Reporting

5. 5. New Laws: FL, ID, IN, NY, SC, SD, TN, UT, VA, WA, WV, WY


1. Victory for WV CNMs – Passage of HB 4334 in March 2016!

This new law repeals Article 15, the section of the WV Nurse Practice Act containing the outdated section of code enacted in 1973 that recognized and entitled CNMs to licensure and prescriptive authority, but also mandated a collaborative relationship with a licensed physician. CNMs became defined as APRNs in 2013, but the collaborative requirement persisted until this repeal. When HB 4334 goes into effect in June 2016, CNMs will achieve full practice authority as APRNs, eliminating the collaborative requirement.


HB 4334 also permits APRN prescribing without the further requirement of a written collaborative agreement, following 3 years of prescriptive authority in a duly-documented collaborative agreement, Schedule III expansions (still no Schedule II), and global signature authority within the APRN’s scope. The bill created a Joint Advisory Council under the Board of Nursing, which will be comprised of 13 members, one of whom will be a CNM.

2. An Important Step Forward -- Florida CNMs Gain Ability to Prescribe Controlled Substances!


A major milestone was reached in Florida on March 30 when the Governor signed House Bill 423 into law. The bill authorizes ARNPs, which include CNMs, to prescribe, dispense, order, and administer controlled substances, but only to the extent authorized under a supervising physician’s protocol. The bill establishes a committee to recommend a formulary of controlled substances that an ARNP may not prescribe or may only prescribe for a specific use or in limited quantities. The Board of Nursing must adopt the recommended formulary by rule by October 1, 2016, along with any revisions recommended by the Board of Medicine, Board of Osteopathic Medicine, or Board of Dentistry.


Florida is the last state in the country to grant prescribing authority for controlled substances to CNMs and other advanced practice nurses. The enactment of H.423 is the culmination of a 22 year effort in the state.

3. Celebrating Virginia’s Step toward Full Practice Authority


Virginia S.463 removes the requirement for physician supervision and a written practice agreement for CNM practices that use only Schedule VI drugs. It instead requires these CNMs to have a practice agreement with an MD for consultation and urgent issues, but it is not required to be written or to be with an OB/GYN physician. This will significantly help CNMs in rural and underserved areas. The bill was signed by the Governor on March 25.

4. Reminder about ACNM State Policy Reporting

Due to the volume of bills tracked by ACNM at the state level, in most instances reporting of legislative actions is restricted to enactments or gubernatorial vetoes. For up-to-date information on legislation ACNM is tracking in your state, visit the state legislative tracking system under the Advocacy tab on ACNM’s website. Please direct any questions regarding ACNM’s state policy activities to Cara Kinzelman at [email protected].

5. New Laws: FL, ID, IN, NY, SC, SD, TN, UT, VA, WA, WV, WY

Florida H.1241 expressly authorizes an Advanced Registered Nurse Practitioner (ARNP, which includes CNMs) to order any medication, including a controlled substance, for administration to a patient in a hospital, ambulatory surgical center, mobile surgical center, or nursing home, within the framework of an established protocol. The bill was signed by the Governor on March 25.

Florida H.1411 amends abortion clinic licensure requirements, prohibits the sale or donation of fetal remains, prohibits public funding of clinics or affiliates of clinics performing abortions, and creates a registration program for abortion referral and counseling agencies. The bill was approved by the Governor on March 25.

Idaho H.338 clarifies that licensed midwives (CPMs) may possess legend drugs limited to formulary drugs consistent with rules promulgated by the Idaho Board of Midwifery. The bill was signed into law on March 17.

Idaho S.1250 adopts the APRN Compact as amended in 2015 by the National Council of State Boards of Nursing (NCSBN). The Compact provides a mechanism for member states to mutually recognize APRN licenses, thereby allowing APRNs to hold one license issued by the primary state of residence that grants the privilege to practice as an APRN in other Compact states, both physically and via technology. The bill was signed by the Governor on March 16.

Indiana H.1263 concerns telemedicine services and prescriptions. Specifically, the bill recognizes APRNs as authorized telemedicine providers, enacts standards for the patient-provider relationship when telemedicine services are provided, and establishes standards for telemedicine prescribing, among other things. The bill was signed into law on March 21.

Indiana H.1278 allows an APRN to include a report from Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) program in a patient’s file. The bill was signed into law on March 21.

Indiana H.1337 enacts measures aimed at ensuring that women considering an abortion after receiving a diagnosis of a lethal fetal anomaly are informed of the availability of perinatal hospice care, among other things. The bill was signed into law on March 24.

Indiana S.28 amends medical malpractice statute by increasing the amount of recoverable damages for injury or death to a patient and health care provider liability limits, among other things. The bill was signed into law on March 24.

Indiana S.186 prohibits APRNs and other providers from releasing to a law enforcement agency a verbal screening or questioning related to drug or alcohol use, a urine test, or a blood test provided to a pregnant woman without the woman’s consent, unless so ordered by a court of law. The bill was signed by the Governor on March 21.

Indiana S.315 directs persons that provide birthing services and prenatal care to distribute information about postnatal fluid and postnatal tissue donation, including cord blood donation, to pregnant patients as part of the postnatal donation initiative. The bill was signed by the Governor on March 21.

New York A.9163/S.6695 prohibits the restraint of pregnant female prisoners during childbirth unless the woman poses an immediate risk of serious injury to herself or others. If restraints are used, law enforcement must report the reason for restraint, the type of restraint used, and length of time. The bill was signed into law on March 21.

South Carolina H.3251 directs the Department of Health and Environmental Control to establish a Maternal Morbidity and Mortality Review Committee to review maternal deaths and to develop strategies for the prevention of maternal deaths. The committee also may review severe maternal morbidity. The bill was signed by the Governor on March 14.

South Dakota S.1157 requires that a doctor provide a woman with information on discontinuing a drug-induced abortion as a part of informed consent. The bill was signed into law on March 29.

Tennessee H.2397/S.2097 requires a healthcare provider who assumes responsibility for the prenatal care of either pregnant women during gestation or women who may become pregnant to give such women the following information regarding cytomegalovirus (CMV), if the provider has determined that the patient is at risk of contracting CMV: (1) The incidence of CMV; (2) The transmission of CMV to at-risk women who are pregnant or who may become pregnant; (3) Birth defects caused by congenital CMV; (4) Methods of diagnosing congenital CMV; and (5) Available preventative measures. The bill became law on March 31.

Utah
H.184 expands the definition of unlawful conduct for direct-entry midwives to include failure to obtain informed consent before engaging in midwifery practice, in addition to making multiple technical changes. The bill was signed into law on March 21.

Utah S.108, among other things, prohibits the Department of Health and the Health Facility Committee from imposing certain requirements on birthing centers licensed under the Health Care Facility Licensing and Inspection Act, such as maintaining admitting privileges at a general acute care hospital, maintaining a transfer agreement with one or more hospitals, maintaining a collaborative practice agreement with a physician, or requiring a physician or CNM to be present at each birth when another licensed maternity care practitioner is present at the birth and remains until the maternal patient and newborn are stable postpartum. The bill was signed by the Governor on March 18.

Virginia H.581 provides that in cases in which a physician who is serving as a patient care team physician dies, becomes disabled, retires from active practice, surrenders his license or has it suspended or revoked by the Board of Medicine, or relocates his practice such that he is no longer able to serve, and an NP who was part of the patient care team is unable to enter into a new practice agreement with another patient care team physician, the NP may continue to practice without a patient care team physician for an initial period not to exceed 60 days upon notification to the designee of the Boards of Medicine and Nursing. The bill was signed into law on March 11.

Washington H.2403 directs the Department of Health to develop resources related to Down syndrome for expectant parents and parents who receive a positive diagnosis of Down syndrome. The bill was signed into law on March 29.

Washington S.6534 establishes a maternal mortality review panel to conduct comprehensive, multidisciplinary reviews of maternal deaths in Washington, identify factors associated with these deaths, and make recommendations for system changes to improve health care services for women. The bill was signed into law on April 1.

West Virginia H.4347 requires substance abuse treatment or recovery service providers that accept Medicaid to give pregnant women priority in accessing services and may not refuse access to services solely due to pregnancy as long as the provider's services are appropriate for pregnant women. The purpose of this bill is to give pregnant women priority to substance abuse treatment. It was signed into law on March 24.

West Virginia H.4365 create a new simplified and expedited certificate of need process. The Governor signed the bill into law on March 25.

Wyoming H.56 adopts the Advanced Practice Nurse Licensure Compact for Wyoming. Entering into the Compact allows advanced practice nurses licensed in one compact state, including Wyoming, to exercise a multi-state licensure privilege in other states that are a party to the Compact. The bill became law on March 2.



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