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2022 SESSION
22101321DBe it enacted by the General Assembly of Virginia:
1. That §§ 54.1-2957, as it is currently effective and as it shall become effective, and 54.1-2957.01 of the Code of Virginia is amended and reenacted as follows:
§ 54.1-2957. (Effective until July 1, 2022) Licensure and practice of nurse practitioners.
A. As used in this section, "clinical:
"Clinical
experience" means the postgraduate delivery of health care directly to
patients pursuant to a practice agreement with a patient care team physician
provider.
"Patient care team provider" means a patient care team physician, as defined in § 54.-2900, or a nurse practitioner who meets the requirements of subsection I and is authorized to practice without a practice agreement.
B. The Board of Medicine and the Board of Nursing shall jointly prescribe the regulations governing the licensure of nurse practitioners. It is unlawful for a person to practice as a nurse practitioner in the Commonwealth unless he holds such a joint license.
C. Every nurse practitioner other than a certified nurse
midwife, certified registered nurse anesthetist, or clinical nurse specialist
or a nurse practitioner who meets the requirements of subsection I shall
maintain appropriate collaboration and consultation, as evidenced in a written
or electronic practice agreement, with at least one patient care team physician
provider. A nurse practitioner who meets the requirements
of subsection I may practice without a written or electronic practice
agreement. A certified nurse midwife shall practice pursuant to subsection H. A
nurse practitioner who is licensed by the Boards of Medicine and Nursing as a
clinical nurse specialist shall practice pursuant to subsection J. A certified
registered nurse anesthetist shall practice under the supervision of a licensed
doctor of medicine, osteopathy, podiatry, or dentistry. A nurse practitioner
who is appointed as a medical examiner pursuant to § 32.1-282 shall practice in
collaboration with a licensed doctor of medicine or osteopathic medicine who
has been appointed to serve as a medical examiner pursuant to § 32.1-282.
Collaboration and consultation among nurse practitioners and patient care team physicians
providers may be provided through telemedicine as described
in § 38.2-3418.16.
Physicians on patient
care teams may require that a nurse practitioner be covered by a professional
liability insurance policy with limits equal to the current limitation on
damages set forth in § 8.01-581.15.
Service on a patient care team by a patient care team member shall not, by the existence of such service alone, establish or create liability for the actions or inactions of other team members.
D. The Boards of Medicine and Nursing shall jointly promulgate
regulations specifying collaboration and consultation among
physicians patient care team
providers and nurse practitioners working as part of
patient care teams that shall include the development of, and periodic review
and revision of, a written or electronic practice agreement; guidelines for
availability and ongoing communications that define consultation among the
collaborating parties and the patient; and periodic joint evaluation of the
services delivered. Practice agreements shall include provisions for (i)
periodic review of health records, which may include visits to the site where
health care is delivered, in the manner and at the frequency determined by the
nurse practitioner and the patient care team
physician provider
and (ii) input from appropriate health care providers in complex clinical cases
and patient emergencies and for referrals. Evidence of a practice agreement
shall be maintained by a nurse practitioner and provided to the Boards upon
request. For nurse practitioners providing care to patients within a hospital
or health care system, the practice agreement may be included as part of
documents delineating the nurse practitioner's clinical privileges or the
electronic or written delineation of duties and responsibilities in
collaboration and consultation with a patient care team
physician provider.
E. The Boards of Medicine and Nursing may issue a license by
endorsement to an applicant to practice as a nurse practitioner if the
applicant has been licensed as a nurse practitioner under the laws of another
state and, pursuant to regulations of the Boards, the applicant meets the
qualifications for licensure required of nurse practitioners in the
Commonwealth. A nurse practitioner to whom a license is issued by endorsement
may practice without a practice agreement with a patient care team physician
provider pursuant to subsection I if such application
provides an attestation to the Boards that the applicant has completed the
equivalent of at least two years of full-time clinical experience, as
determined by the Boards, in accordance with the laws of the state in which the
nurse practitioner was licensed.
F. Pending the outcome of the next National Specialty Examination, the Boards may jointly grant temporary licensure to nurse practitioners.
G. In the event a physician who is
serving as that a
patient care team physician provider
dies, becomes disabled, retires from active practice, surrenders his license or
has it suspended or revoked by the Board or Boards, as may be
appropriate, or relocates his practice such that he is no
longer able to serve, and a nurse practitioner is unable to enter into a new
practice agreement with another patient care team
physician provider,
the nurse practitioner may continue to practice upon notification to the
designee or his alternate of the Boards and receipt of such notification. Such
nurse practitioner may continue to treat patients without a patient care team physician
provider for an initial period not to exceed 60 days,
provided the nurse practitioner continues to prescribe only those drugs
previously authorized by the practice agreement with such
physician patient care team
provider and to have access to appropriate input from
appropriate health care providers in complex clinical cases and patient
emergencies and for referrals. The designee or his alternate of the Boards
shall grant permission for the nurse practitioner to continue practice under
this subsection for another 60 days, provided the nurse practitioner provides
evidence of efforts made to secure another patient care team physician
provider and of access to physician input.
H. Every certified nurse midwife shall practice in accordance with regulations adopted by the Boards and consistent with the Standards for the Practice of Midwifery set by the American College of Nurse-Midwives governing such practice. A certified nurse midwife who has practiced fewer than 1,000 hours shall practice in consultation with a certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or a licensed physician, in accordance with a practice agreement. Such practice agreement shall address the availability of the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician for routine and urgent consultation on patient care. Evidence of the practice agreement shall be maintained by the certified nurse midwife and provided to the Boards upon request. A certified nurse midwife who has completed 1,000 hours of practice as a certified nurse midwife may practice without a practice agreement upon receipt by the certified nurse midwife of an attestation from the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician with whom the certified nurse midwife has entered into a practice agreement stating (i) that such certified nurse midwife or licensed physician has provided consultation to the certified nurse midwife pursuant to a practice agreement meeting the requirements of this section and (ii) the period of time for which such certified nurse midwife or licensed physician practiced in collaboration and consultation with the certified nurse midwife pursuant to the practice agreement. A certified nurse midwife authorized to practice without a practice agreement shall consult and collaborate with and refer patients to such other health care providers as may be appropriate for the care of the patient.
I. A nurse practitioner, other than a nurse practitioner licensed
by the Boards of Medicine and Nursing in the category of certified nurse
midwife, certified registered nurse anesthetist, or clinical nurse specialist,
who has completed the equivalent of at least two years of full-time clinical
experience as a licensed nurse practitioner, as determined by the Boards, may
practice in the practice category in which he is certified and licensed without
a written or electronic practice agreement upon receipt by the nurse
practitioner of an attestation from the patient care team
physician provider
stating (i) that the patient care team physician provider has served as a
patient care team physician provider on a patient care
team with the nurse practitioner pursuant to a practice agreement meeting the
requirements of this section and § 54.1-2957.01; (ii) that while a party to
such practice agreement, the patient care team
physician provider
routinely practiced with a patient population and in a practice area included
within the category for which the nurse practitioner was certified and
licensed; and (iii) the period of time for which the patient care team physician
provider practiced with the nurse practitioner under such a
practice agreement. A copy of such attestation shall be submitted to the Boards
together with a fee established by the Boards. Upon receipt of such attestation
and verification that a nurse practitioner satisfies the requirements of this
subsection, the Boards shall issue to the nurse practitioner a new license that
includes a designation indicating that the nurse practitioner is authorized to
practice without a practice agreement. In the event that a nurse practitioner
is unable to obtain the attestation required by this subsection, the Boards may
accept other evidence demonstrating that the applicant has met the requirements
of this subsection in accordance with regulations adopted by the Boards.
A nurse practitioner authorized to practice without a practice agreement pursuant to this subsection shall (a) only practice within the scope of his clinical and professional training and limits of his knowledge and experience and consistent with the applicable standards of care, (b) consult and collaborate with other health care providers based on the clinical conditions of the patient to whom health care is provided, and (c) establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.
A nurse practitioner
practicing without a practice agreement pursuant to this subsection shall
obtain and maintain coverage by or shall be named insured on a professional
liability insurance policy with limits equal to the current limitation on
damages set forth in § 8.01-581.15.
J. Nurse practitioners licensed by the Boards of Medicine and Nursing in the category of clinical nurse specialist shall practice in consultation with a licensed physician in accordance with a practice agreement between the nurse practitioner and the licensed physician. Such practice agreement shall address the availability of the physician for routine and urgent consultation on patient care. Evidence of a practice agreement shall be maintained by a nurse practitioner and provided to the Boards upon request. The practice of clinical nurse specialists shall be consistent with the standards of care for the profession and with applicable laws and regulations.
§ 54.1-2957. (Effective July 1, 2022) Licensure and practice of nurse practitioners.
A. As used in this section,
"clinical:
"Clinical
experience" means the postgraduate delivery of health care directly to
patients pursuant to a practice agreement with a patient care team physician
provider.
“Patient care team provider” means a patient care team physician, as defined in § 54.-2900, or a nurse practitioner who meets the requirements of subsection I and is authorized to practice without a practice agreement.
B. The Board of Medicine and the Board of Nursing shall jointly prescribe the regulations governing the licensure of nurse practitioners. It is unlawful for a person to practice as a nurse practitioner in the Commonwealth unless he holds such a joint license.
C. Every nurse practitioner other than a certified nurse midwife,
certified registered nurse anesthetist, or clinical nurse specialist or a nurse
practitioner who meets the requirements of subsection I shall maintain
appropriate collaboration and consultation, as evidenced in a written or
electronic practice agreement, with at least one patient care team physician
provider. A nurse practitioner who meets the requirements
of subsection I may practice without a written or electronic practice
agreement. A certified nurse midwife shall practice pursuant to subsection H. A
nurse practitioner who is licensed by the Boards of Medicine and Nursing as a
clinical nurse specialist shall practice pursuant to subsection J. A certified
registered nurse anesthetist shall practice under the supervision of a licensed
doctor of medicine, osteopathy, podiatry, or dentistry. A nurse practitioner
who is appointed as a medical examiner pursuant to § 32.1-282 shall practice in
collaboration with a licensed doctor of medicine or osteopathic medicine who
has been appointed to serve as a medical examiner pursuant to § 32.1-282.
Collaboration and consultation among nurse practitioners and patient care team physicians
providers may be provided through telemedicine as described
in § 38.2-3418.16.
Physicians on patient
care teams may require that a nurse practitioner be covered by a professional
liability insurance policy with limits equal to the current limitation on
damages set forth in § 8.01-581.15.
Service on a patient care team by a patient care team member shall not, by the existence of such service alone, establish or create liability for the actions or inactions of other team members.
D. The Boards of Medicine and Nursing shall jointly promulgate
regulations specifying collaboration and consultation among
physicians patient care team
providers and nurse practitioners working as part of
patient care teams that shall include the development of, and periodic review
and revision of, a written or electronic practice agreement; guidelines for
availability and ongoing communications that define consultation among the
collaborating parties and the patient; and periodic joint evaluation of the
services delivered. Practice agreements shall include provisions for (i)
periodic review of health records, which may include visits to the site where
health care is delivered, in the manner and at the frequency determined by the
nurse practitioner and the patient care team
physician provider
and (ii) input from appropriate health care providers in complex clinical cases
and patient emergencies and for referrals. Evidence of a practice agreement
shall be maintained by a nurse practitioner and provided to the Boards upon
request. For nurse practitioners providing care to patients within a hospital
or health care system, the practice agreement may be included as part of
documents delineating the nurse practitioner's clinical privileges or the
electronic or written delineation of duties and responsibilities in
collaboration and consultation with a patient care team
physician provider.
E. The Boards of Medicine and Nursing may issue a license by
endorsement to an applicant to practice as a nurse practitioner if the
applicant has been licensed as a nurse practitioner under the laws of another
state and, pursuant to regulations of the Boards, the applicant meets the qualifications
for licensure required of nurse practitioners in the Commonwealth. A nurse
practitioner to whom a license is issued by endorsement may practice without a
practice agreement with a patient care team
physician provider
pursuant to subsection I if such application provides an attestation to the
Boards that the applicant has completed the equivalent of at least five years
of full-time clinical experience, as determined by the Boards, in accordance
with the laws of the state in which the nurse practitioner was licensed.
F. Pending the outcome of the next National Specialty Examination, the Boards may jointly grant temporary licensure to nurse practitioners.
G. In the event a physician who is
serving as that a
patient care team physician provider dies, becomes
disabled, retires from active practice, surrenders his license or has it
suspended or revoked by the Board, or relocates his practice such that he is no
longer able to serve, and a nurse practitioner is unable to enter into a new
practice agreement with another patient care team
physician provider,
the nurse practitioner may continue to practice upon notification to the
designee or his alternate of the Boards and receipt of such notification. Such
nurse practitioner may continue to treat patients without a patient care team physician
provider for an initial period not to exceed 60 days,
provided the nurse practitioner continues to prescribe only those drugs
previously authorized by the practice agreement with such
physician patient care team
provider and to have access to appropriate input from
appropriate health care providers in complex clinical cases and patient
emergencies and for referrals. The designee or his alternate of the Boards
shall grant permission for the nurse practitioner to continue practice under
this subsection for another 60 days, provided the nurse practitioner provides
evidence of efforts made to secure another patient care team physician
provider and of access to physician input.
H. Every certified nurse midwife shall practice in accordance with regulations adopted by the Boards and consistent with the Standards for the Practice of Midwifery set by the American College of Nurse-Midwives governing such practice. A certified nurse midwife who has practiced fewer than 1,000 hours shall practice in consultation with a certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or a licensed physician, in accordance with a practice agreement. Such practice agreement shall address the availability of the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician for routine and urgent consultation on patient care. Evidence of the practice agreement shall be maintained by the certified nurse midwife and provided to the Boards upon request. A certified nurse midwife who has completed 1,000 hours of practice as a certified nurse midwife may practice without a practice agreement upon receipt by the certified nurse midwife of an attestation from the certified nurse midwife who has practiced for at least two years prior to entering into the practice agreement or the licensed physician with whom the certified nurse midwife has entered into a practice agreement stating (i) that such certified nurse midwife or licensed physician has provided consultation to the certified nurse midwife pursuant to a practice agreement meeting the requirements of this section and (ii) the period of time for which such certified nurse midwife or licensed physician practiced in collaboration and consultation with the certified nurse midwife pursuant to the practice agreement. A certified nurse midwife authorized to practice without a practice agreement shall consult and collaborate with and refer patients to such other health care providers as may be appropriate for the care of the patient.
I. A nurse practitioner, other than a nurse practitioner
licensed by the Boards of Medicine and Nursing in the category of certified
nurse midwife, certified registered nurse anesthetist, or clinical nurse
specialist, who has completed the equivalent of at least five years of
full-time clinical experience as a licensed nurse practitioner, as determined
by the Boards, may practice in the practice category in which he is certified
and licensed without a written or electronic practice agreement upon receipt by
the nurse practitioner of an attestation from the patient care team physician
provider stating (i) that the patient care team physician
provider has served as a patient care team physician
provider on a patient care team with the nurse practitioner
pursuant to a practice agreement meeting the requirements of this section and §
54.1-2957.01; (ii) that while a party to such practice agreement, the patient
care team physician
provider routinely practiced with a patient population and
in a practice area included within the category for which the nurse
practitioner was certified and licensed; and (iii) the period of time for which
the patient care team physician provider practiced with the
nurse practitioner under such a practice agreement. A copy of such attestation
shall be submitted to the Boards together with a fee established by the Boards.
Upon receipt of such attestation and verification that a nurse practitioner
satisfies the requirements of this subsection, the Boards shall issue to the
nurse practitioner a new license that includes a designation indicating that
the nurse practitioner is authorized to practice without a practice agreement.
In the event that a nurse practitioner is unable to obtain the attestation
required by this subsection, the Boards may accept other evidence demonstrating
that the applicant has met the requirements of this subsection in accordance
with regulations adopted by the Boards.
A nurse practitioner authorized to practice without a practice agreement pursuant to this subsection shall (a) only practice within the scope of his clinical and professional training and limits of his knowledge and experience and consistent with the applicable standards of care, (b) consult and collaborate with other health care providers based on the clinical conditions of the patient to whom health care is provided, and (c) establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers.
A nurse practitioner
practicing without a practice agreement pursuant to this subsection shall
obtain and maintain coverage by or shall be named insured on a professional
liability insurance policy with limits equal to the current limitation on
damages set forth in § 8.01-581.15.
J. Nurse practitioners licensed by the Boards of Medicine and Nursing in the category of clinical nurse specialist shall practice in consultation with a licensed physician in accordance with a practice agreement between the nurse practitioner and the licensed physician. Such practice agreement shall address the availability of the physician for routine and urgent consultation on patient care. Evidence of a practice agreement shall be maintained by a nurse practitioner and provided to the Boards upon request. The practice of clinical nurse specialists shall be consistent with the standards of care for the profession and with applicable laws and regulations.
§ 54.1-2957.01. Prescription of certain controlled substances and devices by licensed nurse practitioners.
A. As used in this section, "patient care team provider" shall have the same meaning as set forth in § 54.1-2957.
B. In accordance with the provisions of this section and pursuant to the requirements of Chapter 33 (§ 54.1-3300 et seq.), a licensed nurse practitioner shall have the authority to prescribe Schedule II through Schedule VI controlled substances and devices as set forth in Chapter 34 (§ 54.1-3400 et seq.).
B. C. A nurse practitioner who
does not meet the requirements for practice without a written or electronic
practice agreement set forth in subsection I of § 54.1-2957 shall prescribe
controlled substances or devices only if such prescribing is authorized by a written
or electronic practice agreement entered into by the nurse practitioner and a
patient care team physician provider. Such nurse
practitioner shall provide to the Boards of Medicine and Nursing such evidence
as the Boards may jointly require that the nurse practitioner has entered into
and is, at the time of writing a prescription, a party to a written or
electronic practice agreement with a patient care team
physician provider
that clearly states the prescriptive practices of the nurse practitioner. Such
written or electronic practice agreements shall include the controlled
substances the nurse practitioner is or is not authorized to prescribe and may
restrict such prescriptive authority as described in the practice agreement.
Evidence of a practice agreement shall be maintained by a nurse practitioner
pursuant to § 54.1-2957. Practice agreements authorizing a nurse practitioner
to prescribe controlled substances or devices pursuant to this section either
shall be signed by the patient care team physician provider or shall clearly
state the name of the patient care team physician provider who has entered into
the practice agreement with the nurse practitioner.
It shall be unlawful for a nurse practitioner to prescribe controlled substances or devices pursuant to this section unless (i) such prescription is authorized by the written or electronic practice agreement or (ii) the nurse practitioner is authorized to practice without a written or electronic practice agreement pursuant to subsection I of § 54.1-2957.
C. D. The Boards of Medicine and
Nursing shall promulgate regulations governing the prescriptive authority of
nurse practitioners as are deemed reasonable and necessary to ensure an
appropriate standard of care for patients. Such regulations shall include
requirements as may be necessary to ensure continued nurse practitioner
competency, which may include continuing education, testing, or any other
requirement, and shall address the need to promote ethical practice, an
appropriate standard of care, patient safety, the use of new pharmaceuticals,
and appropriate communication with patients.
D. E. This section shall not limit
the functions and procedures of certified registered nurse anesthetists or of
any nurse practitioners which are otherwise authorized by law or regulation.
E. F. The following restrictions
shall apply to any nurse practitioner authorized to prescribe drugs and devices
pursuant to this section:
1. The nurse practitioner shall disclose to the patient at the
initial encounter that he is a licensed nurse practitioner. Any party to a
practice agreement shall disclose, upon request of a patient or his legal
representative, the name of the patient care team
physician provider
and information regarding how to contact the
patient care team physician provider.
2. Physicians No patient care team provider
shall not serve as a patient care
team physician
provider on a patient care team at any one time to more
than six nurse practitioners.
F. G. This section shall not
prohibit a licensed nurse practitioner from administering controlled substances
in compliance with the definition of "administer" in § 54.1-3401 or
from receiving and dispensing manufacturers' professional samples of controlled
substances in compliance with the provisions of this section.
G. H. Notwithstanding any
provision of law or regulation to the contrary, a nurse practitioner licensed
by the Boards of Medicine and Nursing in the category of certified nurse
midwife or clinical nurse specialist and holding a license for prescriptive
authority may prescribe Schedules II through VI controlled substances. However,
if the nurse practitioner licensed by the Boards of Medicine and Nursing in the
category of certified nurse midwife or clinical nurse specialist is required,
pursuant to subsection H or J of § 54.1-2957, to practice pursuant to a
practice agreement, such prescribing shall also be in accordance with any
prescriptive authority included in such practice agreement.
H. I. Notwithstanding any
provision of law or regulation to the contrary, a nurse practitioner licensed
by the Boards of Medicine and Nursing as a certified registered nurse
anesthetist shall have the authority to prescribe Schedule II through Schedule
VI controlled substances and devices in accordance with the requirements for
practice set forth in subsection C of § 54.1-2957 to a patient requiring
anesthesia, as part of the periprocedural care of such patient. As used in this
subsection, "periprocedural" means the period beginning prior to a
procedure and ending at the time the patient is discharged.