Legislative Update

Regarding legislation affecting Advanced Practice Registered Nurses
Dear APRNs
CONGRATS!!  Senate bill 345 passed its final vote yesterday!    It will now go to the Governor for a signing.

Click here to access the bill directly.

Please contact these Legislators and give them a big thank you for all their hard work and perseverance.  PLEASE PLEASE PLEASE Thank them.  They are the chief sponsors of our bill.

Senator Tom Davis:   TomDavis@scsenate.gov
Representative Gary Clary:   GaryClary@schouse.gov

Also, contact your own legislator (House and Senate Member) and tell them thank you!  Click button at right for their emails and phone numbers.

Here is a synopsis of the changes for APRNs (NP, CNM, CNS):

NOTE: these changes do not impact CRNAs.

  • A focus of  practice must include serving rural and underserved areas or populations such as HIV, Medicaid, Medicare, children, women, etc.  It is wide open for the amount, where, and who.
    • ‘Underserved or rural area’ means an area determined by a federal or state agency authorized to determine such a designation.
    • ‘Underserved population’ means a population residing in a rural or urban area, which includes, but is not limited to:
      • persons receiving Medicaid, Medicare, Department of Health and Environmental Health care, or free clinic care;
      • those residing in long-term care settings or receiving care from a licensed hospice;
      • those in institutions including, but not limited to, incarceration institutions and mental health institutions; and
      • persons including, but not limited to, the homeless, HIV patients, children, women, the economically disadvantaged, the uninsured, the underinsured, the developmentally disabled, the medically fragile, the mentally ill, migrants, military persons and their dependents, and veterans and their dependents.
  • Removes Physician Supervision:  APRNs must have practice agreements with physicians or medical staff.  The practice agreement can stipulate collaboration, supervision, etc. It will be whatever you work out with your physician(s).  The practice agreement stipulates the medical acts (like prescribing C2, C3 etc)
  • If you enter into a practice agreement with physicians to do medical aspects of care, physicians must be licensed by SC.
    • The practice agreement must include the following general information:
      • name, address, and South Carolina license number of the nurse;
      • name, address, and South Carolina license number of the physician;
      • nature of practice and practice locations of the nurse and physician;
      • date the practice agreement was entered into and dates practice agreement was reviewed and amended; and
    • description of how consultation with the physician is provided and provision for backup consultation and the following information for medical acts:
      •  medical conditions for which therapies may be initiated, continued, or modified;
      • treatments that may be initiated, continued, or modified;
      • drug therapies that may be prescribed;
      • situations that require direct evaluation by or referral to the physician.
  • APRNs can also:
    • provide noncontrolled prescription drugs at an entity that provides free medical care for indigent patients;
    • certify that a student is unable to attend school but may benefit from receiving instruction given in his home or hospital;
    • refer a patient to physical therapy for treatment;
    • pronounce death and sign death certificates;
    • issue an order for a patient to receive appropriate services from a licensed hospice and
    • certify that an individual is handicapped and declare that the handicap is temporary or permanent for purposes of the individual’s application for a placard.

 

  • Physicians must be available for consultation and advice (electronic means)
  • Removes All Mileage constraints
  • Changes the Ratio that a MD can work with:  MD to NP (1:6 at any given time)
  • Increases the APRN (NP, CNS, CNM) prescriptive authority to prescribe C2 Narcotics for 5 days, except for those NPs who work in hospice or palliative care.  This must be agreed to and written in the practice agreement.
  • APRNs can prescribe other C2 for 30 days, ex: Ritalin.  This must be agreed to and written in the practice agreement.
  • Removes Delegated act terms
  • APRNs can order/sign Handicapped placards, Homebound, Provide Meds at Free Clinics, Order PT, Sign Death Certificates, Pronounce death.  This must be written in the practice agreement.
  • APRNs can conduct health assessments, diagnose, and prescribe via tele-health.  If APRN has a sole relationship with a patient via tele-health, then APRN must seek approval from the Board of Nursing and Medicine to prescribe C3-2.  This must be agreed to and written in the practice agreement.
  • Joint Committee for BON and Board of Medicine is to approve C2 and C3 prescribing if you have a sole relationship with a patient via tele-health.

 

Finally, the law will go into effect in late summer.   Please be patient with the LLR Board of Nursing and others as we work to implement the changes.  THESE CHANGES ARE NOT IN PLACE UNTIL JULY.  SO DON’T DO ANYTHING (like write for C2 meds) until you get official notice about the implementation.  We are developing templates for practice agreements and will send out to you all later.

Thank you everyone for your help and support. YOU MADE IT HAPPEN!!

😊

Stephanie Burgess
803-530-9899 cell
scburgess@aol.com

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