1.1                          A bill for an act
  1.2             relating to health; requiring nondiscriminate coverage 
  1.3             of tests; requiring nondiscriminate coverage of nurses 
  1.4             acting as surgical first assistants; defining scope of 
  1.5             practice for advanced practice nurses; modifying 
  1.6             prescriptive authority for advanced practice nurses; 
  1.7             amending Minnesota Statutes 1994, sections 148.235; 
  1.8             and 256B.0625, by adding a subdivision; Minnesota 
  1.9             Statutes 1995 Supplement, section 151.01, subdivision 
  1.10            23; proposing coding for new law in Minnesota 
  1.11            Statutes, chapters 62A; and 148. 
  1.12  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.13     Section 1.  [62A.3091] [NONDISCRIMINATE COVERAGE OF TESTS.] 
  1.14     Subdivision 1.  [SCOPE OF REQUIREMENT.] This section 
  1.15  applies to any of the following if issued or renewed to a 
  1.16  Minnesota resident or to cover a Minnesota resident: 
  1.17     (1) a health plan, as defined in section 62A.011; 
  1.18     (2) coverage described in section 62A.011, subdivision 3, 
  1.19  clauses (2), (3), or (6) to (12); and 
  1.20     (3) a policy, contract, or certificate issued by a 
  1.21  community integrated service network or an integrated service 
  1.22  network licensed under chapter 62N. 
  1.23     Subd. 2.  [REQUIREMENT.] Irrespective of the type of health 
  1.24  care provider who orders a test, coverage described in 
  1.25  subdivision 1 that covers laboratory tests, diagnostic tests, 
  1.26  and X-rays must provide the same coverage for all such tests 
  1.27  ordered by a health care provider operating within the legal 
  1.28  scope of practice. 
  2.1      Sec. 2.  [62A.3092] [SURGICAL FIRST ASSISTING SERVICES.] 
  2.2      Subdivision 1.  [SCOPE OF REQUIREMENT.] This section 
  2.3   applies to any of the following if issued or renewed to a 
  2.4   Minnesota resident or to cover a Minnesota resident: 
  2.5      (1) a health plan, as defined in section 62A.011; 
  2.6      (2) coverage described in section 62A.011, subdivision 3, 
  2.7   clauses (2), (3), or (6) to (12); and 
  2.8      (3) a policy, contract, or certificate issued by a 
  2.9   community integrated service network or an integrated service 
  2.10  network licensed under chapter 62N.  
  2.11     Subd. 2.  [REQUIREMENT.] Coverage described in subdivision 
  2.12  1 that provides for payment for surgical first assisting 
  2.13  benefits or services shall be construed as providing for payment 
  2.14  for a registered nurse who performs first assistant functions 
  2.15  and services that are within the scope of practice of a 
  2.16  registered nurse. 
  2.17     Sec. 3.  [148.233] [DEFINITIONS.] 
  2.18     Subdivision. 1.  [APPLICABILITY.] For purposes of sections 
  2.19  148.233 to 148.235, the terms defined in this section have the 
  2.20  meanings given them. 
  2.21     Subd. 2.  [ADVANCED PRACTICE NURSE.] "Advanced practice 
  2.22  nurse" means a licensed independent practitioner who is a 
  2.23  certified registered nurse anesthetist, certified clinical nurse 
  2.24  specialist, certified clinical nurse specialist in psychiatric 
  2.25  and mental health nursing, certified nurse-midwife, or certified 
  2.26  nurse practitioner. 
  2.27     Subd. 3.  [CERTIFIED REGISTERED NURSE ANESTHETIST.] 
  2.28  "Certified registered nurse anesthetist" means a registered 
  2.29  nurse who:  (1) has graduated from a nurse anesthesia 
  2.30  educational program accredited by the American Association of 
  2.31  Nurse Anesthetists; (2) has successfully completed the 
  2.32  certification exam administered by the American Association of 
  2.33  Nurse Anesthetists; and (3) is currently certified by the 
  2.34  American Association of Nurse Anesthetists. 
  2.35     Subd. 4.  [CERTIFIED CLINICAL NURSE SPECIALIST.] "Certified 
  2.36  clinical nurse specialist" means a registered nurse who:  (1) 
  3.1   has a master's degree; and (2) is certified through a national 
  3.2   professional nursing organization that certifies clinical nurse 
  3.3   specialists and is included in the list of professional nursing 
  3.4   organizations adopted by the board under section 62A.15, 
  3.5   subdivision 3a. 
  3.6      Subd. 5.  [CERTIFIED CLINICAL NURSE SPECIALIST IN 
  3.7   PSYCHIATRIC AND MENTAL HEALTH NURSING.] "Certified clinical 
  3.8   nurse specialist in psychiatric and mental health nursing" means 
  3.9   a registered nurse who:  (1) has a master's degree; (2) is 
  3.10  certified through a national professional nursing organization 
  3.11  that certifies clinical nurse specialists and is included in the 
  3.12  list of professional nursing organizations adopted by the board 
  3.13  under section 62A.15, subdivision 3a; and (3) has successfully 
  3.14  completed no less than 30 hours of formal study in the 
  3.15  prescribing of psychotropic medications and medications to treat 
  3.16  their side effects, including instruction in health assessment, 
  3.17  psychotropic classifications, psychopharmacology, indications, 
  3.18  dosages, contraindications, side effects, and evidence of 
  3.19  application. 
  3.20     Subd. 6.  [CERTIFIED NURSE-MIDWIFE.] "Certified 
  3.21  nurse-midwife" means a registered nurse who:  (1) has graduated 
  3.22  from a program of study designed to prepare registered nurses 
  3.23  for advanced practice as nurse-midwives; and (2) is certified 
  3.24  through the national professional nursing organization for 
  3.25  nurse-midwives. 
  3.26     Subd. 7.  [CERTIFIED NURSE PRACTITIONER.] "Certified nurse 
  3.27  practitioner" means a registered nurse who:  (1) has graduated 
  3.28  from a program of study designed to prepare registered nurses 
  3.29  for advanced practice as nurse practitioners; and (2) is 
  3.30  certified in a specialty practice area through a national 
  3.31  professional nursing organization which certifies nurse 
  3.32  practitioners and is included in the list of professional 
  3.33  nursing organizations adopted by the board under section 62A.15, 
  3.34  subdivision 3a. 
  3.35     Sec. 4.  [148.234] [ADVANCED PRACTICE NURSE; SCOPE OF 
  3.36  PRACTICE.] 
  4.1      Subdivision 1.  [CERTIFIED REGISTERED NURSE ANESTHETIST.] A 
  4.2   certified registered nurse anesthetist may independently 
  4.3   administer anesthesia within the scope of educational 
  4.4   preparation and may perform anesthesia and anesthesia-related 
  4.5   services as outlined by the American Association Nurse 
  4.6   Anesthetist Guidelines and Standards for the Practice of the 
  4.7   Certified Registered Nurse Anesthetist. 
  4.8      Subd. 2.  [CERTIFIED NURSE-MIDWIFE.] A certified 
  4.9   nurse-midwife may independently manage women's health care 
  4.10  focusing particularly on pregnancy, childbirth, the postpartum 
  4.11  period, care of the newborn, family planning, and gynecological 
  4.12  care.  The practice of a nurse-midwife shall be in accord with 
  4.13  the standards for the practice of nurse-midwifery as defined by 
  4.14  the American College of Nurse-Midwives. 
  4.15     Subd. 3.  [CERTIFIED NURSE PRACTITIONER.] A certified nurse 
  4.16  practitioner may provide health care to individuals, families, 
  4.17  and groups across the lifespan in a variety of settings, 
  4.18  including hospitals, long-term care facilities, and 
  4.19  community-based settings consistent with the nurse's specific 
  4.20  practice area and certification.  The certified nurse 
  4.21  practitioner may independently manage a broad range of personal 
  4.22  health services including: 
  4.23     (1) promotion and maintenance of health; 
  4.24     (2) prevention of illness and disability; 
  4.25     (3) management of health care during acute and chronic 
  4.26  phases of illness, including admitting clients to hospitals and 
  4.27  long-term care facilities; and 
  4.28     (4) health education and health counseling guidance and 
  4.29  counseling for individuals and families. 
  4.30     Sec. 5.  Minnesota Statutes 1994, section 148.235, is 
  4.31  amended to read: 
  4.32     148.235 [PRESCRIBING DRUGS AND THERAPEUTIC DEVICES.] 
  4.33     Subdivision 1.  [CERTIFIED NURSE-MIDWIVES.] A ~~registered~~ 
  4.34  ~~nurse who has graduated from a program of study designed to~~ 
  4.35  ~~prepare registered nurses for advanced practice as~~ 
  4.36  ~~nurse-midwives and who is certified through the national~~ 
  5.1   ~~professional nursing organization for nurse-midwives~~ certified 
  5.2   nurse-midwife may prescribe and administer drugs and therapeutic 
  5.3   devices within practice as a nurse-midwife. 
  5.4      Subd. 2.  [CERTIFIED NURSE PRACTITIONERS.] A ~~registered~~ 
  5.5   ~~nurse who (1) has graduated from a program of study designed to~~ 
  5.6   ~~prepare registered nurses for advanced practice as nurse~~ 
  5.7   ~~practitioners, (2) is certified through a national professional~~ 
  5.8   ~~nursing organization which certifies nurse practitioners and is~~ 
  5.9   ~~included in the list of professional nursing organizations~~ 
  5.10  ~~adopted by the board under section 62A.15, subdivision 3a, and~~ 
  5.11  ~~(3) has a written agreement with a physician based on standards~~ 
  5.12  ~~established by the Minnesota nurses association and the~~ 
  5.13  ~~Minnesota medical association that defines the delegated~~ 
  5.14  ~~responsibilities related to the prescription of drugs and~~ 
  5.15  ~~therapeutic devices,~~ certified nurse practitioner may prescribe 
  5.16  and administer drugs and therapeutic devices ~~within the scope of~~ 
  5.17  ~~the written agreement and~~ within practice as a nurse 
  5.18  practitioner.  
  5.19     Subd. 3.  [DISPENSING AUTHORITY.] An advanced practice 
  5.20  nurse who is authorized under this section to prescribe drugs is 
  5.21  authorized to dispense drugs subject to the same requirements 
  5.22  established for the prescribing of drugs.  ~~This authority to~~ 
  5.23  ~~dispense extends only to those drugs described in the written~~ 
  5.24  ~~agreement entered into under this section.~~  The authority to 
  5.25  dispense includes, but is not limited to, the authority to 
  5.26  receive and dispense sample drugs. 
  5.27     Subd. 4.  [CERTIFIED CLINICAL NURSE SPECIALISTS IN 
  5.28  PSYCHIATRIC AND MENTAL HEALTH NURSING.] A ~~registered nurse who~~ 
  5.29  ~~(1) has a masters degree, (2) is certified through a national~~ 
  5.30  ~~professional nursing organization which certifies clinical~~ 
  5.31  ~~specialists in psychiatric and mental health nursing and is~~ 
  5.32  ~~included in the list of professional nursing organizations~~ 
  5.33  ~~adopted by the board under section 62A.15, subdivision 3a, (3)~~ 
  5.34  ~~has successfully completed no less than 30 hours of formal study~~ 
  5.35  ~~in the prescribing of psychotropic medications and medications~~ 
  5.36  ~~to treat their side effects which included instruction in health~~ 
  6.1   ~~assessment, psychotropic classifications, psychopharmacology,~~ 
  6.2   ~~indications, dosages, contraindications, side effects, and~~ 
  6.3   ~~evidence of application, and (4) has a written agreement with a~~ 
  6.4   ~~psychiatrist based on standards established by the Minnesota~~ 
  6.5   ~~nurses association and the Minnesota psychiatric association~~ 
  6.6   ~~that specifies and defines the delegated responsibilities~~ 
  6.7   ~~related to the prescription of drugs in relationship to the~~ 
  6.8   ~~diagnosis,~~ certified clinical nurse specialist in psychiatric 
  6.9   and mental health nursing may prescribe and administer drugs 
  6.10  used to treat psychiatric and behavioral disorders and the side 
  6.11  effects of those drugs ~~within the scope of the written agreement~~ 
  6.12  ~~and~~ within practice as a certified clinical nurse specialist in 
  6.13  psychiatric and mental health nursing. 
  6.14     ~~Nothing in this subdivision removes or limits the legal~~ 
  6.15  ~~professional liability of the treating psychiatrist, clinical~~ 
  6.16  ~~nurse specialist, mental health clinic or hospital for the~~ 
  6.17  ~~prescription and administration of drugs by a clinical~~ 
  6.18  ~~specialist in accordance with this subdivision.~~ 
  6.19     Subd. 4a.  [CERTIFIED REGISTERED NURSE ANESTHETISTS.] A 
  6.20  certified registered nurse anesthetist may prescribe and 
  6.21  administer drugs and therapeutic devices within practice as a 
  6.22  certified registered nurse anesthetist. 
  6.23     ~~Subd. 5.  [RULES.] (a) The board shall promulgate rules to~~ 
  6.24  ~~provide for the following:~~ 
  6.25     ~~(1) a system of identifying advanced practice nurses~~ 
  6.26  ~~eligible to prescribe drugs as authorized under this section;~~ 
  6.27     ~~(2) a system of transmitting to pharmacists the identity of~~ 
  6.28  ~~advanced practice nurses eligible to prescribe drugs; and~~ 
  6.29     ~~(3) a fee to nurse practitioners and certified clinical~~ 
  6.30  ~~specialists in psychiatric and mental health nursing who seek~~ 
  6.31  ~~prescribing authority.~~ 
  6.32     ~~(b) The repeal of subdivision 2, paragraph (b), does not~~ 
  6.33  ~~automatically repeal rules adopted under that paragraph.~~ 
  6.34     Sec. 6.  Minnesota Statutes 1995 Supplement, section 
  6.35  151.01, subdivision 23, is amended to read: 
  6.36     Subd. 23.  [PRACTITIONER.] "Practitioner" means a licensed 
  7.1   doctor of medicine, licensed doctor of osteopathy duly licensed 
  7.2   to practice medicine, licensed doctor of dentistry, licensed 
  7.3   doctor of optometry, licensed podiatrist, advanced practice 
  7.4   nurse authorized to prescribe, dispense, and administer under 
  7.5   section 148.235, or licensed veterinarian.  For purposes of 
  7.6   sections 151.15, subdivision 4, 151.37, subdivision 2, paragraph 
  7.7   (b), and 151.461, "practitioner" also means a physician 
  7.8   assistant authorized to prescribe, dispense, and administer 
  7.9   under chapter 147A~~, or an advanced practice nurse authorized to~~ 
  7.10  ~~prescribe, dispense, and administer under section 148.235~~.  
  7.11     Sec. 7.  Minnesota Statutes 1994, section 256B.0625, is 
  7.12  amended by adding a subdivision to read: 
  7.13     Subd. 41.  [SURGICAL FIRST ASSISTING SERVICES.] To the 
  7.14  extent medical assistance covers surgical first assisting 
  7.15  services, medical assistance shall also cover first assistant 
  7.16  services when performed by a registered nurse. 
  7.17     Sec. 8.  [EFFECTIVE DATE.] 
  7.18     Sections 1 and 2 are effective January 1, 1997, and apply 
  7.19  to coverage issued or renewed on or after that date.