[MMA News Now, April 3, 2014] Once the Senate’s Health and Human Services (HHS) Finance Committee announced plans to take up the APRN bill earlier this week, negotiations to find a compromise accelerated.
As introduced, the bill (SF 511 authored by Sen. Kathy Sheran, DFL-Mankato) would allow APRNs to practice independent of a collaborative practice agreement with physicians and with no requirement for a written prescribing agreement.
During an April 1 hearing, legislators adopted an amendment that attempted to reach compromise on several provisions of the bill. Under the amendment, APRNs would be required to have 2,000 hours of post-graduate clinical experience in a hospital or integrated clinical setting as a condition of licensure. The amendment also added an advisory board to the Board of Nursing that would provide guidance on the regulation of APRNs and study practice trends. The advisory committee would be made up of four APRNs, two physicians who work with APRNs and one public member. The amendment clarified that APRNs cannot interpret advanced diagnostic imaging such as CT and PET scans.
The most contentious issue that remains involves certified registered nurse anesthetists (CRNAs) and interventional pain management. After significant debate, lawmakers adopted an amendment that would maintain current law for CRNAs practicing pain management. Under that amendment, CRNAs practicing pain management would still be required to maintain a collaborative agreement with a physician as well as practice in the same hospital, clinic or health care setting as the collaborating physicians. A separate effort to define interventional pain management as the practice of medicine was defeated. Many questions remain about the impact of this amendment, and further changes are likely.
“While these amendments improve the bill, the MMA still does not support it,” said Dave Renner, MMA’s director of state and federal legislation. “Work is continuing to ensure adequate clinical experience and to ensure that APRNs do not practice beyond their training and expertise.”
The House companion (HF 435) to the Senate bill awaits action on the House floor, though a parliamentary action stripped out the controversial pieces while allowing the bill to meet the committee deadline. Action is not expected in the full Senate for several weeks, though MMA will closely follow developments in the House in the event the bill’s advocates attempt to move it while negotiations continue.