HCS SB 53(L&C): "An Act relating to advanced practice registered nursing; relating to certified direct-entry midwifery; and providing for an effective date."
00 HOUSE CS FOR SENATE BILL NO. 53(L&C) 01 "An Act relating to advanced practice registered nursing; relating to certified direct- 02 entry midwifery; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 08.02.010(a) is amended to read: 05 (a) An acupuncturist licensed under AS 08.06, an audiologist or speech- 06 language pathologist licensed under AS 08.11, a behavior analyst licensed under 07 AS 08.15, a person licensed in the state as a chiropractor under AS 08.20, a 08 professional counselor licensed under AS 08.29, a dentist under AS 08.36, a dietitian 09 or nutritionist licensed under AS 08.38, a massage therapist licensed under AS 08.61, 10 a marital and family therapist licensed under AS 08.63, a medical practitioner or 11 osteopath under AS 08.64, a direct-entry midwife certified under AS 08.65, a 12 registered or advanced practice registered nurse under AS 08.68, an optometrist 13 under AS 08.72, a licensed pharmacist under AS 08.80, a physical therapist or 14 occupational therapist licensed under AS 08.84, a psychologist under AS 08.86, or a
01 clinical social worker licensed under AS 08.95, shall use as professional identification 02 appropriate letters or a title after that person's name that represents the person's 03 specific field of practice. The letters or title shall appear on all signs, stationery, or 04 other advertising in which the person offers or displays personal professional services 05 to the public. In addition, a person engaged in the practice of medicine or osteopathy 06 as defined in AS 08.64.380, or a person engaged in any manner in the healing arts who 07 diagnoses, treats, tests, or counsels other persons in relation to human health or disease 08 and uses the letters "M.D." or the title "doctor" or "physician" or another title that 09 tends to show that the person is willing or qualified to diagnose, treat, test, or counsel 10 another person, shall clarify the letters or title by adding the appropriate specialist 11 designation, if any, such as "dermatologist," "radiologist," "audiologist," "naturopath," 12 or the like. 13 * Sec. 2. AS 08.29.210(a) is amended to read: 14 (a) The board shall approve and certify a person as an approved counselor 15 supervisor for the purposes of this chapter if the person 16 (1) is licensed as a professional counselor or is a licensed physician, 17 licensed advanced practice registered nurse [PRACTITIONER] who is certified to 18 provide psychiatric or mental health services, licensed clinical social worker, licensed 19 marital and family therapist, licensed psychologist, or licensed psychological 20 associate; 21 (2) submits an application for certification and the appropriate fee; 22 (3) has five years of counseling experience; 23 (4) provides to the board for its approval or disapproval a statement 24 that details the person's supervision philosophy, orientation, and experience; and 25 (5) meets other criteria that may be established by the board in 26 regulations. 27 * Sec. 3. AS 08.65.140 is amended to read: 28 Sec. 08.65.140. Required practices. The board shall adopt regulations 29 regarding the practice of direct-entry midwifery. At a minimum, the regulations must 30 require that a certified direct-entry midwife 31 (1) recommend, before care or delivery of a client, that the client
01 undergo a physical examination performed by a physician, physician assistant, or 02 advanced practice registered nurse [PRACTITIONER, OR CERTIFIED NURSE 03 MIDWIFE] who is licensed in this state; 04 (2) obtain informed consent from a client before onset of labor; 05 (3) comply with AS 18.15.150 regarding taking of blood samples, 06 AS 18.15.200 regarding screening of phenylketonuria (PKU), AS 18.50.160 regarding 07 birth registration, AS 18.50.230 regarding registration of deaths, AS 18.50.240 08 regarding fetal death registration, and regulations adopted by the Department of 09 Health and Social Services concerning prophylactic treatment of the eyes of newborn 10 infants; 11 (4) not knowingly deliver a woman with certain types of health 12 conditions, prior history, or complications as specified by the board. 13 * Sec. 4. AS 08.68.010 is amended to read: 14 Sec. 08.68.010. Creation and membership of Board of Nursing. There is 15 created a Board of Nursing, consisting of seven members appointed by the governor as 16 follows: 17 (1) one member shall be a licensed practical nurse who is currently 18 engaged in licensed practical nursing and has practiced for at least two years 19 immediately preceding appointment; 20 (2) one member shall be a registered nurse engaged in nursing 21 education at the associate, baccalaureate, or graduate degree level at an institution that 22 holds national nursing accreditation; 23 (3) one member shall be an advanced practice registered nurse 24 [PRACTITIONER] who is currently engaged in advanced practice registered nursing 25 and has practiced for at least four years immediately preceding appointment; 26 (4) two members shall be registered nurses at large who are currently 27 engaged in registered nursing and have practiced for at least four years immediately 28 preceding appointment; and 29 (5) two members shall be persons who have no direct financial interest 30 in the health care industry. 31 * Sec. 5. AS 08.68.100(a) is amended to read:
01 (a) The board shall 02 (1) adopt regulations necessary to implement this chapter, including 03 regulations 04 (A) pertaining to practice as an advanced practice registered 05 nurse, including requirements for an advanced practice registered nurse to 06 practice as a certified registered nurse anesthetist, certified clinical nurse 07 specialist, certified nurse practitioner, or certified nurse midwife 08 [PRACTITIONER AND A CERTIFIED REGISTERED NURSE 09 ANESTHETIST]; 10 (B) necessary to implement AS 08.68.331 - 08.68.336 relating 11 to certified nurse aides in order to protect the health, safety, and welfare of 12 clients served by nurse aides; 13 (C) pertaining to retired nurse status; and 14 (D) establishing criteria for approval of practical nurse 15 education programs that are not accredited by a national nursing accrediting 16 body; 17 (2) approve curricula and adopt standards for basic education programs 18 that prepare persons for licensing under AS 08.68.190; 19 (3) provide for surveys of the basic nursing education programs in the 20 state at the times it considers necessary; 21 (4) approve education programs that meet the requirements of this 22 chapter and of the board, and deny, revoke, or suspend approval of education 23 programs for failure to meet the requirements; 24 (5) examine, license, and renew the licenses of qualified applicants; 25 (6) prescribe requirements for competence before a former registered, 26 advanced practice registered, or licensed practical nurse may resume the practice 27 of nursing under this chapter; 28 (7) define by regulation the qualifications and duties of the executive 29 administrator and delegate authority to the executive administrator that is necessary to 30 conduct board business; 31 (8) develop reasonable and uniform standards for nursing practice;
01 (9) publish advisory opinions regarding whether nursing practice 02 procedures or policies comply with acceptable standards of nursing practice as defined 03 under this chapter; 04 (10) require applicants under this chapter to submit fingerprints and the 05 fees required by the Department of Public Safety under AS 12.62.160 for criminal 06 justice information and a national criminal history record check; the department shall 07 submit the fingerprints and fees to the Department of Public Safety for a report of 08 criminal justice information under AS 12.62 and a national criminal history record 09 check under AS 12.62.400. 10 * Sec. 6. AS 08.68.160 is amended to read: 11 Sec. 08.68.160. License required. A person practicing or offering to practice 12 registered, advanced practice registered, [PROFESSIONAL] or practical nursing in 13 the state shall submit evidence of qualification to practice and shall be licensed under 14 this chapter. 15 * Sec. 7. AS 08.68.170 is amended by adding a new subsection to read: 16 (c) An applicant for a license to practice advanced practice registered nursing 17 shall submit to the board, on forms and in the manner prescribed by the board, written 18 evidence, verified by oath, that the applicant 19 (1) is licensed as a registered nurse in the state; and 20 (2) has successfully completed an advanced practice registered nurse 21 education program that meets the criteria established by the board under 22 AS 08.68.100. 23 * Sec. 8. AS 08.68.190 is repealed and reenacted to read: 24 Sec. 08.68.190. License by examination. (a) An applicant for a license to 25 practice 26 (1) registered or practical nursing shall pass a registered nursing or 27 practical nursing licensing examination as prescribed by the board; 28 (2) advanced practice registered nursing shall pass an advanced 29 practice registered nursing certification examination as prescribed by the board. 30 (b) If an applicant meets the qualifications set out in AS 08.68.170 for the 31 license for which the applicant applied, the board shall issue a license to practice
01 (1) registered or practical nursing to an applicant who passes the 02 licensing examination to practice registered or practical nursing; or 03 (2) advanced practice registered nursing to an applicant who passes the 04 advanced practice registered nursing certification examination to practice advanced 05 practice registered nursing. 06 * Sec. 9. AS 08.68.200 is amended to read: 07 Sec. 08.68.200. License by endorsement. (a) The board may issue a license 08 by endorsement to practice as a registered, advanced practice registered, or practical 09 nurse, whichever is appropriate, to an applicant who has worked as a nurse within the 10 past five years if the applicant is licensed as [EITHER] a registered, advanced 11 practice registered, or practical nurse under the laws of another state if, in the 12 opinion of the board, the applicant meets the qualifications required for licensing in 13 the state and meets the requirements of AS 08.68.170. 14 (b) The board may issue a license by endorsement to practice as a registered, 15 advanced practice registered, or practical nurse, whichever is appropriate, to an 16 applicant who has not worked as a nurse within the past five years if the applicant 17 meets the requirements of (a) of this section and 18 (1) meets the continuing competency requirements of the board; or 19 (2) completes a course of study approved by the board. 20 * Sec. 10. AS 08.68.220 is amended to read: 21 Sec. 08.68.220. Fees. The Department of Commerce, Community, and 22 Economic Development shall set fees under AS 08.01.065 for each of the following: 23 (1) registered nursing: 24 (A) application; 25 (B) license by examination; 26 (C) license by endorsement; 27 (D) license renewal; 28 (E) temporary permit; 29 (2) practical [OR VOCATIONAL] nursing: 30 (A) application; 31 (B) license by examination;
01 (C) license by endorsement; 02 (D) license renewal; 03 (E) temporary permit; 04 (3) advanced practice registered nursing: 05 (A) application; 06 (B) license by certification examination; 07 (C) license by endorsement; 08 (D) license renewal; 09 (E) temporary permit. 10 * Sec. 11. AS 08.68.230(a) is amended to read: 11 (a) A person licensed to practice registered nursing in the state may use the 12 title ["LICENSED PROFESSIONAL NURSE,"] "registered nurse [,]" and the 13 abbreviation "R.N." 14 * Sec. 12. AS 08.68.230 is amended by adding new subsections to read: 15 (e) A person licensed to practice advanced practice registered nursing in the 16 state may use the title "advanced practice registered nurse" and the abbreviation 17 "APRN." 18 (f) A person licensed to practice advanced practice registered nursing in the 19 state as a 20 (1) certified registered nurse anesthetist may use the title "certified 21 registered nurse anesthetist" and the abbreviation "CRNA"; 22 (2) certified clinical nurse specialist may use the title "clinical nurse 23 specialist" and the abbreviation "CNS"; 24 (3) certified nurse practitioner may use the title "certified nurse 25 practitioner" and the abbreviation "CNP"; or 26 (4) certified nurse midwife may use the title "certified nurse midwife" 27 and the abbreviation "CNM." 28 * Sec. 13. AS 08.68.265 is amended to read: 29 Sec. 08.68.265. Supervision of practical nurses. A practical nurse shall work 30 under the supervision of a licensed registered or advanced practice registered nurse, 31 a licensed physician, a licensed physician assistant, or a licensed dentist.
01 * Sec. 14. AS 08.68.270 is amended to read: 02 Sec. 08.68.270. Grounds for denial, suspension, or revocation. The board 03 may deny, suspend, or revoke the license of a person who 04 (1) has obtained or attempted to obtain a license to practice nursing by 05 fraud or deceit; 06 (2) has been convicted of a felony or other crime if the felony or other 07 crime is substantially related to the qualifications, functions, or duties of the licensee; 08 (3) habitually abuses alcoholic beverages, or illegally uses controlled 09 substances; 10 (4) has impersonated a registered, advanced practice registered, or 11 practical nurse; 12 (5) has intentionally or negligently engaged in conduct that has 13 resulted in a significant risk to the health or safety of a client or in injury to a client; 14 (6) practices or attempts to practice nursing while afflicted with 15 physical or mental illness, deterioration, or disability that interferes with the 16 individual's performance of nursing functions; 17 (7) is guilty of unprofessional conduct as defined by regulations 18 adopted by the board; 19 (8) has wilfully or repeatedly violated a provision of this chapter or 20 regulations adopted under this chapter or AS 08.01; 21 (9) is professionally incompetent; 22 (10) denies care or treatment to a patient or person seeking assistance 23 if the sole reason for the denial is the failure or refusal of the patient or person seeking 24 assistance to agree to arbitrate as provided in AS 09.55.535(a). 25 * Sec. 15. AS 08.68.290 is amended to read: 26 Sec. 08.68.290. Application for accreditation. An institution desiring to 27 conduct a nursing education program to prepare registered, advanced practice 28 registered, or practical nurses shall apply to the board and submit evidence that it is 29 prepared to 30 (1) carry out the curriculum approved by the board for registered 31 nursing, advanced practice registered nursing, or [FOR] practical nursing; and
01 (2) meet other standards established by law and by the board. 02 * Sec. 16. AS 08.68.334 is amended to read: 03 Sec. 08.68.334. Grounds for denial, suspension, or revocation of certificate. 04 The board may deny a certification to, or impose a disciplinary sanction authorized 05 under AS 08.01.075 against, a person who 06 (1) has obtained or attempted to obtain certification as a nurse aide by 07 fraud, deceit, or intentional misrepresentation; 08 (2) has been convicted of a crime substantially related to the 09 qualifications, functions, or duties of a certified nurse aide; 10 (3) has impersonated a registered, advanced practice registered, or 11 practical nurse or other licensed health care provider; 12 (4) has intentionally or negligently engaged in conduct that has 13 resulted in a significant risk to the health or safety of a client or in injury to a client; 14 (5) is incapable of working as a certified nurse aide with reasonable 15 skill, competence, and safety for the public because of 16 (A) professional incompetence; 17 (B) addiction or severe dependency on alcohol or a drug that 18 impairs the licensee's ability to practice safely; 19 (C) physical or mental disability; or 20 (D) other factors determined by the board; 21 (6) has knowingly or repeatedly failed to comply with this chapter, a 22 regulation adopted under this chapter, or with an order of the board; or 23 (7) has misappropriated the property of, abused, or neglected a client. 24 * Sec. 17. AS 08.68.360 is amended to read: 25 Sec. 08.68.360. Unlicensed practice a public nuisance. The practice of 26 registered, advanced practice registered, [PROFESSIONAL] or practical nursing 27 for compensation by a person who is not licensed, or whose license is suspended, or 28 revoked, or expired, is declared to be inimical to the public welfare and to constitute a 29 public nuisance. 30 * Sec. 18. AS 08.68.370 is amended to read: 31 Sec. 08.68.370. Application for injunction. The board may apply for an
01 injunction in a competent court to enjoin a person not licensed or whose license is 02 suspended or revoked or expired from practicing registered, advanced practice 03 registered, [PROFESSIONAL] or practical nursing. The court may issue a temporary 04 injunction enjoining the defendant from practicing registered, advanced practice 05 registered, [PROFESSIONAL] or practical nursing. 06 * Sec. 19. AS 08.68.380 is amended to read: 07 Sec. 08.68.380. Issuance of injunction. If it is established that the defendant 08 has been or is practicing registered, advanced practice registered, 09 [PROFESSIONAL] or practical nursing without a license or has been or is practicing 10 nursing after the defendant's license has been suspended or revoked, or has expired, 11 the court may enjoin the defendant from further practice. 12 * Sec. 20. AS 08.68.805 is amended to read: 13 Sec. 08.68.805. Delegation of nursing functions. A registered, advanced 14 practice registered, or practical nurse licensed under this chapter may delegate 15 nursing duties to other persons, including unlicensed assistive personnel, under 16 regulations adopted by the board. A person to whom the nursing duties are delegated 17 may perform the delegated duties without a license or certificate under this chapter if 18 the person meets the applicable requirements established by the board. 19 * Sec. 21. AS 08.68.850(1) is amended to read: 20 (1) "advanced practice registered nurse [PRACTITIONER]" means a 21 registered nurse licensed [AUTHORIZED] to practice in the state who, because of 22 specialized education and experience, is certified to perform acts of medical diagnosis 23 and the prescription and dispensing of medical, therapeutic, or corrective measures 24 under regulations adopted by the board; 25 * Sec. 22. AS 08.68.850 is amended by adding a new paragraph to read: 26 (11) "practice of advanced practice registered nursing" includes, in 27 addition to the practice of registered nursing, the performance of acts of medical 28 diagnosis and the prescription and dispensing of medical, therapeutic, or corrective 29 measures under regulations adopted by the board. 30 * Sec. 23. AS 08.80.400 is amended to read: 31 Sec. 08.80.400. Other licensees not affected. This chapter does not affect the
01 practice of medicine by a licensed medical doctor and does not limit a licensed 02 medical doctor, osteopath, podiatrist, physician assistant, advanced practice 03 registered nurse [PRACTITIONER], dentist, veterinarian, dispensing optician, or 04 optometrist in supplying a patient with any medicinal preparation or article within the 05 scope of the person's license. 06 * Sec. 24. AS 09.65.300(c)(1) is amended to read: 07 (1) "health care provider" means a physician, physician assistant, 08 dentist, dental hygienist, osteopath, optometrist, chiropractor, registered nurse, 09 practical nurse, [NURSE MIDWIFE,] advanced practice registered nurse 10 [PRACTITIONER], naturopath, physical therapist, occupational therapist, marital and 11 family therapist, psychologist, psychological associate, behavior analyst, assistant 12 behavior analyst, licensed clinical social worker, athletic trainer, or certified direct- 13 entry midwife; 14 * Sec. 25. AS 11.41.470(1) is amended to read: 15 (1) "health care worker" includes a person who is or purports to be an 16 anesthesiologist, acupuncturist, chiropractor, dentist, health aide, hypnotist, massage 17 therapist, mental health counselor, certified direct-entry midwife, nurse, advanced 18 practice registered nurse [PRACTITIONER], osteopath, naturopath, physical 19 therapist, physical therapy assistant, physician, physician assistant, psychiatrist, 20 psychologist, psychological associate, radiologist, religious healing practitioner, 21 surgeon, x-ray technician, or a substantially similar position; 22 * Sec. 26. AS 11.81.430(a) is amended to read: 23 (a) The use of force on [UPON] another person that would otherwise 24 constitute an offense is justified under any of the following circumstances: 25 (1) When and to the extent reasonably necessary and appropriate to 26 promote the welfare of the child or incompetent person, a parent, guardian, or other 27 person entrusted with the care and supervision of a child under 18 years of age or an 28 incompetent person may use reasonable and appropriate nondeadly force on [UPON] 29 that child or incompetent person. 30 (2) When and to the extent reasonably necessary and appropriate to 31 maintain order and when the use of force is consistent with the welfare of the students,
01 a teacher may, if authorized by school regulations and the principal of the school, use 02 reasonable and appropriate nondeadly force on [UPON] a student. If authorized by 03 school regulations and the principal of the school, a teacher may use nondeadly force 04 under this paragraph in any situation in which the teacher is responsible for the 05 supervision of students. A teacher employed by a school board, including a regional 06 educational attendance area school board, may use nondeadly force under this 07 paragraph only if the school regulations authorizing the use of force have been 08 adopted by the school board. 09 (3) When and to the extent reasonably necessary and appropriate to 10 maintain order, a person responsible for the maintenance of order in a common carrier 11 of passengers, or a person acting under that person's direction, may use reasonable and 12 appropriate nondeadly force. 13 (4) When and to the extent reasonably necessary to prevent a suicide, a 14 person who reasonably believes that another is imminently about to commit suicide 15 may use reasonable and appropriate nondeadly force on [UPON] that person. 16 (5) A licensed physician, licensed mobile intensive care paramedic, or 17 registered or advanced practice registered nurse; or a person acting under the 18 direction of a licensed physician, licensed mobile intensive care paramedic, or 19 registered or advanced practice registered nurse; or any person who renders 20 emergency care at the scene of an emergency, may use reasonable and appropriate 21 nondeadly force for the purpose of administering a recognized and lawful form of 22 treatment that is reasonably adapted to promoting the physical or mental health of the 23 patient if 24 (A) the treatment is administered with the consent of the patient 25 or, if the patient is a child under 18 years of age or an incompetent person, with 26 the consent of the parent, guardian, or other person entrusted with care and 27 supervision of the child or incompetent person; or 28 (B) the treatment is administered in an emergency if the person 29 administering the treatment reasonably believes that no one competent to 30 consent can be consulted under the circumstances and that a reasonable person, 31 wishing to safeguard the welfare of the patient, would consent.
01 * Sec. 27. AS 12.55.135(k)(3) is amended to read: 02 (3) "medical professional" means a person who is an anesthesiologist, 03 dentist, dental hygienist, health aide, nurse, nurse aid, advanced practice registered 04 nurse [PRACTITIONER], mental health counselor, physician, physician assistant, 05 chiropractor, psychiatrist, osteopath, psychologist, psychological associate, 06 radiologist, surgeon, or x-ray technician, or who holds a substantially similar position. 07 * Sec. 28. AS 14.30.141(e) is amended to read: 08 (e) In this section, "health care provider" means a licensed physician, 09 advanced practice registered nurse [PRACTITIONER], physician assistant, village 10 health aide, or pharmacist operating within the scope of the health care provider's 11 authority. 12 * Sec. 29. AS 18.08.086(c) is amended to read: 13 (c) A registered or advanced practice registered nurse or licensed practical 14 nurse who escorts a patient in a means of conveyance not equipped as an ambulance is 15 not liable for civil damages as a result of an act or omission in administering patient 16 care services, if done in good faith and if the life of the injured or sick person is in 17 danger. This subsection does not preclude liability for civil damages that are the result 18 of gross negligence or intentional misconduct. 19 * Sec. 30. AS 18.08.087 is amended to read: 20 Sec. 18.08.087. Disclosure of medical records. When requested for the 21 purpose of evaluating the performance of an emergency medical technician, mobile 22 intensive care paramedic, or physician who provided emergency medical care or other 23 assistance to a sick or injured person, a licensed physician, advanced practice 24 registered nurse [PRACTITIONER], or physician assistant may disclose to an 25 emergency medical technician, a mobile intensive care paramedic, or physician the 26 medical or hospital records of a sick or injured person to whom the paramedic, 27 technician, or physician is providing or has rendered emergency medical care or 28 assistance. However, the disclosing physician, advanced practice registered nurse 29 [PRACTITIONER], or physician assistant shall limit disclosure under this section to 30 the records that are considered necessary by the discloser for evaluation of the 31 paramedic's, technician's, or physician's performance in providing the emergency
01 medical care or assistance. A mobile intensive care paramedic, emergency medical 02 care technician, or physician to whom confidential records are disclosed under this 03 section may not further disclose the information to a person not entitled to receive that 04 information under this section or another law. 05 * Sec. 31. AS 18.15.310(a) is amended to read: 06 (a) The withdrawal of blood for a test under AS 18.15.300 - 18.15.320 shall be 07 performed in a medically approved manner. Only a physician or physician assistant 08 licensed under AS 08.64, registered or advanced practice registered nurse, licensed 09 practical nurse, or certified emergency medical technician may withdraw blood 10 specimens for the purposes of AS 18.15.300 - 18.15.320. 11 * Sec. 32. AS 18.15.395(11) is amended to read: 12 (11) "health care practitioner" means a physician, advanced practice 13 registered nurse [PRACTITIONER], or physician assistant licensed or otherwise 14 authorized to practice their respective professions in this state; 15 * Sec. 33. AS 18.29.099(7) is amended to read: 16 (7) "tier II health care professional" means a person licensed or exempt 17 from licensure in the state as a dental hygienist, registered nurse, advanced practice 18 registered nurse [PRACTITIONER], physician assistant, physical therapist, clinical 19 psychologist, or clinical social worker holding at least a master's degree in social 20 work. 21 * Sec. 34. AS 18.50.165(b) is amended to read: 22 (b) The registrar shall distribute copies of the form prepared under (a) of this 23 section to each hospital in the state, to each physician in the state whose practice 24 includes attendance at births, to each certified nurse midwife [NURSE-MIDWIFE] 25 and certified direct-entry midwife in the state, and to each other interested person in 26 the state who requests copies of the form. 27 * Sec. 35. AS 21.36.090(d) is amended to read: 28 (d) Except to the extent necessary to comply with AS 21.42.365 and 29 AS 21.56, a person may not practice or permit unfair discrimination against a person 30 who provides a service covered under a group health insurance policy that extends 31 coverage on an expense incurred basis, or under a group service or indemnity type
01 contract issued by a health maintenance organization or a nonprofit corporation, if the 02 service is within the scope of the provider's occupational license. In this subsection, 03 "provider" means a state licensed physician, physician assistant, dentist, osteopath, 04 optometrist, chiropractor, [NURSE MIDWIFE,] advanced practice registered nurse 05 [PRACTITIONER], naturopath, physical therapist, occupational therapist, marital and 06 family therapist, psychologist, psychological associate, licensed clinical social worker, 07 licensed professional counselor, or certified direct-entry midwife. 08 * Sec. 36. AS 21.42.355 is amended to read: 09 Sec. 21.42.355. Coverage for cost of services provided by certified nurse 10 midwives. (a) If a health care insurance plan or an excepted benefits policy or contract 11 provides indemnity for the cost of services of a physician provided to women during 12 pregnancy, childbirth, and the period after childbirth, indemnity in a reasonable 13 amount shall also be provided for the cost of an advanced practice registered nurse 14 [PRACTITIONER] who provides the same services. Indemnity may be provided 15 under this subsection only if the advanced practice registered nurse is practicing 16 [PRACTITIONER IS CERTIFIED TO PRACTICE] as a certified nurse midwife in 17 accordance with regulations adopted under AS 08.68.100(a), and the services provided 18 are within the scope of practice of [AUTHORIZED BY] that certification. 19 (b) If a health care insurance plan or an excepted benefits policy or contract 20 provides for furnishing those services required of a physician in the care of women 21 during pregnancy, childbirth, and the period after childbirth, the contract shall also 22 provide that an advanced practice registered nurse [PRACTITIONER] may furnish 23 those same services instead of a physician. Services may be provided under this 24 subsection only if the advanced practice registered nurse is practicing 25 [PRACTITIONER IS CERTIFIED TO PRACTICE] as a certified nurse midwife in 26 accordance with regulations adopted under AS 08.68.100(a), and the services provided 27 are within the scope of practice of [AUTHORIZED BY] that certification. 28 * Sec. 37. AS 21.42.397(a) is amended to read: 29 (a) Except for a fraternal benefit society, a health care insurer that offers, 30 issues for delivery, delivers, or renews a health care insurance plan in this state shall 31 provide coverage for the costs of the diagnosis and treatment of autism spectrum
01 disorders. Coverage required by this subsection must include treatment prescribed by a 02 licensed physician, psychologist, or advanced practice registered nurse 03 [PRACTITIONER], provided by or supervised by an autism service provider, and as 04 identified in a treatment plan developed following a comprehensive evaluation. 05 Covered treatment includes medically necessary pharmacy care, psychiatric care, 06 psychological care, habilitative or rehabilitative care, and therapeutic care. In this 07 subsection, 08 (1) "habilitative or rehabilitative care" means professional counseling, 09 guidance services, and treatment programs necessary to develop, restore, or maintain 10 the functioning of an individual to the maximum extent practicable, including applied 11 behavior analysis or other structured behavioral therapies; in this paragraph, "applied 12 behavior analysis" means the design, implementation, and evaluation of environmental 13 modifications, using behavioral stimuli and consequences, including direct 14 observation, measurement, and functional analysis of the relationship between 15 environment and behavior, to produce socially significant improvement in human 16 behavior or to prevent the loss of an attained skill or function; 17 (2) "therapeutic care" means services provided by or under the 18 supervision of a speech-language pathologist licensed under AS 08.11 or an 19 occupational therapist or physical therapist licensed under AS 08.84. 20 * Sec. 38. AS 21.42.397(g)(5) is amended to read: 21 (5) "medically necessary" means any care, treatment, intervention, 22 service, or item prescribed by a licensed physician, psychologist, or advanced practice 23 registered nurse [PRACTITIONER] in accordance with accepted standards of 24 practice that will, or is reasonably expected to, 25 (A) prevent the onset of an illness, condition, injury, or 26 disability; 27 (B) reduce or ameliorate the physical, mental, or developmental 28 effects of an illness, condition, injury, or disability; 29 (C) assist to achieve or maintain maximum functional capacity 30 in performing daily activities, taking into account both the functional capacity 31 of the individual and the functional capacity of other persons of the individual's
01 age. 02 * Sec. 39. AS 21.55.500(12) is amended to read: 03 (12) "home health agency services" means any of the following 04 services provided upon recommendation of a licensed physician as part of a treatment 05 plan: 06 (A) intermittent or part-time nursing services of a registered 07 [PROFESSIONAL] nurse or a licensed practical nurse, that are provided to a 08 person under the continued direction of the person's physician and within the 09 limitation of the nurse's license; 10 (B) nursing services that are provided to a person at the 11 person's residence, including a residential care facility or adult boarding home; 12 a hospital, skilled nursing facility or intermediate care facility is not considered 13 a residence; 14 (C) home health aide services that are prescribed by and under 15 the continued direction of a physician and supervised by a registered 16 [PROFESSIONAL] nurse; 17 (D) home health aide services that are provided to a person at 18 the person's residence, as described in (B) of this paragraph; 19 (E) physical and occupational therapy services, speech 20 pathology, and audiology services that are prescribed by a physician and 21 provided to a person by or under the supervision of a qualified practitioner; 22 these services may be provided to a person who is a patient in an intermediate 23 care facility or skilled nursing facility; 24 * Sec. 40. AS 21.87.330(8) is amended to read: 25 (8) "provider" means a physician, dentist, osteopath, optometrist, 26 chiropractor, certified nurse midwife, or other licensed health care practitioner; 27 * Sec. 41. AS 23.30.395(3) is amended to read: 28 (3) "attending physician" means one of the following designated by the 29 employee under AS 23.30.095(a) or (b): 30 (A) a licensed medical doctor; 31 (B) a licensed doctor of osteopathy;
01 (C) a licensed dentist or dental surgeon; 02 (D) a licensed physician assistant acting under supervision of a 03 licensed medical doctor or doctor of osteopathy; 04 (E) a licensed advanced practice registered nurse 05 [PRACTITIONER]; or 06 (F) a licensed chiropractor; 07 * Sec. 42. AS 25.20.055(a) is amended to read: 08 (a) When a birth occurs to an unmarried woman in a hospital or en route to a 09 hospital to which the woman is later admitted, the hospital shall ensure that a staff 10 member 11 (1) meets with the woman before release from the hospital; 12 (2) attempts to meet with the father of the unmarried woman's child, if 13 possible; 14 (3) presents to the mother and, if possible, the father, a pamphlet or 15 statement regarding the rights and responsibilities of a natural parent; the Department 16 of Health and Social Services shall prepare this pamphlet and distribute copies of it to 17 each hospital in the state, to each physician in the state whose practice includes 18 attendance at births, to each certified nurse midwife [NURSE-MIDWIFE] and 19 certified direct-entry midwife in the state, and to other interested persons in the state 20 who request copies; 21 (4) provides to the mother and, if possible, the father, all forms, 22 statements, or agreements necessary to voluntarily establish a parent and child 23 relationship, including an acknowledgment [ACKNOWLEDGEMENT] of paternity 24 form prepared under AS 18.50.165; 25 (5) on request of the mother and father, assists the father in completing 26 specific forms, statements, or agreements necessary to establish a parent and child 27 relationship between the father and the child; and 28 (6) on request of the mother and father, mails a completed voluntary 29 acknowledgment [ACKNOWLEDGEMENT] of paternity form to the state registrar 30 for filing under AS 18.50.165. 31 * Sec. 43. AS 25.20.055(b) is amended to read:
01 (b) When a birth occurs to an unmarried woman who is not in a hospital for 02 the birth nor admitted to a hospital immediately after the birth, and the birth is 03 attended by a physician, certified nurse midwife [NURSE-MIDWIFE], or certified 04 direct-entry midwife, the physician, certified nurse midwife [NURSE-MIDWIFE], or 05 certified direct-entry midwife shall perform the duties described in (a)(2) - (6) of this 06 section or ensure that an agent performs those duties. 07 * Sec. 44. AS 28.10.181(d) is amended to read: 08 (d) Vehicles owned by veterans with disabilities, including persons disabled in 09 the line of duty while serving in the Alaska Territorial Guard, or other persons with 10 disabilities. Upon the request of a person with a disability that limits or impairs the 11 ability to walk, as defined in 23 C.F.R. 1235.2, the department shall (1) register one 12 motor vehicle in the name of the person without charge; and (2) issue a specially 13 designed registration plate that displays (A) recognition of the disabled veteran if the 14 applicant's disability originated from the applicant's service with the Alaska Territorial 15 Guard or the armed forces of the United States; (B) the international symbol of 16 accessibility (the wheelchair logo); and (C) if the applicant is a veteran, the Alaska and 17 United States flags and red, white, and blue colors. A person who is not otherwise 18 qualified under this subsection, but who meets the qualifications of a disabled veteran 19 under AS 29.45.030(i), may register one motor vehicle without charge, and the 20 department shall issue a specially designed registration plate that displays recognition 21 of the disabled veteran that does not display the international symbol of accessibility 22 and does not carry with it special parking privileges. A disabled veteran who 23 otherwise qualifies for a registration plate under this subsection may elect to receive a 24 plate under (p) or (q) of this section for which the person is otherwise qualified that 25 does not display the international symbol of accessibility and does not carry with it 26 special parking privileges. A disabled person who otherwise qualifies for a registration 27 plate under (2)(B) of this subsection may elect to receive a plate under another 28 provision of this section for which the person is otherwise qualified that does not 29 display the international symbol of accessibility and does not carry with it special 30 parking privileges. For purposes of this subsection, proof of disability may be 31 provided by a person licensed as a physician or physician assistant under AS 08.64 or
01 as an advanced practice registered nurse [PRACTITIONER] under AS 08.68. 02 * Sec. 45. AS 28.33.033(d) is amended to read: 03 (d) The person tested may have a physician, or a qualified technician, chemist, 04 registered or advanced practice registered nurse, or other qualified person of the 05 person's own choosing administer a chemical test in addition to the test administered 06 at the direction of a law enforcement officer. The failure or inability to obtain an 07 additional test by a person does not preclude the admission of evidence relating to the 08 test taken at the direction of a law enforcement officer; the fact that the person under 09 arrest sought to obtain [SUCH] an additional test, and failed or was unable to do so, is 10 likewise admissible in evidence. 11 * Sec. 46. AS 28.35.033(e) is amended to read: 12 (e) The person tested may have a physician, or a qualified technician, chemist, 13 registered or advanced practice registered nurse, or other qualified person of the 14 person's own choosing administer a chemical test in addition to the test administered 15 at the direction of a law enforcement officer. The failure or inability to obtain an 16 additional test by a person does not preclude the admission of evidence relating to the 17 test taken at the direction of a law enforcement officer; the fact that the person under 18 arrest sought to obtain such an additional test, and failed or was unable [SO] to do so, 19 is likewise admissible in evidence. The person who administers the chemical test shall 20 clearly and expressly inform the person tested of that person's right to an independent 21 test described under this subsection, and, if the person being tested requests an 22 independent test, the department shall make reasonable and good-faith efforts to assist 23 the person being tested in contacting a person qualified to perform an independent 24 chemical test of the person's breath or blood. 25 * Sec. 47. AS 33.30.901(10) is amended to read: 26 (10) "health care provider" means 27 (A) a physician assistant [OR NURSE PRACTITIONER] 28 licensed to practice in the state and working under the direct supervision of a 29 licensed physician or psychiatrist; [OR] 30 (B) a mental health professional as defined in AS 47.30.915; or 31 (C) an advanced practice registered nurse as defined in
01 AS 08.68.850; 02 * Sec. 48. AS 47.07.030(b) is amended to read: 03 (b) In addition to the mandatory services specified in (a) of this section and the 04 services provided under (d) of this section, the department may offer only the 05 following optional services: case management services for traumatic or acquired brain 06 injury; case management and nutrition services for pregnant women; personal care 07 services in a recipient's home; emergency hospital services; long-term care 08 noninstitutional services; medical supplies and equipment; advanced practice 09 registered nurse [PRACTITIONER] services; clinic services; rehabilitative services 10 for children eligible for services under AS 47.07.063, substance abusers, and 11 emotionally disturbed or chronically mentally ill adults; targeted case management 12 services; inpatient psychiatric facility services for individuals 65 years of age or older 13 and individuals under 21 years of age; psychologists' services; clinical social workers' 14 services; midwife services; prescribed drugs; physical therapy; occupational therapy; 15 chiropractic services; low-dose mammography screening, as defined in 16 AS 21.42.375(e); hospice care; treatment of speech, hearing, and language disorders; 17 adult dental services; prosthetic devices and eyeglasses; optometrists' services; 18 intermediate care facility services, including intermediate care facility services for 19 persons with intellectual and developmental disabilities; skilled nursing facility 20 services for individuals under 21 years of age; and reasonable transportation to and 21 from the point of medical care. 22 * Sec. 49. AS 47.07.045(b) is amended to read: 23 (b) Before the department may terminate payment for services provided under 24 (a) of this section, 25 (1) the recipient must have had an annual assessment to determine 26 whether the recipient continues to meet the standards under (a) of this section; 27 (2) the annual assessment must have been reviewed by an independent 28 qualified health care professional under contract with the department; for purposes of 29 this paragraph, "independent qualified health care professional" means, 30 (A) for a waiver based on intellectual or developmental 31 disability, a person who is qualified under 42 CFR 483.430 as a qualified
01 intellectual disability professional; 02 (B) for other allowable waivers, a registered or advanced 03 practice registered nurse licensed under AS 08.68 who is qualified to assess 04 children with complex medical conditions, older Alaskans, and adults with 05 physical disabilities for medical assistance waivers; and 06 (3) the annual assessment must find that the recipient's condition has 07 materially improved since the previous assessment; for purposes of this paragraph, 08 "materially improved" means that a recipient who has previously qualified for a 09 waiver for 10 (A) a child with complex medical conditions, no longer needs 11 technical assistance for a life-threatening condition, and is expected to be 12 placed in a skilled nursing facility for less than 30 days each year; 13 (B) intellectual or developmental disability, no longer needs the 14 level of care provided by an intermediate care facility for persons with 15 intellectual and developmental disabilities either because the qualifying 16 diagnosis has changed or the recipient is able to demonstrate the ability to 17 function in a home setting without the need for waiver services; or 18 (C) an older Alaskan or adult with a physical disability, no 19 longer has a functional limitation or cognitive impairment that would result in 20 the need for nursing home placement, and is able to demonstrate the ability to 21 function in a home setting without the need for waiver services. 22 * Sec. 50. AS 47.07.900(2) is amended to read: 23 (2) "advanced practice registered nurse [PRACTITIONER] services" 24 means services furnished by a person who is licensed [CERTIFIED] as an advanced 25 practice registered nurse [PRACTITIONER] under AS 08.68.850 that are within the 26 scope of regulations adopted under AS 08.68.100(a) [THE PERSON'S CERTIFIED 27 AUTHORITY], whether or not the person is under the supervision of, or associated 28 with, a physician or other health care provider; 29 * Sec. 51. AS 47.20.320(d) is amended to read: 30 (d) A hospital or other health facility, clinical laboratory, audiologist, 31 physician, registered or advanced practice registered nurse, certified [NURSE
01 MIDWIFE,] direct-entry midwife, officer or employee of a health facility or clinical 02 laboratory, or an employee of an audiologist, physician, or registered or advanced 03 practice registered nurse is not criminally or civilly liable for furnishing information 04 in good faith to the department or its designee under this section. The furnishing of 05 information in accordance with this section is not a violation of AS 08 or AS 18 or 06 regulations adopted under AS 08 or AS 18 for licensees under those statutes. 07 * Sec. 52. AS 47.30.838(a) is amended to read: 08 (a) Except as provided in (c) and (d) of this section, an evaluation facility or 09 designated treatment facility may administer psychotropic medication to a patient 10 without the patient's informed consent, regardless of whether the patient is capable of 11 giving informed consent, only if 12 (1) there is a crisis situation, or an impending crisis situation, that 13 requires immediate use of the medication to preserve the life of, or prevent significant 14 physical harm to, the patient or another person, as determined by a licensed physician 15 or a registered or advanced practice registered nurse; the behavior or condition of 16 the patient giving rise to a crisis under this paragraph and the staff's response to the 17 behavior or condition must be documented in the patient's medical record; the 18 documentation must include an explanation of alternative responses to the crisis that 19 were considered or attempted by the staff and why those responses were not sufficient; 20 and 21 (2) the medication is ordered by a licensed physician; the order 22 (A) may be written or oral and may be received by telephone, 23 facsimile machine, or in person; 24 (B) may include an initial dosage and may authorize additional, 25 as needed, doses; if additional, as needed, doses are authorized, the order must 26 specify the medication, the quantity of each authorized dose, the method of 27 administering the medication, the maximum frequency of administration, the 28 specific conditions under which the medication may be given, and the 29 maximum amount of medication that may be administered to the patient in a 30 24-hour period; 31 (C) is valid for only 24 hours and may be renewed by a
01 physician for a total of 72 hours, including the initial 24 hours, only after a 02 personal assessment of the patient's status and a determination that there is still 03 a crisis situation as described in (1) of this subsection; upon renewal of an 04 order under this subparagraph, the facts supporting the renewal shall be written 05 into the patient's medical record. 06 * Sec. 53. AS 47.30.915(13) is amended to read: 07 (13) "mental health professional" means a psychiatrist or physician 08 who is licensed by the State Medical Board to practice in this state or is employed by 09 the federal government; a clinical psychologist licensed by the state Board of 10 Psychologist and Psychological Associate Examiners; a psychological associate 11 trained in clinical psychology and licensed by the Board of Psychologist and 12 Psychological Associate Examiners; an advanced practice registered nurse or a 13 registered nurse with a master's degree in psychiatric nursing, licensed by the State 14 Board of Nursing; a marital and family therapist licensed by the Board of Marital and 15 Family Therapy; a professional counselor licensed by the Board of Professional 16 Counselors; a clinical social worker licensed by the Board of Social Work Examiners; 17 and a person who 18 (A) has a master's degree in the field of mental health; 19 (B) has at least 12 months of post-masters working experience 20 in the field of mental illness; and 21 (C) is working under the supervision of a type of licensee listed 22 in this paragraph; 23 * Sec. 54. AS 47.33.020(h) is amended to read: 24 (h) If a resident has received 24-hour skilled nursing care for the 45-day limit 25 set by (g) of this section, the resident or the resident's representative may elect to have 26 the resident remain in the home without continuation of 24-hour skilled nursing care if 27 the home agrees to retain the resident after 28 (1) the home and either the resident or the resident's representative 29 have consulted with the resident's physician; 30 (2) the home and either the resident or the resident's representative 31 have discussed the consequences and risks involved in the election to remain in the
01 home; and 02 (3) the portion of the resident's assisted living plan that relates to 03 health-related services has been revised to provide for the resident's health-related 04 needs without the use of 24-hour skilled nursing care, and the revised plan has been 05 reviewed by a registered or advanced practice registered nurse licensed under 06 AS 08.68 or by the resident's attending physician. 07 * Sec. 55. AS 47.33.230(c) is amended to read: 08 (c) If the assisted living home provides or arranges for the provision of health- 09 related services to a resident, the home shall ensure that a 10 (1) registered or advanced practice registered nurse licensed under 11 AS 08.68 reviews the portion of an assisted living plan that describes how the 12 resident's need for health-related services will be met; and 13 (2) physician's statement about the resident is included in the plan. 14 * Sec. 56. AS 47.37.180(b) is amended to read: 15 (b) The certifying physician, physician assistant, advanced practice 16 registered nurse [PRACTITIONER], spouse, guardian, or relative of the person to be 17 committed, or any other responsible person, may make a written application for 18 commitment under this section, directed to the administrator of the approved public 19 treatment facility. The application must state facts to support the need for emergency 20 treatment and be accompanied by a physician's, physician assistant's, or advanced 21 practice registered nurse's [NURSE PRACTITIONER'S] certificate supporting the 22 need for emergency treatment and stating that the physician, physician assistant, or 23 advanced practice registered nurse [PRACTITIONER] has examined the person 24 sought to be committed within two days before the certificate's date. 25 * Sec. 57. AS 47.37.180(f) is amended to read: 26 (f) A copy of the written application for commitment and of the physician's, 27 physician assistant's, or advanced practice registered nurse's [NURSE 28 PRACTITIONER'S] certificate, and a written explanation of the person's right to legal 29 counsel, shall be given to the person within 24 hours after commitment by the 30 administrator, who shall provide a reasonable opportunity for the person to consult 31 with legal counsel.
01 * Sec. 58. AS 47.37.190(a) is amended to read: 02 (a) A spouse or guardian, a relative, the certifying physician, physician 03 assistant, advanced practice registered nurse [PRACTITIONER], or the 04 administrator in charge of an approved public treatment facility may petition the court 05 for a 30-day involuntary commitment order. The petition must allege that the person is 06 an alcoholic or drug abuser who (1) has threatened, attempted to inflict, or inflicted 07 physical harm on another and that unless committed is likely to inflict physical harm 08 on another; or (2) is incapacitated by alcohol or drugs. A refusal to undergo treatment 09 does not constitute evidence of lack of judgment as to the need for treatment. The 10 petition must be accompanied by a certificate of a licensed physician, physician 11 assistant, or advanced practice registered nurse [PRACTITIONER] who has 12 examined the person within two days before submission of the petition, unless the 13 person whose commitment is sought has refused to submit to a medical examination, 14 in which case the fact of refusal must be alleged in the petition. The certificate must 15 set out the physician's, physician assistant's, or advanced practice registered nurse's 16 [NURSE PRACTITIONER'S] findings of the examination in support of the 17 allegations of the petition. 18 * Sec. 59. AS 47.37.200(a) is amended to read: 19 (a) At the hearing for a 30-day commitment required under AS 47.37.190(b), 20 the court shall hear all relevant testimony, including, if possible, the testimony of at 21 least one person who has examined the person whose commitment is sought under 22 AS 47.37.180(b) or 47.37.190(a). The person whose commitment is sought shall be 23 present unless the court believes that being present is likely to be injurious to the 24 person, in which case the court may conduct the hearing telephonically. The court may 25 examine the person in open court, or, if advisable, examine the person out of court. If 26 the person has refused to be examined under AS 47.37.180(b) or 47.37.190(a), the 27 person shall be given an opportunity to request examination by a court-appointed 28 licensed physician, physician assistant, or advanced practice registered nurse 29 [PRACTITIONER]. If the person fails to request a medical examination and there is 30 sufficient evidence to believe that the allegations of the petition are true, or, if the 31 court believes that more medical evidence is necessary, the court may issue a
01 temporary order committing the person to a private or public facility for a period of 02 not more than five days for purposes of a diagnostic examination. 03 * Sec. 60. AS 08.68.850(7); AS 21.87.330(4); and AS 47.07.900(14) are repealed. 04 * Sec. 61. This Act takes effect July 1, 2016.