AT A GLANCE

This bill authorizes Alabama to grant physician assistants “compact privileges” in other member states if they hold a qualifying license meeting eligibility and reporting requirements.

FULL SUMMARY

The bill establishes Alabama’s participation in the Physician Assistant (PA) Licensure Compact, creating a multi-state system for “compact privileges” that allow a licensed PA to provide medical services in other participating states where the patient is located at the time of the encounter, under the remote state’s laws and rules. It adopts definitions, including “compact privilege,” “qualifying license,” “remote state,” “adverse action,” and a “data system,” and it states that participating states retain authority to impose adverse action on compact privileges issued in their state through compact procedures.

The bill sets eligibility and operating conditions for exercising a compact privilege. To exercise the privilege, a licensee must meet education and certification requirements (including current NCCPA certification), have no felony or misdemeanor conviction, have no disqualifying history involving controlled substance authorization, hold a qualifying license, have no current license restrictions due to adverse action (with a two-year waiting period after restrictions end), and comply with additional remote-state requirements such as notifying the commission, meeting the remote state’s “jurisprudence” requirement and paying applicable fees, and reporting adverse actions taken by non-participating states within 30 days. The compact privilege is valid until the qualifying license expires or is revoked, and adverse action against the qualifying license deactivates privileges in remote states until specified conditions occur.

The bill requires participating states to participate in the compact commission’s data system and to submit uniform data sets covering licensure, adverse actions, application denials, and the existence of “significant investigative information,” with confidentiality limits for certain information designated as not for public sharing while still being reported to the commission. It also establishes investigation and disciplinary procedures, including subpoena authority, rules on how one state treats reported conduct from other compact states for adverse action purposes, the sharing of investigative and compliance materials for joint investigations, cost-recovery permission for participating states, and procedures for deactivation and notice when adverse action is taken.

The bill creates and governs the PA Licensure Compact Commission, including delegate membership, voting, public meeting/open-records rules (with specified closed-meeting exemptions), financing (annual assessments on participating states and potential compact privilege fees on licensees), rulemaking procedures (notice, comment, effective-date timing, emergency rule authority, and legislative rejection provisions), and oversight/enforcement (default notice and cure, possible termination, dispute resolution procedures, and litigation venue/jurisdiction). Alabama’s enactment incorporates these compact rules into state practice and provides that the act becomes effective October 1, 2026.

AT A GLANCE

This bill requires the Board of Nursing and Board of Medical Examiners to add K–12 athletic participation physical endorsement options by July 1, 2026, and prohibits leagues from rejecting qualifying CRNP/CNM- or assistant-endorsed forms.

FULL SUMMARY

HB276 requires that, when state law or rules call for a physician’s signature/certification/stamp/verification/endorsement, the same authorization can be satisfied by a certified registered nurse practitioner (CRNP) or certified nurse midwife (CNM) for specified document types—while limiting that authority to permitted categories and subjecting CRNP/CNM use to an active collaboration agreement. It also expands the categories to explicitly include K–12 school athletic participation physical examination forms as physician-endorsement equivalents, and it directs the Board of Nursing to add these physicals as an option to the applicable endorsement/physical forms on or before July 1, 2026.

For school athletics specifically, HB276 prohibits an athletic association, club, or league from refusing to accept K–12 physical examination forms that are endorsed in compliance with the CRNP/CNM endorsement rules (including forms for interscholastic athletic activities). The bill carries forward a parallel prohibition for physical examination forms endorsed by an assistant to a physician (PA-assistant) who meets specified eligibility conditions under Alabama’s physician assistant statute/regime.

HB276 also amends the physician assistant (assistant to a physician) provision to allow an assistant to a physician who has completed the Physician Assistant National Certification Examination and is registered under an approved job description to sign K–12 school athletic participation physicals without requiring an additional physician signature. The State Board of Medical Examiners must update its forms to include these physicals as an option for the supervising physician and eligible assistant on or before July 1, 2026. The bill again prohibits athletic associations/clubs/leagues from refusing K–12 athletic physicals that are endorsed by an assistant to a physician in compliance with the assistant rules.

The act takes effect June 1, 2026.

AT A GLANCE

This bill authorizes Alabama pharmacists to dispense ivermectin without an individualized prescription to adults, and to minors with parental consent, if the pharmacist relies on a signed standing order.

FULL SUMMARY

HB146 establishes a framework allowing pharmacists in Alabama to dispense ivermectin to individuals without an individualized prescription when they receive a signed, non–patient-specific standing order from a qualified health care provider (physician, physician assistant, or certified registered nurse practitioner). A pharmacist may dispense to persons age 19 and older, and to unemancipated minors under 19 with written consent from the minor’s parent or legal guardian, as authorized by the standing order.

The standing order must include (1) a pharmacist-facing risk assessment protocol for people who request ivermectin, with a plan for treating adverse events; (2) a standardized information sheet for the dispensing pharmacist to provide, covering indications/contraindications, instructions for use, and the importance of follow-up care plus referral information; and (3) a record form for the pharmacist to document completion of the risk assessment protocol and the dosage dispensed. The bill also creates behavioral limits: health care providers and pharmacists may not participate in, or accept anything of value from, any program that would induce them to affirmatively commend or endorse ivermectin to individuals or the public.

HB146 limits regulatory consequences. The governing licensing board may not take disciplinary action against a health care provider for signing such a standing order based on the pharmacist’s dispensing pursuant to that order. The State Board of Pharmacy may not take disciplinary action against a pharmacist on specified grounds: failure in good faith to correctly interpret and follow the standing order; defects in the standing order the pharmacist relies upon; or refusal to dispense ivermectin to a person notwithstanding the existence of a standing order that covers the pharmacist’s employer or practice.

The bill clarifies that its section does not establish standards or evidentiary rules for the practice of medicine or pharmacy, and it does not alter or supersede specified existing Alabama medical liability/statute provisions and related judicial interpretations. It also does not limit third-party payors (including the Alabama Medicaid Agency and insurers/managed care entities) in determining coverage scope and contract terms, while preserving an exception regarding assignment of benefits at the same benefit as paid to a contract provider. The act takes effect October 1, 2026.

SB80 establishes a hospital licensing condition for any Alabama hospital with an emergency department: as part of licensing and renewal under Article 2 of Chapter 21 of Title 22 (Code of Alabama 1975), the hospital must have at least one physician on duty and physically present who is primarily responsible for the emergency department at all times the emergency department is open.

The bill specifies that the requirement applies to hospitals with emergency departments regardless of classification, and it ties compliance to the hospital’s ability to obtain or renew its license.

The act takes effect on October 1, 2026.

The Alabama Board of Nursing has approved amendments to the administrative rules governing advanced practice nursing, particularly focusing on the collaborative practice between certified registered nurse practitioners (CRNPs) and physicians. These amendments, adopted on November 14, 2025, restore previously repealed rules that outline the qualifications and practices for CRNPs and certified nurse midwives (CNMs). The changes aim to enhance collaboration in healthcare delivery, with an effective date of January 10, 2026.

Key provisions of the amendments include the requirement for collaborating physicians to complete continuing medical education on collaborative practice rules every 48 months, starting January 1, 2024. Additionally, physicians are limited to entering into collaborative agreements with CRNPs for a maximum of 360 hours per week, which encompasses all agreements across states. Quality assurance measures are mandated for physicians collaborating with more than four full-time equivalents, requiring monthly reviews for new CRNPs.

CRNPs are granted prescriptive authority under specific conditions, including the completion of pharmacology courses and adherence to approved protocols. They are prohibited from prescribing for themselves or immediate family members, with limited exceptions. The amendments also outline the responsibilities of CNMs, including maintaining documentation of practice sites and establishing quality assurance plans.

The regulatory changes are expected to impact the healthcare industry by defining the scope of practice and collaboration requirements for CRNPs and CNMs, potentially influencing operational practices and compliance costs within healthcare facilities. The amendments reflect a commitment to improving the collaborative relationship between advanced practice nurses and physicians, ultimately aiming to enhance healthcare delivery in Alabama.

The Alabama Board of Nursing is proposing amendments to regulations concerning Advanced Practice Nursing to reinforce its authority in establishing qualifications for registered nurses seeking certification in advanced practice roles. The amendments aim to enhance the regulation of advanced practice nurses, including certified registered nurse anesthetists, clinical nurse specialists, nurse practitioners, and nurse midwives, while streamlining the certification process. The proposed changes will not significantly increase costs or have a notable economic impact.

Key requirements for certified registered nurse anesthetists include maintaining an active Alabama registered nurse license, paying renewal fees, and completing continuing education in pharmacology. Clinical nurse specialists must hold a master's degree in nursing and certification from a recognized agency, while certified registered nurse practitioners are required to document extensive direct patient care experience and maintain national certification. These regulations are designed to ensure that advanced practice nurses meet specific educational and certification standards to provide safe and effective care.

For certified nurse midwives, the regulations emphasize the importance of collaborative practice agreements and the need for timely notification of any terminations. They must also meet renewal requirements, including continued collaboration with physicians and completion of pharmacology continuing education. Additionally, both certified nurse practitioners and nurse midwives may receive temporary or provisional approvals to practice under certain conditions while their applications are pending.

Overall, these proposed amendments and regulations are intended to strengthen the framework for advanced practice nursing in Alabama, ensuring that practitioners are well-qualified and adhere to established standards of care. The healthcare industry, particularly the nursing and advanced practice sectors, will be significantly impacted by these changes, which aim to enhance the quality of care provided to patients.

The Alabama Board of Nursing is proposing amendments to regulations concerning Advanced Practice Nursing, specifically focusing on the collaborative practice between certified registered nurse practitioners (CRNPs), certified nurse midwives (CNMs), and physicians. The amendments aim to repeal sections unrelated to collaborative relationships and reconstitute them within a different chapter to ensure consistent regulation across advanced practice roles. The proposed changes are not expected to harm public health or increase costs, and they emphasize the importance of ongoing education for healthcare providers.

Effective January 1, 2024, CRNPs and CNMs will be required to complete continuing education related to collaborative practice rules within specified timeframes. Physicians involved in collaborative practice will also need to fulfill similar continuing medical education requirements. Additionally, there are limitations on the number of collaborative agreements physicians can enter into, which may impact staffing and operational costs in healthcare settings.

The regulations outline the responsibilities of collaborating physicians, including oversight and documentation of the CRNPs' and CNMs' practice experiences. Quality assurance measures must be established, and prescriptive authority for CRNPs and CNMs is contingent upon completing specific educational requirements. Temporary approvals for practice may be granted under certain conditions, affecting hiring practices within healthcare facilities.

Overall, these amendments are designed to clarify the collaborative roles of advanced practice nurses and physicians, ensuring that educational standards are met while maintaining a focus on quality assurance in healthcare delivery. The changes are expected to influence the operational dynamics within the healthcare industry in Alabama, particularly in nursing and medical practices.

The Alabama Board of Medical Examiners is proposing an amendment to Rule No. 540-X-3-.24, which relates to the Certificate and Limited License Under the Retired Senior Volunteer Program (RSVP). The primary change involves eliminating the requirement for physicians to volunteer a minimum of 100 hours annually to qualify for the program. This amendment aims to encourage retired physicians to participate in providing outpatient health care services at established free clinics, thereby improving public health access.

The proposed rule is not expected to have any economic impact or increase the costs of goods or services involved. It is designed to enhance public health and is exempt from the moratorium on rule amendments as outlined in a recent executive order.

Interested parties are invited to submit comments on the proposed rule until September 4, 2025. The rule will take effect after the notice period and any necessary approvals are completed.

AT A GLANCE

This bill requires licensed physician assistants in Alaska to obtain and comply with a written collaborative agreement unless practice occurs in specified facility settings or the board authorizes practice without one.

FULL SUMMARY

The bill expands and clarifies what physician assistants may do and when they may practice in Alaska, primarily by revising the state’s “scope of practice” and related licensing/qualification provisions for physician assistants. It requires a written collaborative agreement for PA practice except in specified facility settings or when the board authorizes practice without a collaborative agreement.

AS 08.64.010 is changed so that the State Medical Board consists of five physicians plus one physician assistant (rather than one physician assistant under AS 08.64.107, which the bill repeals and replaces). AS 08.64.107 is repealed and reenacted with updated scope-of-practice language: it explicitly lists services a qualified PA may provide (including obtaining histories and performing examinations; evaluating/diagnosing/managing treatment; ordering and evaluating diagnostic/therapeutic procedures; limited sonography on a focused target; educating on health promotion/disease prevention; medical consultation; writing medical orders; obtaining informed consent; supervising/delegating/assigning measures to personnel per regulations; certifying health/disability for programs; authenticating documents; pronouncing death under statute; planning and initiating nonpharmacological therapeutic regimens; prescribing federal Schedule II–V controlled substances and all federal legend drugs; administering/procuring drugs and medical devices; dispensing drugs when pharmacy services are not reasonably available or an emergency/best-interest condition exists; and requesting/receiving/signing for professional samples and distributing professional samples). The new section also specifies PA responsibility for patient care and sets the collaborative agreement requirement and the circumstances allowing practice without a collaborative agreement.

The bill adds a new PA-licensure qualification section (AS 08.64.206) requiring, for PA applicants, education/credential proof tied to specific accreditation bodies based on graduation date (before Jan. 1, 2001 vs. on/after Jan. 1, 2001), proof of current National Commission on Certification of Physician Assistants certification, and proof of a passing score on the national certifying examination. It also adds a licensing provision directing the board/executive secretary to issue a PA license when an applicant passes the exam and meets the AS 08.64.206 and AS 08.64.255 requirements. AS 08.64.250(a) is revised to include AS 08.64.206 among the credential/continued-competence criteria for credential-based waiver of examination. Temporary-permit provisions are adjusted to: (i) allow temporary permits for applicants meeting the updated PA-related requirements, and (ii) expressly require PAs applying under the temporary-permit authority to meet AS 08.64.206 and a named additional requirement (AS 08.64.279) and submit evidence of holding a license to practice in another qualifying jurisdiction.

Across other medical-board and cross-cutting provisions, the bill updates statutory references and policy constraints relevant to physician assistants: it revises sanction grounds in AS 08.64.326(a) to include an opioid-related condition (prescribing/dispensing opioids above the maximum dosage authorized under AS 08.64.363); adjusts physician-assistant inclusion in voluntary surrender, mandatory reporting for impaired/mentally ill/addicted providers (AS 08.64.336), immunity/limits on withholding or refusing reports/evidence, and related definitions; clarifies the penalty for unlicensed practice (removing an explicit carve-out for “physician assistant” while retaining the general “person licensed or authorized under another law” exception); updates “practice of medicine” and related definitions to remove bracketed stricken language tied to how titles are used (while still addressing limits on title use); revises “physician assistant” definitions in controlled-substance and worker/EMS contexts; and changes insurer contract restrictions in AS 21.07.010(b) so that a participating provider contract may not impose PA practice/education/collaboration requirements that are inconsistent with or more restrictive than those imposed under AS 08.64 or State Medical Board regulations. It also updates the definition of “health care provider” in AS 33.30.901(10) to include a PA licensed to practice in the state without the previously specified “direct supervision” condition, and it repeals AS 08.64.170(a)(1).

AT A GLANCE

This bill requires opioid prescribers to offer opioid overdose drug prescriptions when prescriptions exceed a three-day supply or meet listed dosage, benzodiazepine, or patient-history conditions.

FULL SUMMARY

HB 195 changes Alaska law terminology from “physician assistant” to “physician associate” across multiple statutes, including board membership provisions, licensure and practice limitations, definitions, death pronouncement/medical-record provisions, and involuntary treatment/commitment processes.

The bill also establishes new opioid safety obligations. For physician and pharmacist prescribers who issue an opioid prescription, the prescriber must offer an opioid overdose drug prescription when specified thresholds and circumstances apply: the opioid prescription exceeds a three-day supply; the total daily opioid dosage is a morphine milligram equivalent of at least 50 milligrams; the patient is concurrently prescribed a benzodiazepine; or the patient has a history of overdose or substance use disorder. Separately, the pharmacist continuing education requirement is expanded to include at least two hours during the concluding licensing period in pain management and opioid use and addiction, with exemptions if the pharmacist does not include pain management/opioid prescription or administration in practice, or lacks a valid federal Drug Enforcement Administration registration.

On pharmacist collaborative practice, the bill adds a new statutory section barring the department or boards from imposing certain limitations on collaborative practice agreements (including requiring fees to enter or provide services, requiring board approval, defining the nature/scope of patient care services, or otherwise regulating such agreements). It also updates pharmacist collaborative practice framework by tying it to agreements authorized under AS 08.80.337(a) and clarifying that “patient care services” exclude certain categories of drug prescribing/administration unless used for opioid use disorder in a clinic. In addition, it adds a requirement that pharmacists prescribing or administering drugs/devices under this framework recognize the limits of their education/training/experience and consult/referral as appropriate. Pharmacist “opioid” definition is expanded to include opium/opiate substances and derivatives listed in the controlled substances schedule.

The bill makes additional conforming changes to “practitioner” definitions (replacing the bracketed “physician assistant” with “physician associate” in various health-care and controlled-substance contexts) and modifies related “health care provider” and “health care professional” definitions to include physician associates where applicable. It also repeals AS 08.80.337(c) and adds uncodified provisions directing the revisor to replace “physician assistant” with “physician associate” in a specified future bill context and providing conditional effectiveness depending on whether SB 89 is enacted. Most provisions take effect January 1, 2027, with certain sections taking effect only if SB 89 is not enacted (not all sections share the same timing).

AT A GLANCE

This bill requires Alaska genetic counselors to obtain State Medical Board licensure, setting qualifications and temporary permits and authorizing the board to discipline licensees for violations of the practice standards.

FULL SUMMARY

The bill establishes a new Alaska licensing and regulatory framework for genetic counselors, including a State Medical Board–run license requirement, qualifications, temporary licensing, credential-based licensure, renewal/continuing education rules, and practice scope and discipline authority. It also creates the Genetic Counseling Advisory Council to advise the board, and adds a continuing standard of care and regulatory tools (e.g., a code of ethics required by regulation) for administering the new chapter.

The bill amends multiple existing professional-licensure provisions. It updates the definition of “health care provider” and the roster of covered professions to include genetic counselors (and later, respiratory care practitioners under specified authorization). It requires physicians and other specified applicants for expedited or other licenses to submit fingerprints and obtain criminal history record checks, and it clarifies that criminal justice information and national criminal history information are used only for license qualification/fitness and compact privilege determinations. It also updates qualifications that must include education in pain management and opioid use/addiction (with an exemption tied to holding a valid DEA registration). The bill further adds statutory authority and process elements related to interstate compacts for physicians (Interstate Medical Licensure Compact), physician assistants (PA Licensure Compact), and psychologists (Psychology Interjurisdictional Compact), plus related data/reporting, enforcement, and rulemaking structures.

The bill creates a new respiratory care practitioner chapter establishing licensure requirements, renewal conditions (including continuing education credit hours), scope of practice rules (including supervision protocols and what respiratory care tasks may be performed), disciplinary sanctions, and exemptions. It also updates existing “health care provider” definitions in several statutes to include genetic counselors and respiratory care practitioners, and expands criminal history record check provisions to specific EMS and respiratory-related pathways as described in the amendments. It modifies group health insurance unfair-discrimination coverage to include respiratory care practitioners in the defined “provider” list.

Finally, the bill establishes governance for rural health transformation via a new Rural Health Transformation Program Advisory Council (membership, appointment sources, operating cadence, and advisory duties), and it provides transitions and effective dates: it allows unlicensed practice by “current” genetic counselors until a specified date (and sets limits on initial advisory council service without a genetic counselor license), allows certain respiratory care practitioners to continue practice temporarily without initial licensure, and sets specified take-effect dates for selected sections (notably January 1, 2027 for several licensing/definition sections).

AT A GLANCE

This bill authorizes the Department of Commerce, Community, and Economic Development to issue a temporary naturopathy endorsement allowing a licensed naturopath to prescribe and administer prescription drugs only while supervised as required.

FULL SUMMARY

The bill expands Alaska’s naturopathy regulatory framework by adding mechanisms for naturopaths to receive temporary and regular endorsements to prescribe and administer prescription drugs, and by imposing new continuing education and license-renewal standards. It also revises certain practice restrictions, disciplinary-sentencing procedures, criminal liability language for unlicensed/unendorsed practice, and updates the penalty provisions for fraudulent licensing/endorsement.

It creates a new temporary endorsement process in AS 08.45.033: the department issues a temporary endorsement to a licensed naturopath who pays an application fee, has passed the elective pharmacology examination portion of the Naturopathic Physicians Licensing Examination (or an equivalent approved exam), and meets department regulatory requirements. While holding a valid temporary endorsement and being supervised as required, a naturopath may prescribe and administer prescription drugs for preventive and therapeutic purposes, subject to exceptions in AS 08.45.050. A supervising physician must review the naturopath’s prescriptions/administration and provide feedback on safe, lawful practice. The bill limits supervision to physicians licensed under AS 08.64 who have at least five years of prescribing/administration experience and document the arrangement on a department form. After one year of supervision (unless additional supervision is required), the supervising physician must report to the department recommending whether to issue an endorsement, require further supervision, or deny endorsement; the temporary endorsement terminates upon issuance/denial of the endorsement under the related endorsement provision.

To support ongoing eligibility, the bill adds AS 08.45.037 (continuing education requirements): the department must require all licensed naturopaths to complete continuing education as a condition of renewal. Before renewal, the naturopath must submit evidence that required continuing education (completed in the 24 months preceding renewal) has been met, totaling 60 hours approved by the department, including at least 20 hours on pharmacotherapy. The department may grant exemptions for inability to comply due to extenuating circumstances, but may not exempt more than 15 hours in a four-year period. The bill also amends AS 08.45.038 to require renewal only if the licensee: (1) applies and pays the fee, (2) meets continuing education requirements under the new AS 08.45.037, (3) has not been convicted/pled guilty/no contest to a disqualifying crime, and (4) has current cardiopulmonary resuscitation (CPR) certification.

The bill amends AS 08.45.050 to clarify the restriction on prescribing/recommending prescription drugs: a naturopath may not give/prescribe/recommend a prescription drug except as authorized by an endorsement issued under AS 08.45.033 (temporary endorsement path) or AS 08.45.034 (endorsement issuance). It also amends AS 08.45.060 to update the title and formatting of the disciplinary sanctions authority (while retaining the listed grounds for sanctions). It amends AS 08.45.070(a) to remove an extraneous “IT” reference and make probation reporting requirements read more cleanly (“report regularly to the department on matters involving the basis of probation”), and amends AS 08.45.070(c) to retain the authority for summary suspension when the licensee poses a clear and immediate danger. It further amends the misdemeanor provision for unlicensed or unendorsed practice (AS 08.45.080) to specify that the offense applies to a person practicing naturopathy without a valid license or who prescribes/administers drugs without a valid endorsement (with a class A misdemeanor penalty retained), and updates the fraudulent licensing/endorsement statute (AS 08.45.090) to align references so that the penalty applies to obtaining or attempting to obtain a naturopathic license or endorsement, including forging/counterfeiting or fraudulently altering a license or endorsement, with retained penalties (fine up to $500 and/or imprisonment up to six months).

The document outlines significant amendments to the licensure and regulation of nursing professionals in Alaska, focusing on fee structures, training requirements, and compliance measures. The Department of Health is tasked with establishing fees for nursing licenses that reflect actual regulatory costs, with multistate license fees set at double that of single-state licenses. Annual reviews of these fees will ensure they remain aligned with regulatory expenses, impacting healthcare providers that employ nursing professionals.

Key changes also include enhanced training requirements for advanced practice registered nurses (APRNs) in pain management and opioid use, as well as the establishment of criteria for approving non-accredited practical nurse education programs. Additionally, applicants for nursing licenses will now be required to undergo criminal background checks, which may impose extra costs and administrative burdens. The implementation of the Multistate Nurse Licensure Compact aims to facilitate nurse mobility across state lines, potentially affecting the nursing workforce and healthcare delivery.

The amendments further empower the Board of Nursing to impose probation, require reporting from employers regarding nurse conduct, and grant immunity to individuals reporting misconduct in good faith. A coordinated licensure information system will be established to track the licensure and disciplinary history of nurses, enhancing regulatory oversight and compliance across party states.

Changes to assisted living homes include provisions allowing residents who have received 24-hour skilled nursing care to opt to remain in their homes under specific conditions. These amendments require that health-related services provided in assisted living facilities be reviewed by a registered or advanced practice registered nurse, ensuring compliance with updated regulations.

Overall, these amendments are expected to have significant implications for the nursing profession, healthcare providers, and educational institutions involved in nursing education and training, as they aim to enhance regulatory compliance, improve public safety, and streamline licensure processes across state lines.

AT A GLANCE

This bill requires employers of nurses practicing in Alaska under a multistate licensure privilege to report the nurse’s name and hire date before work begins and notify the board of termination.

FULL SUMMARY

The bill makes multiple changes to Alaska’s nursing licensure system and hospital staffing requirements, and establishes the Multistate Nurse Licensure Compact (the “Compact”) as Alaska law. It also creates new nurse-employment reporting requirements for nurses practicing under a multistate licensure privilege and adds restrictions on hiring during nursing strikes.

Fee-setting requirements in Alaska’s nursing-licensure fee statute are modified to (1) require annual review and fee adjustments based on whether fee collections match regulatory costs, and (2) add a new fee rule for license types: total fees collected for single-state nursing licenses must approximately equal total regulatory costs to the Department of Commerce, Community, and Economic Development (“DCCED”) and the Board of Nursing; and fees collected for multistate licenses or multistate licensure privileges must approximately equal half of those total regulatory costs. Related fee schedules are revised to reframe categories for nursing licenses (including multistate license fees) and to remove earlier language tied to implementation of the Compact within the board’s fee-related duties.

The bill enacts the Multistate Nurse Licensure Compact (AS 08.68.500) and adds additional Compact-related sections, including a Compact fee section (AS 08.68.510) requiring a fee collected from entities licensed under AS 47.32 so that total collected fees approximately equal half of the regulatory costs for nursing practice under multistate licenses/privileges, with deposits into the general fund. It also adds a registry and reporting system (AS 08.68.720) requiring employers of nurses practicing in Alaska under a multistate licensure privilege to submit the nurse’s name and date of hire before the nurse begins work in Alaska and to notify the board when employment terminates; it directs the Board of Nursing to maintain a registry of this information and specifies that failure to provide the required information cannot be the basis for discipline against the nurse or the nurse’s privilege or prevent the nurse from practicing.

Operationally, the bill also establishes hospital nurse staffing committees (AS 18.20.087): each hospital must create a committee with at least 50% registered nurses and licensed practical nurses in non-management positions; the committee must adopt minimum ratios of nurses to patients and certified nurse aides to patients for all units and must report annually to the Board of Nursing the hospital’s rate of compliance with each ratio. It amends the nursing chapter’s scope exceptions to clarify that certain out-of-state nurses may practice in Alaska without holding a multistate licensure privilege (e.g., limited nurse-education/consultation contact days and time-limited patient transport), adds definitions for “multistate license,” “multistate licensure privilege,” and “single-state license,” and requires that fees collected under the nursing multistate fee provisions be added to a particular accounting category (AS 37.05.146(c)). Finally, it adds a hiring restriction during nursing strikes (AS 47.32.210): during a strike notice and strike involving nurses, covered entities may hire only nurses licensed under a single-state license or nurses who were employed under a multistate licensure privilege immediately before notice; hiring under multistate privileges may resume after withdrawal of the notice or conclusion of the strike.

The State of Alaska has enacted a series of regulatory changes across various sectors, including agriculture, fisheries, healthcare, and environmental management. The Agriculture Revolving Loan Fund has seen an increase in loan limits, aimed at improving access to funding for farmers and agricultural businesses. In the fisheries sector, new regulations have been adopted to enhance sustainability, including updated rules for herring, groundfish, and salmon fisheries, as well as amendments to bycatch management and hunting regulations.

In healthcare, the Department of Health has streamlined Medicaid Behavioral Health Services, potentially increasing access to care without imposing additional financial burdens on the state budget. The Board of Nursing has revised the scope of practice for nursing professionals, aligning it with national standards, while the Board of Marital and Family Therapy has enhanced continuing education requirements for practitioners. These changes are designed to improve service delivery and operational efficiency within the healthcare sector.

Environmental regulations have also been updated, particularly concerning hazardous waste management and public water systems. New provisions have been adopted to align state regulations with federal standards, enhancing the management of hazardous materials and ensuring public health safety. Additionally, regulations related to homemade foods and marijuana cultivation have been revised to support local businesses and streamline compliance processes.

The regulatory changes reflect Alaska's commitment to sustainable resource management and economic development while balancing the interests of various industries. These updates aim to support local economies, improve access to services, and ensure compliance with statutory standards across multiple sectors. Overall, the amendments signify ongoing efforts to enhance operational practices and promote environmental protection in the state.

The Board of Nursing in Alaska has adopted new regulations that update the scope of practice for Licensed Practical Nurses (LPNs). These changes, which align LPN practice standards with national benchmarks, are expected to enhance the quality of nursing care and improve patient outcomes within healthcare facilities.

The updated regulations were reviewed by the Department of Law, which found no legal issues, allowing for their implementation. Importantly, these changes are not anticipated to impose any additional financial burden on state resources.

Overall, the adoption of these regulations reflects a commitment to maintaining high standards in nursing practice while adapting to the evolving needs of the healthcare industry.

The Alaska Board of Nursing has adopted new regulations that update the Nurse Practice Standards for licensed practical nurses (LPNs). These changes will take effect on June 27, 2025, following their filing by the Lieutenant Governor on May 28, 2025. The updated regulations align with national standards as outlined in the May 30, 2023 edition of the Nurse Practice Standards for Licensed Practical & Licensed Vocational Nurses.

The Department of Law has reviewed the regulations and found no legal issues, indicating that the changes will not require an increased appropriation, and therefore, no fiscal note is necessary. The regulations were adopted after a public comment period, during which the Board of Nursing considered potential costs to private individuals.

These changes will impact the healthcare and nursing services industries, particularly those employing licensed practical nurses. The aim is to enhance the practice standards for LPNs, which may influence operational practices within healthcare facilities.

The Naturopathic Physicians Medical Board in Arizona has proposed amendments to several rules regarding the licensing and continuing education requirements for naturopathic physicians. Key changes include the formalization of full legal name disclosure on applications, the replacement of the term "naturopathic college" with "School of Naturopathic Medicine," and a simplification of language concerning the State of Arizona Jurisprudence examination for licensure applicants. Additionally, the pharmacology education requirement for applicants licensed before January 1, 2005, has been clarified, allowing for the use of a national examination as proof of compliance.

The proposed rulemaking also eliminates the requirement for applicants to submit a passport-sized photo, which is considered burdensome, and reduces the annual continuing medical education (CME) requirement from 30 to 20 hours. This reduction aligns with the requirements of other medical boards in Arizona and mandates at least one credit hour in Ethics each year, with no carryover of hours permitted. These changes are expected to provide a slight economic benefit to licensees by decreasing the time and costs associated with CME compliance.

The document outlines the CME credit hour system, which allows for a maximum of four credit hours for preparing or writing materials related to naturopathic medicine and up to eight credit hours for various self-directed activities. Licensees must submit a complete renewal application by January 1 each year, certifying their CME completion, with the Board auditing at least 10% of active licensees annually for compliance.

For those seeking reinstatement of expired, suspended, or revoked licenses, applicants must complete 20 hours of CME for each year their license was inactive and provide proof of compliance with educational standards. The reinstatement process requires a complete application form and payment of necessary fees, emphasizing the importance of ongoing education and compliance in the naturopathic medicine field.

Overall, these amendments aim to streamline the licensing process, reduce unnecessary burdens on practitioners, and ensure that educational standards are maintained within the profession.

The Arkansas State Board of Nursing proposes revisions to its registered nurse practitioner rules (Title 17, Chapter XXII, Part 122, Subpart 1—Scope of Practice; and Subpart 3—Name or Address Change). The proposal includes a requirement for licensees to update board contact information using a broader set of fields than previously required.

The key change is to the address-change requirement in 17 CAR § 122-302: instead of requiring only notification of an “address” change, the rule requires a licensee to immediately notify the Arkansas State Board of Nursing in writing when any of the following changes from the address on file occur: (1) mailing address, (2) residential address, (3) email address, or (4) telephone number.

Public participation is provided through a 30-day comment period that begins with publication and ends no later than Friday, March 13, 2026. No specific public meeting location and time is set in the cover materials (listed as TBD).

AT A GLANCE

This notice solicits public comments on proposed Arkansas State Board of Nursing APRN rule revisions by March 13, 2026.

FULL SUMMARY

The document contains proposed revisions to Arkansas State Board of Nursing rules governing Advanced Practice Registered Nurse (APRN) practice in Title 17, Chapter XXII, Part 123 (including Subparts on scope/standards, background checks, delegation, prescriptive authority, education programs, and prescribing guidelines). It also includes (in the introductory “Rule Revision Summary” pages) the stated policy purpose for several targeted updates tied to recent Arkansas statutes.

Key proposed changes described in the rule revision summary include: (1) adding required APRN/ licensee contact-information updates to include mailing address, residential address, email address, and telephone number (Subpart 302); (2) updating APRN authority to sign death certificates and pronounce death to align with Act 862 of 2025 (Subpart 402(e)(6)); (3) clarifying that orthotics, prosthetics, and diabetic shoes or inserts are included within “durable medical equipment” for APRN authorization purposes, reflecting Act 431 of 2025 (Subpart 402(e)(9)); (4) authorizing APRN delegation of certain nursing tasks to qualified unlicensed healthcare workers under Act 959 of 2025, while clarifying limits for CRNAs (no delegation of anesthesia administration) (Subparts 402(h) and 404(h)); (5) clarifying APRN ability to substitute therapeutically equivalent medication with notification to the original prescriber (Subpart 604(c)(8)(D)), consistent with Act 963 of 2025; (6) clarifying delegation limits for CRNAs and APRNs regarding calling in legend-drug prescriptions versus controlled-substance prescriptions to unlicensed ancillary staff (Subpart 604(c)(11)(A)-(B)); and (7) expanding Certified Nurse Midwife full practice authority parameters to reflect Act 138 of 2025 (Subpart 701).

The proposed rule text also addresses prescriptive authority and related operational/legal requirements across multiple APRN rule sections. It includes prescriptive authority guardrails such as: APRN prescription documentation and recordkeeping; constraints on opioid prescribing (including opioid antagonist co-prescribing conditions and limited duration for certain Schedule II opioids, with referral requirements); prohibitions on APRNs prescribing controlled substances for self or immediate family; restrictions on delegation of controlled-substance “calling in” to unlicensed ancillary staff; and conditions and protocol requirements for controlled substances and hydrocodone Schedule II products. It further sets/clarifies telemedicine standards, including requirements for establishing an APRN–patient relationship prior to delivering services, documentation and transparency obligations, limitations on controlled-substance prescribing via telemedicine (generally requiring in-person evaluation or appropriate exception scenarios), and requirements for emergency referral protocols.

Public comment is solicited for amended APRN rules (Part 123) beginning with publication, with a final public comment deadline stated as March 13, 2026. The notice also directs that copies of proposed rules are available via the Board’s website and that written comments be submitted to the Board’s Director (address included) by the deadline.

AT A GLANCE

This bill establishes staggered initial four-year terms for Governor-appointed members of the Board of Naturopathic Medicine, limits consecutive service to two terms, and sets related licensing fee and fictitious-name requirements.

FULL SUMMARY

SB 1303 makes multiple changes to the California Business and Professions Code provisions governing naturopathic doctors, including the Board of Naturopathic Medicine’s structure/terms, license administration, fictitious-name practice rules, and fee schedules.

The bill amends Section 3621 to modify board member term mechanics: board members serve four-year terms expiring four years after appointment; members may not serve more than two consecutive terms; and Governor-appointed members after the bill’s effective date receive staggered initial terms (two years, three years, or four years) to ensure staggered terms, after which all appointments are for four-year terms. It also amends the board’s fee-related/administrative framework by updating the relevant provisions of Section 3680 (fees) and amends the duration/expiration trigger for the chapter by changing Section 3686 so the chapter remains in effect only until January 1, 2031 (instead of January 1, 2027).

SB 1303 repeals Section 3633.1. It adds new licensing-administration provisions: Section 3636.1 authorizes the Board to accept voluntary cancellation of a naturopathic doctor’s license upon written request (but not in lieu of an administrative enforcement action); a voluntarily canceled license is deemed surrendered and cannot be reinstated, and any former licensee must apply for a new license and meet current requirements. The bill also adds Section 3638, creating a fictitious-name permit pathway for naturopathic doctors practicing under a name that would otherwise violate Section 3661.5; the Board must issue the permit if specified conditions are met (including that the practice is wholly owned and controlled by licensed naturopathic doctors, the proposed name is not deceptive/misleading/confusing, and permit holders display required notices). The bill authorizes Board processes for revocation/suspension for noncompliance and provides automatic revocation when a sole practitioner’s naturopathic practice license is revoked.

The bill adds Section 3661.5, defining unprofessional conduct for a naturopathic licensee’s use of fictitious/assumed names (or names other than the licensee’s own) in public communications/advertisements/signage/announcements without obtaining the fictitious-name permit required under Section 3638, with exceptions for certain employees/contractors of entities that hold the relevant permit and for staff employed by specified licensed clinics. It amends Section 3680 to set fee amounts and distinctions: (1) application fee for a naturopathic doctor is capped at $500 (up to $600); (2) initial license fee is $1,000 (up to $1,200); (3) renewal fee for an active license is $1,000 (up to $1,200) and for an inactive license is one-half of the current active renewal fee; late renewal fee is $225; and other fees remain specified (fingerprint processing at DOJ’s current fee; duplicate/replacement at $38). It further specifies fees for fictitious-name permits within Section 3680 as $100 to apply and $50 to renew.

AT A GLANCE

This bill requires the Medical Board of California to issue time-limited physician graduate licenses to eligible applicants who completed medical school but not residency, under approved supervision and testing requirements.

FULL SUMMARY

The bill creates two new components in California law relating to physician workforce supply and supervised pathways to practice. First, it adds an “Article 6.1. Graduate Medical Education” to the Business and Professions Code establishing a Department of Health Care Access and Information (HCAI) workgroup on graduate medical education capacity in California, focused on access to residency positions. Second, it adds an “Article 6.1. Physician Graduate License Act” establishing a new pathway under the Medical Board of California to issue a time-limited “physician graduate” license to individuals who have completed medical school but not a residency program, with mandatory supervision requirements.

Under the Graduate Medical Education article (added section 2127), HCAI must convene the workgroup on or before January 1, 2028. The workgroup must include interested stakeholders, including specified entities such as the Medical Board of California, the Osteopathic Medical Board of California, California accredited medical schools, teaching hospitals/health systems operating residency programs, physician organizations, organizations representing students/interns/residents, and organizations representing international medical graduates and consumer/patient advocacy groups. After discussions, HCAI must submit, in consultation with the Medical Board of California, a report to the Legislature no later than July 1, 2028. The report must assess residency capacity (current number and distribution), quantify the gap between graduates seeking residency and available slots (including in-state and out-of-state applicants), identify barriers to expanding residency positions (including federal funding limitations, state/institutional financing constraints, regulatory/accreditation requirements, and infrastructure/faculty capacity limits), evaluate how residency placement affects practice location (especially underserved/rural areas), analyze barriers specific to international medical graduates, assess potential “loss” of California medical graduates to other states and the likelihood of return, identify best practices from other states/countries, and provide recommendations for increasing residency capacity, improving geographic/specialty distribution, and reducing barriers to entry—explicitly including consideration of supervised practice for medical graduates who have not completed residency as an alternative to postgraduate training requirements for full licensure. The workgroup/report provisions remain effective only until January 1, 2030, when the article is repealed.

Under the Physician Graduate License Act (added sections 2127 and following), the Medical Board must issue a physician graduate license to applicants meeting specified eligibility criteria: graduation within the preceding four years from an accredited (LCME/COCA) medical school or an out-of-country school recognized by the board under regulation (with transparent criteria including accreditation/curriculum/clinical training and verification), passage of specified medical licensing examinations (USMLE Steps 1 and 2 or COMLEX-USA Levels 1 and 2, or equivalent), no completion of specified ACGME/AOA-accredited residency, no prior revoked/suspended physician graduate license, English proficiency, and a valid employment offer under a supervising practice agreement with a sponsoring physician practicing in California (plus ECFMG or equivalent credentials for foreign medical school graduates). A physician graduate license is valid for three years and renewable for additional three-year periods if: the licensee continues under an approved supervising practice agreement; completes at least 50 hours of continuing medical education per renewal period; the sponsoring physician submits a satisfactory performance evaluation; and the licensee receives positive evaluations from all sponsoring physicians.

Practice is permitted only through supervision: a physician graduate must at all times practice under a supervising practice agreement with a sponsoring physician. The sponsoring physician must hold a full and unrestricted California physician’s and surgeon’s license, be board-certified in the specialty in which the physician graduate will practice, maintain an active California practice, and not be subject to pending disciplinary action. The supervising practice agreement must be submitted to and approved by the board and must include the authorized scope of practice, supervision plan (including frequency of direct supervision, chart review protocols, and availability for consultation), sponsoring physician identity/license/specialty, and the practice locations. The board must establish supervision standards by regulation (including direct supervision requirements for the first six months, maximum physician graduates a sponsoring physician may supervise, emergency/after-hours protocols, minimum supervision ratios, on-site supervision requirements, and documentation/reporting requirements), and must define permissible and prohibited clinical activities by regulation (including limitations based on training, experience, and practice setting). The bill also requires disclosure to patients, in writing and verbally if requested, that the physician is a physician graduate practicing under supervision, before providing treatment and including the sponsoring physician’s name and contact information. The board must set application, initial licensure, and renewal fees to cover costs of administering the article, capped at amounts not exceeding physician and surgeon license fees; and for purposes of medical practice, a physician graduate is considered a full-scope physician if practicing in accordance with the article.

The California Children’s Services (CCS) Program is being amended to allow advanced practice providers, such as nurse practitioners and physician assistants, to become CCS paneled. This change enables them to provide care independently for certain professional services, enhancing access to necessary medical services for physically handicapped children from low-income families.

The amendment is expected to positively impact healthcare providers, particularly those involved in pediatric care. CCS-paneled advanced practice providers who are enrolled as Medi-Cal ordering, referring, and prescribing providers will have the ability to bill Medi-Cal directly for office and inpatient visits, which could lead to increased revenue for these practitioners.

Overall, these changes aim to streamline the participation of advanced practice providers in the CCS Program, ultimately improving service delivery to eligible children in need of care.

The document outlines amendments to the Radiologic Technology Act in California, focusing on the practice of venipuncture by radiologic technologists. A significant change is the revised definition of "direct supervision," which now permits licensed physicians to supervise procedures through audio and video communication, provided they have access to the patient's medical imaging records and can direct onsite personnel. This adjustment aims to enhance supervision flexibility while maintaining patient safety.

Additionally, the amendments require healthcare facilities to implement safety protocols and ensure that licensed personnel are present to respond to any adverse events, unless a licensed physician is physically present. Radiologic technologists must also complete a minimum of 10 supervised venipunctures before they can perform the procedure independently.

These changes are anticipated to affect the healthcare industry, particularly facilities employing radiologic technologists, by potentially increasing operational costs associated with compliance to the new supervision and safety protocols. However, the bill specifies that local agencies and school districts will not receive reimbursement for costs incurred due to these amendments.

The effective date for these changes will be established following the passage of the bill.

The amendments to California's Health and Safety Code introduce significant changes to the registration and certification of deaths and fetal deaths, particularly expanding the role of nurse practitioners. They will now be authorized to complete and attest to the medical and health section data on death certificates, as well as prepare and register certificates of fetal death. This inclusion aims to streamline the certification process, especially for patients in skilled nursing or intermediate care facilities.

The new regulations also establish specific requirements for reporting gender identity on death certificates. The informant must report the decedent's gender identity unless certain documents are provided. In cases of disagreement among those with rights to control the disposition of remains, legal proceedings may be initiated to determine the correct gender identity to be recorded.

These changes are expected to impact various sectors, including healthcare, funeral services, and legal professions, as they will need to adapt to new documentation and compliance standards. The requirement for electronic signatures and the handling of gender identity may necessitate updates to existing systems and processes within these industries.

Overall, the amendments aim to enhance the accuracy and representation of decedents' identities while ensuring that the certification process is more efficient and inclusive. The involvement of nurse practitioners and the new gender identity reporting requirements reflect a broader effort to modernize and improve the handling of death documentation in California.

The document outlines significant amendments to the Nurse Anesthetists Act in California, which expand the scope of practice for nurse anesthetists. These changes explicitly authorize nurse anesthetists to perform anesthesia services, including preoperative, intraoperative, and postoperative care, as well as pain management. This expansion may require healthcare facilities, particularly acute care settings, to adapt to the enhanced role of nurse anesthetists.

Under the new provisions, an order from a physician, dentist, or podiatrist will serve as the authorization for nurse anesthetists to select and implement anesthesia modalities and modify them during patient care. This streamlined process is expected to improve operational efficiency in surgical and procedural environments.

Additionally, the amendments clarify that the selection and administration of medications by nurse anesthetists for anesthesia-related care will not be classified as a prescription under federal law. This clarification aims to reduce regulatory burdens on nurse anesthetists and healthcare facilities, allowing for more flexible medication management.

The amendments also emphasize the importance of compliance with existing safety standards and regulations, which may necessitate healthcare facilities to review and update their policies and procedures regarding nurse anesthetist practices. Overall, these changes are likely to have significant implications for the healthcare industry, particularly in the areas of anesthesia services and nurse anesthetist employment.

The document outlines significant changes to the regulation of physician assistants and podiatrists in California, primarily affecting the Medical Practice Act and the Physician Assistant Practice Act. The Podiatric Medical Board of California and the Physician Assistant Board will continue their operations until January 1, 2030, with an emphasis on public protection in their licensing and regulatory functions.

Key amendments include an increase in the number of physician assistants that a physician can supervise from four to eight, and the inclusion of the term "podiatric surgeon" in regulations prohibiting misleading titles. Additionally, the requirement for podiatric medicine certification applicants to have passed specific examinations within the last ten years will be eliminated.

Fee adjustments are notable, with the biennial renewal fee for podiatrists rising to $1,900 and various fees for physician assistants increasing, including an application fee of $60 and a potential maximum renewal fee of $500. The renewal application process for physician assistants will transition to an electronic format, necessitating legal verification of the information provided.

The amendments also specify the scope of practice for doctors of podiatric medicine, including surgical treatments and the administration of anesthetics, while restricting certain procedures to licensed facilities. A comprehensive review of practice agreement structures for physician assistants is mandated, ensuring that no additional regulatory responsibilities are imposed on the board.

Overall, these changes aim to enhance the regulation of podiatric medicine and physician assistant practices in California, with specific financial implications for licensing and renewal processes.

AT A GLANCE

This bill requires the statewide high school activities association to permit licensed physical therapists to perform preparticipation physical examinations and provide written clearance when the association requires them.

FULL SUMMARY

The bill adds an authorization for physical therapists to perform school preparticipation physical examinations when required by the statewide high school activities association. Specifically, if the association requires a physical examination and written clearance from a health-care provider before a student may play or participate in a team athletic activity, the association must permit a licensed physical therapist (licensed under Colorado’s physical therapist licensing law in title 12, article 285) to provide both the physical examination and the written clearance.

This requirement is added to Colorado’s statutory framework governing extracurricular and interscholastic activities by inserting a new definition section, 22-32-116.5(6.5), that directs the statewide association’s policy in this situation.

The act takes effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly (August 12, 2026, if adjournment sine die is May 13, 2026), unless a referendum petition is filed within the specified period—then it will not take effect unless approved by voters at the November 2026 general election and will take effect upon the governor’s official declaration of the vote.

AT A GLANCE

This bill permits one or more physician assistants to hold majority ownership in Colorado professional service corporations organized solely to provide medical-aesthetic services.

FULL SUMMARY

The bill allows certain non-physician licensees to hold majority ownership in Colorado professional service corporations that are organized solely to provide medical-aesthetic services, by creating a specific ownership exception for medical-aesthetic-focused corporations.

Under current rules for physician professional service corporations, a physician assistant generally cannot own a majority of a medical practice. The bill changes that restriction by permitting one or more physician assistants to own a majority of a corporation organized solely for providing medical-aesthetic services.

The bill also revises the ownership eligibility framework for medical-aesthetic service corporations: if a corporation is organized solely for providing medical-aesthetic services, shareholders may include individuals who hold active licenses issued in Colorado by their respective licensing bodies in the following professions—esthetician, cosmetologist, practical nurse, registered nurse, advanced practice registered nurse, and physician assistant. In addition, the bill keeps the requirement that the corporation must not engage in conduct that would violate applicable standards of professional conduct, making violations grounds for the relevant board (or applicable regulator) to revoke or suspend the license(s) of responsible person(s). It further preserves licensee-level accountability for causing the corporation to act or fail to act in ways that violate professional conduct standards.

The act takes effect at 12:01 a.m. on the day following expiration of the ninety-day period after final adjournment of the General Assembly, with an exception for referendum petitions filed under the state constitution, in which case the affected provisions would take effect only if approved by voters at the November 2026 election.

The Colorado Medical Board has introduced new regulations for physician assistants (PAs) that will take effect on August 7, 2023. These changes shift the focus from supervisory oversight to collaborative agreements between PAs and physicians or physician groups. All PAs are now required to maintain a written collaborative agreement at their primary practice location, which must be available for review by the Board.

To obtain licensure by endorsement through the Occupational Credential Portability Program, PAs must demonstrate continued competency, including proof of active practice, current certification, and completion of continuing medical education (CME). Those who have been inactive for two or more years must provide specific documentation, including a personalized competency evaluation report, to apply for a reentry license, which is valid for three years.

Physicians or physician groups must conduct periodic performance evaluations of PAs under collaborative agreements to assess their competency, with documentation required for Board audits. Additionally, PAs must have a registration from the United States Drug Enforcement Administration to prescribe controlled substances and can only obtain medications from collaborating physicians or pharmacists.

The healthcare industry, particularly facilities employing PAs, will need to adjust practice management and compliance protocols to align with these new regulations. The financial implications may include increased administrative costs associated with training, evaluation, and the maintenance of collaborative agreements.

The document outlines regulations and guidelines for Licensed Practical Nurses (LPNs) and Certified Midwives (CMs) in Colorado, focusing on their roles in intravenous (IV) therapy and prescriptive authority. LPNs are allowed to perform specific IV therapy procedures under the supervision of a professional nurse or physician, although certain procedures remain outside their scope of practice.

For Advanced Practice Registered Nurses (APRNs), the document details the requirements for obtaining provisional and full prescriptive authority, which include national certification and clinical experience. Applicants must submit their applications for full prescriptive authority within three years of receiving provisional authority.

Certified Midwives must complete 750 hours of mentorship with a qualified mentor to obtain full prescriptive authority, which must be done within three years of receiving provisional authority. They are also required to maintain an active nursing license, unrestricted DEA registration, and national certification from the American Midwifery Certification Board.

Additionally, both APRNs and CMs with prescriptive authority must complete training in substance use prevention. The document notes significant amendments to these regulations, with effective dates for various rules, including changes anticipated in December 2023 and March 2024.

These regulations establish clear guidelines for practice and authority in nursing and midwifery, influencing operational procedures and training programs within healthcare facilities in Colorado.

The Colorado Medical Board has established updated rules and regulations regarding the licensure and practice of physician assistants, with significant changes effective August 7, 2023, and further revisions on October 15, 2023. The Board recognizes the USMLE, COMLEX-USA, and FLEX as acceptable examinations for licensure, with specific eligibility requirements for applicants, including the completion of accredited postgraduate training and time limits for examination attempts.

A key update mandates that all physician assistants maintain a Collaborative Agreement at their primary practice location, which must be available for Board inspection. Additionally, physicians and physician groups are required to conduct periodic Performance Evaluations of physician assistants, focusing on various competency domains, which may increase administrative responsibilities for healthcare providers.

Physician assistants are now authorized to issue prescriptions for drugs and controlled substances, contingent upon meeting specific requirements, including obtaining registration from the United States Drug Enforcement Administration. This change is expected to impact pharmacies and healthcare providers involved in medication dispensing.

The Board may grant waivers for certain provisions of these rules upon a demonstration of good cause, potentially enhancing operational flexibility for physician assistants in underserved areas. Collaborative Agreements must be documented in writing and signed by both the physician and the physician assistant, necessitating additional administrative processes for healthcare organizations.

Overall, these changes aim to improve the collaborative practice environment, enhance patient safety, and clarify expectations for physician assistants and their supervising physicians in Colorado.

The document outlines regulations from the Colorado State Board of Nursing concerning the scope of practice for various nursing roles, including Licensed Practical Nurses (LPNs), Advanced Practice Registered Nurses (APRNs), Certified Nurse Aides (CNA-Meds), and Certified Midwives (CMRX). It emphasizes the importance of compliance with state standards to ensure the safety and competency of nursing practices in Colorado.

For LPNs, those with IV authority are allowed to perform specific tasks related to intravenous therapy, which impacts healthcare facilities and nursing practices. The document also details the approval process for medication aide training programs, highlighting the necessity for adherence to state and federal regulations to maintain operational approval for training institutions and healthcare providers.

Advanced Practice Registered Nurses must meet educational and experiential requirements to be included on the Advanced Practice Registry, with the potential for denial based on qualifications or disciplinary actions. Additionally, RXN-Ps are required to complete a 750-hour mentorship to obtain Full Prescriptive Authority, affecting training and operational processes in healthcare settings.

The regulations also address the authority of medication aides, outlining the endorsement process for obtaining this authority, which is significant for CNAs looking to expand their practice. Furthermore, there are specific requirements for the renewal and reinstatement of medication aide authority, which could influence workforce availability in healthcare environments.

Lastly, the document specifies the requirements for Certified Midwives seeking prescriptive authority, including mentorship and experience prerequisites. Provisional prescriptive authority is granted under certain conditions, and applicants must attest to their registration with the prescription drug monitoring program. These regulations establish essential standards for licensure and practice in midwifery and related medical fields in Colorado.

The document outlines a series of regulations and requirements affecting various aspects of nursing and healthcare practices in Colorado. It emphasizes the need for compliance with standards for Licensed Practical Nurses (LPNs) with IV Authority, Advanced Practice Registered Nurses (APRNs), Certified Nurse Aides (CNAs), and Certified Midwives. The regulations aim to enhance the quality of care provided by ensuring that healthcare professionals are adequately trained, supervised, and meet specific educational and certification standards.

Healthcare providers, nursing education institutions, and long-term care facilities are significantly impacted by these regulations, which may lead to increased operational costs associated with training, compliance, and maintaining necessary certifications. The financial implications extend to individual practitioners who must meet educational requirements, obtain liability insurance, and pay application fees for licensure and prescriptive authority.

The document also highlights the importance of ongoing evaluation and reporting for training programs, including the requirement for onsite surveys and annual compliance assessments. Programs that fail to meet the established criteria risk losing their ability to admit new students or maintain their operational status.

Overall, the regulations are designed to ensure that healthcare professionals in Colorado, including LPNs, APRNs, CNAs, and Certified Midwives, adhere to high standards of practice, thereby improving patient safety and care quality across the healthcare system. The changes reflect a commitment to maintaining rigorous training and oversight in the nursing and healthcare sectors.

AT A GLANCE

This rule requires eligible Connecticut physicians in good standing to apply to the Department to convert an active license into a retired physician license, including signed retirement and uncompensated-service attestations.

FULL SUMMARY

The regulation establishes a new regulatory framework in Connecticut for “retired physician licenses” by adding new sections 19a-88-11 through 19a-88-15 to the Regulations of Connecticut State Agencies. It defines key terms (including “active employment,” “licensee,” “good standing,” “retired from the profession,” and “retired physician license”) and implements procedures for converting an eligible active license into a retired physician license.

Under the new section 19a-88-12, a physician who is in good standing and retired from compensated practice may apply to convert to a retired physician license by submitting a complete department application. The application must include a statement of retirement, signed attestations regarding professional liability insurance (per Conn. Gen. Stat. § 20-11b) and that all medical services will be uncompensated and meet the scope restrictions in § 19a-88-13, as well as required fees (per Conn. Gen. Stat. § 19a-88(b)) and any additional department-required information. The commissioner may issue the retired physician license upon a determination of eligibility. Holders must publicly post—or be able to produce upon request—a current retired physician license, must comply with continuing medical education requirements (Conn. Gen. Stat. § 20-10b), and must renew annually during the licensee’s birth month by submitting renewal forms that include the information required for conversion. The board may take disciplinary action under Conn. Gen. Stat. § 20-13c, and holders must comply with applicable state and federal laws and regulations.

Section 19a-88-13 restricts the scope of practice under a retired physician license to providing volunteer services without monetary compensation, limited to the physician’s competence (based on education, training, and experience) and within the scope of practice of physicians.

Section 19a-88-14 creates reinstatement procedures for people whose chapter 370 licenses became void under Conn. Gen. Stat. § 19a-88. Eligibility requires that the prior license was in good standing when it became void, that the void status occurred no more than two years before the reinstatement application, that continuing education meets the requirements in Conn. Gen. Stat. § 20-10b(g), and that other requirements in § 19a-88-12 are met; applications are submitted on department forms and must include the same items required for conversion. If eligibility is not met, the applicant must use the existing licensure reinstatement process in sections 19a-14-1 to 19a-14-5. Section 19a-88-15 allows conversion from a retired physician license (in good standing) to an active employment license by applying with the required fee (Conn. Gen. Stat. § 20-12) and documentation of volunteer services provided in the two years immediately preceding the application; if volunteer services were not regularly completed in that two-year period, conversion must proceed under the existing procedures in sections 19a-14-1 to 19a-14-5. The stated statutory authority is Public Act 25-96 (sections 11, 12, and 13).

AT A GLANCE

This bill requires physician associates to practice only under required collaboration and oversight, including written collaborative agreements on file, and authorizes Delaware’s Regulatory Council to set related independent-practice and re-entry conditions.

FULL SUMMARY

The bill establishes and revises Delaware’s regulatory framework for physician assistants/physician associates, including the structure and duties of the Regulatory Council and requirements governing collaboration, independent practice, licensure, discipline, enforcement, temporary/temporary re-entry practice, and disaster/emergency care.

It also changes Delaware’s statutory terminology from “physician assistant” to “physician associate,” specifying that the name change is not intended to alter existing rights/privileges, and updating multiple Delaware Code sections across Titles 14, 16, 18, 20, 21, 22, 26, and 29 so that “physician assistant” references function as “physician associate,” including in reimbursement, board composition, disability parking plate certification, and various healthcare-related definitions.

Key changes to the physician-assistant/physician-associate law include: (1) revising definitions and practice framework by shifting to a combined “physician assistant associate/physician associate” terminology and modifying collaboration standards (including consultation availability and electronic access concepts); (2) requiring written collaborative agreements kept on file and made available to the Board/Council on request; (3) prohibiting physician-associate practice without required oversight/collaboration except as otherwise provided; (4) setting limits/conditions on physician collaboration (including a cap on the number of physician assistants/associates a collaborating physician may collaborate with at any time, with an exception for those in the same physical office/facility building with active physician coverage); (5) creating/strengthening rules for independent practice for physician associates with more than 6,000 post-graduate clinical practice hours, including Council rulemaking to create application forms and processes depending on whether at least one Delaware licensed physician is present in the practice setting; and (6) adding a process for denial-waiver reapplication and for re-entry after inactive status, allowing a Board-issued “re-entry license” with potential additional practice/collaboration conditions.

The bill further provides: (a) participation authorization and billing/claims constraints for physician associates, including that physician associates must be authorized to bill and be identified as the rendering professional when appropriate, and prohibiting payers from imposing requirements more restrictive than Delaware law; (b) temporary licensing for individuals who meet qualifications but have not yet taken the national certifying examination (with license validity tied to examination results and rescission if the exam is not passed), restricting prescriptive practice/medical acts to the collaborating physician’s physical presence; (c) fee-setting authority for licensing/renewal via biennial fees; (d) prohibited acts and civil/criminal penalties for unlicensed practice or misrepresentation; and (e) disaster/emergency care rules that allow service without collaboration where feasible and provide liability protection for good-faith emergency care.

A final set of conforming changes updates numerous definitions and program eligibility lists to include “physician associate(s)” where “physician assistant(s)” previously appeared (including in concussion care definitions, presumption-of-capacity examiners, perinatal provider definitions, mobile-integrated healthcare/paramedicine lists, and pharmacist reimbursement cross-references). The bill takes effect immediately, with implementation tied to the earlier of (1) one year after enactment and (2) approval of enabling regulations by the Board upon submission from the Regulatory Council of Physician Associates.

AT A GLANCE

This bill authorizes attending physicians, licensed APRNs, or physician assistants acting under Title 24 to complete, sign, and return medical certifications of death within 48 hours when no official death investigation is required.

FULL SUMMARY

The bill makes changes to Delaware’s death-registration statutes to expand practitioner roles and adjust required procedures. In Title 16 (death registration), it allows an attending physician, an advanced practice registered nurse (APRN) acting under the specified Title 24 authority, or a physician assistant (PA) acting under the specified Title 24 authority to complete, sign, and return the medical certification within 48 hours when no official death investigation is required (or as soon as possible under the applicable subsections).

It also updates who may pronounce death under Title 16 by adding PAs as pronouncers of death (and retaining the listed physician, medical examiner, and APRN and medical control physician options under the cited cross-references). Further, it requires that all medical certifications of death electronically be prepared, certified, and signed by one of the designated individuals in the pronunciation subsections (cross-referenced within the same section), aligning the electronic preparation/signature requirement with the revised practitioner list.

In Title 24 (physician assistant regulation), the bill revises the scope of PA medical acts to expressly include pronouncing death and completing and signing a medical certification of death within PA practice and regulation. The included Synopsis in the bill text indicates that registered nurses are removed from the list of practitioners who may complete a medical certification of death, due to scope-of-practice conflict in Title 24, and that the bill also contains technical drafting conformance changes.

The Delaware Board of Medical Licensure and Discipline has approved a regulation change that replaces the term "supervision" with "collaboration" in the context of physician assistants working with physicians. This amendment clarifies the collaborative relationship between physicians and a maximum of four physician assistants, potentially impacting the operational dynamics within the healthcare industry.

The document outlines comprehensive regulations for medical licensure and practice in Delaware, detailing requirements for examinations, institutional certificates, and the renewal process for medical licenses. It emphasizes the necessity of continuing medical education for both physicians and physician assistants, as well as the importance of ethical conduct and compliance with established medical practices.

Additionally, the regulations address the responsibilities of healthcare providers in emergency medical services, including the delegation of medical tasks and the management of controlled substances. The guidelines also highlight the importance of maintaining accurate patient records and the need for ongoing monitoring of treatment effectiveness, particularly in pain management.

The document further specifies the requirements for Emergency Medical Technicians-Paramedics, including recertification criteria and the importance of maintaining current certifications in essential life support courses. It underscores the significance of adherence to ethical standards and regulatory compliance to ensure public health and safety in Delaware's healthcare system.

Overall, the regulations aim to enhance the quality of medical practice, promote collaboration among healthcare professionals, and ensure that practitioners are equipped to provide safe and effective care to patients.

The Delaware Board of Nursing has enacted regulatory changes that permit certified nurse midwives to conduct out-of-hospital births, including home births, and clarify return-to-practice requirements for Advanced Practice Registered Nurses (APRNs) who have been inactive for over five years. The amendments also increase the minimum number of supervised clinical hours required in APRN programs. Despite public notification and opportunities for comment, no feedback was received, and the Board determined that these changes would have minimal impact on the state's climate resilience.

The regulations establish standards for nursing education programs, emphasizing the necessity for adequate resources, qualified faculty, and systematic evaluation plans to ensure that graduates are prepared for safe nursing practice. Nursing education programs must adhere to specific approval statuses, submit annual reports, and comply with faculty-to-student ratios, curriculum standards, and student health requirements, including background checks.

Additionally, the document outlines the responsibilities of Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) regarding various infusion therapies, including chemotherapy and pain management. LPNs are authorized to perform specific tasks, while RNs have broader responsibilities. The scope of practice for APRNs is also detailed, highlighting their authority to perform a range of medical procedures and the educational requirements necessary for licensure.

Continuing education requirements for RNs and LPNs are mandated, with a specified number of contact hours required every biennium. Compliance with these educational standards is essential for maintaining licensure, and the Board of Nursing will conduct audits to ensure adherence. The document also emphasizes the duty of licensed nurses to report suspected violations of nursing regulations and introduces a Voluntary Treatment Option for professionals with chemical dependency.

Overall, the regulations aim to enhance the quality of nursing practice in Delaware, ensuring that nursing professionals are adequately trained and qualified to meet the demands of the healthcare industry while maintaining public safety and professional accountability.

The Delaware Board of Nursing is proposing significant revisions to its regulations, allowing certified nurse midwives to conduct out-of-hospital births, including home births. These changes also aim to clarify return-to-practice requirements for Advanced Practice Registered Nurses (APRNs) who have been inactive for over five years and to increase the minimum number of supervised clinical hours required in APRN programs. The revisions are expected to impact nursing education programs and practices involving certified nurse midwives, potentially influencing operational costs and training requirements.

The proposed regulations emphasize the importance of maintaining high standards in nursing education programs, including qualified faculty, rigorous admission processes, and a robust curriculum. Institutions will need to adhere to specific faculty-to-student ratios and ensure non-discriminatory admission policies while providing a minimum number of clinical experience hours for students. Compliance with these standards is essential for maintaining accreditation and may lead to increased operational costs.

Additionally, the document outlines the responsibilities and training requirements for unlicensed assistive personnel (UAP) and instructors involved in medication administration. UAPs must complete a core curriculum and demonstrate competency in medication administration, while instructors are required to have specific qualifications and ongoing training. These regulations are designed to enhance accountability and ensure safe medication practices within healthcare settings.

The licensure requirements for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in Delaware emphasize the importance of maintaining active practice hours and completing continuing education. The regulations aim to ensure the competency and qualifications of nursing professionals, which is crucial for delivering high-quality patient care. Renewal and reinstatement of APRN licensure require detailed documentation of practice hours and continuing education, underscoring the importance of compliance with continuing education standards.

Overall, the proposed changes and outlined regulations are intended to enhance the quality of nursing education and practice in Delaware, fostering a more competent and accountable healthcare environment. These revisions are likely to have significant implications for the nursing workforce, healthcare delivery, and educational institutions involved in training APRNs and RNs in the state.

The Delaware Board of Nursing has introduced amendments to its regulations to clarify eligibility for supervised practice plans, specify the types of abortions that Advanced Practice Registered Nurses (APRNs) may perform, and require nurses to keep the Board updated on their email addresses. These changes are not expected to significantly impact the state's climate resilience or greenhouse gas emissions.

The new regulations establish standards for nursing education programs, focusing on program approval, faculty qualifications, faculty-to-student ratios, and curriculum guidelines. The Board has the authority to approve or deny nursing programs based on their compliance with these standards, ensuring that nursing students receive adequate clinical experience and education.

Additionally, the regulations outline the qualifications and training requirements for Unlicensed Assistive Personnel (UAP) involved in medication administration, as well as the licensure requirements for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). These measures aim to enhance the quality of nursing education and practice, preparing nursing professionals to meet the evolving needs of healthcare.

The standards of nursing practice emphasize accountability for RNs and LPNs, detailing their responsibilities in patient care, medication dispensing, and intravascular therapy. The regulations are designed to improve patient safety and ensure that nursing practices align with established professional standards, ultimately impacting healthcare delivery in Delaware.

Furthermore, the guidelines stress the duty of nurses to report any violations of nursing regulations and provide a framework for supporting chemically dependent or impaired professionals through a Voluntary Treatment Option. This initiative aims to promote accountability and public safety within the nursing profession while maintaining public trust in the healthcare system.

AT A GLANCE

This proposed rule would require District of Columbia APRNs—including CRNAs, CNMs, CNPs, and CNSs—to meet updated nurse-licensure, practice, and controlled-substance-for-pain standards to renew and prescribe.

FULL SUMMARY

The rulemaking would establish updated District of Columbia nurse-licensure and practice regulations for four advanced practice registered nurse (APRN) professions—certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), certified nurse practitioners (CNPs), and clinical nurse specialists (CNSs). It specifies updated licensing eligibility and renewal conditions, practice standards and conduct requirements, and standards governing prescribing (including controlled substances for pain), professional title restrictions, student supervision, delegation, and discipline. It also updates or adds definitions used across the chapters, including delegation-related concepts and terms for nursing staff categories.

Across all four chapters, the document would (1) modify professional naming/title conventions and related “license vs. certificate” terminology; (2) clarify that required national certification is used to obtain and maintain the District APRN license; (3) revise scope-of-practice and standards-of-practice sections to add provisions tied to general prescription practice competency; (4) add new controlled-substance-for-pain standards; (5) revise delegation standards to formally incorporate national nursing delegation guidelines and impose continuing responsibilities on APRNs when delegating tasks; and (6) adjust or add definitions, including delegation and LGBTQ+ continuing education.

For CRNAs specifically, it would: require NBCRNA certification to obtain and maintain the District CRNA license; update the CRNA standards-of-conduct (including adoption references to the ANA Code of Ethics) and supersession rule over conflicting registered nurse standards; expand and reorganize authorized functions, explicitly include ordering/performing IV techniques, and expressly allow independent practitioner practice within Board-recognized standards; revise prescribing-controlled-substance requirements to use “CRNA” terminology and require both federal DEA registration and District controlled-substance registration; and add new Section 5711 establishing detailed standards for prescribing controlled substances for pain (legitimate medical purpose, documentation of unrelieved pain, patient evaluation and documented treatment plans, ongoing monitoring and reassessment, written agreements for high-risk patients, recordkeeping, and referral/consultation duties). It also would remove the specific permission to use the title “nurse anesthesiologist,” revise references to a repealed Act section, and update delegation and other administrative/procedural provisions including license reinstatement limits.

For CNMs, CNPs, and CNSs, parallel changes would apply: each chapter would update licensing/renewal structure; adopt updated ethics/practice conduct references; clarify independent practitioner status and authorized functions including diagnosis/prescribing within statutory/Board standards; add a new controlled-substances-for-pain section with substantially parallel requirements (patient evaluation, written objectives-driven treatment plans, ongoing monitoring and adjustments, written patient agreements when high risk, consult/referral requirements, and comprehensive recordkeeping); and revise delegation guidance to require APRN accountability and compliance with employer delegation policies not conflicting with APRN delegation rules. Comments are due within seven (7) days after publication in the District of Columbia Register (no later date is specified in the text provided).

AT A GLANCE

This bill requires licensure to practice naturopathic medicine and prohibits unlicensed persons from using protected titles or abbreviations, with misdemeanor penalties.

FULL SUMMARY

The bill revises Florida’s regulation of “naturopathy/naturopaths” by establishing a licensing framework for “naturopathic medicine” and creating a dedicated Board of Naturopathic Medicine within the Department of Health. It renames chapter 462 (currently “Naturopathy”) as “Naturopathic Medicine,” updates related definitions, and clarifies scope through new statutory sections addressing applicability/exceptions, core definitions (including what naturopathic medicine includes and excludes), and legislative intent to modernize regulation and remove a prior near-total prohibition.

Key regulatory changes include (1) revising the definition of “telehealth provider” under s. 456.47 to include licensed naturopathic doctors; (2) creating s. 462.001 (legislative findings and intent) and s. 462.002 (exceptions) that exempt certain regulated activities such as supervised students/residents, religious practice, and dietary supplement information, while also preserving limits on what non-licensed persons may say/do regarding protected titles; (3) creating s. 462.006 to require licensure to practice naturopathic medicine and to prohibit use of specified protected titles/abbreviations by unlicensed persons, with misdemeanor penalties; (4) creating s. 462.007 (licensure by examination) with minimum eligibility and education/training, moral character, background screening, and national exam requirements; and (5) creating s. 462.008 (licensure by endorsement), requiring the department to issue licenses when the board certifies endorsement eligibility.

The bill also establishes Board governance and rulemaking (s. 462.004) by creating a seven-member board appointed by the Governor (with Senate confirmation), including requirements for member qualifications and staggered terms. It requires rule adoption by the board and department to implement the chapter (including licensing procedures and disciplinary guidelines), and it relocates and restructures existing chapter provisions by renumbering multiple sections (including continuing education, renewal/reactivation of inactive licenses, and disciplinary grounds). It creates and amends continuing education and renewal provisions: naturopathic doctor licenses must be renewed biennially; renewal requires evidence of compliance with continuing education; continuing education must be at least 60 hours per biennial period with approval/discretion mechanisms for continuing education providers/substitute programs; and the licensee must use the Department of Health’s electronic continuing education tracking system. Reactivation of inactive licenses requires board rules with continuing education conditions not fewer than 20 classroom hours for each year the license was inactive.

Discipline and enforcement are reorganized: grounds for disciplinary action are renumbered and expanded/clarified, including detailed prohibitions (e.g., practicing outside scope, recordkeeping, advertising/solicitation misconduct, impairments, and improper drug prescribing/dispensing in prohibited circumstances). The bill repeals obsolete penalty provisions (repealing s. 462.17) and requires the board (rather than the department) to enter orders denying licensure or imposing discipline for specified violations, plus requiring board rulemaking for disciplinary guidelines. It also updates cross-references in other statutes to include “naturopathic medicine/naturopathy” where relevant (e.g., provisions defining “practitioners,” “licensed practitioner,” insurance risk apportionment “health care provider,” and criminal code-related definitions), and it updates the criminal punishment code’s offense severity chart to reflect the addition/renumbering of “practicing naturopathy/naturopathic medicine without a license” as a Level 7 offense. The bill takes effect December 31, 2026.

The document establishes a comprehensive regulatory framework for naturopaths in Florida, including the reestablishment of licensure, scope of practice, and disciplinary procedures. It creates the Board of Naturopathy within the Department of Health, detailing its composition, appointment process, and authority. Licensure requirements are specified, including eligibility criteria, titles, and restrictions on certain titles, while the scope of practice excludes medical procedures such as surgery, injections, and acupuncture, but permits prescribing specific nutritional products.

New infection control rules are introduced, requiring naturopaths to implement prevention and disposal measures for infectious materials, and existing statutes related to naturopathic practice are repealed or amended to clarify disciplinary grounds, obligations to observe health regulations, and prohibitions against prescribing controlled substances and engaging in unprofessional conduct. The regulations also specify that practicing without a license after revocation is unlawful, with provisions for license reinstatement after six months and penalties for fraudulent acts, including third-degree felonies.

Additionally, the document mandates that licensed naturopaths complete 25 hours of continuing education annually in naturopathy and medical nutrition therapy, including attendance at a two-day educational program conducted by the Florida Naturopathic Physicians Association, Inc., or an approved substitute. The Department is responsible for notifying licensees at least 30 days before May 1 of each even-numbered year and may grant exemptions during national emergencies or for other sufficient reasons. An effective date of January 1, 2027, is specified for these continuing education requirements.

The bill creates section 465.1894, Florida Statutes, authorizing pharmacists who meet specific qualifications—namely, postgraduate residency or three years of hospital patient care experience—to administer medications at Level I or II trauma centers under physician delegation during life-threatening emergencies. It requires trauma centers to retain documentation of pharmacists' qualifications. Additionally, the bill revises the definition of "practice of the profession of pharmacy" in section 465.003, Florida Statutes, to include the administration of vaccines, testing and treatment of minor health conditions, preparation of prepackaged drugs, ordering and evaluating laboratory tests, conducting patient assessments, and modifying or administering drugs under certain statutes. These amendments are incorporated into references concerning orthotics, pedorthics, and pharmacy benefit manager transparency through reenactments of sections 465.1901 and 626.8825(1)(r). The changes are effective July 1, 2026.

AT A GLANCE

This act requires PA and APRN formulary restrictions on controlled substances, including limiting Schedule II supplies and restricting psychiatric mental health controlled substances for children, while deleting PA prescribing-notice and labeling requirements.

FULL SUMMARY

The bill changes prescription-related requirements for physician assistants (PAs) and advanced practice registered nurses (APRNs) in Florida by revising statutory conditions for PA prescriptive authority and reformulating controlled-substance formulary rules for both PAs and APRNs. It also removes certain supervisory-physician administrative and prescribing-label requirements for PAs and adjusts formulary restrictions, including different treatment for psychiatric medications and psychiatric nurses.

For physician assistants, the bill revises the PA supervision and prescribing conditions in s. 458.347. It deletes the requirement that a supervising physician notify the Florida Department of Health in writing of delegation of prescribing authority to a PA, and deletes the requirement that the PA prescription include the supervising physician’s name. In the PA formulary provision (s. 458.347(4)(f)), it revises limits on Schedule II controlled substances, including an explicit distinction for Schedule II psychiatric/mental health controlled substances (allowing a longer supply under specified conditions) and adding a framework for the formulary’s establishment/adoption, consulting requirements, and the fee authority to fund formulary-related provisions.

For advanced practice registered nurses, the bill amends s. 464.012(6)(a) to revise the committee/formulary restrictions for controlled substances that APRNs may prescribe. The formulary must restrict psychiatric mental health controlled substances for children under 18 to a 30-day supply, except when prescribed by APRNs who are also psychiatric nurses under the referenced statutory definition. The formulary must also limit Schedule II controlled substances to a 7-day supply, except for psychiatric medications prescribed by psychiatric nurses under the same definition.

The act takes effect July 1, 2026.

The document revises the requirements and authorizations related to the autonomous practice and clinical privileges of certified registered nurse anesthetists. It permits certain nurse anesthetists to perform acts under established protocols approved by medical staff or governing boards, and allows them to engage in autonomous practice, particularly within primary care settings, under specific conditions outlined in s. 464.0123. Additionally, the scope of practice for autonomous advanced practice registered nurses in primary care and related roles is clarified. These changes expand autonomous practice authority for qualifying nurse anesthetists and specify practice scope for autonomous advanced practice registered nurses. The effective date of these provisions is July 1, 2026.

AT A GLANCE

This bill authorizes eligible pharmacists to administer medications during life-threatening emergency events at Level I, Level II, or pediatric trauma centers only if a physician delegates the act.

FULL SUMMARY

The bill creates a new Florida statute section, s. 465.1894, allowing—only during a life-threatening emergency event—eligible pharmacists to administer medications to a patient at a Level I, Level II, or pediatric trauma center, but only when delegated by a physician licensed under chapter 458 or 459.

Eligibility is limited to pharmacists who have either (a) completed an accredited postgraduate residency training program or (b) completed at least 3 years of direct patient care in a hospital setting. The new statute requires recordkeeping: any trauma center that permits physician delegation must maintain records under s. 395.0197(5), including documentation that the administering pharmacist meets the qualifications in s. 465.1894. The Board of Pharmacy must adopt rules to implement the new section.

The bill also amends s. 395.0197(1)(b) to add, as part of a licensed facility’s internal risk management program for Level I, Level II, and pediatric trauma centers, the development, implementation, and ongoing evaluation of procedures/protocols/systems to permit and comply with pharmacist administration of medications during life-threatening emergency events when delegation is allowed under s. 465.1894.

The act takes effect July 1, 2026.

The regulation amends section 464.0123 of the Florida Statutes to authorize certain advanced practice registered nurses, specifically psychiatric mental health advanced practice nurses, to engage in autonomous practice to provide mental health services. This change expands the scope of autonomous practice for these nurses, allowing them to deliver mental health services independently, as defined by board rule. The authorization is effective starting July 1, 2026, and is contingent upon nurses being registered under this section and certified as psychiatric mental health advanced practice nurses. Definitions of "autonomous practice" and "mental health services" are noted as necessary for understanding the scope of this change.

The document expands the scope of practice and autonomous authority for certain nursing professionals. Specifically, it revises the protocols and conditions under which certified registered nurse anesthetists (CRNAs) may perform acts independently, including their ability to administer anesthesia and related procedures under established protocols approved by medical staff or governing boards, or when practicing under s. 464.0123. Additionally, it broadens the responsibilities of advanced practice registered nurses (APRNs), including certified nurse midwives and CRNAs, by explicitly authorizing them to practice autonomously in primary care and other specified roles, as well as to admit, manage, and discharge patients in healthcare facilities and provide certain legal certifications. These changes are effective starting July 1, 2026, and include definitions for terms such as "autonomous practice registered nurses" and "established protocol" where necessary for clarity.

The document introduces new provisions allowing physician assistants to practice without physician supervision if they are registered with the relevant council and meet specific criteria. These criteria include holding an active, unencumbered license; having completed at least 3,000 clinical practice hours within the past five years; and not having recent disciplinary actions. Registration requirements are established, including demonstrating financial responsibility through liability insurance or a letter of credit. Physician assistants practicing without supervision are permitted to engage in primary care and perform certain patient management functions.

Additionally, the document sets forth detailed registration standards, including restrictions on issuing certain certifications and surgical procedures, and mandates biennial renewal of registration coinciding with licensure renewal periods. It requires the department to distinguish physician assistants' licenses in practitioner profiles and mandates that physician assistants provide written disclosures to patients regarding their qualifications and practice status. The rules authorize the council to adopt further regulations to implement these provisions and clarify that practicing under a supervisory agreement remains unaffected by these changes.

Definitions are clarified for terms such as "physician assistant" and "practitioner profile" where necessary to support the new practice standards and registration requirements. The effective date for these provisions is specified as July 1, 2026.

The legislation introduces new requirements for the publication of information regarding nursing education programs on the Florida Board of Nursing's website, including graduate passage rates and accreditation status. It establishes specific standards for graduate passage rates, requiring thresholds relative to national averages, and outlines procedures for programs that do not meet these standards, such as probation and remediation processes. Additionally, the bill creates a new section (s. 464.0125, F.S.) to specify criteria and conditions for issuing provisional nursing licenses, including application requirements, validity periods until full licensure, supervision obligations, and conditions under which provisional licenses may be voided. It also mandates that the Board of Nursing request the National Council of State Boards of Nursing to provide licensing exams and test preparation resources in Spanish by July 1, 2027. Definitions necessary for understanding these changes include "provisional license," "graduate passage rate," and "accredited nursing education program."

AT A GLANCE

This bill prohibits any person from practicing naturopathic medicine in Florida or using protected titles unless licensed under the new Chapter 462.

FULL SUMMARY

The bill redesignates Florida’s existing naturopathy chapter as “Naturopathic Medicine,” establishes legislative findings and purpose, and creates a new statutory structure for regulating naturopathic practice under Chapter 462. It creates an exceptions provision (e.g., certain licensed practitioners within scope, supervised students/residents, out-of-jurisdiction naturopathic doctors at board-approved continuing education, church religious practice, and domestic administration of recognized family remedies) and sets out a new definitions section, including a detailed definition of “naturopathic medicine” and express exclusions from that term (e.g., prescribing outside limited non-pharmacologic substances, performing surgery, and practicing/claiming to practice as various other licensed professions).

It creates the Board of Naturopathic Medicine within the Department of Health (seven Governor-appointed, Senate-confirmed members), with required composition (four licensed naturopathic doctors who are Florida residents, two Florida-resident physicians, and one Florida resident who has never been licensed in closely related professions; at least one member must be age 60+). It restructures rulemaking and board/department duties, and creates a “license required” prohibition: unless licensed under the chapter, a person may not practice naturopathic medicine in Florida or use protected titles/post-nominals (including “N.D.” and “N.M.D.”). The bill creates licensure by examination standards, including education credential requirements and a competency-based national examination passing score requirement, and requires the department and board to use an investigative process; it authorizes the State Surgeon General (or designee) to issue a 90-day licensure delay under specified circumstances and bars board certification for licensure when an applicant is under investigation in another jurisdiction for conduct that would violate the chapter or chapter 456.

It creates licensure renewal and continuing education requirements (biennial renewal; payment of a nonrefundable renewal fee capped at $1,000; at least 60 hours of continuing education per biennium), and requires use of the department’s electronic continuing education tracking system to demonstrate compliance. It creates standards for reactivating inactive licenses, including board rulemaking and a continuing education floor of at least 20 classroom hours per year inactive. It updates disciplinary grounds within the chapter’s grounds-for-discipline framework and repeals the obsolete “penalty for offenses relating to naturopathy” section (s. 462.17). The bill also revises related provisions across multiple health licensing and insurance statutes to conform to the new terminology “naturopathic medicine/naturopathy” (including Department of Health organizational references, disease reporting by practitioners, and exemptions/definitions in other chapters).

The act takes effect December 31, 2026.

The Florida Board of Medicine is proposing a revision to the application process for Physician Office Surgery Registration. This initiative aims to clarify existing rule text and may affect medical practices that conduct surgeries in office settings.

The proposed changes address the potential for disciplinary action even when a corrective action plan is in place. The rulemaking authority for this development is based on specific Florida Statutes.

A workshop for rule development may be scheduled if there is a written request and it is deemed necessary by the agency head. Interested parties can reach out to the Executive Director of the Board of Medicine for more information and to obtain a preliminary draft of the proposed rule.

Specific implementation dates for the changes have not been provided.

The document outlines the updated requirements for licensure as physician assistants in Florida, which significantly affect the healthcare industry, particularly in the training and employment of these professionals. Key changes include the introduction of specific application forms that applicants must use for various licensure processes, including standard licensure, licensure by endorsement, and temporary certificates for areas of critical need.

Additionally, there are new examination requirements for applicants who have not successfully passed the National Commission on Certification of Physician Assistants exam within five attempts. Such applicants must now complete a minimum of three months in a full-time review course at an accredited program approved by the Chair of the Council on Physician Assistants.

The regulations also impose supervision restrictions, stating that physician assistants cannot be supervised by physicians whose licenses are currently on probation. This measure aims to ensure a higher standard of oversight in the practice of physician assistants.

Furthermore, supervising physicians are required to notify the Department when they act as dispensing physician assistants, using a specified form. These changes are designed to enhance the licensure process and ensure the competency of physician assistants in Florida, with revisions taking effect in 2021 and 2025.

The document outlines the updated requirements for licensure as physician assistants in Florida, which significantly affect the healthcare industry and the training of these professionals. Key changes include the introduction of specific application forms that applicants must utilize for various licensure processes, including standard licensure, licensure by endorsement, and temporary certificates for areas of critical need.

Additionally, there are new examination requirements stipulating that applicants who have not successfully passed the National Commission on Certification of Physician Assistants exam within five attempts must complete a minimum of three months in a full-time review course at an accredited program. This aims to ensure that candidates are adequately prepared for certification.

To enhance patient safety, physician assistants are prohibited from being supervised by physicians whose licenses are currently on probation. This regulation is designed to uphold compliance with regulatory standards in medical practice.

Furthermore, supervising physicians are required to notify the Department when they are acting as dispensing physician assistants, using a designated form. These changes reflect a commitment to maintaining high standards in the licensure and practice of physician assistants in Florida, with some updates effective as recently as August 2025.

The Florida Department of Health is updating the Conrad 30 program, which pertains to foreign physicians seeking sponsorship. The proposed changes aim to clarify various aspects of the program, including eligibility criteria, application requirements, and sponsorship priorities.

While the specific financial impacts of these updates are not detailed, they may affect the operational procedures of healthcare facilities that employ foreign physicians. A rule development workshop may be scheduled if there is a written request and it is deemed necessary by the agency head.

For further information and access to the preliminary draft, interested parties can contact Keri Andersen Taggart. The effective date for these changes has not yet been specified.

The Florida Board of Pharmacy has received a petition from The Florida Pharmacy Association, Inc. regarding the administration of COVID-19 vaccines by pharmacists. Filed on September 19, 2025, the petition seeks clarification on whether Florida pharmacists are permitted to administer the current formulation of COVID-19 vaccines prior to their recommendation by the Centers for Disease Control and Prevention.

The outcome of this petition could significantly impact the pharmacy industry, particularly concerning vaccine administration practices. Stakeholders interested in participating in this matter are required to file their motions within 21 days of the notice's publication.

The Department of Health's Board of Osteopathic Medicine has announced a technical change to Rule 64B15-6.003, which governs the licensure of physician assistants. The updated requirements stipulate that all applicants must use the revised Form DH-MQA 2000, titled "Physician Assistant Application for Licensure," which was updated in December 2021. This form is available through designated online resources.

The changes to the rule do not introduce any new fees or monetary impacts related to the licensure process. The effective date for this technical change is August 26, 2025.

Additionally, the National Commission on Certification of Physician Assistants (NCCPA) has changed its address to 12000 Findley Road, Suite 200, Johns Creek, GA 30097.

For further inquiries regarding the proposed rule, individuals can contact Stephanie Webster, Executive Director of the Board of Osteopathic Medicine/MQA, at the provided address or via email.

The Department of Health's Board of Medicine in Florida has announced a technical change to Rule 64B8-30.003, which governs the licensure of physician assistants. This change involves the adoption of the revised Form DH-MQA 2000, titled "Physician Assistant Application for Licensure," which is required for all applicants seeking licensure under relevant Florida Statutes.

Additionally, the notice provides an updated address for the National Commission on Certification of Physician Assistants (NCCPA), now located at 12000 Findley Road, Suite 200, Johns Creek, GA 30097. This update may be relevant for physician assistants and healthcare providers needing to contact the NCCPA for certification.

The changes will take effect on August 26, 2025, and the rule has seen multiple amendments since its initial adoption in 1976. While the notice does not specify the monetary impacts of these changes, they may influence the costs associated with the licensure application process.

For further inquiries regarding the proposed rule, interested parties can contact Morgan Rexford, Executive Director of the Board of Medicine/MQA.

The document outlines the licensure requirements for physician assistants in Florida, emphasizing the impact on the healthcare industry, particularly for those involved in training and employing these professionals. Applicants must complete specific forms for licensure, including the standard licensure form, forms for licensure by endorsement, temporary licensure extensions, and temporary certificates in critical need areas, with various revision dates noted.

A key requirement for applicants is the examination mandate; those who have not passed the National Commission on Certification of Physician Assistants exam within five attempts must complete a minimum of three months in a full-time review course at an accredited program, which must be documented.

Additionally, there are supervision restrictions in place to ensure patient safety, as physician assistants cannot be supervised by physicians whose licenses are on probation. This measure aims to uphold a standard of care in practice.

Supervising physicians are also required to notify the Department when acting as dispensing physician assistants, using a specified form. These changes and requirements reflect a commitment to maintaining high standards in the licensure and practice of physician assistants in Florida.

The document outlines the licensure requirements for physician assistants in Florida, which significantly impact the healthcare industry, particularly in the training and employment of these professionals. Applicants must utilize specific forms for licensure, including the standard licensure form DH-MQA 2000, the endorsement form DH-MQA-5103, the temporary license extension form DH-MQA 1076, and the temporary certificate form DH-MQA 5088 for critical need areas.

Examination requirements stipulate that applicants who have not passed the National Commission on Certification of Physician Assistants exam within five attempts must complete a minimum of three months in a full-time review course at an accredited program, with documentation required. Additionally, physician assistants cannot be supervised by physicians whose licenses are on probation, which may influence staffing and operational practices in healthcare facilities.

Supervising physicians are also required to notify the Department when acting as dispensing physician assistants, following specific regulatory forms. These changes aim to enhance the competency and regulatory compliance of physician assistants, potentially leading to increased operational costs for healthcare providers due to the necessity for additional training and compliance measures. The document specifies effective dates for certain forms and requirements as 12/2024 and 06/2024.

The Florida Board of Nursing has received a petition from Laurie Forrest, RN, BSN, seeking clarification on the scope of practice for Registered Nurses in Florida. The petition, submitted on June 18, 2025, specifically inquires whether a Registered Nurse can be delegated the task of administering botulinum toxin and dermal fillers by a licensed physician.

The petition encompasses several responsibilities, including conducting patient exams, writing orders for the substances, obtaining informed consent, and performing the administration of the medications. The outcome of this petition could have significant implications for the healthcare and cosmetic industries, particularly in the realm of aesthetic procedures.

Interested parties are invited to file motions for leave to intervene within 21 days of the publication of this notice. A copy of the petition is available upon request from the Board of Nursing.

The Board of Nursing has received a petition for a declaratory statement from a registered nurse regarding the applicability of Section 464.003, F.S. The petition, submitted on June 9, 2025, seeks clarification on whether Florida registered nurses specializing in vascular access are permitted to perform arterial and central venous catheter (CVC) placements.

The outcome of this petition may have significant implications for the nursing industry, particularly for those involved in vascular access procedures. Interested parties are invited to file motions for leave to intervene within 21 days from the publication of this notice.

A copy of the petition is available from the Board of Nursing's Executive Director.

The Board of Nursing has received a petition for a declaratory statement from Constance Girgenti concerning the applicability of Section 464.003, F.S., to the practice of highly skilled nurses specializing in vascular access. The petition seeks clarification on whether these nurses are permitted to perform arterial and central venous catheter (CVC) placements in Florida.

The notice accompanying the petition indicates that motions for leave to intervene must be filed within 21 days of publication. The petition was submitted on April 21, 2025, and it primarily affects the healthcare and nursing industries, particularly those involved in vascular access procedures.

While the petition raises important questions regarding nursing practices, specific monetary impacts related to this issue are not detailed in the text.

The Florida Board of Nursing has received a petition from a registered nurse seeking clarification on the scope of practice regarding the administration of botulinum toxin and dermal fillers. Submitted on April 1, 2025, the petition questions whether a Florida Registered Nurse can be delegated the task of medication administration by a licensed physician after conducting an initial comprehensive intake and examination for clients.

The petition emphasizes the importance of obtaining informed consent from the patient, the nurse, and the ordering provider before proceeding with the administration of these cosmetic treatments. This inquiry is particularly relevant to the healthcare and cosmetic services industries, especially those focused on aesthetic treatments.

While the potential monetary impacts of this clarification are not specified, the outcome may influence operational practices and revenue within these sectors. Interested parties have 21 days from the publication of this notice to file motions for leave to intervene, and a copy of the petition can be requested from the Board of Nursing.

The Board of Nursing has received a petition for a declaratory statement from Chrysanthos Darios, DC, MSN, APRN, FNP-BC, on May 22, 2025. The petition seeks clarification on whether a Florida registered nurse can perform ear acupuncture under the supervision of a licensed medical practitioner who assesses the patient and prescribes the treatment.

This inquiry may have implications for the nursing and healthcare industries, particularly in the areas of alternative therapies and acupuncture practices. The notice indicates that motions for leave to intervene must be filed within 21 days of publication.

While the petition raises important questions regarding nursing practices, no specific monetary impacts or changes in practice are detailed in the text. A copy of the petition is available from the Board of Nursing.

The document outlines the requirements for physician office surgery registration, inspection, and accreditation, specifically targeting healthcare facilities that perform surgical procedures such as liposuction. Offices must register with the Department of Health unless they are already licensed under specific chapters of Florida Statutes. This registration process includes submitting a designated form and paying a registration fee.

Before registration, a pre-registration inspection is mandatory, requiring offices to submit an application and supporting documentation. If any deficiencies are identified during the inspection, the responsible physician has 30 days to provide a corrective action plan to avoid registration denial.

Each registered office must have a designated physician accountable for compliance with health and safety standards. Physicians are required to inform the Board within ten days of any changes in their practice status and must meet financial responsibility criteria.

Offices that are not accredited by recognized agencies must undergo annual inspections, while those with current accreditation can submit their surveys to bypass these inspections. Any changes in accreditation status must be reported to the Department.

The regulation is subject to review every five years, allowing for potential updates or modifications. Overall, the aim is to enhance compliance and safety in surgical practices, which may affect operational costs for healthcare providers due to associated fees and inspection expenses.

The Florida Board of Nursing has denied a petition for a declaratory statement regarding the delegation of Botox Cosmetic medication administration from a licensed physician to a registered nurse. This decision was made during a public meeting on October 24, 2024, due to the petitioner's failure to provide specific parameters necessary for compliance with the relevant statute.

The Board clarified that a registered nurse's ability to administer Botox is contingent upon certain conditions. These include the requirement for the physician to be physically present during the procedure and to have conducted a physical examination of the patient prior to administration.

The Board's Final Order on this matter was filed on January 27, 2025. This decision has implications for the healthcare industry, particularly in nursing and cosmetic procedures, although it does not indicate any direct financial impacts.

The document outlines the regulations governing graduate assistant physicians, emphasizing the requirements for their limited license and the necessary supervision. A key provision is the requirement for a written protocol that details the duties, responsibilities, and supervision structure for these physicians. This protocol must accompany the application for licensure and includes guidelines on clinical supervision, task delegation, patient care, prescriptive authority, documentation, and ethical behavior.

Supervision of graduate assistant physicians mandates the physical presence of a supervising physician, who is limited to overseeing no more than two graduate assistant physicians simultaneously. The supervising physician must hold a valid license under Chapter 458, F.S., and be in good standing. Any changes to the protocol must be reported to the Board within ten days, and both the supervisor and the graduate assistant are required to keep copies of the original protocol and any modifications.

The new regulations are set to take effect on November 14, 2024, impacting the healthcare and medical education sectors, particularly those involved in the training and supervision of graduate assistant physicians. While specific monetary impacts are not detailed, the regulations may affect operational costs for healthcare facilities employing these physicians, as well as costs related to compliance and supervision.

The document outlines the requirements for obtaining a limited license as a graduate assistant physician in Florida, effective November 14, 2024. A key provision is the necessity for a written protocol between the graduate assistant physician and a supervising physician. This protocol must detail aspects such as clinical supervision, delegation of tasks, patient care guidelines, prescriptive authority, documentation, and communication standards.

The regulations are expected to significantly impact the healthcare industry, particularly in the field of osteopathic medicine, as they govern the practice and supervision of graduate assistant physicians. The protocol must be submitted with the application for licensure, and supervising physicians are limited to overseeing no more than two graduate assistant physicians at a time.

While the document does not explicitly detail monetary impacts, the requirements for protocols and supervision may lead to increased administrative costs for healthcare facilities employing graduate assistant physicians. Additionally, compliance with these regulations may necessitate changes in operational practices within medical practices and training programs.

Overall, the changes aim to enhance the quality of care provided by graduate assistant physicians while ensuring proper oversight and adherence to ethical standards in patient care.

The document outlines the supervision and reporting requirements for physicians licensed in the United States, with a particular focus on the responsibilities of the full-time director of the county health department or a licensed physician approved by the board. The director is tasked with supervising any limited licensee unless a different physician has been specifically approved by the board.

Supervising physicians must be approved and adhere to Rule 64B8-4.025, F.A.C., unless otherwise specified by the Board or its designee. The rulemaking authority is based on sections 458.309 and 458.317 of the Florida Statutes, with the law implemented under section 458.317 F.S.

The history of the rule includes its establishment on March 31, 1980, and subsequent amendments on March 9, 1987, November 11, 2015, October 29, 2019, and a scheduled amendment on October 31, 2024.

The impacted business industries primarily include healthcare and medical services, especially those involving limited licensees and county health departments. However, specific monetary impacts are not detailed in the document.

The Board of Medicine has proposed an amendment to the licensure process for Physician Assistants, which includes the introduction of a Temporary Certificate for those practicing in Areas of Critical Need. This change is not anticipated to negatively impact small businesses or result in regulatory costs exceeding $200,000 within the first year of implementation.

The Board has determined that the rule change will not affect existing licensees, their businesses, or their employers. It will not lead to increased fees, business costs, or personnel expenses, nor will it diminish profit opportunities or necessitate specialized knowledge for compliance.

A Statement of Estimated Regulatory Costs (SERC) was considered unnecessary for this amendment, and there is no requirement for legislative ratification. Interested parties have a 21-day window from the notice date to provide input on estimated regulatory costs or suggest lower-cost alternatives.

The proposed rule was approved by the Board of Medicine on June 7, 2024, and the notice of proposed rule development was published in the Florida Administrative Register on July 26, 2024.

AT A GLANCE

This bill authorizes pharmacists to dispense and administer long-acting injectable PrEP or PEP for qualified patients only after completing a State Board–approved training program and meeting specified CDC-based screening and documentation requirements.

FULL SUMMARY

The bill adds a new pharmacy authorization pathway for HIV prevention drugs by creating Code Section 26-4-120. It authorizes pharmacists to issue PEP (postexposure prophylaxis) or PrEP (preexposure prophylaxis) orders and to dispense and administer PrEP/PEP products under specified conditions and pursuant to a PEP/PrEP protocol agreement involving a physician (referenced to newly created Code Section 43-34-26.2).

The new 26-4-120 requires pharmacists to complete a State Board of Pharmacy–approved training program on use of PrEP/PEP before dispensing or administering these drugs; the program must be accredited/approved as specified and approved no later than January 1, 2027. Pharmacists may dispense at least a 30-day supply and up to a 90-day supply (and may administer a long-acting injectable PrEP) only when patient and documentation conditions are met, including: the patient is HIV negative using acceptable recent HIV test documentation (or the pharmacist may order/administer a CLIA-waived HIV test if documentation is not provided, with results verified/sent to the pharmacist); the patient does not report contraindicated medications; pharmacist documentation in pharmacy record systems; dispensing to a single patient aligned with CDC clinical practice guidelines (or other direction by a licensed practitioner); and notification of the patient’s primary care provider (or, if none/refused consent, a list of providers for follow-up). For PEP, pharmacists may dispense a 30-day supply only after screening confirms clinical criteria under CDC guidelines and after primary care provider notification or provision of follow-up contact information.

Separately, the bill creates Code Section 43-34-26.2 governing physician-pharmacist protocol agreements for long-acting injectable PEP/PrEP. It defines key terms (including PEP/PrEP and the “PEP or PrEP protocol agreement” and “PEP or PrEP order”), authorizes a physician to prescribe long-acting injectable PEP/PrEP for a group of patients via a protocol agreement to be administered by a pharmacist, and requires the protocol agreement to include multiple operational safeguards (physician/pharmacist identifying details; immediate consultation provisions; case history and contraindication screening; recipient education; written Department of Public Health–developed information encouraging primary care; dose administration documentation requirements; adverse event follow-up procedures; privacy requirements for administration; patient observation after injection; and specific liability insurance coverage minimums of $250,000). The protocol must also be renewed/updated biennially or expire, and it must include pharmacist affidavit and location information for submission to and public availability by the State Board of Pharmacy; the Board must also create and make available an approved standard protocol template.

The bill establishes limits and compliance consequences: a pharmacist in a protocol agreement may not delegate administration to anyone other than a pharmacy intern or qualified pharmacy technician under specified supervision/approval conditions; physicians are barred from entering such agreements with more than ten pharmacists at a time and it is unlawful for certain physician–employment relationships to delegate to employed pharmacists; the protocol provisions do not apply to administration by hospitals/selected facilities. The State Board of Pharmacy may impose fines and/or prohibit administration for specified failures to comply with training-related documentation/insurance/affidavit posting or submission duties under the new 43-34-26.2, with sanctions ranging up to $5,000 fines and administration prohibitions for periods up to one year depending on the specific paragraph not followed. The bill also includes a general repeal of conflicting laws.

AT A GLANCE

This bill authorizes podiatric physicians to delegate to physician assistants podiatric prescribing, controlled-substance formularies, and related document-signing only through board-approved job descriptions.

FULL SUMMARY

The bill expands Georgia’s physician assistant (PA) practice framework to allow podiatric physicians to delegate specified podiatric and pharmaceutical-related authorities to PAs, and it correspondingly authorizes PAs to receive delegated authority from podiatric physicians. It adds new/clarified definitions for “alternate supervising podiatric physician,” “primary supervising podiatric physician,” and other related terminology within the PA statutes (Title 43, Chapter 34).

For PAs, the bill revises the licensure/utilization approval process to incorporate podiatry supervision alongside physician supervision. It requires that PAs have a signed, board-approved job description at all times while providing patient services. It also adds podiatry-related regulatory linkage by authorizing podiatric physicians (via the State Board of Podiatry Examiners) to submit new or amended job descriptions and to obtain approval for PA utilization, and it extends existing mechanisms for alternate supervision and automatic approval in certain job-description change scenarios.

The bill significantly changes PA delegated authority over prescription-related functions. It authorizes physician/podiatric physician delegation (in a job description) for PAs to issue orders for prescription drugs and devices, and it specifies additional limits for hydrocodone/oxycodone and certain controlled substances (including emergency authorization conditions, age restrictions, evaluation requirements, and limits on initial supply). It also requires periodic evaluation of patients receiving controlled substances (at least every three months), establishes recordkeeping and form-content requirements for PA prescription/device orders, adds continuing-education requirements for prescriptive authority (including an added hour for hydrocodone/oxycodone delegation), and clarifies limits such as refill duration and that authority must be contained in the job description.

On the podiatry side, the bill amends podiatry definitions and adds new authorities to the podiatry practice chapter. It creates a new section (43-35-3.1) allowing podiatric physicians to delegate to PAs: (1) authority to order a formulary of controlled substances (selected by the board) and to order dangerous drugs, podiatric treatments, and diagnostic studies; (2) authority to request/receive/sign for professional samples and to distribute professional samples, with recordkeeping/list-maintenance requirements; and (3) authority to sign/certify/endorse specified documents related to podiatric healthcare within the PA’s scope. It provides conditions under which PAs may dispense dangerous drugs through specified exempt or outpatient-clinic settings and requires board-approved job descriptions. The bill also adds a new effectiveness provision stating that podiatric physicians’ authority to delegate to PAs does not become effective until the Georgia Composite Medical Board has licensed persons under the PA licensure requirements, and it repeals conflicting laws.

AT A GLANCE

This bill adds puberty-blocking medications to the prohibited gender-dysphoria therapies for minors under state law and bars state funds and state facilities or providers from covering gender-affirming care.

FULL SUMMARY

The document establishes new restrictions on state funding and state-provided health coverage/facility services related to gender-affirming care, and it expands an existing restriction on certain gender dysphoria treatment methods for minors.

Specifically, it changes Code Sections 31-7-3.5 and 43-34-15 (both relating to treatment of minors for gender dysphoria, including prohibited therapies and enforcement). The change is targeted: in paragraph (2) of subsection (a) of each listed Code section, the bill inserts the phrase “or puberty blocking medications” after “therapies,” thereby adding puberty-blocking medications to the category of prohibited items under those provisions.

It also adds a new Code section, 50-1-14, within Chapter 1 of Title 50 (general provisions relative to state government). Under this new section: (a) no state funds may be expended for health benefits coverage that includes coverage for gender-affirming care as provided for in Code Section 45-18-4; (b) no state-owned or -operated healthcare facility and no physician or other healthcare provider employed by a state agency/entity may provide gender-affirming care as provided for in Code Section 45-18-4.

The new 50-1-14 includes two express limitations preserving separate, non-state funding and non-state coverage options: (1) it allows individuals/entities/local governments to purchase separate coverage including gender-affirming care, if paid entirely with funds not authorized or appropriated by the state; and (2) it does not restrict non-state health benefits coverage providers from offering such coverage or local governments from contracting separately with such providers, so long as the coverage is paid entirely with non-state-authorized/appropriated funds.

AT A GLANCE

This bill authorizes qualified APRNs and PAs in Georgia to issue limited initial prescriptions for hydrocodone or oxycodone and stimulant medications under nurse-protocol or job-description terms requiring direct patient evaluation and specified continuing education.

FULL SUMMARY

The bill makes targeted changes to Georgia’s laws governing prescription authority by advanced practice registered nurses (APRNs) and physician assistants (PAs), expanding who may issue certain prescriptions under protocol/job-description limits and adding specific definitions and continuing-education requirements.

For APRNs under Code Section 43-34-25, it adds definitions for “controlled substance” scope (excluding Schedule I and certain Schedule II substances except as authorized) and defines “stimulant.” It also creates new prescription authority for APRNs under nurse protocol agreements: (1) in emergency situations, an APRN with at least one year post-licensure clinical experience and in good standing may issue an initial, up to five-day prescription for hydrocodone, oxycodone, or compounds, for patients age 18 or older, if the authorization is included in the nurse protocol, the APRN directly evaluated the patient, and the APRN completes one hour of biennial continuing education in ordering and use of those opioids/compounds; and (2) an APRN may issue prescription drug orders for stimulants under similar protocol conditions, if the APRN directly evaluated the patient and completes one additional hour of biennial continuing education in ordering and use of stimulants. The bill revises emergency-medical-services limitations for APRNs operating in systems with a full-time physician medical director who does not order drugs, generally allowing up to a 14-day supply in emergency situations but with exclusions/limitations tied to benzodiazepines and controlled substances (allowing only hydrocodone/oxycodone/compounds among otherwise excluded Schedule II controlled substances), and it preserves prohibitions on ordering radiographic imaging/diagnostic studies/medical devices under that emergency paragraph. It also clarifies that APRNs cannot issue Schedule I or II controlled substances except as authorized under the newly created emergency/hydrocodone-oxycodone and stimulant provisions, and it maintains limits on prescription refills beyond 12 months except for specified categories.

For PAs under Code Section 43-34-103, the bill revises the delegation framework by adding (i) explicit authorization conditions for emergency hydrocodone/oxycodone delegation to qualifying PAs (at least one year post-licensure clinical experience, in good standing, authorization specifically included in the job description, direct patient evaluation, initial prescription limited to five-day supply, and patient age 18 or older); (ii) authorization for issuing prescriptions for stimulants under similar eligibility/job-description/direct-evaluation requirements; and (iii) continuing education requirements for PAs with delegated authority to issue prescription drug or device orders: a minimum of three hours biennially in practice-specific pharmaceuticals relevant to the PA’s prescriptive privileges, plus one additional hour biennially for those delegated to prescribe stimulants and/or hydrocodone/oxycodone/compounds.

Finally, the bill includes a conflict-repealer clause stating that all laws and parts of laws in conflict with the Act are repealed.

AT A GLANCE

This bill permits out-of-state chiropractic physicians in good standing to temporarily practice in Georgia for a specific sports or performing arts event, limited to authorized team or event members and the designated venue.

FULL SUMMARY

The bill revises Georgia’s chiropractic statutes to update terminology from “chiropractor” to “chiropractic physician,” including related conforming changes across the Title 43 chiropractic chapter. It expands an exemption for out-of-state licensed “chiropractic” practitioners by allowing those in good standing to practice temporarily in Georgia for a specific sports or performing arts event, limited to the team’s or event’s members, coaches, and staff, and limited to the designated venue. It also clarifies that an out-of-state practitioner may use only practices and procedures authorized under Georgia law and approved by Board rule, and it preserves an allowance for assistants to help under direct order and supervision of a licensed doctor of chiropractic who is physically present.

Within the chiropractic scope-of-practice provision, the bill changes the wording to “chiropractic physicians” and revises terminology while keeping the substantive framework that chiropractic physicians may evaluate, diagnose, and adjust patients for spinal subluxations/adjust articulations, while observing public health regulations. The section continues to define allowed chiropractic adjustments (including manual and electrical/mechanical traction or vibration devices) and lists permissible modalities and therapeutic procedures. It retains limits on using chiropractic methods outside the scope set in the chapter and maintains prohibitions on prescribing/administering medicine, performing surgery, practicing obstetrics or osteopathy, and using invasive techniques (with an explicit carve-out allowing those licensed to perform acupuncture under another specified article to engage in acupuncture). It also updates the title-usage language, allowing only specified titles (including “chiropractic physician” and “D.C.”), and keeps requirements related to reasonable care/skill and standard-of-care when chiropractic physicians perform acts that are also standard medical procedures.

The bill updates penalties and enforcement language by revising the felony provision to cover practicing chiropractic without a license and to include prohibition on using the listed titles (with “chiropractic physician” replacing “chiropractor” in the enumerated title list). It further updates multiple provisions across the Official Code where “chiropractor(s)” terms appear, replacing them with “chiropractic physician(s).” Key substantive change outside Title 43: Title 14’s professional corporation statute is revised to allow chiropractic physicians practicing within their lawful scope to jointly organize and jointly own a professional corporation with physicians practicing within their lawful scope, while continuing to prohibit chiropractic physicians from attaching the title “physician” to their names or the corporation name.

The bill also makes conforming updates in Title 45 regarding subpoenas and confidentiality of records in coroner/medical examiner investigations, replacing references to “chiropractors’ offices” with “chiropractic physicians’ offices.” The act becomes effective upon the Governor’s approval or when it otherwise becomes law without approval, and it repeals conflicting laws.

The bill establishes expanded nurse and physician assistant prescriptive authorities in Georgia—specifically for emergency situations involving stimulants, hydrocodone, and oxycodone—by defining “stimulant,” adjusting required training, and increasing the maximum initial prescription supply from five days to 30 days. It also removes the prior prohibition that limited certain prescribing authority for minors, expands what advanced practice registered nurses and physician assistants may order in specified circumstances, and updates continuing-education requirements.

Operative statutory changes are made to Georgia Code provisions governing (1) delegation of medical acts to advanced practice registered nurses and issuance of prescription drug orders (Code Section 43-34-25) and (2) delegation of authority to physician assistants to issue prescription drug/device orders (Code Section 43-34-103). The bill further includes a repeal clause for conflicting laws.

The Georgia Composite Medical Board is proposing amendments to its rules regarding Nurse Protocol Agreements, focusing on the definitions and requirements for Advanced Practice Registered Nurses (APRNs) and their delegating physicians. These amendments aim to clarify existing regulations and align them with recent legislative changes, particularly concerning controlled substances and the ratios of physicians to APRNs.

The proposed changes will impact healthcare providers employing APRNs, as they will need to adapt to the updated requirements for nurse protocol agreements. Key provisions include the delegation of authority for APRNs to prescribe medications and the necessity for immediate consultation with delegating physicians. Additionally, the amendments will address documentation requirements and the training and continuing education necessary for APRNs.

Physicians will be required to maintain detailed records and review patient records, especially for those receiving controlled substances. The amendments also stipulate limitations on the number of APRNs a physician can delegate to and the need for prior approval for physicians with restricted medical licenses.

The public hearing for these proposed amendments is scheduled for May 8, 2025, with written comments due by May 1, 2025. The amendments are set to take effect following the public hearing and subsequent Board consideration, with specific legislative changes referenced as effective from July 1, 2024, and May 1, 2024.

Overall, the proposed amendments seek to enhance the regulatory framework governing nurse protocol agreements, ensuring that APRNs operate within clearly defined guidelines while maintaining patient safety and care standards.

AT A GLANCE

This bill establishes a three-year SHPDA-administered pilot allowing qualifying licensed clinical psychologists to prescribe psychotropic medications for eligible patients at specified federally qualified health centers under physician supervision.

FULL SUMMARY

The bill establishes a three-year pilot program administered by the State Health Planning and Development Agency (SHPDA) in partnership with the Board of Psychology that allows licensed clinical psychologists to prescribe psychotropic medications for patients ages 18–65 who are receiving care from the psychologist at a federally qualified health center located in either Kauai County or Hawaii County. Prescriptions under the pilot are eligible for Medicaid reimbursement to the extent they would be eligible if prescribed by a physician or psychiatrist. The pilot is limited to psychologists who meet licensure requirements, complete board-approved APA training for prescriptive practice, pass a Psychopharmacology Examination for Psychologists (or an equivalent board-approved national exam), and are employed (including as a contract provider) by a qualifying federally qualified health center in Kauai or Hawaii County, plus any additional Board of Psychology requirements.

The Board of Psychology must adopt implementing rules under chapter 91, and the pilot program permits participating psychologists to prescribe only under supervision by a supervising physician or psychiatrist who accepts professional responsibility for the provision of psychopharmacology. SHPDA must submit a report to the Legislature no later than 20 days prior to the convening of the regular session of 2029, with findings and recommendations, including whether to expand to other underserved areas, make prescriptive authority for qualified psychologists permanent statewide, or permanently end the pilot. The bill also defines key terms including “prescriptive authority,” “psychopharmacology,” “psychotropic medication” (agents related to diagnosis and treatment of mental/emotional disorders, including controlled substances, but not narcotics), and “supervising physician or psychiatrist.”

The bill changes Hawaii’s controlled-substance framework by amending Section 329-1, Hawaii Revised Statutes: it adds a definition of “psychologist certified to prescribe” limited to persons approved by the Board of Psychology to participate in the 2026 pilot program, but who are not authorized to request, receive, or sign for professional controlled substance samples. It also amends the definition of “practitioner” to include a “licensed psychologist certified to prescribe” who is registered under Section 329-32 and authorized to prescribe and dispense controlled substances in accordance with the pilot program’s requirements and limitations, and otherwise retains the existing categories of practitioners described in the statute.

The bill amends Hawaii’s birth-certificate update statute (HRS §338-17.7) by expanding the class of health care providers who may submit an affidavit supporting issuance of a new birth certificate for certain “birth registrants” undergoing gender transition.

Specifically, in HRS §338-17.7(a)(4), the provider categories allowed to attest are broadened to include advanced practice registered nurses. The existing affidavit pathway for a U.S. licensed physician or physician assistant is modified so that advanced practice registered nurse may provide the required attestation regarding (A) a bona fide provider-patient relationship with the birth registrant, (B) treatment/evaluation of the birth registrant and review/evaluation of the birth registrant’s medical history, (C) appropriate clinical treatment for gender transition, and (D) the new gender not aligning with the sex designation on the birth registrant’s birth certificate.

The bill also includes an effective date provision: it takes effect on July 1, 3000. On the basis of the visible legislative text, the document creates a change to an existing statute by revising the wording of HRS §338-17.7(a).

AT A GLANCE

This bill establishes the Physician Assistant Licensure Compact in Hawaii and authorizes the Governor to enter into the compact with other states that legally join.

FULL SUMMARY

The bill establishes the Physician Assistant Licensure Compact (PA Licensure Compact) as a new chapter in the Hawaii Revised Statutes and authorizes the Governor to enter into the compact with other states that legally join. It sets key compact rules, including that the practice/delivery of medical services by a physician assistant (PA) occurs where the patient is located at the time of the encounter, requiring PA practice authority to be under the jurisdiction of the state where the patient is located.

The compact framework created in the bill allows PAs to obtain a “compact privilege” in remote participating states through mutual recognition of an unrestricted “qualifying license” held in a participating state. To participate, a state must (among other requirements) license PAs, participate in the compact data system, have complaint and investigation mechanisms, report adverse actions and “significant investigative information” to the Commission, fully implement criminal background check requirements on a Commission schedule, comply with Commission rules, use a recognized national exam as a licensure requirement, and grant compact privileges to qualifying license holders. Exercising the compact privilege requires meeting specific eligibility conditions (including graduation from an accredited program, holding current NCCPA certification, no felony/misdemeanor convictions, no history of suspension/revocation of controlled substance authorizations, holding a qualifying license, and maintaining conditions after adverse actions), and includes special requirements for prescribing controlled substances and for remote-state jurisprudence requirements.

The bill also creates the PA Licensure Compact Commission as a national administrative body for participating states, including its governance (delegates, voting, meetings), core powers and duties (including adopting rules binding on participating states), and enforcement/oversight mechanisms (default, dispute resolution, legal action authority, and termination/withdrawal processes). It requires development and use of a coordinated data system for licensure and adverse action reporting, including reporting of significant investigative information to participating states, and provides confidentiality limits and procedures for removal/expungement of information. For Hawaii implementation, the bill restricts public funding of annual compact assessments absent legislative appropriation, provides state approach to indemnification funding (Commission funds most indemnity obligations), conditions arbitration participation on appropriated funds, and subjects arbitration decisions involving the State to judicial review under applicable state law.

The bill appropriates $75,000 for fiscal year 2026–2027 to the Department of Commerce and Consumer Affairs for upgrades to its professional and vocational licensing division internal database. Effective timing is staged: Section 1 (the compact chapter and its Hawaii implementation provisions) takes effect January 1, 2027, while the remainder of the Act takes effect July 1, 2050.

AT A GLANCE

This act defines “qualified health care provider” statewide and replaces narrower physician-based references in specified Hawaii statutes with the broader category for provider eligibility, authorizations, testing, reporting, and related duties.

FULL SUMMARY

The bill creates a standardized, broad definition of “qualified health care provider” to be used across multiple areas of Hawaii law, and then systematically replaces narrower references (often “physician,” “licensed physician,” or similar terms) with that broader category where appropriate. A “qualified health care provider” is defined as a person with a current, active license or certification issued under Title 19 or Title 25 whose scope of practice, as authorized by applicable law and rules, authorizes the person to provide health care services.

It also makes numerous conforming and substantive changes by updating specific statutory provisions to: (1) substitute “qualified health care provider” for specified provider types (including where definitions or duties previously referenced physicians/other narrower roles); (2) expand who may perform or be involved in specified health-related processes (e.g., adding qualified providers to authorizations, certifications, affidavits, referrals, examinations, testing, and administrative reporting in contexts such as elections, blood draws in DUI-related testing, school immunization documentation, medical record access, trauma-exposure photograph duties, and many other statutes covering health care and related professions); and (3) standardize language in definitions of health-care-related terms used in insurance, probate, minors, child protective proceedings, penal provisions, and other “professional practice” settings. Specific examples visible in the text include replacing physician requirements with qualified provider requirements for certain eligibility determinations or certifications, expanding the class of providers who may order or be involved in health testing and medical determinations, and ensuring that references in scope-of-practice-adjacent areas (education, insurance utilization management, corrections, and criminal sentencing/probation conditions) use the unified terminology.

The bill further includes several policy-specific updates beyond terminology standardization: it updates Hawaii’s “pain patient’s bill of rights” to redefine “prescriber” and adjust related provisions (Part VI); modifies insurance-related coverage references to allow services within the lawful scope of more provider types by using “qualified health care provider” in the relevant benefit/coverage standards and notices (Part VII); and amends Uniform Probate Code provisions to use qualified health care providers in determinations involving capacity and guardianship evaluations. In addition, it repeals an obsolete program/chapter (Hawaii Health Corps; Part IX includes repeal of Chapter 309H).

Effective dates are set: the act generally takes effect on January 30, 2050, while Sections 2 through 197 take effect on July 1, 2028. Several specified health-care-related sections are protected from later repeal when they are reenacted on December 31, 2027 pursuant to referenced session-law authority. According to the bill’s own final pages, this overall structure is intended to reduce scope-of-practice barriers and improve access to care while maintaining patient safety through consistent terminology across existing statutes.

AT A GLANCE

This bill defines “qualified health care provider” statewide in Hawaii Revised Statutes and replaces physician-specific references with that term across listed health, insurance, court, and related provisions.

FULL SUMMARY

The bill establishes a broad, standardized statewide definition of “qualified health care provider” for use across multiple areas of Hawaii Revised Statutes. The definition is added to HRS Chapter 325 and covers any person with a current, active license or certification issued under Title 19 (health) or Title 25 (professions and vocations), whose scope of practice under applicable law and rules authorizes providing the health services described in the relevant chapter.

The bill then amends numerous statutes to (1) replace older, narrower references to particular provider types (e.g., “physician,” “physician assistant,” “psychiatrist,” “licensed physician,” and similar terms) with “qualified health care provider,” and (2) update terminology in specific contexts to ensure consistent usage. Examples include expanding who can provide the “qualified health care provider” certification used in election candidate withdrawals; who may be listed/provided for certain benefits and medical services; who may administer or withdraw blood or order tests in implied consent contexts; eligibility/verification roles in school immunization and attendance provisions; roles in long-term care program certification; duties or permissions in corrections, juvenile/family court, and consent-related settings; and qualification terms used throughout health, insurance, probate/guardian-related, and penal-law provisions.

Beyond terminology standardization, the bill changes certain operative rules in discrete places. It updates medical/health-related benefit and reporting provisions (e.g., free medical treatment language in HRS 88-4/88-5 shifts from “government physician” to “qualified health care provider” employed by the state/county). It also modifies several provider-specific certification/eligibility requirements (e.g., in criminal justice or administrative contexts where an ill-health medical statement or HIV-related counseling/disclosure provider role was previously limited to specific provider categories). The bill repeals the obsolete Hawaii Health Corps (Part IX) and repeals Chapter 309H. It further includes a sweeping directive (Part X) substituting “qualified health care provider” grammar variants wherever “physician” terms appear in specified listed statutes, as context requires.

The effective date is July 1, 3000, with a specified provision that amendments made to HRS 346-59.1, 431:10A-116.3, 432:1-601.5, and 432D-23.5 will not be repealed when those sections are reenacted on December 31, 2027 (referencing reenactment law).

AT A GLANCE

This bill requires the Hawaii medical board to license anyone practicing as a surgical assistant in the State, except as provided, and establishes licensure pathways and renewal requirements.

FULL SUMMARY

The bill establishes a new statutory framework in Hawaii for regulating “surgical assistants” through a new chapter in the Hawaii Revised Statutes. It defines key terms including “direct supervision,” “surgical assistance,” “surgical assistant,” “supervising physician,” and “supervising podiatrist,” and sets a requirement that the Hawaii medical board require licensure for anyone practicing medicine or podiatric medicine as a surgical assistant in the State (with specified exceptions). It authorizes licensure pathways: initial licensure based on education/training standards and (where applicable) a board-approved national certification exam; temporary licensure with a one-time issuance subject to completion of a first approved exam; and licensure by endorsement, including prerequisites relating to active practice history and lack of certain disciplinary or adverse findings.

The bill requires the medical board to set the degree of supervision surgical assistants must receive; a supervising physician/podiatrist who fails to supervise to the required degree is deemed to have engaged in professional misconduct. It sets renewal/continuing-education obligations beginning with renewals for the biennium starting February 1, 2028, including continuing medical education (CME) compliance, potential random audits, and required production of audit documentation within 60 days. It requires biennial renewal by January 31 of each even-numbered year, provides for license forfeiture upon nonrenewal/nonpayment (with possible restoration), and provides that a license forfeited for one renewal term automatically terminates and cannot be restored (requiring a new application). The bill also adds mandatory reporting: specified persons in the operating room must report relevant concerns to the board regarding violations, grounds for board discipline under existing medical/podiatric discipline provisions, or threats to public welfare posed by a surgical assistant; good-faith reporters are given civil immunity for board communications, in addition to other statutory immunities.

The bill creates additional enforcement and governance mechanisms within the new surgical assistant chapter: it provides the board authority to deny, not renew, revoke, limit, or suspend surgical assistant licenses under existing medical and podiatric discipline statutes; authorizes board use of subpoenas, oaths, specialist examinations, and competency evaluations, and establishes contempt referral procedures for recalcitrant witnesses; and creates a perjury reporting/prosecution trigger for false sworn statements in board proceedings. It sets a penalty provision (fines up to $500 or imprisonment up to six months, with each day treated as a separate offense) for violations of the chapter. It also establishes a Surgical Assistant Advisory Committee under the Hawaii medical board (six members: three experienced practicing surgical assistants, two supervising physicians/podiatrists, and one experienced perioperative nurse/APRN/RN), with meeting and appointment/eligibility rules, including conflict-of-interest restrictions.

Beyond the new surgical assistant chapter, the bill amends multiple existing statutes to integrate surgical assistants into other regulatory and legal contexts. It expands volunteer medical assistance and emergency medical disaster response personnel lists (HRS 321-2.5 and 321-23.3) to include surgical assistants acting under specified supervision/employment roles while providing volunteer services. It updates Medicaid Prospective Payment System eligibility for federally qualified health center/rural health clinic services (HRS 346-53.64) to add surgical assistants as eligible professionals delivering covered services within lawful scope. It amends the temporary licensure eligibility statute for spouses of active-duty service members (HRS 436B-14.7) to include “surgical assistant” among professions for which temporary licensure may be approved. It adds “surgical assistant” to provisions governing electronic mail address filing for certain licensed practitioners (HRS 451D-5) and modifies liability-immunity language in the physician licensing discipline statute (HRS 453-8) to include surgical assistants. It updates the physician/serious injury reporting statute (HRS 453-14) to include surgical assistants. It updates the abortion-care statute (HRS 453-16) to permit licensed surgical assistants to provide surgical assistance in abortion care (and defines/links “surgical assistance” to the new surgical assistant chapter). Finally, it amends Good Samaritan-style civil liability protections (HRS 663-1.5) to include surgical assistants in emergency care and automated external defibrillator program provisions, and amends the definition of “health care provider” (HRS 671-1) to include surgical assistants. The act takes effect upon approval.

AT A GLANCE

This bill requires pharmacies and practitioners dispensing medication abortion care to use anonymous prescription-label placeholders when a pregnant person elects anonymity, and it allows first-trimester medication abortion by qualifying advanced practice registered nurses.

FULL SUMMARY

The bill revises Hawaii’s prescription-drug labeling and prescription-transfer rules and creates a more limited set of required label elements when a pregnant person chooses an anonymous label for medication abortion care. It amends HRS §328-16 (prescription drug dispensing label contents; and permitted transfer of prescription information) to add explicit medication-abortion exceptions to certain seller/practitioner label fields, and to extend the prescription-transfer “elements” requirement so that transferred prescription information also covers the newly renumbered/updated subsection elements.

Under the amended HRS §328-16(a), the label content that normally must include the seller’s name, address, and telephone number, and that must identify the practitioner when the seller is not the practitioner, is modified “except as otherwise authorized” for medication abortion care. The bill also clarifies that, for medication abortion care, an anonymous prescription label may be used consistent with the anonymous-label authorization in the abortion statutes. In addition, HRS §328-16(c)’s prescription-information communication provisions are updated so that the special “as needed/prn” refill limitation applies only to pharmacies and medical oxygen distributors practicing in the State (a bracketed removal is shown), and HRS §328-16(c) is expanded with an explicit medication-abortion anonymous-label cross-reference.

The bill amends HRS §453-16 to continue to protect a pregnant person’s right to abortion and to specify that when a pregnant person elects an anonymous prescription label, medication abortion care must be dispensed under HRS §328-16 with a label substituting generic placeholders: “Medication Abortion Care” instead of the person’s name, “Seller Name” instead of the seller name, “Business Address” instead of the seller business address, a placeholder telephone number (“000-000-0000” or comparable indication), and “Practitioner Name” if the seller is not the practitioner. It also renumbers the anonymous-label subsection and aligns cross-references, while maintaining the existing definitions of “abortion” and “nonviable fetus” for that section.

Finally, it amends HRS §457-8.7 to allow advanced practice registered nurses to provide medication abortion care in the first trimester if specified licensure/practice conditions are met, and to require the same anonymous-label substitutions for medication abortion care under HRS §328-16 when the pregnant person elects an anonymous label. The bill sets an effective date of January 1, 2027.

AT A GLANCE

This bill requires Hawaii healthcare facilities to assign registered nurses to meet minimum patient-to-RN ratios during every shift, except during a declared state of emergency, and to maintain related staffing records.

FULL SUMMARY

The bill establishes a new Hawaii Revised Statutes chapter requiring healthcare facilities to maintain minimum registered nurse staffing assignments (with specific nurse-to-patient ratios by patient service/unit), and creates related staffing, technology-use, patient-advocacy, recordkeeping, auditing, complaint, enforcement, and rulemaking requirements. It defines key terms (e.g., “health care facility,” “patient care unit,” “registered nurse,” and “declared state of emergency”), clarifies that the chapter does not change registered nurse scope of practice and does not create exemptions from other minimum staffing requirements, and specifies that the staffing rules generally apply to hospitals, home care agencies, adult residential care homes, and expanded adult residential care homes.

The core requirement is that, except during a declared state of emergency, a healthcare facility must assign at least the number of registered nurses at all times during every shift consistent with the bill’s minimum requirements. The bill also caps each registered nurse’s patient assignment at prescribed levels depending on the patient’s care setting and condition (e.g., one patient for critical/intensive care, operating room provisions (including a required scrub assistant per operating-room patient), conscious sedation, post-anesthesia care; three or four patients for step-down/intermediate, emergency services without critical/trauma, telemetry, medical-surgical, observational, rehabilitation, specialty, presurgical admissions, ambulatory surgical care, and psychiatric care; and different limits for antepartum, intrapartum, postpartum, and newborn/couplet scenarios). It further requires facilities to assign according to the highest intensity/type of care in the unit and, when multiple requirements apply, use the lowest numerical patient assignment; it allows additional nurse assignments when a registered nurse’s professional judgment indicates more staffing is needed.

The bill sets staffing calculation and operational constraints: facilities cannot average ratios across a unit; they cannot count ancillary staff or nurses who do not provide direct in-person hands-on care toward the required ratios (with limited circumstances allowing certain nurse administrators/managers to be counted only when they have an active direct-care assignment and meet strict conditions); ancillary staff cannot perform tasks requiring professional judgment or registered nurse skills (e.g., patient assessment/evaluation, nursing care plan implementation, and medication administration) even under RN supervision. The bill prohibits mandatory overtime for registered nurses, prohibits layoffs/reducing ancillary staff availability to meet RN assignments, and prohibits using electronic/remote monitoring to satisfy staffing requirements; it requires planning for routine patient-volume fluctuations. It also restricts adoption of technologies that substitute for direct nursing care or limit professional judgment (including AI/clinical guideline systems in the specified way) and permits nurses to override prohibited technology/guidelines without penalty when it is in the patient’s best interest.

The bill establishes patient advocacy protections and facility duties for registered nurses (professional judgment and duty/right to act for the patient; requirements for competence, risk determination before accepting assignments; a nurse’s right to object/refuse activities or assignments believed to violate staffing requirements, nursing scope/statutory practice, or create unpreparedness risk). It prohibits facilities and facility managers primarily responsible for management or patient care from interfering with professional judgment, limiting nursing-process duties, preventing patient-advocacy roles, or retaliating against nurses for reporting unsafe practices or legal/policy violations. It requires healthcare facilities to maintain and disclose extensive staffing records (patient counts per unit per shift; RN identity/duty hours per unit/patient; ancillary staff identity/duty hours; certification of rest/meal breaks and relief duty hours; and copies of required notices), maintain those records for at least three years, submit them to the Department with an officer certification under penalty of perjury, post a conspicuous notice in each patient care unit with actual staffing and variance from required ratios (and include ancillary skill mix), and make records available on the facility website. The Department must conduct periodic audits; may order corrective action; imposes administrative fines (up to $10,000 per day for specified sections and up to $25,000 per day for violations of the nurse advocacy section); allows individuals to file complaints with the Department; and authorizes Department rulemaking. The act takes effect January 1, 2026.

AT A GLANCE

This bill requires the Department of Health to amend emergency medical services protocols so EMTs may administer buprenorphine after administering an opioid antagonist during opioid overdoses.

FULL SUMMARY

The bill requires that EMTs (and certain other licensed emergency personnel) be authorized to administer an opioid antagonist for opioid overdoses and extends that existing authorization by requiring EMTs to also be authorized to administer buprenorphine after an opioid antagonist has been given during an overdose response.

It amends Hawaii Revised Statutes §329E-3 (Opioid antagonist administration; emergency personnel and first responders) by adding a new EMT authority for buprenorphine administration following opioid antagonist administration. The amendment also directs the Department of Health to (1) adopt rules classifying an opioid-related drug overdose as a life-threatening emergency equivalent to heart attacks and strokes, with standard protocols aimed at stabilizing physical conditions and reducing repeat occurrences; (2) incorporate buprenorphine administration after opioid antagonist administration as a standard component of emergency medical services protocols for opioid-related overdoses, aligned with national best practices and coordination with hospitals and treatment providers for patients transitioning into recovery services; (3) allocate resources to train EMTs in buprenorphine administration; and (4) coordinate with emergency medical services providers in the state to implement the updated section.

The act’s stated purpose is to authorize EMTs to administer buprenorphine after opioid antagonist administration during opioid overdose responses and to require the Department of Health to adopt implementing rules, fund EMT training, and coordinate with EMS providers to make buprenorphine administration a standard EMS protocol component for opioid overdose responses.

Effective upon approval.

AT A GLANCE

This bill requires accident and health insurers and hospital or medical service plan contracts delivered in Hawaii after July 1, 2026 to cover participating registered pharmacists’ health maintenance or treatment services.

FULL SUMMARY

The bill establishes mandatory insurance coverage for health care services provided by participating registered pharmacists practicing within the scope of their licenses, contingent on the insurer/plan providing benefits for identical services when rendered by another health care provider. For accident and health or sickness insurance policies and for hospital or medical service plan contracts issued for delivery in Hawaii after July 1, 2026, coverage must include pharmacist-provided health maintenance or treatment services. It defines a “participating registered pharmacist” as a pharmacist licensed under Hawaii’s pharmacy licensing chapter who has contracted with the insurer (for insurers) or with the mutual benefit society (for mutual benefit societies) to provide health care services.

The bill also expands Medicaid reimbursement eligibility by amending (1) the definition of services eligible for prospective payment system reimbursement under section 346-53.64 to explicitly include services delivered exclusively by health care professionals, expressly listing pharmacists among those acting within the lawful scope of their licenses; and (2) the payment framework in section 346-59 to include pharmacists among the individual practitioner/provider types whose rate of payment is based on the Hawaii Medicaid fee schedule and constrained by federal and state limits. Separately, it expands the definition of “health care provider” for telehealth purposes in section 346-59.1 to expressly include pharmacists licensed under the pharmacy licensing chapter.

Finally, it directs the Department of Human Services to apply to the U.S. Department of Health and Human Services for any necessary Medicaid state plan amendments or Medicaid waiver(s) to implement the Medicaid-related changes in sections 4 through 6, with submission timing left blank in the text. The bill takes effect upon approval, except that sections 4 through 6 take effect upon approval of the Hawaii Medicaid state plan by CMS; it also preserves rights, duties, penalties, and proceedings that matured or began before the effective date.

AT A GLANCE

This act requires the Hawaii Department of Health to issue a new birth certificate to a birth registrant who qualifies, and it permits an affidavit from an ARPN, as well as a physician or physician assistant.

FULL SUMMARY

S.B. 947 establishes that the Hawaii Department of Health must issue a new birth certificate in specific circumstances for “birth registrants” who already have a birth certificate on file.

It specifically changes the criteria for obtaining a new birth certificate based on gender transition. For the affidavit used in this circumstance, the bill expands the categories of health care providers authorized to attest to required medical and patient-history facts by allowing affidavits not only from a licensed physician or physician assistant, but also from an advanced practice registered nurse (ARPN). The bill updates the referenced statutory subsection to reflect this expanded provider authorization within the affidavit requirement.

The bill also retains other existing triggers for a new birth certificate—such as paternity establishment or modification, court determinations regarding nonexistence of a parent-child relationship, and adoption decrees—and preserves the law enforcement safety-request process for an alternative birth certificate that contains the agency-requested information, uses a new number, is filed separately, and does not replace the original certificate.

The act takes effect upon its approval.

AT A GLANCE

This bill authorizes the Governor to enter Hawaii into the Nurse Licensure Compact and requires party states to implement multistate licensure criminal-history procedures.

FULL SUMMARY

The bill authorizes the Governor to enter Hawaii into a Nurse Licensure Compact with other states and directs creation of a new Hawaii “Nurse Licensure Compact” chapter in the Hawaii Revised Statutes. The compact establishes mutual recognition of home-state multistate nurse licenses across “party states” under a multistate licensure privilege, requires each party state to implement procedures for criminal history record consideration (including fingerprints/biometrics) for applicants for multistate licensure/endorsement, and sets shared eligibility and disclosure conditions for obtaining or retaining a multistate license in the home state (including education, English proficiency for certain foreign-education cases, passing NCLEX or equivalent, active unencumbered status, criminal-history and offense restrictions, alternative-program status limitations, and a valid U.S. social security number).

Under the compact framework, a nurse practicing in a party state must comply with the “state practice laws” of the state where the patient/client is located, and the nurse is subject to the jurisdiction of that state’s licensing board, courts, and laws for that practice. Party states authorize adverse action mechanisms affecting a nurse’s multistate licensure privilege and provide for the deactivation of a nurse’s privilege in all party states when the home state takes adverse action; the home state must notify the coordinated licensure information system and remote states similarly. The compact also establishes a coordinated licensure information system for sharing licensure and disciplinary/enforcement-related information, requires prompt reporting of adverse actions, significant investigative information, denials (with reasons), and alternative-program participation, limits sharing/exposes confidentiality rules, and requires expungement synchronization when required by the contributing state.

The bill further creates governance and operational requirements for an Interstate Commission of Nurse Licensure Compact Administrators, including public meeting rules, member/administrator voting, commission rulemaking with notice and public hearing procedures (including emergency rules under defined public-health and timing conditions), oversight, dispute resolution (mediation and binding mechanisms including arbitration panels), enforcement and default/termination procedures for noncompliant states, and specified protections such as qualified immunity/defense/indemnification for commission personnel. A compact effective-date and withdrawal/termination process is included, including rules for transitioning away from the prior nurse licensure compact.

In Hawaii, the bill also changes state nursing-related requirements by amending Hawaii Revised Statutes Chapter 457. It adds a new section requiring that, beginning July 1, 20__ (year left blank in the text provided) and annually thereafter, each person holding a multistate nurse license issued by a state other than Hawaii and employed by a Hawaii “health care facility” must complete demographic data surveys as a condition of employment, and requiring each health care facility to report within 30 days of the nurse’s employment and attest completion. Finally, it amends fee-setting authority in the licensing statutes for both registered nurses and licensed practical nurses by providing that the Board may charge different fees for applicants holding a multistate license issued by the State.

The act’s effective date is July 1, 3000; however, Section 1 (the nurse licensure compact authorization/chapter) takes effect and becomes binding two years after the act takes effect.

AT A GLANCE

This bill requires bridge year physicians to practice under licensed physician supervision or a collaborative practice agreement and to meet board supervision standards at least as strict as physician assistant oversight.

FULL SUMMARY

The bill establishes/adjusts requirements governing physician assistants’ practice, medical discipline grounds, and the licensing structure for “bridge year physicians,” and it declares an emergency with an effective date.

For physician assistants, it revises the statutory framework in Idaho Code § 54-1807A. Key changes include (1) clarifying that the required collaboration/oversight must involve one or more physicians licensed under the chapter, with the facility/practice degree and nature of collaboration specified in facility bylaws or procedures (for facilities with credentialing/privileging) or in a written collaborative practice agreement (for other settings); (2) requiring that collaborative practice agreements be provided to the Idaho State Board of Medicine upon request; and (3) continuing to allow physician assistants (or groups) to independently own a medical practice in Idaho, but conditioning such independent ownership on each physician assistant having the required collaborative practice agreement(s) and being licensed/registered/certified as a physician assistant in another U.S. jurisdiction for at least two years.

For physician discipline, it amends Idaho Code § 54-1814 by removing a limitation previously referenced in the text and restructuring the list of “grounds for medical discipline” to add/retain specific bases—most notably including language addressing (among other items) failing to supervise health professionals who require supervision (now including physician assistants/health professionals who require supervision), and additional unprofessional/conduct-based and reporting/delegation grounds (e.g., interfering with investigations/disciplinary proceedings; delegating to unlicensed or out-of-scope licensees; and failure to report certain felony matters to the board within a specified timeframe).

For bridge year physicians, it amends Idaho Code § 54-1867 to require that persons practicing under a limited bridge year license practice under supervision of a licensed physician or pursuant to a collaborative practice agreement, qualify as one of a supervising physician’s permitted advanced practice professionals, and meet supervision requirements set by the board that cannot be less stringent than physician assistant supervision requirements. It also keeps board authority to implement the program via rules, sets/retains the up-to $300 limited license fee authority, and requires a board report no later than January 31, 2033 to specified legislative health and welfare committees. The act is declared an emergency and takes effect July 1, 2026.

The new licensure rules for physician assistants and graduate physician assistants in Idaho are set to take effect on March 28, 2023. These regulations are designed to standardize the licensure process and ensure that these healthcare professionals meet the necessary educational and professional standards to practice in the state.

The healthcare industry, particularly facilities that employ physician assistants and graduate physician assistants, will be directly affected by these changes. This includes hospitals, clinics, and private practices that utilize their services.

Licensure fees for physician assistants and graduate physician assistants will not exceed $250, with annual renewal fees capped at $150. Reinstatement fees are set at $50 plus any past renewal fees, while the reinstatement fee for graduate physician assistants is capped at $100. Inactive license fees and annual renewal fees for inactive licenses are also capped at $150 and $100, respectively.

Continuing education requirements mandate that physician assistants must attest to maintaining current certification, which includes completing a minimum of 100 hours of continuing medical education over a two-year period prior to license renewal. Additionally, collaborative practice agreements must comply with Idaho Code and include specific elements such as the parties involved and the authorized scope of practice.

AT A GLANCE

This bill requires prescribing psychologists, when delegating prescriptive authority, to work under a written collaborative agreement with limits on delegated medications and controlled substances, including notice and registration duties.

FULL SUMMARY

The bill establishes changes to the Clinical Psychologist Licensing Act, specifically to Section 4.3 (“Written collaborative agreements”), governing when prescribing psychologists must have written collaborative agreements with a collaborating physician and the scope and limits of delegated prescriptive authority.

It changes the statutory restrictions on what medications a collaborating physician may delegate to a prescribing psychologist. The delegation is limited to medications for mental health disease or illness generally provided by the collaborating physician in the normal course of clinical practice, but excludes specified patient groups (patients under age 17 or over age 65; patients during pregnancy; and patients with serious medical conditions such as heart disease, cancer, stroke, or seizures, plus those with developmental disabilities and intellectual disabilities). It also restricts delegated authority for controlled substances by excluding benzodiazepines and limiting delegated controlled substances to certain schedules (and, as stated in the text, no Schedule II controlled substance may be delegated and no injected medications may be delivered under delegated authority).

The bill also maintains/sets operational requirements for documentation and accountability within the collaborative framework: the collaborating physician must file notice of delegation and termination with the Department per Department rules; prescribing psychologists must register for a mid-level practitioner controlled substance license upon receipt of delegations to prescribe any nonnarcotic Schedule III through V controlled substances; prescriptions must include the psychologist’s name and signature; and prescribing psychologists may not prescribe narcotic drugs as defined in the Illinois Controlled Substances Act. The collaborative agreement must describe the working relationship, delegate prescriptive authority as provided, and define collaboration in terms of documented training/experience and collaboration/consultation.

Additional compliance and structural limits are included: collaboration does not require employment; termination/change notice provisions are required in the written agreement (except for notice given for just cause); the signed agreement must be available to the Department upon request; prescribing psychologists must inform each collaborating physician of all signed collaborative agreements and provide copies; and no collaborating physician may enter into more than three collaborative agreements with prescribing psychologists. The act takes effect upon becoming law.

AT A GLANCE

This bill authorizes qualifying physician assistants to practice without a written collaborative agreement if they file a notarized attestation and complete required CME and clinical experience.

FULL SUMMARY

The bill revises Illinois law governing physician assistant (PA) practice under the Physician Assistant Practice Act of 1987 and makes corresponding changes to the Illinois Controlled Substances Act. It creates an “optimal practice” model that allows qualifying PAs to practice and prescribe/dispense drugs without a physician’s written collaborative agreement or delegation, and it adds a direct prescriptive authority provision stating that a physician may authorize PAs to prescribe controlled substances without delegation when the collaboration writing is not otherwise required.

Key practice changes: (1) PAs are authorized to prescribe, dispense, order, administer, and procure drugs and medical devices, and the Act’s “prescriptive authority” section clarifies that a physician may grant these powers without delegation by a physician, including for Schedule II–V controlled substances; (2) a new Section 7.9 establishes that a PA may practice without a written collaborative agreement if the PA files a notarized attestation with the Department showing completion of at least 250 hours of Category 1 CME (or equivalent) and at least 2,000 hours of clinical experience in the specific intended field after first achieving national certification; (3) for “optimal practice,” the PA’s scope expressly includes full PA practice, practice in all settings consistent with the Act without a written collaborative agreement, and authority to prescribe both legend drugs and Schedule II–V controlled substances, including over-the-counter medications, legend drugs, and Schedule II–V controlled substances as defined, while still excluding operative surgery from the PA’s scope.

Hospital/affiliate framework is retained but adjusted: the bill keeps a hospital/hospital affiliate/FQHC/ambulatory surgical treatment center pathway where PAs may provide services and may prescribe/select/order/administer medications, including controlled substances, under the facility’s credentialing/privileging framework; it also provides that PAs in those settings are not required to obtain a mid-level controlled substance license to order controlled substances under the Controlled Substances Act section referenced by the Physician Assistant Practice Act. It also adds clarifications that delegation of prescriptive authority by a physician is not required under certain circumstances, and it maintains the prohibition against authorizing PAs to provide care that by law/rule must be performed by a physician.

Controlled substance licensing registration changes: the bill amends the Controlled Substances Act sections including definitions and Section 303.05 (mid-level practitioner registration) to incorporate physician assistants as mid-level practitioners and to specify circumstances under which PAs may obtain/hold authority. It provides that a mid-level practitioner license is limited to schedules for which authority exists, but carves out that a physician assistant may have prescriptive authority consistent with the Physician Assistant Practice Act “without delegation by a physician.” It also updates procedural pathways and conditions for PA controlled-substance authority (including requirements that were tied to delegation/collaboration in the prior framework), and it aligns the Controlled Substances Act’s definitions of terms like “mid-level practitioner,” “prescriber,” and related registration concepts to include the newly described PA authority and optimal-practice framework.

The document outlines significant amendments to the Nurse Practice Act in Illinois, including the ratification of the Nurse Licensure Compact. This compact allows for the issuance of multistate licenses for nurses, enabling them to practice in their home state and other compact states. The changes aim to enhance the mobility of nursing professionals, streamline the licensing process, and improve access to nursing care.

The healthcare industry, particularly nursing and related services, will be notably impacted by these regulations. Hospitals, clinics, and nursing education programs will need to adapt to the new licensing framework, which is expected to reduce administrative costs and potentially increase workforce availability. This could lead to improved patient care and operational efficiencies within healthcare facilities.

Nurses applying for a multistate license will undergo background checks to ensure they have no prior encumbrances. The compact establishes a coordinated licensure information system to track the licensure and disciplinary history of nurses, facilitating the exchange of information regarding adverse actions. Additionally, the Interstate Commission of Nurse Licensure Compact Administrators will oversee the implementation of uniform rules and procedures across party states.

The Commission will manage its operations, including financial responsibilities and rulemaking processes, while ensuring accountability and transparency. It is empowered to intervene in legal proceedings affecting its powers and to mediate disputes among party states. The overall goal of these changes is to modernize nursing practice regulations, enhance regulatory cooperation, and address nursing shortages by facilitating multistate licensure for nurses.

AT A GLANCE

This bill allows Illinois-licensed CRNAs with full practice authority to practice without a written collaborative agreement if they meet specified education, certification, and clinical- experience requirements.

FULL SUMMARY

SB2932 changes Illinois law governing anesthesia services and the role of certified registered nurse anesthetists (CRNAs), including how collaboration/collaboration agreements operate and when written collaborative agreements are required.

In the Ambulatory Surgical Treatment Center Act and the Hospital Licensing Act (Section 6.5 and Section 10.7, respectively), the bill removes requirements that anesthesia be under physician direction with specialized anesthesiology preparation and removes requirements that an anesthesiologist participate through discussion/agreement with the anesthesia plan and remain physically present/available. Instead, it specifies that for anesthesia services in ASTCs and hospitals, a CRNA must seek consultation regarding development of an anesthesia plan and patient treatment as appropriate to the CRNA’s expertise/scope and patient needs. It also authorizes CRNAs with clinical privileges to perform acts of advanced assessment and diagnosis and to provide functions for which the CRNA is educationally/experientially prepared. The bill also permits CRNAs to select, order, and administer anesthesia-related drugs and apply appropriate medical devices under the anesthesia plan agreed with the anesthesiologist (or operating physician where an anesthesiologist is unavailable under the facility’s alternative policy).

In the Medical Practice Act (Section 54.5), the bill adds more specific terms for when collaboration written agreements are “adequate” with respect to CRNAs: it requires the collaboration agreement to be written to promote professional judgment by the CRNA commensurate with education/experience; requires that the CRNA provide services based on a written collaborative agreement with the collaborating physician; and requires methods of communication for consultation/collaboration/referral (in person or via telecommunications). It changes the anesthesia-specific adequacy standard by requiring that, for anesthesia services, collaboration is adequate if the anesthesiologist/physician participates through discussion of and agreement with the anesthesia plan and is physically present/available on the premises during delivery for diagnosis, consultation, and emergency conditions. The bill also includes an anesthesia-plan “agreement prior to delivery” concept.

The Nurse Practice Act is substantially modified: it amends (i) the general written collaborative agreement rules for advanced practice registered nurses (Section 65-35), (ii) the hospital/hospital affiliate/ASTC rule (Section 65-45) to address when written collaborative agreements are not required in those settings, and (iii) it adds a new Section 65-75 establishing conditions under which a written collaborative agreement is not required for an Illinois-licensed CRNA with full practice authority. New Section 65-75 deems qualifying CRNAs able to practice without a written collaborative agreement if they meet specific credentials/education/clinical-experience requirements (including national certification and either a professional doctorate or substantial continuing education hours plus extensive clinical experience, with attestation requirements). It also enumerates the “scope of practice” for CRNAs with full practice authority, including prescriptive authority for legend drugs and Schedule II through V controlled substances (including obtaining an Illinois controlled substance license and a federal DEA number), and explicitly includes authority related to prescribing for Schedule II through V and other preparations (including botanical/herbal remedies). The bill further amends the Illinois Dental Practice Act (Section 8.1) to specify that when a nurse anesthetist is administering moderate sedation, an appropriate dental permit is required and a valid written collaborative agreement must exist unless the nurse anesthetist has full practice authority under new Section 65-75; similar collaborative-agreement/permit conditions are added/clarified for deep sedation and general anesthesia. Finally, it amends the Podiatric Medical Practice Act (Section 20.5) to align CRNA anesthesia collaboration requirements with the new CRNA full-practice authority framework.

The bill provides that it takes effect upon becoming law (effective immediately upon enactment).

AT A GLANCE

This bill removes the requirement that an anesthesiologist remain physically present and available on premises during anesthesia delivery, and it instead requires collaboration through discussion and agreement with the anesthesia plan for CRNA services.

FULL SUMMARY

The bill changes Illinois law governing who may deliver anesthesia and under what supervision requirements, and it adjusts related delegation/collaboration provisions for anesthesia services by certified registered nurse anesthetists (CRNAs). It amends the Ambulatory Surgical Treatment Center Act (210 ILCS 5/6.5), the Hospital Licensing Act (210 ILCS 85/10.7), the Medical Practice Act of 1987 (225 ILCS 60/54.5), and the Nurse Practice Act (225 ILCS 65/65-45).

For ambulatory surgical treatment centers and hospitals, the bill removes the requirement that an anesthesiologist (in particular, an “anesthesiologist, Board certified or Board eligible”) must remain physically present and available on the premises during delivery of anesthesia services. Instead, it requires that the anesthesiologist participate through discussion and agreement with the anesthesia plan (and it retains an “in the absence of 24-hour availability” concept in the facility rules, but shifts away from “remain physically present” as the operative requirement). The anesthesia-services framework continues to limit who may administer anesthesia (including licensed physicians, dentists, podiatric physicians, and licensed CRNAs), and it retains physician-determined oversight of the CRNA’s role.

In the Medical Practice Act delegation/collaboration section, the bill modifies the specific anesthesia-collaboration standard for a collaborating anesthesiologist or physician collaborating with a CRNA: the collaboration is considered adequate based on joint formulation/approval and periodic review of orders and services, plus participation through discussion and agreement with the anesthesia plan—without requiring the anesthesiologist/physician to be physically present and available on the premises during anesthesia delivery. It also includes conforming language directing anesthesia services to be conducted under the facility-specific anesthesia provisions (hospital and ASTC).

In the Nurse Practice Act, the bill changes the CRNA anesthesia-services condition to remove the “remain physically present and be available” requirement applicable to anesthesiologists, physicians, dentists, or podiatric physicians. It instead keeps the participation-through-discussion-and-agreement-with-the-anesthesia-plan model, while preserving existing exceptions that allow facility policy (adopted under specified clauses) to provide otherwise.

The document outlines new regulations for the licensure and practice of certified anesthesiologist assistants (CAAs) and other healthcare professionals in Illinois. It establishes a framework for the licensure of CAAs, requiring a master's degree in anesthesia, successful examination completion, and a criminal history background check. CAAs must work under the supervision of licensed anesthesiologists, who are responsible for their activities during medical procedures. The legislation aims to enhance public health and safety by ensuring that only qualified individuals practice as CAAs.

Additionally, the document details the financial aspects of licensure, including fees for applications, renewals, and criminal history checks, which will support the Department's administrative expenses. It also addresses the requirements for continuing education and the process for license restoration after suspension or revocation. The Department has the authority to enforce compliance through examinations and evaluations, ensuring that licensed individuals maintain their fitness to practice.

The regulations also cover the operation of ambulatory surgical treatment centers (ASTCs) and hospitals, emphasizing the necessity for licensed professionals to perform operative procedures and the requirement for anesthesiologists to be present during anesthesia administration. The amendments to the Medical Practice Act of 1987 further clarify the roles of various medical professionals involved in anesthesia services, including certified registered nurse anesthetists (CRNAs) and physician assistants.

Overall, these changes are designed to formalize the roles of healthcare professionals in anesthesia services, improve operational protocols, and ensure compliance with established standards. The healthcare industry, particularly those involved in anesthesia and surgical services, will be significantly impacted by these regulations, which aim to enhance patient safety and care quality.

AT A GLANCE

This bill requires Illinois to participate in the Nurse Licensure Compact by authorizing multistate nurse licensure through applications, upgrades, and renewals subject to fee minimums and continuing-education requirements.

FULL SUMMARY

The bill amends Illinois’ Nurse Practice Act (225 ILCS 65) by (1) revising the existing nurse-licensure application fee authority in Section 50-26 and (2) adding a new Article 85 that ratifies and implements the Nurse Licensure Compact (multistate licensure).

The bill requires Illinois to participate in the Nurse Licensure Compact by authorizing multistate licenses (including applications, upgrades, and renewals) and by establishing fee-related minimums for multistate licensure and renewal. It also codifies key Compact implementation rules tied to Illinois licensing procedures, including requirements that Illinois not share certain criminal-history-record-check contents with the Compact administrator or other states, and that compact-participating nurses complete specified continuing-education hours (including named mandatory training topics).

The bill further adds employer-attestation requirements for employers hiring nurses with multistate licenses from out-of-state, and it adds exclusions/limits stating that the Compact provisions in Article 85 do not apply to advanced practice registered nurses.

Finally, Article 85 contains additional Compact-related state rules, including that the Compact does not supersede state labor laws and establishing that Illinois’ role in criminal-history background checks is restricted with respect to disclosure content.

The document outlines amendments to the Acupuncture Practice Act in Illinois, which expand the definition and scope of acupuncture practice. Key changes include allowing licensed acupuncturists to order laboratory tests for pain management and herbal medicinal plans, as well as removing restrictions that previously limited their ability to present themselves as qualified to provide physical therapy services unless they were also licensed physical therapists.

These amendments broaden the services that licensed acupuncturists can offer, potentially increasing their business opportunities and client base. They also clarify the roles and responsibilities of acupuncturists in patient care, emphasizing the importance of referrals to licensed physicians or dentists when conditions exceed their scope of practice.

The changes are set to enhance the integration of acupuncture within the broader healthcare framework in Illinois, which may impact healthcare delivery and patient management strategies. However, they may also lead to increased operational costs for acupuncturists due to the need for compliance with new regulations and potential investments in additional training or resources.

Overall, the amendments aim to improve the practice of acupuncture and its role in patient care within the healthcare system.

AT A GLANCE

This bill authorizes registered professional nurses to delegate nursing interventions, tasks, and limited medication administration to other licensed or unlicensed personnel only after a comprehensive assessment shows delegation is appropriate.

FULL SUMMARY

The bill establishes that “registered professional nursing practice” is a scientific process founded on a professional body of knowledge and is a learned profession based on understanding the human condition across the life span and environment. It clarifies that registered professional nurses (RNs) provide the full scope of nursing practice (including holistic nursing care through the nursing process) and defines nursing acts as performed using professional knowledge, judgment, and skills obtained through completion of an approved professional nursing education program.

The bill also revises RN delegation rules. It authorizes RNs to delegate (1) nursing interventions and tasks to other registered professional nurses and licensed practical nurses based on a comprehensive nursing assessment that evaluates patient stability, potential for harm, complexity of the intervention/task, predictability of outcomes, and the competency of the delegatee; and (2) tasks to unlicensed personnel based on the same assessment factors. It permits delegation of medication administration to other licensed nurses, and in community-based or in-home care settings allows delegation of certain medication administration to unlicensed personnel limited to oral or subcutaneous dosage and topical or transdermal application, provided the Section 50-75 delegation conditions are met.

The bill tightens prohibitions on delegation. It prohibits any individual or entity from mandating an RN to delegate a nursing intervention if the RN determines delegation is inappropriate; it also protects nurses from disciplinary or adverse action for refusing to delegate based on patient safety. It removes/updates delegation restrictions by adding a specific prohibition on an RN delegating work requiring nursing knowledge, assessment, judgment, inference, and decision-making (including medication administration), as well as prohibiting delegation of the development and evaluation of a plan of care to unlicensed non-nurse personnel. It further eliminates prior delegation permissions that applied in community-based or in-home contexts and otherwise adjusts the medication delegation carve-outs to align with the new framework (including the limited modalities for medication delegation to unlicensed personnel).

Finally, the bill updates the RN scope-of-practice provision by describing RN practice as the full scope of nursing (with enumerated functions tied to the nursing process, including delegating interventions/tasks to licensed nurses and delegating tasks to unlicensed personnel to implement the plan of care). The changes take effect upon becoming law.

AT A GLANCE

This bill removes Illinois’ “remain physically present and be available on the premises during anesthesia delivery” requirement for anesthesiologists and collaborating clinicians when a certified registered nurse anesthetist provides anesthesia in hospitals and ambulatory surgical treatment centers.

FULL SUMMARY

The bill establishes changes to Illinois statutes regulating who may administer anesthesia in ambulatory surgical treatment centers and hospitals, and to delegation/collaboration rules involving certified registered nurse anesthetists.

It amends: (1) the Ambulatory Surgical Treatment Center Act (210 ILCS 5/6.5) by removing the requirement that, for anesthesia services, an anesthesiologist “shall remain physically present and be available on the premises during the delivery of anesthesia services” (and the related alternate policy tied to anesthesiologist 24-hour availability). (2) the Hospital Licensing Act (210 ILCS 85/10.7) similarly removes the “remain physically present and be available on the premises” requirement for an anesthesiologist during delivery of anesthesia services, and removes the related alternate policy language tied to anesthesiologist 24-hour availability.

It also amends the Medical Practice Act of 1987 (225 ILCS 60/54.5) by revising delegation/collaboration provisions for anesthesia services provided by a certified registered nurse anesthetist: the anesthesia-collaboration standard is changed by deleting the requirement that the collaborating anesthesiologist or physician be “physically present and available on the premises” during anesthesia delivery. Correspondingly, it amends the Nurse Practice Act (225 ILCS 65/65-45) by removing the requirement that, for anesthesia services provided by a certified registered nurse anesthetist, an anesthesiologist/physician/dentist/podiatric physician “shall participate… and remain physically present and be available on the premises” during anesthesia delivery—while preserving that the anesthesia plan participation/agreeing requirement remains, and that hospital or ambulatory surgical treatment center policies may provide otherwise.

No new substantive anesthesia scope or eligibility categories are added; the operative change across the three chapters is the elimination of the “physical presence/availability during delivery” requirement for the physician anesthesiologist/other qualifying clinicians in these settings.

The new legislation in Illinois establishes the Naturopathic Medical Practice Act, which regulates the licensure of naturopathic doctors to address the primary care shortage in both urban and rural areas. This Act aims to enhance healthcare access by allowing qualified naturopathic doctors to practice, thereby increasing healthcare options for the public. Key provisions include the creation of a Naturopathic Medical Board to oversee licensure, the establishment of qualifications for licensure, and the definition of the scope of practice for naturopathic doctors, including their ability to prescribe medications.

The legislation also amends existing laws to include naturopathic doctors in the definitions of "prescriber" and "prescription," allowing them to prescribe medications, which could significantly impact the pharmaceutical industry. Naturopathic doctors are required to enter into collaborative agreements with physicians for prescriptive authority, although exemptions exist for those with sufficient experience or education. The Act outlines the scope of practice, which includes performing physical examinations and ordering lab tests, while prohibiting major surgeries and certain invasive procedures.

Additionally, the document addresses regulations concerning controlled substances and the responsibilities of healthcare providers, including pharmacists and mid-level practitioners, in prescribing and managing these substances. It emphasizes the importance of compliance with new regulations to ensure patient safety and quality of care. The changes are expected to impact various healthcare professions and industries, enhancing collaborative practices while ensuring regulatory compliance.

Overall, the legislation aims to improve healthcare delivery in Illinois by expanding the roles of naturopathic doctors and other healthcare professionals, thereby addressing the needs of underserved populations and enhancing patient care options.

The recent amendments to various healthcare regulations in Illinois significantly alter the roles and responsibilities of healthcare professionals, particularly focusing on certified registered nurse anesthetists (CRNAs), advanced practice registered nurses (APRNs), and physician assistants. One of the key changes allows CRNAs to independently develop anesthesia plans and provide services without the need for an anesthesiologist's physical presence, thereby increasing their autonomy in ambulatory surgical treatment centers (ASTCs).

Additionally, the amendments enable physician assistants to collaborate with physicians under specific guidelines, allowing for a greater number of collaborative agreements in federally designated health professional shortage areas. APRNs can now engage in clinical practice without a written collaborative agreement, provided they have the necessary clinical privileges, and they are authorized to order and administer medications, including controlled substances, under certain conditions.

In the dental and podiatric medicine sectors, new regulations require dentists and podiatric physicians to hold permits for anesthesia administration and to establish collaborative agreements with nurse anesthetists or APRNs. These agreements must ensure that the collaborating physician is adequately trained in anesthesia delivery and that they have access to patient records managed by the APRN.

Overall, these regulatory changes aim to enhance the operational flexibility of healthcare providers, improve access to care, and streamline collaborative practices among various healthcare professionals. The amendments are expected to impact the delivery of healthcare services, particularly in surgical settings, nursing, and anesthesia administration.

The document outlines significant amendments to the Physician Assistant Practice Act of 1987 and related regulations in Illinois, which enhance the autonomy and scope of practice for physician assistants and other mid-level practitioners. Key changes include the ability for physician assistants to prescribe, dispense, and manage medications without requiring delegation from a physician, provided they meet specific continuing education and clinical experience criteria. This shift is expected to improve healthcare delivery efficiency and reduce administrative burdens.

Additionally, the requirement for a written collaborative agreement between physician assistants and collaborating physicians has been modified, allowing experienced physician assistants to practice independently. The amendments also clarify the definitions and scope of practice for physician assistants, enabling them to perform a broader range of medical services, including diagnosing and managing treatment.

The document further addresses the prescriptive authority of advanced practice registered nurses (APRNs) and other mid-level practitioners, detailing the conditions under which they can prescribe controlled substances. This includes requirements for continuing education in pharmacology and the necessity for written delegation from collaborating physicians for certain medications.

Overall, these regulatory changes are poised to impact various sectors within the healthcare industry, including hospitals, clinics, and pharmacies, by allowing for greater flexibility in staffing and enhancing the roles of physician assistants and APRNs in patient care. The amendments aim to streamline processes, improve patient care efficiency, and ensure compliance with updated standards in the practice of medicine.

The new legislation establishes comprehensive regulations for staffing and patient care standards in healthcare facilities, particularly hospitals. It mandates specific maximum patient assignments for registered nurses based on unit type, ensuring that critical care, emergency, maternal child care, and psychiatric units maintain appropriate nurse-to-patient ratios. Facilities are required to provide adequate staffing levels without layoffs of ancillary support staff and to ensure that registered nurses possess the necessary competence for their assigned units.

To enhance patient care, the legislation prohibits the use of video monitors as substitutes for direct in-person observation by registered nurses. Facilities must also ensure that nurses receive relief during meal periods and breaks while maintaining compliance with patient limits. Additionally, healthcare facilities are required to manage patient census fluctuations and maintain detailed records of staff assignments for transparency and accountability.

Hospitals must establish nursing care committees to develop and recommend annual staffing plans, which should be publicly accessible. These committees are responsible for addressing staffing issues and ensuring that the staffing plan adheres to the patient limits set by the legislation. The exercise of nursing judgment is prioritized, with hospitals prohibited from implementing policies that restrict nurses' ability to advocate for patient care.

Overall, these regulations aim to improve patient safety and care quality by enforcing stricter staffing requirements and promoting transparency in nursing practices. The healthcare industry will need to adapt to these changes, which may involve increased operational costs due to compliance and training initiatives.

AT A GLANCE

This bill expands Pharmacy Practice Act exemptions so licensed professionals may prescribe or supply drugs regardless of typical specialty use or self-prescription, except for controlled substances.

FULL SUMMARY

HB4655 amends Illinois’ Pharmacy Practice Act (225 ILCS 85) by changing Sections 4 (Exemptions) and 30 (Refusal, revocation, suspension, or other discipline).

Section 4 expands and clarifies exemptions from the Act’s restrictions for certain licensed professionals’ prescribing/supplying of drugs, medicines, or poisons by making the exemption apply regardless of whether the drugs are not typically prescribed by that professional (including within the same or similar specialty) or whether the drugs are self-prescribed—while expressly preserving an exception for controlled substances.

Section 30 adds a discipline-related framework governing pharmacy licensee “good faith” refusal to compound, fill, or dispense physicians’ prescriptions. It provides that a licensee does not act in good faith if the refusal is based solely on the prescription not being typically issued by that physician or by physicians in the same or similar specialty, or because it is self-prescribed—again excepting controlled substances. The bill further makes it a violation for any prescriber or dispenser to adopt a contrary policy.

The bill’s changes take effect immediately upon becoming law (no later effective date is specified).

The document outlines significant amendments to the Nurse Practice Act in Illinois, focusing on addressing the maternal health crisis and improving access to out-of-hospital services. Key changes include enhanced regulations for advanced practice registered nurses (APRNs), such as certified nurse midwives, certified nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialists. These amendments aim to foster collaboration among healthcare professionals and expand the practice authority of APRNs, ultimately enhancing patient care.

The regulations also detail the collaborative agreements required between APRNs and physicians, dentists, or podiatric physicians. For instance, certified registered nurse anesthetists must have a written agreement with an anesthesiologist or operating dentist when providing anesthesia in dental settings. Additionally, APRNs can continue existing agreements with podiatric physicians and are permitted to assist in surgical procedures, although they cannot perform tasks reserved for physicians.

Notably, advanced practice registered nurses certified as nurse midwives can provide out-of-hospital birth services without a collaborative agreement if they have clinical privileges from the birth center's clinical director. This provision is particularly relevant in health professional shortage areas, where access to care is critical.

The amendments also address liability protections for physicians concerning the actions of APRNs under collaborative agreements, ensuring that physicians are not held liable unless they have reason to question the competency of the APRN. This aspect is crucial for maintaining operational practices within the healthcare industry, particularly in nursing, anesthesia services, and midwifery.

Overall, these changes reflect a concerted effort to improve maternal and neonatal care in Illinois by empowering APRNs and facilitating their collaboration with other healthcare providers. The amendments are expected to influence healthcare costs and reimbursement structures, particularly regarding the services provided by APRNs.

The document outlines the Nurse Licensure Compact (NLC) amendments to the Nurse Practice Act in Illinois, which significantly impact the nursing industry by allowing for the issuance of multistate licenses. This enables nurses to practice in their home state and other participating states without needing additional licensure, thereby enhancing staffing flexibility in healthcare facilities and potentially improving patient care.

Key provisions of the Compact include the establishment of a coordinated licensure information system to facilitate the exchange of licensure and disciplinary information among states. This system aims to enhance enforcement efforts and may require significant investment in technology and data management. Additionally, the Compact mandates that nurses complete 20 hours of approved continuing education every two years, covering essential topics such as mandated reporter training and implicit bias training.

The Commission overseeing the Compact will provide liability protection for its members, which could reduce legal costs for healthcare organizations employing nurses under this framework. A structured rulemaking process has also been established to ensure transparency and public participation in the development of healthcare regulations.

While the Compact aims to streamline nursing licensure and increase workforce availability, it imposes new educational and compliance requirements on healthcare employers. Notably, the provisions do not apply to advanced practice registered nurses, which may affect their licensure and scope of practice. Overall, the Compact seeks to promote cooperation among states in nursing regulation and enhance public safety.

The document outlines significant amendments to the Nurse Practice Act in Illinois, set to take effect on August 1, 2025. These changes redefine the scope of registered professional nursing practice, emphasizing that it is rooted in a scientific process and a professional body of knowledge. Registered professional nurses (RNs) will gain the authority to delegate nursing interventions and tasks to other RNs and licensed practical nurses (LPNs) based on comprehensive assessments, while being prohibited from delegating tasks requiring nursing knowledge or judgment to unlicensed personnel.

Additionally, the amendments remove previous provisions regarding delegation in community-based or in-home care settings. RNs will be allowed to delegate the administration of certain medications to unlicensed personnel under specific conditions, although this delegation is not permitted in institutional or long-term care facilities. RNs are also protected from disciplinary actions for refusing to delegate tasks if they believe it may compromise patient safety.

The scope of practice for RNs includes health promotion, illness prevention, care coordination, and advocacy, with responsibilities for comprehensive patient assessments and care plan implementation. The changes are expected to impact healthcare providers, particularly those involved in community-based and in-home care services, potentially leading to increased operational costs as organizations adapt to the new delegation standards and training requirements.

Certain sections of the Act will be repealed on January 1, 2028, indicating a timeline for further regulatory changes. Overall, these amendments aim to enhance the clarity and effectiveness of nursing practice in Illinois, ensuring patient safety and quality care.

The Department of Financial and Professional Regulation in Illinois has adopted significant amendments to the Nurse Practice Act, set to take effect on May 9, 2025. These changes primarily affect licensed practical nurses (LPNs), registered nurses (RNs), advanced practice registered nurses (APRNs), and certified nurse midwives. Key amendments include streamlined approval processes for English proficiency tests for foreign-educated applicants, the establishment of adverse occurrence reporting requirements for certified nurse midwives, and clarifications regarding the program approval process for nursing education institutions.

The regulations also emphasize the importance of care counseling and treatment agreements for impaired nurses, mandating automatic substance abuse assessments for related allegations. Applicants for nursing licensure must provide comprehensive documentation, including proof of education and compliance with English proficiency standards. Nursing programs are required to maintain a minimum pass rate of 75% on the National Council Licensing Examination (NCLEX) to remain in good standing, with institutions facing potential probation or disapproval for failing to meet this standard.

Furthermore, nursing education programs must demonstrate adequate financial support and facilities, ensuring quality clinical training through defined student-to-faculty ratios. Institutions seeking to establish or modify programs must submit detailed proposals for approval, and any changes to program names or faculty must be reported promptly to maintain compliance.

The amendments aim to enhance the quality and safety of nursing education and practice in Illinois, ensuring that nursing programs are well-supported and that graduates are adequately prepared for licensure and professional practice. Overall, these changes reflect a commitment to improving the regulatory framework governing nursing in the state, ultimately benefiting public health and safety.

The recent amendments to various healthcare regulations in Illinois significantly impact the roles and responsibilities of advanced practice registered nurses (APRNs), particularly certified registered nurse anesthetists (CRNAs), as well as dentists administering anesthesia. Notably, CRNAs are now permitted to develop anesthesia plans and administer anesthesia without the physical presence of an anesthesiologist, allowing for greater autonomy in patient care.

In the dental field, new permit requirements mandate that dentists obtain authorization from the Department to administer general anesthesia, deep sedation, or moderate sedation. Dentists must also complete specific training programs to ensure they are qualified to provide these services safely. Additionally, collaboration between dentists and nurse anesthetists is required, with written agreements necessary unless the nurse anesthetist has full practice authority.

The regulations also clarify the collaborative agreements required for APRNs, which are not needed in certain healthcare settings like hospitals and ambulatory surgical treatment centers. CRNAs must still consult with physicians when developing anesthesia plans, although the amendments allow for more flexibility in their practice.

Furthermore, CRNAs who achieve national certification and meet specific educational and clinical experience criteria can practice without a written collaborative agreement, expanding their scope to include prescribing controlled substances. This change is expected to enhance the operational capabilities of healthcare providers and improve patient care delivery.

Overall, these regulatory changes aim to streamline the practice of APRNs and dentists in Illinois, promoting patient safety while allowing for increased flexibility and autonomy in healthcare delivery.

The document outlines significant amendments to the Nurse Practice Act in Illinois, set to take effect on August 1, 2025. These changes redefine the scope of registered professional nursing practice, emphasizing that it is rooted in a scientific process and a professional body of knowledge. Registered professional nurses (RNs) will gain the authority to delegate nursing interventions and tasks to other RNs and licensed practical nurses (LPNs) based on comprehensive assessments, while they are prohibited from delegating tasks requiring nursing knowledge and judgment to unlicensed personnel.

Additionally, the amendments remove previous provisions regarding delegation in community-based or in-home care settings, which may affect home health care services and agencies. The intent behind these changes is to enhance patient safety and care quality by ensuring that only qualified personnel perform specific nursing tasks.

The regulations also specify that RNs may delegate the administration of certain medications to unlicensed personnel under specific conditions, although this is not permitted in institutional or long-term care facilities. RNs are protected from disciplinary actions for refusing to delegate tasks if they believe it may compromise patient safety.

Furthermore, the RN scope of practice includes comprehensive patient assessments, care coordination, and the development and implementation of nursing care plans. However, certain tasks requiring nursing knowledge and judgment cannot be delegated to unlicensed personnel, and re-delegation of tasks by unlicensed personnel is not allowed.

The amendments indicate a timeline for ongoing evaluation, with certain sections scheduled for repeal on January 1, 2028. These changes may have financial implications for healthcare facilities, nursing education programs, and home health care providers as they adapt to the new regulations and training requirements for nursing staff.

The document outlines significant amendments to the Nurse Practice Act in Illinois, focusing on the roles and regulations of advanced practice registered nurses (APRNs) and certified nurse midwives (CNMs). Key changes include the introduction of collaborative agreements that allow CNMs with full practice authority to work more flexibly with other APRNs, enhancing collaboration among healthcare professionals.

The amendments clarify the authority of APRNs, enabling them to practice independently without a written collaborative agreement under certain conditions. This shift is expected to improve healthcare delivery by granting APRNs and CNMs greater autonomy, which could increase access to care, particularly in rural and underserved areas.

Additionally, the regulations specify that certified registered nurse anesthetists (CRNAs) must establish written collaborative agreements with anesthesiologists, physicians, or operating dentists when providing anesthesia services. These agreements outline the working relationship and authorized procedures, ensuring a structured approach to care.

The amendments also address prescriptive authority, allowing collaborating physicians or CNMs to delegate the ability to prescribe medications to APRNs, including controlled substances, contingent upon obtaining the necessary licenses. Furthermore, APRNs seeking full practice authority must meet specific continuing education and clinical experience requirements to ensure they are adequately prepared for independent practice.

Overall, these regulatory changes aim to modernize nursing practice in Illinois, enhancing the roles of APRNs and CNMs while promoting patient safety and collaborative healthcare delivery.

The document outlines significant amendments to the regulations governing the practice of physician assistants (PAs) and advanced practice registered nurses (APRNs) in Illinois, enhancing their prescriptive authority and collaborative practice requirements. PAs are now permitted to prescribe, dispense, and manage medications independently, without needing a written collaborative agreement if they meet specific education and experience criteria. This change is expected to improve healthcare delivery efficiency and expand the scope of services that PAs can provide.

Additionally, APRNs can prescribe Schedule II controlled substances under delegated authority from a collaborating physician, with specific conditions regarding prescription limits and required consultations. These changes aim to streamline operations in healthcare settings, allowing for greater flexibility in employing PAs and APRNs, particularly in hospitals and clinics.

The amendments also address the oversight of controlled substances, impacting various healthcare providers and businesses involved in pharmaceuticals. The regulations emphasize the importance of compliance and the roles of different stakeholders in ensuring safe prescribing practices.

Overall, these updates are anticipated to enhance the roles of PAs and APRNs in Illinois, potentially leading to improved patient care and operational efficiencies in the healthcare system. The changes reflect a broader trend towards increasing the autonomy of mid-level practitioners in response to evolving healthcare needs.

The proposed amendments to the Nurse Practice Act aim to streamline the approval process for English proficiency tests and improve adverse occurrence reporting for licensed midwives. These changes primarily impact healthcare professionals, particularly in nursing and midwifery, by creating a more uniform acceptance process for applicants educated outside the United States. This is expected to reduce costs associated with the current fragmented approach to test acceptance and program approval.

The regulations also address the licensure process for licensed practical nurses (LPNs), requiring applicants to submit comprehensive documentation, including proof of graduation from approved programs and English proficiency test scores for non-native speakers. Institutions seeking to establish or revise nursing programs must submit detailed proposals and maintain compliance with pass rate standards on the National Council Licensing Examination (NCLEX).

In addition, the document outlines requirements for nursing education programs, emphasizing the need for qualified faculty, comprehensive curricula, and adequate financial support and facilities. Programs must regularly evaluate student performance and maintain specific student-to-faculty ratios during clinical experiences. Out-of-state programs must adhere to Illinois standards for clinical placements.

Furthermore, the regulations include reporting requirements for adverse occurrences related to neonatal emergencies, specifically for certified nurse midwives and birth centers. These reports must be submitted within specified timeframes and include essential details about the incidents, ensuring timely communication while maintaining confidentiality for the reporting entities.

Overall, these amendments and regulations are designed to enhance the quality and safety of nursing education and practice, ensuring that programs and professionals meet established standards while facilitating a more efficient licensure process.

AT A GLANCE

This bill requires the Agricultural Promotion and Regulation Task Force to submit its report to the legislative council by Nov. 1, 2026.

FULL SUMMARY

The document establishes and restructures multiple Indiana commissions, task forces, boards, funds, and regulatory processes, with many provisions taking effect in 2026 and 2027. It also creates new legislative duties for legislative interim study committees and makes broad changes to state administration of public safety communications, building/fire safety governance, and numerous agency fee/tax allocations.

Key changes include: (1) amending an interim study committee chapter to add/modify substantive interim study activities (roads and transportation vehicle plate suitability advice; corrections criminal-behavior trend review with potential legislation preparation; courts/judiciary even-year review of requests for new courts and annual posting requirements; courts/“weighted caseload” identification and recommendations; child services even-year review of fatality review team reports and reporting to the legislative council; government even-/odd-year evaluations of “groups” and interstate compacts; and adding a 2026–2027 sunset review of a child welfare task force report). (2) Creating a new Agricultural Promotion and Regulation Task Force (Chapter 53.5) as a temporary general-assembly-serving entity with defined membership, quorum/action rules, study topics about shifting Purdue-linked agricultural administration/regulation, an information/testimony process, a report due to the legislative council by Nov. 1, 2026, staffing by the legislative services agency, and expiration June 30, 2027.

Major substantive statutory restructuring targets include public safety communications and building/fire safety administration. The bill transitions the integrated public safety commission framework to the department of homeland security (and updates related fund administration and procurement authority); creates an RFP/scoring process for communications systems equipment; and updates system governance, user agreements, operational responsibilities, and fund/appropriation mechanics for the statewide wireless public safety voice/data communications system and its infrastructure fund. In parallel, it substantially revises building and fire safety law administration by transferring powers/duties/liabilities from the Fire Prevention and Building Safety Commission to the department of homeland security effective July 1, 2027, including rules adoption/precedence structures, rule readoption/transition treatment, and governance references (with a new “Transition of Responsibilities” chapter). It also expands self-certification of design releases for certain Class 1 construction projects in 2027, adding eligibility requirements, electronic certification, departmental issuance without technical plan review, audit/discipline authority, and safeguards.

The bill also performs numerous commission/board “cleanup and consolidation” actions: it adds a new Indiana Cultural Commission chapter (effective July 1, 2026) with defined membership, quarterly meeting expectations, subcommittees by community concern, funding via a dedicated special fund, and constraints on studying tribal sovereignty/gaming; it repeals multiple existing commissions and advisory bodies effective July 1, 2026/2027 and establishes new versions for cultural and other functions; and it changes eligibility/fee distributions and operational rules across vehicle title/registration, license/permit administration, and related state funds. It further adjusts civil procedure exposure and administrative processes for agencies (e.g., tort claim coverage and confidentiality-related provisions), modifies rulemaking/fee/inspection authorities for child care facilities (including consultation requirements and updated fire-related compliance and variance/waiver interactions), updates driver education and other board structures, and makes numerous technical and governance updates to various professions and regulated industries.

AT A GLANCE

This bill requires medical spas registered in Indiana to designate a responsible practitioner physically present enough to ensure compliance and to notify the board of serious adverse events within 15 days.

FULL SUMMARY

The bill establishes Indiana rules for “bulk drug substances” and the “compounding” of prescription drugs using bulk substances, effective July 1, 2026, by creating a new Chapter 22.5 in IC 16-42-22.5 and adding two definitional sections in IC 16-18-2.

Under the new IC 16-42-22.5, the Chapter applies to compounding using bulk drug substances intended for incorporation into a finished drug product and to furnish pharmacological activity or other direct effect. “Bulk drug substance” and “compounding” are defined, while the Chapter excludes certain activities from “compounding,” including mixing/reconstituting per manufacturer labeling approved by the federal FDA, and addition of flavoring. A key limitation also applies: the Chapter does not apply to compounding of, or a compounded drug for, animal use.

The bill restricts when and how a person may engage in compounding: a person may not compound unless the bulk drug substance is not research grade (unless part of an IRB-approved study) and not veterinary grade; the bulk drug substance was manufactured by an FDA-registered human drug establishment (21 U.S.C. 360); the substance is accompanied by a valid certificate of analysis including identity/content and original manufacturing country; quality control testing was conducted; the compounding complies with the federal Food, Drug, and Cosmetic Act; and it complies with applicable United States Pharmacopeia (USP) chapters. For nonresident pharmacies shipping compounded drugs into Indiana using bulk drug substances, the Indiana board of pharmacy may request documentation of compliance, which must be provided within a reasonable time. The bill also requires any person selling, transferring, or distributing compounding drugs to maintain acquisition/examination/testing records for at least two years after the expiration date of the last lot of compounded drugs containing the bulk drug substance.

The bill establishes governance and reporting for oversight of drug compounding and creates a new framework for “medical spas.” It assigns the Indiana board of pharmacy primary investigative authority over sourcing, storage, labeling, handling, and compounding of prescription drugs, and authorizes investigation of alleged violations of the Chapter. The state department, in consultation with specified entities, must publish a report twice yearly (by March 1 and September 1) on compounding oversight and associated risks/benefits, including counts of license types involved, licensed compounding facilities/practices in retail/outpatient settings (including 503A pharmacies and medical spas), summaries of deficiencies/violations, number of investigations, and disciplinary actions (including improper marketing/advertising/promotion). Separately, it creates IC 25-22.5 Chapter 12.5 defining “medical spa,” “practitioner,” and requiring medical spas to be registered beginning January 1, 2027; the board must establish a registration procedure by October 1, 2026 with an application including the spa’s names, address, website, intended health care services, whether it engages in compounding, and responsible practitioner information. A medical spa must designate a “responsible practitioner” with prescriptive authority and appropriate education/training, who must be physically present for enough time to ensure compliance; the responsible practitioner must ensure individuals working at the spa are properly licensed within scope and trained. Medical spas must notify the board of a “serious adverse event” within 15 days, with specified content (patient/name, medication/treatment/date, nature/location, and medical records), and the board may investigate the responsible practitioner, with violations subject to discipline under IC 25-1-9. A medical spa generally may not provide services/treatments at locations other than the medical spa office except for educational or training purposes. It also requires medical spa compliance with advertising rules (IC 25-1-10.3) and allows registration suspension for violations. Finally, the bill amends IC 25-26-13-4 (effective July 1, 2026) to have the board of pharmacy “oversee and investigate” IC 16-42-22.5 and includes related changes aligning the board’s rulemaking and authority with this new compounding oversight regime.

AT A GLANCE

This bill requires Indiana’s Office of Medicaid to reimburse eligible APRN-provided services in community mental health centers under each APRN’s scope of practice, and adds APRNs as eligible supervisors for outpatient mental health or substance abuse treatment plans.

FULL SUMMARY

The bill makes multiple changes to Indiana’s regulation of advanced practice registered nurses (APRNs), primarily by removing collaborative/practice-agreement requirements tied to APRN practice and by repealing provisions governing audits of APRN practice agreements, while adding limited controlled-substance prescribing authority for weight loss/obesity.

Effective July 1, 2026, it amends the Medicaid reimbursement framework for APRNs employed by community mental health centers by requiring the Office of Medicaid policy/planning (the “office”) to reimburse eligible Medicaid claims for specified services provided by an APRN within the APRN’s scope of practice, and by including APRNs as eligible providers for supervising outpatient mental health or substance abuse treatment plans. It also changes existing constraints by removing the requirement that reimbursement applies only if services are included in an APRN’s practice agreement with a collaborating physician.

It amends the APRN statutory framework to remove practice-agreement/collaboration language in several places: the section governing authority to prescribe stimulant medications is updated to apply to practitioners including APRNs only where their “practice agreement” reflects specified conditions; the APRN definition statute is revised to remove a reference to settings and retains/clarifies scope-based practice; the board’s rulemaking authority is updated to remove provisions about standards and renewal/audit procedures for APRN practice agreements while retaining the board’s authority to set prescriptive-legend-drug authority requirements; and the prescriptive authority section removes the practice agreement as a condition for APRN prescriptive authority in its scope/rule references. It also deletes/repeals the prior “practice agreement” audit scheme and replaces it with new, board/enforcement mechanisms: repeals IC 25-23-1-19.8, which previously required random audits of a percentage of APRN practice agreements with legend drug prescribing authority.

For controlled substances, it creates new prescribing rules for weight reduction/obesity: APRNs granted prescriptive authority may prescribe a Schedule III or IV controlled substance for weight reduction or to control obesity, but not a Schedule II controlled substance for that purpose. For Schedule III/IV, the bill requires the APRN to determine—through review of prior weight-loss efforts and related records—that a reasonable weight-loss program using non-controlled-regimen methods was attempted and ineffective, and to obtain a thorough history and physical examination before initiating treatment. It also requires discontinuation when professional judgment determines controlled substances are no longer necessary or appropriate (including when decreasing contribution toward weight loss occurs, or when the patient has relevant history/propensity for alcohol/drug abuse or has not followed directions about controlled substances). The bill also adds (in the controlled-substance section) that a Schedule III/IV prescriber may not begin/continue after these professional-judgment determinations, and it retains limits on Schedule II prescribing by APRNs.

AT A GLANCE

This bill removes nurse-collaboration prerequisites for Indiana APRNs and requires the Medicaid office to reimburse qualifying APRN community mental health services within scope of practice.

FULL SUMMARY

Removes several nurse-collaboration prerequisites from Indiana law governing advanced practice registered nurses (APRNs). Effective July 1, 2026, an APRN no longer must have a practice agreement with a collaborating physician as a condition tied to Medicaid reimbursement eligibility, and the law removes related requirements that APRNs operate under a “collaborative practice agreement” (or hospital privileges) and removes certain provisions governing auditing of APRN practice agreements.

Creates/adjusts Medicaid-related participation rules for APRNs working in community mental health centers. The Medicaid “office” must reimburse eligible Medicaid claims for services within an APRN’s scope of practice provided by an APRN employed by a community mental health center, including mental health services, behavioral health services, substance abuse treatment, primary care services, evaluation/management for inpatient or outpatient psychiatric treatment, and prescription drugs; the office must also include an APRN as an eligible provider to supervise a plan of treatment for outpatient mental health or substance-abuse treatment services when the supervision is within the APRN’s scope of practice, education, and training.

Allows APRNs with prescriptive authority to prescribe a Schedule II controlled substance for weight reduction or to control obesity. Under the revised controlled-substance limits effective July 1, 2026, an APRN with prescriptive authority is permitted to treat patients with a Schedule III or IV controlled substance for weight reduction/obesity only if specified clinical prerequisites are met (including review of prior weight-loss efforts without controlled substances and a thorough history and physical examination) and the APRN must discontinue after professional judgment conditions are met. The bill also specifies that an APRN may not prescribe a Schedule II controlled substance for weight reduction/obesity; however, it separately provides that an APRN with prescriptive authority may prescribe a Schedule II controlled substance for weight reduction or control of obesity (as described in the bill digest).

Makes conforming changes to related Indiana Code provisions across professional practice, Medicaid, nursing board authority, and controlled-substance provisions, including modifying the statutory definitions and updating a practitioner guideline requirement for stimulant prescribing to follow the most recent American Academy of Pediatrics/American Academy of Child and Adolescent Psychiatry guidance when prescribing for children with attention deficit disorder or attention deficit hyperactivity disorder.

The Indiana Department of Revenue has revised the Physician Practice Ownership Tax Credit, effective August 2025, to broaden eligibility to all physicians who own qualifying practices, not just those in primary care. This change aims to encourage greater physician ownership across various specialties.

Starting in 2025, eligible physicians can receive a tax credit of $20,000 per year for three years, provided their practice has been billing for health care services for at least six months. In 2024, however, the credit remains exclusive to primary care physicians with ownership in qualifying primary care practices.

To apply for the credit from 2025 onwards, physicians must use Form IN-PPOTC, with applications accepted annually from July 1 to June 30. The total amount of credits awarded each fiscal year is capped at $10,000,000.

Additionally, physicians must own at least 5% of their practice's income to qualify for the credit. For practices with more than ten physician owners, the minimum ownership requirement is adjusted accordingly.

These updates are designed to enhance access to tax credits for a wider range of medical professionals and promote physician ownership in healthcare practices.

The Indiana Medical Licensing Board is proposing amendments to regulations governing physician assistant practice and collaboration agreements. These changes aim to modernize the framework in line with recent legislative updates, including the transition from "supervising physician" to "collaborating physician." The amendments are designed to comply with state statutory requirements established by recent House Enrolled Acts, which have altered the collaboration dynamics between physician assistants and physicians.

Key changes include requirements for physician assistants to clearly identify their professional status to patients and to operate under the supervision of a collaborating physician. Additionally, the amendments outline specific certification fees and emphasize the importance of maintaining competent practice standards, including proper patient record-keeping and adherence to opioid management protocols.

The regulations also introduce stricter guidelines for managing opioid prescriptions, mandating thorough patient evaluations, regular follow-up visits, and drug monitoring. These measures are intended to enhance patient safety and reduce the risk of opioid misuse, ensuring that physician assistants operate within their delegated responsibilities.

The public comment period for these proposed changes is open until December 20, 2024, allowing stakeholders to provide feedback before the amendments take effect. The current regulations will remain in place until that date, giving affected parties time to review the proposed modifications.

Overall, these amendments are expected to impact the healthcare industry significantly, particularly for physician assistants and their collaborating physicians, as they adapt to the new requirements and enhance their practices in line with updated standards.

AT A GLANCE

This bill requires the Iowa Code editor and agencies to replace statutory and administrative references to “physician assistant” with “physician associate” by January 1, 2027.

FULL SUMMARY

The bill establishes a statewide terminology shift in Iowa’s statutory and administrative references from the title “physician assistant” to “physician associate.” It requires the Iowa Code editor and agencies to update references in the Iowa Code, related noncodified enactments, and administrative rules/guidance/forms to reflect the new title, while maintaining that the change does not alter the scope of practice or rights/responsibilities of individuals licensed under Iowa’s physician assistant licensing framework (Code chapter 148C).

Key statutory change: Code section 147.74(17) is revised so that a person qualifying for licensure as a “physician assistant licensed associate” may use “physician assistant associate” after the person’s name or signify the same with “P.A.” (Sec. 1). The bill also declares that references to “physician assistant” in the Iowa Code/Iowa Administrative Code are to be revised to “physician associate,” and it treats the terms “physician assistant,” “physician associate,” and “P.A.” as synonymous, without affecting existing rights and responsibilities.

Operational/transition requirements: employing/coordinating treatment with, following orders from, training/educating/contracting with, or otherwise dealing with a person licensed as a physician assistant must continue the relationship without interruption or alteration solely due to the title change. It prohibits discrimination in contracting/employment/otherwise solely based on an individual’s use of “physician associate.” For a period before the title “physician associate” enters common usage, eligible persons under chapter 148C may use either “physician assistant,” “physician associate,” or “P.A.,” and others may rely on the person having all physician assistant rights and responsibilities.

Implementation and editorial update directives: by January 1, 2027, each agency must amend active versions of sub-regulatory guidance, documents, and forms to reflect the title change. The Code editor is directed to replace references to “physician assistant” and derivatives with “physician associate” and derivatives throughout the Code, and to make corresponding changes in noncodified enactments amended or enacted by other acts. Agencies are also authorized to submit limited, editorial amendments to administrative rules to effect the terminology update (Sec. 4).

The Department of Health and Human Services is proposing significant changes to the Iowa Medicaid program, aiming to modernize language and practices related to medical and remedial services. This initiative includes the adoption of a new Chapter 78 of the Iowa Administrative Code, which is expected to yield state savings of $480,000 initially, with annual savings projected to reach $2.8 million by fiscal year 2025. Key adjustments will affect various healthcare sectors, particularly rehabilitation and speech therapy, by revising payment policies and clarifying coverage for specific services.

The proposed changes will allow nurse practitioners and physician assistants to operate without on-site physician supervision and align payments for chronic renal disease treatment with Medicare standards. Nutritional counseling for young individuals will be reimbursed when provided by licensed dietitians, and regulations will clarify conditions for sterilization procedures and reproductive health services. Additionally, outpatient services will see new prior authorization requirements, and home health services will focus on medically necessary care with updated documentation standards.

The document also outlines comprehensive regulations for mental health and rehabilitation services, emphasizing the need for structured service delivery and appropriate staffing qualifications. Coverage for therapies such as physical, occupational, and speech therapy will depend on adherence to treatment plans and medical necessity, impacting billing practices for providers. Enhanced services for high-risk pregnancies and requirements for certain clinics to enroll in vaccination programs are also highlighted.

Furthermore, the regulations address telehealth services and community-based neurobehavioral rehabilitation, allowing for increased flexibility in service delivery without the need for in-person contact. Members seeking these services must undergo a needs assessment, and treatment plans will require approval from Iowa Medicaid. The document also specifies prior authorization processes for various personal care and psychosocial services, ensuring compliance with established guidelines.

Overall, these proposed changes reflect a comprehensive effort to streamline Medicaid services, enhance cost-effectiveness, and ensure that healthcare providers adhere to updated standards. The anticipated revisions are expected to significantly impact the operational practices of healthcare providers and improve access to services for individuals in need.

The document outlines a legislative bill in Iowa that aims to enhance the prescribing, ordering, dispensing, and administering authority of pharmacists and practitioners. A key provision of the bill is the prohibition of any restrictions imposed by licensing boards or employers that would prevent these professionals from exercising their best professional judgment in medication or treatment decisions.

Under this bill, any restrictions documented in contracts, agreements, or employee handbooks are deemed unenforceable. This means that such restrictions cannot serve as a basis for disciplinary action by employers against pharmacists and practitioners.

The legislation is designed to protect healthcare professionals who act within their legal scope of practice and in accordance with their professional judgment, ensuring they will not face disciplinary actions related to their licenses.

The impacted industries primarily include healthcare, specifically pharmacy and medical practices, as the bill seeks to promote greater autonomy for healthcare professionals in their prescribing practices. The document does not provide information on monetary impacts or specific implementation dates.

The Iowa Board of Medicine is proposing to rescind and adopt a new chapter regarding the supervision of physician assistants by physicians. This rulemaking is based on the authority granted by various Iowa Code chapters and aims to align with recent amendments to the Iowa Code.

The proposed changes will impact the healthcare industry in Iowa, specifically the practices of physicians and physician assistants. It requires that a licensed physician assistant must be supervised by a physician during their first two years of independent practice unless they have previously practiced under supervision for at least two years.

A public hearing is scheduled for early June 2025, and written comments on the proposed rulemaking must be submitted by mid-June 2025. The fiscal impact of these changes is expected to be negligible, with no significant monetary effects or job impacts identified for the State of Iowa.

The proposed rules will outline specific eligibility criteria for supervising physicians, exemptions, notification requirements, and communication protocols regarding supervisory relationships.

The document outlines comprehensive regulations for nursing education programs in Iowa, focusing on the approval process, program requirements, and the responsibilities of institutions. Nursing programs must adhere to specific criteria to gain approval from the Nursing Board, which can be granted for up to six years. Institutions seeking interim approval for new programs must submit detailed applications, including evidence of need and qualified faculty, and are required to provide annual reports on admissions and faculty qualifications.

Key provisions emphasize the importance of aligning nursing programs with institutional philosophy and outcomes, necessitating a written evaluation plan to assess program effectiveness. The head of the nursing program must possess current licensure, relevant clinical experience, and teaching qualifications, while faculty members are expected to meet specific educational and professional development standards. Adequate resources must be provided by the controlling institution to support the nursing program effectively.

The document also addresses the collaboration between nursing programs and clinical facilities regarding preceptorships, requiring the selection of qualified preceptors who align with the program's goals. Programs must monitor their NCLEX® passing rates and report any significant changes to the Nursing Board, ensuring transparency and accountability in maintaining educational standards.

Overall, these regulations aim to enhance the quality of nursing education in Iowa, ensuring that programs are well-structured, adequately resourced, and capable of producing competent nursing professionals. The changes will take effect on June 4, 2025, impacting both the nursing education sector and clinical facilities involved in training.

The document outlines the standards and regulations governing the practice of registered nurses (RNs) and licensed practical nurses (LPNs) in Iowa, emphasizing their roles, responsibilities, and the legal boundaries of their practice. It highlights the importance of professionalism, accountability, and ongoing education for nursing professionals, requiring them to maintain competence and report unsafe practices while clearly identifying their professional status during patient care.

A significant focus is placed on the scope of practice for LPNs, particularly regarding intravenous therapy and telehealth services. LPNs are permitted to perform certain nursing tasks under the supervision of RNs or physicians, including limited intravenous therapy and patient advocacy, provided they have documented competency. However, they are restricted from initiating or discontinuing specific intravenous procedures and administering high-risk medications.

The document also details the delegation process for RNs when assigning tasks to LPNs and unlicensed assistive personnel (UAPs), ensuring that all delegated tasks fall within the delegatee's scope of practice and that appropriate supervision is maintained. This framework aims to enhance patient safety and ensure compliance with healthcare standards in Iowa.

Effective dates for various regulatory changes are noted, with significant amendments set to take effect on June 4, 2025. The document indicates that these changes will impact the healthcare industry, particularly nursing facilities, hospitals, and telehealth services, potentially affecting staffing practices, training requirements, and operational protocols.

Overall, the document establishes a comprehensive framework for nursing practice in Iowa, reinforcing the importance of safety, accountability, and continuous professional development within the nursing profession.

The document outlines new regulations for conditional prescribing psychologists in Iowa, effective May 21, 2025. These regulations establish clear guidelines for the practice of prescribing psychologists, emphasizing the importance of supervision and collaboration with primary care physicians to ensure comprehensive patient care.

Conditional prescribing psychologists are required to complete a minimum of two years of supervised practice, which includes treating at least 300 patients with diagnosed mental disorders and 100 patients with psychotropic medications. Supervising physicians must be licensed and board-certified, and they can oversee a maximum of two conditional prescribing psychologists at a time. Regular performance evaluations and initial assessments are mandated to ensure the competence of prescribing psychologists.

Informed consent and the release of patient information are essential components of the collaborative practice, with a designated primary care physician assigned to each patient. A written collaborative practice agreement must be established, detailing the scope of practice, communication methods, and any limitations on medications and patient populations.

Additional training is required for prescribing to specific populations, such as children, the elderly, or patients with serious medical conditions. These regulations aim to enhance patient safety and improve outcomes in mental health treatment by ensuring that psychologists prescribing medications are adequately supervised and trained.

Overall, the changes are designed to strengthen the framework for psychopharmacology services provided by psychologists, thereby impacting the healthcare industry, particularly mental health services.

The Iowa Board of Nursing is proposing to rescind and replace Chapter 6 of the Iowa Administrative Code, which governs nursing practice for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). The new chapter aims to establish updated standards of practice that align with national care standards and evidence-based practices, enhancing clarity in nursing definitions and standards to protect the public and improve nursing practice.

The proposed changes outline the scope of practice and responsibilities for LPNs, emphasizing professionalism, accountability, and ongoing education. LPNs will participate in patient care under the supervision of RNs or physicians, with specific limitations on their practice, particularly regarding activities that require RN-level knowledge. They may engage in a limited scope of intravenous therapy under supervision, provided they have documented competency.

Additionally, LPNs are permitted to delegate tasks to other LPNs or unlicensed assistive personnel, ensuring that the tasks are within the appropriate scope of practice. The proposed regulations also address the supervision of LPNs in various healthcare settings and outline an expanded scope of practice for LPNs who complete board-approved certification courses.

The document also details regulations concerning intravenous therapy and telehealth services. Certain intravenous procedures cannot be delegated to LPNs, which may lead to increased operational costs for healthcare facilities due to the need for more RNs. Telehealth providers, including RNs and LPNs, must maintain compliance with technology and care standards, ensuring secure practices and proper record-keeping.

Overall, these changes are designed to enhance the quality of nursing care in Iowa while potentially increasing costs for healthcare providers related to staffing and technology investments.

The Board of Medicine in Iowa is proposing new regulations for prescribing psychologists, aimed at enhancing supervision requirements to ensure safe and competent patient care. This rulemaking primarily impacts the healthcare industry, particularly psychologists and medical professionals involved in mental health treatment, while also potentially affecting related sectors such as medical education and training programs.

Conditional prescribing psychologists will be required to complete a year of supervised practice with specific populations, including children and the elderly. They must collaborate with a licensed physician who regularly prescribes psychotropic medications, ensuring patient safety and appropriate clinical examinations.

The collaborating physician is responsible for obtaining informed consent, designating a primary care physician for each patient, and maintaining regular communication about the treatment plan. A written collaborative practice agreement will be necessary, outlining the roles and responsibilities of both the prescribing psychologist and the collaborating physician.

Overall, these proposed changes aim to establish stricter guidelines for the collaboration between psychologists and physicians, thereby enhancing the standards of practice in mental health services in Iowa.

The Iowa Nursing Board has proposed new standards of practice for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) to enhance the quality of nursing care and ensure public safety. A public hearing is scheduled for November 19, 2024, where stakeholders can provide feedback. The rulemaking affects approximately 74,000 licensed nursing professionals in Iowa, with costs primarily impacting practitioners, who may pass these costs onto consumers. The Board emphasizes that no less costly or intrusive methods exist to achieve the proposed standards.

Key changes include a defined delegation process where RNs must ensure that tasks assigned to LPNs or unlicensed assistive personnel align with their qualifications and patient needs. LPNs face specific restrictions regarding intravenous therapy, including prohibitions on certain procedures, which may affect healthcare facilities that employ them. They are allowed to perform limited intravenous therapy under RN supervision and must act as patient advocates while maintaining professionalism.

Additionally, LPNs are authorized to dispense medications in opioid treatment programs, contingent upon RN assessment and consultation. They may supervise other LPNs or unlicensed personnel in certain settings, provided they complete required training. LPNs can also perform expanded intravenous therapy procedures after completing a board-approved certification course, which requires a current Iowa license and relevant practice hours.

The proposed regulations aim to clarify the scope of practice for LPNs, particularly in relation to opioid treatment and telehealth services, ensuring they adhere to the same standards of care as in-person services. These changes are expected to influence healthcare facilities, nursing education programs, and operational dynamics in patient care across Iowa.

The proposed rulemaking in Iowa focuses on the supervision of physician assistants by licensed physicians, outlining the requirements for supervisory agreements and the conditions for supervision. This initiative aims to enhance public safety by establishing clear standards for the oversight of physician assistants, particularly during their first two years of independent practice.

The rulemaking is expected to impact healthcare providers, including hospitals, clinics, and private practices that employ physician assistants. While there are no direct costs imposed on the general public, compliance costs will be incurred by physician assistants and their supervising physicians. The Board of Medicine will face minimal costs, primarily related to staff time for reviewing agreements and addressing any complaints.

By clarifying the processes for supervision and the responsibilities of both physician assistants and their supervisors, the rulemaking seeks to benefit Iowa residents, licensees, and employers. Written comments on the Regulatory Analysis can be submitted to the Iowa Department of Inspections, Appeals, and Licensing by the specified deadline.

AT A GLANCE

This bill requires the Kansas State Board of Healing Arts to fingerprint and obtain both state and national criminal history record checks for physician assistant applicants.

FULL SUMMARY

The bill adds a criminal history fingerprint check requirement for physician assistant licensure and oversight. A new section authorizes the Kansas State Board of Healing Arts to require applicants for initial physician assistant licensure, reinstatement, or applicants under investigation to be fingerprinted and submit to both state and national criminal history record checks under the procedures in K.S.A. 22-4714, and authorizes the Board to charge a fee sufficient to reimburse the costs, deposited to the Healing Arts Fee Fund.

It revises the statewide criminal history check statute (K.S.A. 22-4714) and expands the list of agencies eligible to receive criminal history record information from the Kansas Bureau of Investigation. The revisions specifically add the state board of healing arts for physician assistant applicants/licensees in connection with the new physician assistant criminal history process (including checks “pursuant to section 1”). The bill also makes related conforming changes within that statute, including confidentiality and disclosure/penalty provisions as provided in the amended text.

The bill substantially restructures Kansas’ physician assistant practice framework by modifying core definitions, practice authorization, and collaboration/supervision rules. It creates/adjusts the Physician Assistant and Physician Associate licensure act naming and updates definitions to remove references to “supervising physician” and “responsible physician” concepts in favor of defined “collaboration,” “supervision,” and related terms; it also clarifies that collaboration does not require a physician’s personal presence at the time/place of care. It amends practice permission rules to establish a collaboration model for physician assistants with at least 4,000 hours of postgraduate clinical experience, subject to a practice agreement kept at the practice site and available to the board, and it requires that the collaborating physician (or group and setting-specific systems) sets the terms/limits. For physician assistants with fewer than 4,000 hours, it requires practice under physician supervision via a written practice agreement. It also adds a continuing-authorization rule allowing practice in a written agreement for up to 180 days (with possible one extension of up to an additional 180 days) after the loss/absence of a collaborating physician, subject to board approval and restrictions tied to disciplinary history.

The bill amends physician assistant licensure practice authorities and physician assistant responsibilities. It updates the list of healthcare services that physician assistants may provide and expands/clarifies prescribing and dispensing authority, including: physician assistants may prescribe drugs and, beginning January 11, 2016, may dispense certain prescription-only drugs within board rules and limited circumstances (best interests of the patient, when pharmacy services are not readily available, and not exceeding a 72-hour supply). It also requires physician assistants to identify themselves to patients and others as physician assistants, require board rulemaking for governance of delegation/supervision/drug prescribing, and updates enforcement and professional discipline triggers by changing/re-numbering disciplinary grounds in K.S.A. 65-28a05. Finally, the bill repeals K.S.A. 65-28,127 and numerous physician assistant-related provisions (K.S.A. 65-28a01 through 65-28a12 and K.S.A. 2025 Supp. 22-4714), and sets the effective date as January 1, 2027 (plus publication in the statute book).

AT A GLANCE

This bill expands Kansas optometry practice to include specified device use, topical pharmaceutical use for certain ocular conditions, and enumerated non-surgical procedures, while excluding retinal surgery and other listed surgical acts.

FULL SUMMARY

The bill changes Kansas optometry law by expanding and clarifying what constitutes the practice of optometry, updating definitions used in the optometry statutes, revising optometrist credentialing requirements for certain procedures, changing governance/administration provisions within the optometry board framework, and adjusting optometrist professional liability insurance participation requirements. It also modifies provisions governing the healthcare stabilization fund and its oversight board, including increasing the board’s size, adding optometry representation, and (through the referenced optometrist insurance exemption) delaying when certain optometrists become subject to professional liability insurance requirements.

For optometry scope-of-practice, the bill amends K.S.A. 65-1501. It specifies that optometry includes use of medical devices and related prescribing/dispensing/adapting of lenses; use of topical pharmaceutical drugs (except intraocular injections) through all routes of administration for specified ocular conditions; removal of non-perforating foreign bodies and other enumerated non-surgical or limited procedures; and performance of additional procedures within an optometrist’s education/training, but only if the board first receives an interprofessional advisory committee recommendation that the procedure is appropriate. It also amends the list of excluded procedures (K.S.A. 65-1501(b)), adding/clarifying that retinal surgery, corneal transplant/penetrating keratoplasty, administration/surgery under general anesthesia, and other listed surgical procedures are not within optometry, while permitting pre- and post-operative care for excluded procedures.

Credentialing and continuing obligations are modified. The bill amends K.S.A. 65-1509a to require credentialing (including reporting) for optometrists who administer or perform procedures referenced in K.S.A. 65-1501(a)(4) or (5) that require injections or lasers. Optometrists graduating on or after July 1, 2020 receive credentialing upon request; those graduating before then must provide proof of completing a 32-hour certification program with specified didactic and clinical/lab components approved by the board. Credentialed optometrists must submit quarterly reports including identity, total procedures, locations, and outcomes, certify report accuracy, and the board must compile and publicly disclose the reported information beginning July 1, 2027 with personally identifiable information redacted; the reporting framework expires July 1, 2031.

The bill also amends the healthcare stabilization fund provisions applicable to professional liability coverage and the composition of the fund’s board of governors (K.S.A. 40-3402 and K.S.A. 40-3403). It increases the board of governors from 11 to 12 members and adds a seat for an optometrist nominee from the Kansas optometric association. It changes optometrist participation in the professional liability insurance requirement for active licensure by limiting when optometrists are subject to the insurance requirements and under what conditions: optometrists are subject only if credentialed to provide specified procedures (incision and curettage of a chalazion, removal/biopsy of certain skin lesions, laser capsulotomy, and laser trabeculoplasty), and optometrists are not subject if the initial healthcare stabilization fund surcharge exceeds 15%, with the optometrist insurance provision taking effect on and after January 1, 2028. Finally, the bill revises optometry-related definitions (K.S.A. 65-1501a), adjusts optometry board governance and administration language (K.S.A. 74-1504 and 74-1505), and repeals the listed optometry-law and stabilization-fund sections identified in the bill (including K.S.A. 65-1514). The bill takes effect upon publication in the Kansas statute book.

AT A GLANCE

This bill authorizes licensed naturopathic doctors to order and prescribe specified therapies, tests, and imaging—subject to required referrals, DEA registration for authorized controlled substances, and strict prescribing and recordkeeping rules.

FULL SUMMARY

The bill expands the lawful scope of practice for licensed naturopathic doctors and creates new regulatory obligations for prescription authority, documentation, and records. It authorizes naturopathic doctors to order/perform physical and orofacial examinations (excluding endoscopies), diagnostic laboratory tests for diagnostic purposes, phlebotomy, clinical laboratory tests, speculum examinations, and physiologic function tests; to order diagnostic imaging studies but requires referral to a properly licensed and qualified professional to perform and interpret imaging results; and to prescribe, recommend, or administer a broad range of nonprescription and other listed therapeutic products (including specified nutrition-related supplements, botanicals, homeopathic preparations, and related substances) and to prescribe-only drugs (as defined in the Kansas pharmacy act) plus testosterone as specifically designated in the controlled-substances provisions. The bill also authorizes additional naturopathic services (minor office procedures and naturopathic acupuncture, care for pregnant patients, specified routes of administration, and use of non-diagnostic ultrasound) while retaining prohibitions on surgery, obstetrics/labor/delivery or procedures involving reproductive organs of a pregnant patient, therapeutic use of ionizing radiation, use of general or spinal anesthetics, using/performing/interpreting diagnostic imaging except as authorized, termination-of-pregnancy drug/procedure authority, and prescribing/dispensing controlled substances not authorized by the act.

When a naturopathic doctor prescribes under the newly authorized categories, the bill adds prescribing compliance requirements: each prescription order must be recorded in writing (including electronically recorded/transmitted communications), include the prescriber’s identifying information, and be made only when the doctor has adequate education, training, and experience to safely manage the regimen. It also requires registration with the U.S. DEA to prescribe controlled substances authorized by the act. The bill further creates new patient-record requirements: naturopathic doctors must maintain a record for each patient including dates of service, significant clinical information, examination/testing results, diagnosis, and treatment/recommendations, and must keep patient records for at least 10 years. It adds a severability clause for the naturopathic doctor licensure framework and creates a new delineation of what naturopathy does and does not include (including excluding practice by others merely under supervision/referral and preserving other Kansas-licensed professionals’ ability to practice within their own scopes).

To align the broader naturopathic scope with Kansas pharmacy and controlled-substances regulation, the bill amends multiple statutory definitions to ensure naturopathic doctors are treated consistently in the relevant licensing statutes. In the healthcare stabilization fund/professional liability insurance framework, it adds “licensed naturopathic doctor” to the definition of “healthcare provider” for purposes of that act (inserting the naturopathic doctor category into the list of covered provider types). In the pharmacy act’s definitions, it removes language making “Dispenser” include a naturopathic doctor by striking/withdrawing the prior exclusion note so that naturopathic doctors are not treated as dispensers under that act. In the controlled-substances act’s definitions, it amends the definition of “Dispenser” to remove naturopathic doctors from the dispenser definition. It also amends the naturopathic doctor licensure act provisions: fees remain set by the board but are re-enacted with unchanged caps shown in the bill; disciplinary grounds and processes are updated to incorporate additional categories such as failing to report adverse actions and improper prescribing; license renewal procedures are clarified/rewritten (including a continuing-education condition for renewal requiring at least 25 hours annually, and renewal/cancellation/reinstatement mechanics with notice and a 30-day reinstatement window); and it amends the membership and operation of a naturopathic advisory council (five members, with appointment rules and meeting compensation).

Finally, the bill repeals specified existing sections within the naturopathic doctor licensure act and related cross-referenced statutes, and provides that it takes effect and is in force from and after its publication in the statute book. It also amends the professional liability insurance requirement for naturopathic doctors, including setting minimum coverage levels the board must require and requiring proof of maintained coverage before rendering professional services and for license renewal.

AT A GLANCE

This bill requires the University of Kentucky, the University of Louisville, and Eastern Kentucky University to coordinate a statewide physician-shortage solution search and submit a January 1, 2027 report to the Legislative Research Commission.

FULL SUMMARY

The General Assembly directs the University of Kentucky, the University of Louisville, and Eastern Kentucky University to coordinate a statewide search for actionable solutions to physician shortages and to explore and expand health care opportunities in medically underserved areas in collaboration with community groups, state agencies, professional associations, and other stakeholders. The search must focus on (1) shortages of primary and specialty care physicians in medically underserved areas, (2) chronic lack of access to physician care by medically underserved populations, (3) retaining physicians in medically underserved areas, and (4) workforce, technological, and community-based opportunities to increase access.

The coordination must include review of current efforts and how to build on them, as well as innovative actions, including: sponsoring community graduate medical education programs; growing graduate medical education sites in medically underserved areas; encouraging safe international physician recruitment; increasing basic administration reimbursement for recruitment and placement services for medical students, residents, and physicians; integrating workforce diversification into educational programs; expanding technology-enabled health care delivery options; and considering community-based medical models. The universities must also analyze regulatory or statutory barriers to attracting providers to medically underserved areas, without limiting the ability to modify or expand medical education programs.

The three universities must jointly produce a report for submission to the Legislative Research Commission by January 1, 2027. The report must (a) provide county-level data on medically underserved areas/populations, including primary/specialty physician shortages, lack of access to physician care, and physician retention; (b) summarize current actions, options for building on them, innovative actions, and regulatory/statutory barriers; and (c) lay out detailed actionable solutions and opportunities to expand health care access, including responsible agencies, resources needed, and a suggested timeframe.

Additionally, the General Assembly authorizes the University of Kentucky to develop a feasibility study, in collaboration with health care workforce partners in and around the Owensboro region, to take advantage of HealthForce Kentucky to address persistent physician and other clinician shortages. The feasibility study may be provided to the General Assembly by December 1, 2026, and the General Assembly is directed to consider funding up to $10,000,000 in the 2027 Regular Session based on the study’s findings.

AT A GLANCE

This bill requires physician assistants who prescribe or administer Schedules II–V controlled substances to obtain board approval and DEA and Kentucky electronic monitoring registrations before prescribing.

FULL SUMMARY

The bill revises Kentucky’s physician assistant regulatory framework in KRS Chapter 311 (Articles 840–862) by changing supervision terminology and oversight rules, tightening or clarifying supervision agreements and physician assistant practice limits, expanding continuing education requirements, updating controlled-substance prescribing limitations and procedures, adjusting disciplinary authority/grounds as to physician assistants, and adding a new reevaluation/oversight concept (as reflected in KRS 311.856 changes). It also amends Kentucky’s driver vision testing statute for operator and instruction permit applicants (KRS 186.577) by updating credentialing/testing form requirements and administrative provisions, and it repeals one physician assistant statute section (KRS 311.860).

Key changes to physician assistant supervision and licensing definitions and operations include: (1) KRS 311.840 redefines “Supervision” to require oversight of medical services rendered by a physician assistant and confirmation that approved medical tasks are appropriate to training/experience, with clear identification/access to supervising physicians and an evaluation process; and it expressly clarifies that supervision does not require a supervising physician’s physical presence during services (page 1). (2) The physician assistant supervision agreement requirements in KRS 311.854 are reworked to emphasize board-approved standardized forms, completed/signed agreement maintenance by the board and at the primary practice location, and the need for a completed and in-effect supervision agreement before the physician assistant performs services (page 4). The bill also clarifies that supervision agreements can be amended by mutual agreement, must be submitted to and maintained by the board, and that health care facilities may use board-approved alternative filing methods and designate alternate supervising physicians (pages 4–5). (3) KRS 311.858 is revised to reflect that a physician assistant may perform services within the supervision agreement’s described scope, that emergency evaluation/treatment may be initiated without specific approval, and that controlled substance prescribing authority is contingent on explicit board approval and additional prerequisites.

Controlled-substance rules are made more detailed in KRS 311.858. A physician assistant may prescribe/administer nonscheduled legend drugs and medical devices to the extent approved by the supervising physician (page 6). For Schedules II–V controlled substances, the bill requires board approval before prescribing/administering (page 6), including: at least one year of experience as a licensed/practicing physician assistant, a prescriptive authority application signed by the supervising physician, board notice of approval, and obtaining DEA controlled substance registration plus registration with Kentucky’s electronic monitoring system (KRS 218A.202) (page 6). It also sets specific refill/supply limits by drug schedule: Schedule II narcotic (generally) limited to a 72-hour supply without refills; hydrocodone combination products and other Schedule II nonnarcotic and Schedule III limited to a 30-day supply without refills; Schedule IV/V limited to the original prescription with refills not exceeding a six-month supply; and adds/retains a carve-out limiting benzodiazepines and Carisoprodol to a 30-day supply without refills (pages 6–7).

The bill modifies physician assistant disciplinary/oversight grounds and continuing education. In KRS 311.844, continuing education at renewal is adjusted to require 100 hours of approved continuing education over the prior two-year period (page 1), and it adds specific one-time courses during the first two years of licensure (pediatric abusive head trauma prevention/recognition; and a one-time, one-hour board-approved course on Alzheimer’s/dementia education topics, with curriculum substitution options for graduating students) (pages 2). It also includes, for physician assistants authorized to prescribe/administer Schedules II–V controlled substances, a continuing education minimum of 7.5 hours related to diversion/pain management/addiction/electronic monitoring or a combination of listed topics (page 2). In KRS 311.850 (discipline), the bill includes additional/continued enumerated grounds such as practicing without a designated supervising physician, exceeding supervising physician–approved scope/agreements, exceeding facility credentialed scope, assisting unlawful practice, violating confidential communications, incompetence/gross negligence/unprofessional practice, violations of administrative regulations, probation violations, and failure to complete required approved continuing education (page 3). It amends KRS 311.856 by requiring supervising physicians to ensure physician assistants follow the supervision agreement and KRS 311.840–311.862, to require identification as physician assistants, and it updates enumerated supervision-related duties; it also changes prior language around physician assistant monitoring/countersignature and includes a removal of older opt-in disclosures (pages 5–6). Separately, KRS 186.577 is amended to govern vision testing for operator/instruction permit applicants by updating: who may conduct vision testing (including credentialed osteopaths/physicians/physician assistants/advanced practice registered nurses credentialed by the cabinet), how driver vision testing forms must attest to meeting minimum standards and be signed/completed within 12 months of application, what the forms must disclose (including corrective lens restrictions and screening-not-complete-exam language), and additional administrative/cost/technology provisions (page 8). Finally, KRS 311.860 is repealed (Section 8, page 8), removing the specific prior statutory framework for services performed in a separate location from the supervising physician, including related definition/exception content.

The document is a concurrent resolution that sets out the General Assembly’s policy-recognition and commitments rather than creating enforceable statutory or regulatory requirements.

It recognizes the importance of having a physician present in every emergency department as a critical element for improving rural health care (Sections 1). It also commits the General Assembly to supporting physician education and recruitment as a top priority for investing in quality rural health care (Section 2).

Operationally, it directs the Clerk of the House of Representatives to transmit a copy of the resolution to Representative Mark Hart (Section 3).

AT A GLANCE

This bill requires hospitals with Level IV verified trauma centers to provide 24/7 on-site emergency department coverage at all times by a physician or a supervised advanced practice provider.

FULL SUMMARY

The bill revises Kentucky’s trauma system provisions by tightening definitions and clarifying requirements for on-site emergency department coverage at Level IV verified trauma centers, while also adjusting how the Department for Public Health (DPH) develops the statewide trauma care program.

It updates the definitions in KRS 211.492 by (1) adding the phrase “For the purposes of” to the definition section header, (2) defining “Trauma” by reference to KRS 311A.010, and (3) keeping “Trauma center,” “Advanced practice provider,” and “Trauma center verification” consistent with referenced terms, including the sources of trauma center verification (American College of Surgeons or DPH).

It amends KRS 211.494 to restate DPH’s mandate to establish a comprehensive statewide trauma care program, including the statewide trauma care director and state trauma registrar (funded through federal funds or, if available, the trauma care system fund in KRS 211.496) and to allow contracting with outside entities. The statewide trauma care program must pursue goals including reducing trauma death/disability regardless of insurance/ability to pay, using best-practice protocols, minimizing economic impact from lost wages/productivity, and containing trauma-care costs. The bill also modifies the advisory committee composition by expressly referencing Level I/II/III/IV “verified” trauma centers for seat selection (including one representative from each of the Level I–IV categories described) and retains the committee’s structure, staggered terms, quarterly meetings, no-compensation rule (with expense reimbursement), and funding of committee expenses through the trauma care system fund.

Operationally, it requires that a hospital with a Level IV verified trauma center provide 24/7 on-site emergency department coverage by either a physician or an advanced practice provider supervised by an on-site or off-site physician “at all times.” It also changes the DPH authority regarding implementation: the department must (rather than may) promulgate administrative regulations to implement the Level IV coverage requirement, explicitly including rules to allow emergency department coverage by an advanced practice provider consistent with the new subsection on Level IV coverage.

The bill creates a new statutory requirement for Kentucky hospitals that offer emergency medical services. It requires each such hospital to ensure that, at all times the emergency department is open, at least one physician is on site and on duty and is responsible for the emergency department.

The physician must meet specific credentials: the physician must be licensed in Kentucky and must be board certified or board eligible in emergency medicine.

The change is implemented as a newly created section within KRS Chapter 216B, with the operative obligation tied to continuous on-site coverage whenever the emergency department is open.

AT A GLANCE

This bill limits APRNs’ controlled-substance prescriptions to specified maximum supply lengths and no-refill or limited-refill conditions, including 72-hour Schedule II limits and 30-day Schedule III limits.

FULL SUMMARY

KRS 314.011 (definitions for Kentucky’s nursing practice chapter) is revised to adjust wording around “dispense/dispensing” and to clarify APRN medication-dispensing authority and certain controlled-substance prescription limits. The revised definition of “Registered nursing practice” also incorporates medication administration components and cross-references to the chapter’s updated “dispense/dispensing” concept.

For advanced practice registered nurses (APRNs), the changes tighten how “dispensing” is defined and how it relates to existing statutory language in KRS 315.010 for APRNs authorized to dispense nonscheduled legend drugs. The definition changes include removing a prior internal cross-reference format and replacing it with a clearer structure so that dispensing by APRNs is tied directly to the KRS 315.010 framework.

The APRN prescription authority section within KRS 314.011 specifies supply-length limits for controlled substances prescribed by APRNs: Schedule II controlled substances (excluding hydrocodone combination products) are limited to a 72-hour supply with no refills; hydrocodone combination products are limited to a 30-day supply with no refills; psychostimulants require a 30-day supply only when prescribed by an APRN certified in psychiatric-mental health nursing and providing services in a qualifying health facility or mental health/regional program setting. It also provides that Schedule III prescriptions are limited to a 30-day supply with no refills, while Schedules IV and V require refills that do not exceed a combined six-month supply.

In addition to medication-related changes, the revised KRS 314.011 retains and slightly reorganizes other defined terms relevant to nursing regulation (e.g., “dispense/dispensing,” dialysis-related terms, and related definitions), including maintaining that “conviction” encompasses specified types of criminal adjudications and pleas regardless of whether any penalty is rebated, suspended, or probated.

AT A GLANCE

This bill removes the “except as authorized” limitation around when nurse licensure applicants must pass required examinations for registered and practical nurses.

FULL SUMMARY

The bill makes multiple changes to Kentucky nursing practice licensing rules, controlled-substance prescribing collaboration requirements for advanced practice registered nurses (APRNs), adult-abuse registry notification timelines/processes, and school medication/self-administration rules, while creating a new framework for “undesignated glucagon” in schools.

For registered nurse (KRS 314.041) and licensed practical nurse (KRS 314.051) licensure, the bill removes the bracketed “except as authorized” limitation around when an applicant must pass licensure examinations (so the licensure examination requirement is stated without that parenthetical limitation). For APRNs (KRS 314.042), it revises the CAPA-NS and CAPA-CS framework: APRN provisional/endorsement pathways and CAPA-NS prescriptive authority collaboration requirements remain, but the controlled-substances side is substantially reworked by adding an administrative structure and operational requirements.

The bill creates/clarifies a “Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances” (CAPA-CS) committee in KRS 314.042. The committee is established as four members (two APRNs and two physicians), tasked with developing a standardized CAPA-CS form (initially within statutory timeframes referenced in the text) and allowing reconvening to update the standardized form. It also adds more detailed controlled-substance operational requirements tied to CAPA-CS, including: entering into a written standardized CAPA-CS with a physician who has an active and unrestricted Kentucky license; requiring CAPA-CS availability at patient-care sites; specifying notice, rescission/termination mechanics (including board notifications and timelines); requiring the APRN to obtain a DEA Controlled Substance Registration Certificate; requiring registration with Kentucky’s electronic controlled-substance monitoring system (KASPER/PDMP system) and providing the certificate/registration information to the board; and setting collaboration/communication requirements and recordkeeping/auditability.

For controlled-substance prescribing without a CAPA-CS, the bill creates a process under KRS 314.042(17) for APRNs with sufficient prescribing experience (and maintaining DEA registration and monitoring account) to request board review for removal of the CAPA-CS condition. If the license is in good standing, CAPA-CS is no longer required (though the APRN may keep it voluntarily). The bill also specifies consequences for not being in good standing and adds random audit and disciplinary authority tied to PDMP/KASPER data. Separately, it amends the APRN endorsement exemption criteria for CAPA-CS (including requirements about years of prescribing authority and good standing) and reiterates that an APRN must not prescribe controlled substances without being exempt after board review and written notification.

Beyond APRN controlled-substance rules, the bill shortens a reporting deadline for criminal convictions to 30 days (from 90 days) in KRS 314.109 and amends KRS 209.032 definitions and procedures for adult-abuse/neglect/exploitation query-based background checks for vulnerable-adult service providers, including: the definition of “employee,” the definition of “validated substantiated finding,” and procedural requirements around administrative hearing/appeals, secure query processes, error-resolution, provider notification when an appeal is pending, and limits on the cabinet’s response to queries. The bill also creates a new school-health glucagon statute within KRS 158.830 to 158.838 allowing certain authorized entities and trained individuals to receive/prescribe/dispense/administer “undesignated glucagon” in emergency situations (including emergency administration when a school nurse or other licensed practitioner is not immediately available). It requires specific storage, designation of a responsible trained individual, notification to local EMS/dispatch, parent/guardian and EMS contact after administration, Good Samaritan immunity (with an explicit gross negligence/willful or wanton misconduct carve-out), and establishes or amends school medication self-administration rules in KRS 158.834 through 158.836 to: expand the list of covered medications beyond asthma/anaphylaxis to include documented medical conditions and require parent authorization plus a health-care practitioner statement and an individual health care plan; encourage maintaining emergency supplies on-site; and extend civil immunity for school employees administering prescribed medications in good faith for life-threatening allergic/anaphylactic reactions and for asthma/respiratory distress, hypoglycemia, and adrenal crisis.

The administrative regulation establishes standards for Licensed Practical Nurse (LPN) infusion therapy in Kentucky, requiring LPNs to complete specific education and training before performing such procedures. This regulation aims to enhance the safety and effectiveness of infusion therapy practices by ensuring that LPNs possess the necessary skills and supervision.

Approximately 13,000 licensed LPNs in Kentucky will be impacted by this regulation, although the exact number of those practicing infusion therapy is unknown. The regulation does not anticipate any compliance costs for these entities, nor will it establish or increase any fees.

Key dates related to the regulation include its adoption on October 23, 2025, and its filing with the Legislative Research Commission on November 12, 2025. A public hearing is scheduled for January 21, 2026, with a comment period ending on January 31, 2026.

The document outlines the regulations governing pharmacy technicians in Kentucky, focusing on their qualifications, responsibilities, and the application processes for both certified and registered pharmacy technicians. It emphasizes the importance of these roles within the pharmacy and healthcare sectors, which are significantly impacted by these regulations.

One notable aspect of the regulations is the fee exception for individuals serving voluntarily as pharmacy technicians in charitable pharmacies. This provision aims to alleviate financial burdens for both the technicians and the organizations they assist.

Key deadlines include the requirement for initial applications for pharmacy technician registration to be submitted within 30 calendar days of starting employment at a pharmacy. Additionally, registered pharmacy technician licenses will expire on March 31 of the year following initial registration, necessitating annual renewal.

Pharmacy technicians are also required to inform the board of any changes in employment within 14 calendar days. The document further mentions that application forms will be available through the Kentucky Board of Pharmacy's website, facilitating access for prospective applicants.

These regulations are set to take effect on October 22, 2025, marking a significant update in the oversight of pharmacy technicians in the state.

The document outlines regulations governing the prescriptive authority of Advanced Practice Registered Nurses (APRNs) in Kentucky, particularly concerning controlled substances. APRNs are required to establish a Collaborative Agreement for Prescriptive Authority for Controlled Substances (CAPA-CS) and must adhere to specific standards of practice. They are mandated to consult with collaborating physicians quarterly in the first year and biannually thereafter, ensuring that they operate within their defined scope of practice.

APRNs are authorized to prescribe medications, including controlled substances, but must follow guidelines from the Kentucky Office of Drug Control Policy and the CDC. Notably, they are prohibited from prescribing Schedule II controlled substances for more than a three-day supply for acute pain, with certain exceptions. Additionally, APRNs must maintain comprehensive medical records, document treatment plans, and conduct drug screenings for chronic pain management, which may lead to increased administrative costs for healthcare facilities.

Exemption requests from the CAPA-CS requirements can be made by APRNs who meet specific criteria, including having four years of controlled substance prescribing authority. However, self-prescribing or administering controlled substances to immediate family members is generally prohibited, with limited exceptions in emergencies. Compliance with these regulations is essential for APRNs holding a DEA Controlled Substance Registration Certificate, who must review the Prescription Drug Monitoring Program (PDMP) every six months.

The regulations are effective immediately upon adoption, with ongoing compliance required for all APRNs involved in prescribing controlled substances. The changes are expected to impact healthcare providers, pharmacies, and potentially lead to increased costs associated with compliance and documentation. Overall, these regulations aim to enhance safe prescribing practices and ensure that APRNs operate within a structured framework.

The document outlines regulations for Advanced Practice Registered Nurses (APRNs) in Kentucky, focusing on their authority to prescribe and dispense controlled substances. APRNs are required to have a license in good standing and, if they have prescribed controlled substances for less than four years, they must enter into a Collaborative Agreement for Prescriptive Authority for Controlled Substances (CAPA-CS) with a Kentucky-licensed physician. This agreement mandates regular collaboration and documentation, including maintaining comprehensive medical records and querying the Prescription Drug Monitoring Program (PDMP) at least quarterly.

The regulations impose specific prescribing standards, including limitations on hydrocodone combination products to a three-day supply for acute conditions, with exceptions for chronic pain and other specific scenarios. APRNs are also permitted to prescribe controlled substances electronically, adhering to established guidelines. The regulations emphasize the importance of patient safety and effective prescribing practices, requiring APRNs to obtain thorough medical histories and develop written treatment plans.

Additionally, APRNs can request an exemption from the CAPA-CS requirements after four years of controlled substance prescribing authority, provided they meet certain criteria. The regulations aim to enhance the safety and efficacy of prescribing practices among APRNs while ensuring compliance with state laws and guidelines. Overall, the impact on the healthcare industry is significant, particularly for nursing and medical practices, but the regulations are designed to avoid imposing major economic burdens on practitioners.

AT A GLANCE

This proposed rule requires Louisiana physician assistants and supervising physicians to follow revised terminology and clarified supervision, documentation, and practice obligations that the Louisiana State Board of Medical Examiners will consider through public comment until 4:00 p.m. June 30, 2025.

FULL SUMMARY

The document establishes a proposal by the Louisiana State Board of Medical Examiners to amend its physician assistant (PA) rules (Title 46, Part XLV, Chapters/Sections including Subpart 1 and Subpart 2 and the practice chapter) to update terminology, revise and clarify obligations/responsibilities of supervising physicians (SPs) and PAs, and define terms.

It contains multiple existing regulatory provisions reproduced for context (fees; licensure/renewal requirements; reinstatement; qualifications for SPs and PAs; registration procedures for prescriptive authority; and PA practice obligations/prohibitions). The submission also specifies key process and input dates: written public comments accepted until 4:00 p.m. Tuesday, June 30, 2025; and, if requested in writing within 20 days of the notice date, a public hearing is scheduled for Tuesday, June 30, 2026 at 11:00 a.m.

The accompanying fiscal/economic impact statements estimate a one-time state cost of $1,000 for publication in FY 2026, expect no increases in revenue for state/local units, and anticipate no impacts on costs/benefits to directly affected persons, small businesses, employment/competition, or poverty-related impacts.

Operative substance beyond the stated intent appears to focus on updating SP/PA obligations and clarifying supervision-related requirements within the PA practice rules, including documentation and clinical practice guidelines; however, the provided text excerpt does not clearly show the actual redlined “new vs. existing” changes (it appears largely as the full current rule text plus the notice/impact sections), so the specific modified clauses are not distinguishable from reproduced provisions in the extracted content.

AT A GLANCE

This bill requires the Louisiana State Board of Medical Examiners to consult the Physician Assistants Associates Advisory Committee before acting on matters relating to physician assistant associates.

FULL SUMMARY

The bill creates and integrates a “Physician Assistants Associates Advisory Committee” within the Louisiana Department of Health to advise the Louisiana State Board of Medical Examiners on licensing, discipline, and related rulemaking for physician assistant associates; it also requires that the board consult the committee before acting on matters relating to a physician assistant associate.

It updates the Part governing physician assistants to use the position name “physician assistant associate” and changes references accordingly (with an exception for references to the National Commission on the Certification of Physicians’ Assistants). Substantively, it adjusts governance and regulatory structure: the board’s rulemaking authority expressly includes approval and regulation of supervising physicians, it clarifies that supervision is continuous but not necessarily physically present (with documentation and annual review reflecting patient acuity and procedure nature), and it requires that supervising physicians submit intent to supervise, submit a supervision statement, and maintain a written supervision agreement that is updated annually and kept available at the practice site.

The bill modifies operative standards and authorization for practice. It reiterates that physician assistant associates are deemed agents of the supervising physician for practice-related activities, and it restricts practice without supervision except for life-threatening emergencies and disaster-relief situations. It clarifies prescriptive authority eligibility by requiring a minimum of 500 clinical training hours prior to graduation and restricts the board from imposing additional eligibility qualifications through administrative rulemaking. It also allows physician assistant associates to provide medication-assisted treatment (MAT) as authorized by specified federal authority and in accordance with board rules, including a minimum requirement that the supervising physician be authorized and compliant with federal and state MAT laws and rules.

It retains and specifies licensing controls and enforcement: working permits may be granted in limited circumstances pending national exam completion/results; inactive licenses exempt renewal fees and prohibit practice; discipline authority remains for violations of enumerated grounds; and it updates title and practice protection to penalize unlicensed practice and improper title use. Exemptions remain for certain emergency, student, and federal employment scenarios. The bill also authorizes the Louisiana State Law Institute to change all Louisiana Revised Statutes references from “physician assistant” to “physician associate”.

AT A GLANCE

This bill authorizes the Louisiana Naturopathic Medicine Examining Board to license naturopathic doctors and to set scope, education, exams, controlled-substance prescribing, and disciplinary rules for lawful practice in Louisiana.

FULL SUMMARY

The bill creates Louisiana’s naturopathic medicine licensure framework by establishing the Louisiana Naturopathic Medicine Examining Board within the Louisiana Department of Health and placing it as the exclusive state authority to license naturopathic doctors to practice. It creates Chapter 62 of Title 37 (“Louisiana Naturopathic Doctor’s Practice Act”) and adds the Board to the Department of Health transfer provision (R.S. 36:259(A)(25)). It also states that naturopathic medicine practice under the chapter does not require physician oversight, supervisory agreements, or collaboration as a condition of licensure or lawful practice.

The Board is composed of four naturopathic doctor members selected from a qualified-candidate list submitted by the Louisiana Association of Naturopathic Physicians and one governor-selected consumer member, with governor appointments subject to Senate confirmation. It sets initial staggered three-year terms, limits members to no more than three consecutive terms, allows removal for good cause, elects a chairperson, meets at least twice annually, and may create committees. The Board must issue rules/procedures for licensing, approving naturopathic education programs and competency examinations, establishing continuing education and ethical/professional standards, governing practice, and handling complaints, investigations, and discipline; it must also develop scope-of-practice rules, advertising standards, supervision standards for students/other healthcare professionals, procedures for minor procedures, and standards related to prescribing controlled substances.

The chapter defines the term “naturopathic medicine,” “minor office procedure,” and multiple practice-relevant concepts (including therapeutic substances, clinical laboratory procedures, and biological products). It authorizes licensed naturopathic doctors to perform physical examinations, order and interpret laboratory examinations and diagnostic imaging studies (including actions based on a radiologist’s report), and to prescribe/order drugs within the chapter, subject to Board-developed requirements. Prescribing/ordering of controlled dangerous substances is restricted: a licensee may prescribe and order controlled substances except Schedule II controlled dangerous substances (including opioids/opioid derivatives), and prescriptive authority is conditioned on compliance with state and federal law and required Board conditions (e.g., written prescription recording that may be electronic, prescription only when the doctor has adequate education/training/experience, and DEA registration to prescribe controlled substances authorized by the chapter). The chapter specifies a range of “therapeutic substances” and allowed administration routes, permits certain minor office procedures subject to additional training/examination by Board rule, and allows limited prenatal care and labor support services while prohibiting independent labor/delivery management and services reserved to licensed midwives or physicians. It requires patient referrals when conditions are beyond the licensee’s scope or require non-authorized care.

Licensure requirements include: prohibition on practicing without a license; a two-year license validity period; application submission and fees; proof of graduation from an approved naturopathic medical education program (U.S. programs accredited or in candidacy status by the Council on Naturopathic Medical Education or equivalent federally recognized accrediting bodies, or approved Canadian programs with provincial approval for government-funded student aid); and passage of a competency-based national licensing examination administered by the North American Board of Naturopathic Examiners (or an equivalent recognized agency). Renewal requires a renewal application, renewal fee(s), meeting Board continuing education requirements, and maintaining good standing; the Board may deny, suspend, revoke, or discipline licenses. Fee amounts are capped and nonrefundable, and the Board may assess certain additional renewal-related fees only within Board-authorized programs and subject to caps. Licensees must conspicuously display their license and provide evidence of completed approved education and competency examination at the principal place of practice.

The bill establishes prohibitions on licensees including: practicing outside the Board-defined family/primary care scope (as defined by Board rule), holding out as other licensed medical professions unless separately licensed, performing surgery outside the minor office procedure scope, using general or spinal anesthesia, administering therapeutic ionizing radioactive substances, conducting/interpreting diagnostic imaging except as authorized by the Board, performing labor/delivery/operative or invasive obstetrical procedures involving reproductive organs of a pregnant patient, prescribing/dispensing/administering controlled dangerous substances except as authorized, and performing surgical laser procedures or certain surgeries beyond superficial tissue (e.g., involving eye/ear/tendon/nerves/veins/arteries). It creates exceptions preserving lawful practice by other licensed professionals, student practice under supervision in approved programs, and general wellness product sellers providing product information.

For title and marketing, it protects specified licensee titles/abbreviations (e.g., “Naturopathic Medical Doctor” or “Naturopathic Doctor,” and “N.D./ND/NMD/N.M.D.” and exclusive rights to “naturopathic doctor,” “doctor of naturopathic medicine,” etc.). Unlicensed individuals may use “traditional naturopath” or “naturopath” only if they comply with disclosure requirements: they must clearly and conspicuously disclose the education level and credential basis (including highest relevant degree/credential and granting institution/program type) in specified locations (website homepage/main page; business profile/main marketing sites; client intake/service description materials; and print/digital/social media advertising where the title is used) and must not use terms implying licensure as a naturopathic doctor (including “doctor,” “physician,” the naturopathic doctor abbreviations/titles, or similar terms) unless licensed. The chapter also clarifies limited consultations by out-of-state practitioners entering Louisiana for consultation with a licensee, restricted to consultation/examination/recommendation/testimony.

The Department of Health's Board of Medical Examiners has introduced amendments to the licensure and certification rules for physicians, focusing on those aged 70 and older. A new "Retired Physician License" has been established, allowing these physicians to limit their practice to volunteer services without compensation.

To obtain this license, physicians must attest to their commitment to volunteer work and apply for renewal. Additionally, the renewal fees for eligible physicians will be reduced by half, benefiting those who have surrendered their licenses to prescribe controlled substances or have stopped practicing due to physical or mental disabilities.

The continuing medical education (CME) requirements have also been modified, with retired physicians now required to complete 10 hours of CME annually, compared to the standard 20 hours for their active counterparts.

These changes, effective August 2025, aim to support retired physicians in maintaining their licenses at a reduced cost while contributing to community health through volunteer and charity medical services.

AT A GLANCE

This act establishes a unified Maine Board of Medicine licensing structure covering all physicians and physician associates and creates the Maine Board of Medicine Medical Practice Act in Title 32, Chapter 153.

FULL SUMMARY

The law establishes a single Maine Board of Medicine licensing structure for all physicians (allopathic and osteopathic) and physician associates, and creates a new “Maine Board of Medicine Medical Practice Act” in Title 32, Chapter 153. It defines key terms (including physician, osteopathic physician, physician associate, and “practice of medicine”), sets core licensing rules (including limits on unlicensed practice, individual licensing, and confidentiality/redaction procedures for records), and creates a unified board with specified membership categories, quorum rules, officer elections, compensation framework, and board powers/duties (including investigations, subpoenas, rulemaking, and issuance of specialty/administrative licenses).

Within Chapter 153, it also establishes: (1) investigatory and adjudicatory processes, including investigative committee composition, powers (investigations, dismissals, guidance letters, informal conferences, consent agreements, voluntary surrenders, and referrals to hearings), complaint and response timelines, and emergency action authorities (including compelled mental/physical exams and injunctive relief); (2) detailed grounds for discipline and a judicial review path limited to Superior Court for nonconsensual revocations; and (3) specific licensure and practice requirements for physicians, osteopathic physicians, and physician associates, including qualification criteria, examinations, fees (with caps), license renewal timing, reinstatement after lapse, inactive status rules, delegations, physician associate scope-of-practice structure (including dispensing rules and collaborative agreement requirements for less-than-4,000-hours physicians), and confidentiality/immunity provisions for peer/medical staff review materials.

The Act adds several substantive clinical/practice provisions: an authorization framework for long-term antibiotic therapy for Lyme disease (with definitions and documentation requirements), rules for treatment involving minors (including limits/permissions regarding sexually transmitted infection/substance use disorder services and sexual assault evidence collection without parental consent), Medicare assignment posting requirements with enforcement/penalties, release requirements for contact lens prescriptions (including an expiration limit and civil/disciplinary consequences), a prohibition on advertising/offering/administering conversion therapy to minors, duty-to-warn/protect regarding patient violence risk, and telehealth authorization rules (definitions, permitted telehealth services, confidentiality compliance, and board rulemaking for standards/restrictions). It further imposes opioid prescribing limits and compliance mechanics (including electronic prescribing by a date certain, continuing education, policy requirements for health care entities, and civil penalties), with enumerated exceptions.

Operationally, Part A repeals certain existing licensing chapters and restructures governance references so that statutory authority and prior board functions vest in the new Maine Board of Medicine. Part A also includes a transition plan ensuring continuity of existing licenses, transfer of funds/assets/contracts/records/property, carryover and staggered initial board member terms, assignment of pending complaints to the board’s investigative committees, and sets an effective date for Part A: January 1, 2027. Separate amendment provisions update cross-references throughout other Maine statutes to reflect the new Title 32, Chapter 153 physician/physician associate framework, including Medicaid/managed care coverage references and administrative crosswalks for enforcement, licensure, and nurse/physician authority definitions; Part D provides appropriations/allocations funding for Attorney General hearing capacity, transition/implementation costs, and staffing for the Maine Board of Medicine.

The 132nd Maine Legislature's First Special Session has introduced significant legislative changes to the practice of optometry, which will impact various sectors within healthcare and pharmaceuticals. The amendments clarify the scope of practice for optometrists, allowing them to perform certain types of ophthalmic surgeries, provided they meet specific credentialing requirements established by the State Board of Optometry. This expansion may influence surgical centers and clinics that offer ophthalmic services.

Additionally, the new regulations broaden the authority of optometrists to dispense drugs, including the ability to prescribe certain hydrocodone combination products. This change is likely to affect pharmaceutical companies and pharmacies, as well as the market for pain management medications.

The legislation also permits licensed optometrists to provide telehealth services, which could create new opportunities for telehealth platforms and technology providers in the healthcare sector. Furthermore, changes to the regulations regarding the dispensing of contact lenses will require compliance from optical retailers and mail-order suppliers.

Overall, these amendments aim to enhance the authority of optometrists and adapt to modern healthcare delivery methods, potentially leading to increased operational costs and compliance requirements for affected businesses.

AT A GLANCE

This bill amends Maine’s physician associate practice statutes to require a collaborating physician to be accessible at all times and to allow electronic or telecommunications consultation.

FULL SUMMARY

The bill establishes emergency changes to Maine’s physician associate practice statutes by altering consultation authority/requirements, repealing specific consultation-related subsections, and updating parallel requirements in both primary-care physician associate provisions (32 MRSA §2594-#) and physician associate provisions applicable to other contexts (32 MRSA §3270-#).

It makes two main statutory tracks conforming changes:
1) In 32 MRSA §2594-E, it updates cross-referenced “collaborative agreements and practice agreements” requirements; in 32 MRSA §2594-F, it repeals subsection 1, paragraph F, and further amends subsection 4 (Consultation) to clarify when/how physician associates may consult/collaborate/refer, while requiring a physician to be accessible at all times, including allowing electronic/telecommunications consultation.

2) It mirrors the same pattern in 32 MRSA §3270-E and §3270-G: it amends the cross-reference regarding collaborative/practice agreement requirements; repeals §3270-G, subsection 1, paragraph F; amends §3270-G, subsection 4 (Consultation) with the same “shall may… consult/collaborate/refer” structure, “physician accessible at all times” requirement, and electronic/telecommunications consultation language; and repeals §3270-G, subsection 6.

The bill includes an emergency clause providing that it takes effect when approved.

AT A GLANCE

This bill requires the State Board of Nursing to adopt updated certified nurse practitioner practice standards by March 15, 2026, and to classify rules implementing them as routine technical rules.

FULL SUMMARY

The bill requires the State Board of Nursing to establish updated practice standards for certified nurse practitioners (CNPs) who qualify as advanced practice registered nurses, including standards governing (1) the required length of time a CNP must practice as an advanced practice registered nurse, (2) the minimum time a CNP must practice with a supervising nurse practitioner serving in a mentorship role (based on experience and licensing status), (3) permitted practice settings, including employment requirements for clinics or hospitals that have a supervising nurse practitioner serving in a mentorship role, and (4) any other factors the board determines necessary. The bill also authorizes the board to adopt rules to implement these requirements, with rules adopted under this new subsection classified as routine technical rules.

While the board has not yet adopted these practice-standard rules, the bill creates an interim requirement: a CNP qualifying as an advanced practice registered nurse must practice for at least 24 months under supervision of a licensed physician or a supervising nurse practitioner, or must be employed by a clinic or hospital whose medical director is a licensed physician. The CNP must submit written evidence to the board upon completion of the required clinical experience. The bill correspondingly changes licensing-related statutory cross-references by repealing the prior paragraph requiring specified board requirements under section 2205-B and replacing it with a requirement that the applicant meet the practice standards specified by the board in rule.

The bill also updates an existing eligibility provision by changing the requirement for “practiced as an advanced practice registered nurse” from a minimum of 5 years in the “same speciality” (as previously enacted) to “same speciality specialty” as written in the bill text (a technical drafting change). Finally, it imposes a procedural deadline: by no later than March 15, 2026, the State Board of Nursing must submit proposed practice standards for CNPs to the Joint Standing Committee on Health Coverage, Insurance and Financial Services for review, and the committee may report out a bill to the Second Regular Session of the 132nd Legislature. An emergency clause provides that the legislation takes effect upon approval.

AT A GLANCE

This rule requires most physician license applicants to submit credential verification through FCVS and sets 10-calendar-day notification duties for specified contact, legal, and employment changes.

FULL SUMMARY

Chapter 1 establishes Maine’s Board of Licensure in Medicine rules for physician licensure, registration, notification duties, and continuing medical education (CME), including definitions and specific administrative processes administered by or delegated to Board staff and the Board Secretary.

The rule sets core physician licensure eligibility criteria, including medical education (accredited vs. unaccredited pathways), medical examination sets and scoring/attempt limits, the Maine jurisprudence examination requirement (with an interview contingency upon failure, except for certain interstate telemedicine registrants), postgraduate training duration requirements by graduation date, and a waiver framework for certain foreign medical school graduates based on licensing status, clinical experience, and specified evidence of clinical fellowship/expertise. It also requires credential verification via the Federation Credentials Verification Service (FCVS) for most applicants, while exempting specified categories (e.g., license-status conversions; Interstate Telemedicine Consultation registrants; educational certificate applicants; youth camp and emergency 100-day license applicants with FCVS proof/workflow).

It establishes detailed licensing application and issuance standards for different license types: active clinical status licenses, administrative licenses, educational certificates (limited to a specific Maine residency program/hospital with up to 7-year duration and automatic expiration triggers), emergency 100-day licenses (issued once per applicant for up to 100 days, limited to a specific practice location, with automatic expiration rules), emeritus and inactive status licenses (including conversion between renewal dates), Interstate Telemedicine Consultation registration (registered physicians may not open an office, meet patients, or receive calls in Maine and may provide only consultative services), reentry licenses (after clinical inactivity of 24 months with an approved reentry plan and reentry-to-practice agreement, plus renewal conditions), temporary licenses (up to 1 year, limited to a specific location, with restrictions on repeated temporary licensing), youth camp licenses (specific camp location and automatic expiration triggers), and volunteer licenses (exclusively indigent/needy care, no compensation, location reporting, and renewal requirements). It also specifies conversion of inactive/administrative licenses to active clinical licenses, requiring CME evidence, ongoing clinical competency demonstrations, and examination/CME-related Board presentation if issues arise.

The rule governs renewal/recertification, reinstatement, and withdrawal: it sets odd/even-year expiration tied to birth month (with enumerated exceptions), requires renewal applications to be administratively complete by expiration, provides reinstatement timelines (reinstatement up to 90 days after expiration for payment/fees, otherwise lapse; reinstatement authority remains with the Board), defines active-renewal criteria (including CME compliance except for Interstate Telemedicine Consultation, Board jurisprudence exam when directed, minimum data set survey completion, and no disqualifying cause), and addresses renewal for non-active and other license/registration types including CME extension for certain circumstances (with a maximum extension period for non-active categories). It establishes continuing clinical competency requirements (Board discretion to determine adequacy; possible competency assessments/remediation; probationary or reentry options), CME requirements (generally 40 Category 1 credit hours each biennial period for active-status physicians, plus 3 Category 1 hours every two years on opioid prescribing as required by another Board rule), CME audit evidence via random audits, and CME exceptions/deferments (e.g., up to 6 months for illness/undue hardship/extenuating circumstances; prorating in first licensure period; staying CME for active military duty; partial/full exemptions for returning military veterans).

Operational compliance requirements include physician notification to the Board within 10 calendar days for changes in contact information; criminal arrests/summons/charges/convictions; employment or hospital-privilege changes/limitations; and location termination for certain temporary/special licenses and educational certificates; plus 10 days for disciplinary actions and 10 days for material changes in qualifications/information, and 30 days for legal name changes with documentation. Noncompliance with specified notifications can trigger administrative citations with administrative fines in defined amounts ($100 for certain notification failures; $200 for others), with notice of the right to pay or request a hearing and a 30-day deadline to do so. Finally, it states that violations constitute unprofessional conduct and that the Board Secretary reviews negative/questionable applications, can request additional information, can present matters to the full Board, provides final approval for USMLE special testing accommodations, reviews withdrawal requests, and may delegate assigned duties.