The Alabama Board of Nursing proposes removing Rule 610-X-5-.05(1)(a), which requires a physician collaborating with more than four full-time-equivalent CRNPs to conduct documented quality-assurance reviews with each new CRNP every month for six months after the collaborative practice begins. The deletion is shown on page 3 and is described as eliminating the monthly quality-assurance review requirement for new CRNPs.

Written or verbal comments must be submitted by 4:30 p.m. on November 4, 2026. The notice does not specify an effective or compliance date; the rule’s effective-date entry remains blank.

The proposed rule removes the Joint Committee’s discretionary authority to waive written verification of physician availability when exceptional circumstances are documented. The existing exemption from written-verification requirements for employees of state and county health departments remains in place.

The change is proposed to align the Alabama Board of Medical Examiners’ collaborative-practice rules for physicians and certified nurse midwives with a July 20, 2026, Attorney General opinion concerning the Joint Committee for Advanced Practice Providers. Written comments may be submitted through November 4, 2026; the notice does not specify an effective date.

The Alabama Board of Nursing adds a definition of “Covering Physician” to Rule 610-X-5-.01. A covering physician must be an Alabama-licensed physician who agrees in writing to remain readily available to collaborate with and provide medical oversight to one or more certified registered nurse practitioners or certified nurse midwives and, when indicated, provide medical intervention during the collaborating physician’s absence. The covering physician must belong to the same medical practice, practice group, or multidisciplinary medical team as the collaborating physician, or practice in the same or a similar specialty, and must comply with Board of Nursing and Board of Medical Examiners rules.

The change is effective November 14, 2026.

The Alabama Board of Medical Examiners proposes to remove the provision allowing a physician in collaborative practice to request Joint Committee approval for additional full-time certified nurse midwife positions. The related approval criteria—physician availability; practice setting and extended-hours staffing needs; patient risk; the parties’ education, specialty, and experience; and the complexity and risk of procedures—would also be deleted.

The rule would specify that a written request for a 45-day transitional allowance to orient an incoming CNM must be submitted to the Board of Medical Examiners. The proposed action is intended to align the Board’s rules with a July 20, 2026, Attorney General opinion concerning the Joint Committee for Advanced Practice Providers’ role in recommendations on collaborative relationships.

Written comments may be submitted until and including November 4, 2026. The proposal states that no economic impact or increase in the cost of goods or services is expected.

The Alabama State Board of Respiratory Therapy proposes changes to Chapter 798-X-5, Licensure, to shorten the post-expiration grace period for respiratory-therapist license renewal from 90 days to 60 days. Licensees would be required to renew within 60 days after expiration to avoid lapse; the existing prohibition on practicing while a license is expired would remain.

The proposal would clarify the student exemption from licensure. Respiratory-therapy students enrolled in a CoARC/CAAHEP-accredited program could perform only limited procedures completed as part of clinical training while employed by any healthcare facility, must be designated as students or trainees, and must work under the direct supervision of a licensed respiratory therapist. The Board would maintain a list of students covered by the exemption. Public comments must be submitted by November 4, 2026; no effective date is specified.

The Alabama Board of Nursing proposes removing the requirement that a physician collaborating with more than four full-time-equivalent positions conduct documented monthly quality-assurance reviews with each new certified nurse midwife for the first six months of collaborative practice.

Written or verbal comments must be submitted by 4:30 p.m. on November 4, 2026. The proposal does not state an effective date.

The Alabama Board of Medical Examiners proposes to remove the Joint Committee for Advanced Practice Providers’ authority to waive written verification of physician availability upon documentation of exceptional circumstances under Rule 540-X-8-.08(7). The existing exemption for employees of state and county health departments would remain. The stated purpose is to align the collaborative-practice rule with a July 20, 2026, Attorney General’s opinion concerning the Joint Committee’s role in recommendations involving physicians, certified registered nurse practitioners, and certified nurse midwives.

Written comments may be submitted by mail or email through November 4, 2026. The proposal does not specify an effective date or public hearing date.

The Alabama Board of Medical Examiners proposes to remove the provision allowing a physician in collaborative practice to seek Joint Committee approval for additional full-time CRNP positions. The associated criteria—physician availability, extended-hours staffing, patient risk, the parties’ education and experience, and procedure complexity—would also be deleted. This change is intended to align Rule 540-X-8-.12 with a July 20, 2026, Attorney General opinion concerning the Joint Committee for Advanced Practice Providers.

The rule would retain protection for CRNPs already practicing with a collaborating physician before the rule’s effective date, providing that continued approval may not be denied solely because of the rule’s numerical ratio. The transitional allowance for a physician already at the 360-hour/nine-FTE limit would be renumbered and would permit up to 45 days of additional hours to orient an incoming CRNP; the physician must request the allowance in writing from the Board of Medical Examiners and specify its start date.

Written comments may be submitted by mail or email through November 4, 2026. The proposal does not specify an effective date.

FULL SUMMARY

Alabama adopts the PA Licensure Compact, allowing a physician assistant licensed in one participating state to obtain a compact privilege to practice in another participating state where the patient is located, without obtaining a separate license, subject to the remote state’s laws and any required jurisprudence assessment or fees. Participating states must license PAs, use the compact commission’s data system, investigate complaints, report adverse actions and significant investigative information, conduct criminal background checks, comply with commission rules, use a recognized national examination, and grant compact privileges to qualifying licensees.

To exercise a compact privilege, a PA must graduate from an accredited or commission-approved program, maintain current NCCPA certification, have no felony or misdemeanor conviction, have no history of suspension or revocation of controlled-substance authority, hold a qualifying unrestricted license, satisfy specified adverse-action and restriction requirements, notify the commission of the privilege sought, meet the remote state’s jurisprudence requirements, and report adverse action by a nonparticipating state within 30 days. A privilege generally lasts through expiration or revocation of the qualifying license, but adverse action against that license deactivates privileges in all remote states until restrictions are removed and two years have elapsed; controlled-substance prescribing remains subject to each remote state’s requirements.

The act establishes the PA Licensure Compact Commission as a joint governmental body with one delegate from each participating state, rulemaking authority, financial and administrative powers, public-meeting and rulemaking procedures, and authority to collect state assessments and compact privilege fees. It also creates a coordinated data system for licensure, denials, adverse actions, and significant investigative information; authorizes joint investigations, subpoena enforcement, dispute resolution, federal court enforcement, and termination of noncompliant states; and preserves state authority over qualifying licenses and professional malpractice. The compact takes effect when enacted by the seventh participating state, while the act itself becomes effective October 1, 2026.

FULL SUMMARY

The bill adds K–12 school athletic physicals, including interscholastic athletics, to the forms that a certified registered nurse practitioner or certified nurse midwife may endorse without an additional physician endorsement, provided the physical examination is consistent with the provider’s scope of practice and certification. The Board of Nursing must add these physicals as an allowable standard skill option to applicable model practice protocols by July 1, 2026. Athletic associations, clubs, and leagues may not refuse compliant athletic eligibility forms endorsed by a certified registered nurse practitioner or certified nurse midwife.

The bill also authorizes an assistant to a physician who has passed the Physician Assistant National Certification Examination, is registered to a physician, and practices under an approved job description to sign K–12 athletic eligibility physicals without an additional physician signature. The State Board of Medical Examiners must update its forms by July 1, 2026, to make these physicals an allowable standard skill option for the supervising physician and eligible assistant. Athletic associations, clubs, and leagues may not refuse compliant forms endorsed by such an assistant. The act takes effect June 1, 2026.

FULL SUMMARY

The bill permits a pharmacist to dispense Ivermectin without an individual prescription to individuals age 19 or older, and to unemancipated individuals under 19 with written parental or guardian consent, when authorized by a standing order signed by a licensed physician, physician assistant, or certified registered nurse practitioner. Each standing order must include a pharmacist risk-assessment protocol with an adverse-event treatment plan, a standardized information sheet covering indications, contraindications, usage instructions, follow-up care, and referral information, and a form documenting the assessment and dosage dispensed.

A health care provider signing such an order and a pharmacist dispensing under it may not participate in a program or accept anything of value that induces them to affirmatively commend or endorse Ivermectin to an individual or the public. Licensing boards may not discipline a qualifying provider based on dispensing under the order, and the State Board of Pharmacy may not discipline a pharmacist for a good-faith failure to correctly interpret or follow the order, defects in the order, or refusing to dispense despite an applicable standing order. The provision preserves existing medical-liability law and third-party payors’ authority over coverage, contracts, and reimbursement, while prohibiting covered contracts from excluding assignment of benefits to a provider at the same benefit level as a contract provider. The act takes effect October 1, 2026.

The bill requires every Alabama hospital with an emergency department, regardless of classification, to have at least one physician on duty and physically present who is primarily responsible for the emergency department whenever it is open. Compliance is made a condition of hospital licensing and license renewal under Article 2 of Chapter 21 of Title 22, Code of Alabama 1975. The requirement takes effect 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.

FULL SUMMARY

The Act replaces statutory references to “physician assistant” with “physician associate,” including provisions governing licensure, supervision, delegated duties, telehealth, medical-board membership, emergency and mental-health authority, death determinations, advance directives, and other health-care laws. It also directs the revisor to make the same terminology change in SB 89 if that bill is enacted, except for references to the two named national physician-assistant organizations. Several terminology-related sections take effect only if SB 89 is not enacted.

The Act prohibits the Department of Health and professional boards from requiring fees for, approving, defining the scope of, or otherwise regulating pharmacist collaborative practice agreements. Pharmacists may provide patient-care services under a written protocol approved by a nonpharmacist practitioner, while independently providing services for wellness, prevention, and certain minor or self-limited conditions. The bill removes the prior statutory pathway for independent services under AS 08.80.337(c), permits certain pharmacist-guided diagnoses using tests, defines covered patient-care services and excludes specified high-risk or restricted drugs except for opioid-use-disorder treatment in a clinic, and requires pharmacists to recognize their limits and consult or refer as appropriate. It also adds pharmacy-board authority over opioid-overdose-drug prescribing and dispensing, requires specified pain-management and opioid-use education for pharmacist licensure and renewal subject to stated exemptions, adds the education requirement to reciprocity, and expressly includes pharmacists who prescribe or administer controlled substances within the definition of “practitioner.”

Physicians, dentists, advanced practice registered nurses, and optometrists covered by the revised provisions must offer a prescription for an opioid-overdose drug when an opioid prescription exceeds a three-day supply, reaches at least 50 morphine-milligram equivalents per day, is concurrent with a benzodiazepine prescription, or involves a patient with a history of overdose or substance-use disorder. The Act also broadens related statutory recognition of physician associates in telehealth prescribing, nonphysical-examination care, emergency and mental-health interventions, death certification, do-not-resuscitate orders, and other health-care-provider definitions.

Sections 4–6, 13–14, 25–30, 32–36, 38–39, 45, and 84 take effect January 1, 2027; section 84 repeals AS 08.80.337(c).

FULL SUMMARY

The bill replaces Alaska’s physician-assistant scope-of-practice provision. Physician assistants may provide medical services for which they are qualified and competent, including evaluation, diagnosis, treatment, ordering diagnostic or therapeutic procedures, limited sonography, prescribing federal legend drugs and Schedule II–V controlled substances, administering and procuring drugs and devices, limited dispensing, and other specified clinical and administrative functions. Physician assistants generally must practice under a written collaborative agreement with a qualified physician, attest to the agreement at licensure or renewal, and provide it to the State Medical Board on request. An agreement is not required when practicing at specified physician-directed, state-licensed, federal or tribal, federally qualified, rural, military, or veterans’ facilities, or when the Board authorizes practice elsewhere without one. Physician assistants are made responsible for care they provide.

The bill establishes physician-assistant applicant qualifications, including graduation from an appropriately accredited program, current certification by the National Commission on Certification of Physician Assistants, and a passing score on the national certifying examination. Applicants who pass the examination and satisfy the applicable requirements must receive a license for the authorized scope of practice. Physician assistants are added to credential-based licensure, temporary permits, continuing-education exemptions, and specified temporary-employment and out-of-state-license provisions, with temporary-permit applicants required to meet the new qualifications and hold an applicable license elsewhere. The State Medical Board’s membership requirement is revised to require a physician assistant licensed in Alaska rather than one licensed under the former scope-of-practice provision.

The bill extends physician-assistant coverage throughout related licensing, disciplinary, reporting, controlled-substance, death-pronouncement, workers’ compensation, health-care-provider, and practice-of-medicine provisions. It authorizes physician assistants to pronounce death under the existing emergency conditions; recognizes them as controlled-substance practitioners and attending physicians; removes a prior direct-supervision condition from the definition of health care provider; and allows specified out-of-state physician assistants to assist with diagnosis or treatment, volunteer, or provide athletic-team services. Physician assistants are included in mandatory impairment reporting, reporting immunity, and confidentiality-related reporting duties, and a voluntary surrender may not be returned when surrender resulted in dropping or suspending civil or criminal charges against a physician assistant. The bill also prohibits health-insurer contracts from imposing physician-assistant practice, education, or collaboration requirements that are inconsistent with or more restrictive than State Medical Board requirements, removes the physician-assistant exclusion from the general penalty for unlicensed practice, revises related terminology, and repeals AS 08.64.170(a)(1).

FULL SUMMARY

The bill establishes Alaska licensure and regulation for genetic counselors under a new AS 08.53. It prohibits unlicensed practice and use of protected titles, sets education, examination, character, and experience qualifications, provides temporary and credential-based licenses, requires 50 continuing-education units every two years subject to hardship waivers, and authorizes supervised genetic-counseling interns. It defines the profession’s scope of practice, disciplinary grounds, exemptions, a class B misdemeanor penalty, and State Medical Board regulations and criminal-history checks. The board must establish a three- to five-member Genetic Counseling Advisory Council; individuals already practicing genetic counseling may continue without a license until July 1, 2027, and may serve initially on the council without a license subject to obtaining one by that date.

A new AS 08.90 creates respiratory-care practitioner licensure. Applicants generally must have a high-school diploma or equivalent, complete an accredited program, pass a nationally recognized registered-respiratory-therapist examination, and satisfy departmental requirements; licensure by credentials is available for substantially equivalent out-of-state, territorial, or foreign credentials. Renewal requires 20 continuing-education hours per licensing period. The chapter defines a supervised scope of practice, including respiratory assessment and treatment, ventilation, oxygen therapy, airway management, emergency protocols, transport, ECMO, inhalation therapy, and permitted telehealth; authorizes qualified medical directors and advanced techniques after formal training; establishes disciplinary sanctions, exceptions, and a class B misdemeanor penalty. Existing practitioners may continue performing qualified acts without a license for up to one year after the respiratory-care provisions take effect.

The bill enacts Alaska participation in the Interstate Medical Licensure Compact, PA Licensure Compact, Psychology Interjurisdictional Compact, and EMS Personnel Licensure Interstate Compact. These frameworks create interstate commissions, coordinated licensure and disciplinary-information systems, criminal-background-check and reporting requirements, mutual recognition or expedited licensure privileges, state and commission enforcement powers, rulemaking procedures, dispute resolution, default and withdrawal mechanisms, and safeguards governing adverse actions. The psychology compact authorizes qualifying telepsychology across state lines and temporary in-person practice for up to 30 days per calendar year; the EMS compact recognizes specified privileges for EMTs, advanced EMTs, paramedics, and equivalent levels, including transport and emergency-response practice. The bill also adds fingerprint and national criminal-history checks for specified physician, osteopath, podiatrist, physician-assistant, psychologist, and EMS applicants; adds compact-related fees and board duties; includes respiratory practitioners and genetic counselors in specified health-care-provider definitions, malpractice-liability provisions, school-health provisions, and group-health-insurance nondiscrimination protections; and directs implementation of the EMS compact.

The Department of Health’s Rural Health Transformation Program Advisory Council is established with eight specified members representing state government, tribal health organizations, federally qualified health centers, hospitals, local government, the Alaska Mental Health Trust Authority, and the legislature. The department must establish grant-scoring criteria, publish the state application and updates on applications, awards, use of funds, grantee progress, and funded projects, provide prior-year federal reports to the legislature, and may award grants consistent with the approved state application. The rural-health provisions are repealed December 31, 2031. Sections 1, 3, 5, 24, 26, 28, 30, 34, and 39 take effect January 1, 2027.

FULL SUMMARY

The bill amends Alaska’s naturopathy statutes to create temporary and permanent prescription-drug endorsements. The Department of Health must issue a temporary endorsement to a licensed naturopath who pays the fee, passes the pharmacology portion of the Naturopathic Physicians Licensing Examination or an approved equivalent, and meets regulatory requirements. A temporarily endorsed naturopath may prescribe and administer prescription drugs for preventive and therapeutic purposes, subject to statutory restrictions and supervision by a licensed physician who has prescribed and administered prescription drugs for at least five years and documents the supervisory arrangement. The supervising physician must review the naturopath’s prescribing and administration, provide feedback, and, after one year, recommend issuance, denial, or further supervision. The department must act on the recommendation, and a permanent endorsement authorizes the same prescribing and administration activities.

The bill requires licensed naturopaths to complete 60 hours of department-approved continuing education during the 24 months before license renewal, including at least 20 hours in pharmacotherapy. The department may grant an exemption for extenuating circumstances, but may not waive more than 15 hours in a four-year period. Renewal also requires application and payment of the fee, compliance with continuing education requirements, no disqualifying conviction or plea, and current cardiopulmonary-resuscitation certification.

The practice restrictions are revised to permit prescription drugs only when authorized by an endorsement, while continuing to prohibit controlled substances and poisons and expressly prohibiting cancer chemotherapeutic and antipsychotic drugs, surgery, use of “physician” in a naturopath’s title, and administration of therapeutic ionizing radiation or radioactive substances. Disciplinary provisions are expanded to cover endorsements: the department may impose sanctions for specified misconduct, revoke or suspend a license or endorsement, impose probation or practice conditions, and summarily suspend an endorsement when continued practice presents a clear and immediate danger, with a hearing required within seven days after the order takes effect. Unlicensed naturopathic practice or prescribing or administering drugs without the required endorsement remains a class A misdemeanor, subject to an exception for persons authorized under another chapter of title 8; fraudulent acquisition, forgery, counterfeiting, or alteration of an endorsement is subject to the existing misdemeanor penalties for fraudulent licenses.

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.

FULL SUMMARY

The bill establishes Alaska’s participation in the Multistate Nurse Licensure Compact, allowing qualifying registered and practical nurses holding a multistate license from a party state to practice in other party states under a multistate licensure privilege. Eligibility includes state licensure requirements, approved nursing education, NCLEX passage, an active unencumbered license, fingerprint-based criminal-history checks, no disqualifying felony or nursing-related misdemeanor, compliance with alternative-program disclosures, and a valid Social Security number. Nurses must follow the practice laws of the state where the patient is located. Licensing boards may restrict or discipline a multistate privilege, while the home state retains authority over the underlying license; party states must exchange licensure, investigative, disciplinary, and alternative-program information through a coordinated system. The bill also creates an Interstate Commission of Nurse Licensure Compact Administrators with rulemaking, enforcement, dispute-resolution, funding, and administrative powers.

The Department of Commerce, Community, and Economic Development must set nursing-license fees so single-state license fees approximately cover the department’s and Board of Nursing’s regulatory costs, while fees for multistate licenses and privileges cover approximately half those costs. It must also establish a fee on entities licensed under AS 47.32 to cover approximately half of the regulatory costs associated with multistate nursing practice, deposit the receipts in the general fund, and report the fee revenue for possible legislative appropriation. The Board of Nursing receives authority to adopt compact-implementation regulations and must report to the legislature within 30 days if compact requirements do not meet or exceed single-state licensing requirements. Employers of nurses practicing under a multistate privilege must report each nurse’s name and hire date before practice and report termination; the board must maintain a registry, while nonreporting cannot support discipline or bar practice.

Each hospital must establish a nurse staffing committee with at least 50 percent registered or practical nurses employed in nonmanagement positions. The committee must adopt minimum nurse-to-patient and certified-nurse-aide-to-patient ratios for every hospital unit and report annual compliance to the Board of Nursing. During a nursing strike, an entity may hire only nurses licensed under a single-state license or nurses who were already working for the entity under a multistate privilege the day before the strike notice; broader hiring may resume after the notice is withdrawn or the strike ends. The bill also removes the condition that certain out-of-state nurses lack a multistate privilege for exceptions covering nursing education or consultation of no more than 20 working days per licensing period and patient transportation of no more than 48 hours per transport, and adds definitions for multistate and single-state licenses.

The general provisions take effect July 1, 2026. Sections revising the fee framework, removing compact-related Board of Nursing and fee provisions, modifying the out-of-state practice exceptions, and repealing the compact, registry, definitions, staffing-committee, funding, and strike-hiring provisions take effect July 1, 2032, effectively ending the compact-related framework and associated requirements on that date.

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.

FULL SUMMARY

The bill authorizes Arizona pharmacists, under a State Board of Pharmacy-approved statewide written protocol, to independently order, perform, and interpret FDA-authorized tests waived under the Clinical Laboratory Improvement Amendments of 1988. Pharmacists may initiate treatment for eligible patients who are at least 12 years old, or the age authorized for the treatment if older, when test results indicate treatment is needed for influenza, group A streptococcal pharyngitis, SARS-CoV-2 or another coronavirus respiratory illness, and conditions related to an emerging or existing public-health threat identified by the Department of Health Services for which a statewide standing order, rule, or executive order exists. Protocols must address documentation, record retention, referrals, screening and medical history, exclusions, age- and history-based treatment instructions, follow-up care, and pharmacist training and certification, and pharmacists must follow specified evidence-based clinical guidelines.

The bill requires referral or follow-up recommendations when a patient is ineligible for treatment but symptomatic or does not respond to initial treatment. Pharmacists initiating treatment must notify an identified primary care provider within 72 hours, retain testing and treatment records for at least seven years, report witnessed or reported adverse reactions within 48 hours, and provide pediatric preventive-care information. Testing may be delegated to supervised licensed pharmacy staff, but clinical judgment and treatment may not be delegated. Pharmacists are not required to provide these services; may not independently initiate opioid treatment or test or treat a minor without written parental or guardian consent; and must provide disclosures, patient privacy areas, and professional liability insurance for services provided under the authority.

The Board must establish an independent testing and treatment advisory committee, with pharmacists, physicians, a patient-advocacy representative, and a nurse practitioner, to assist with protocol development and recommendations. Members must be appointed within 60 days after the section’s effective date, serve without compensation or expense reimbursement, and review the protocols annually; the Board must provide the protocols to specified legislative committees and post them publicly. Separately, pharmacists may initiate and dispense HIV preexposure prophylaxis and postexposure prophylaxis under the statewide protocol. PrEP requires a CLIA-waived negative HIV test and assessment of contraindications, interactions, and eligibility; PEP requires presentation within 72 hours of potential exposure and an HIV test if feasible. Dispensing is limited to a 30-day PrEP supply or a complete 28-day PEP course, with required counseling, written follow-up referral, and provider notification with patient consent.

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 regulation revises 17 CAR § 122-302 to require registered nurse practitioner licensees to immediately notify the Arkansas State Board of Nursing in writing of any change in mailing address, residential address, email address, or telephone number. The revised provision replaces the prior address-change language. The rule is scheduled to take effect July 1, 2026; the stated deadline for public comment was March 13, 2026.

FULL SUMMARY

The Arkansas State Board of Nursing revises APRN rules effective July 1, 2026; the public-comment deadline was March 13, 2026. Licensees must immediately notify the Board in writing of changes to mailing, residential, or email addresses and telephone numbers. The rule also removes the general incorporation-by-reference provision for registered-nurse rules while retaining the requirement that APRNs comply with the standards in 17 CAR Part 120, subject to conflicting role- and population-specific standards.

The regulation expands APRN authority in specified areas. APRNs may delegate qualifying medication-administration tasks and phlebotomy to trained, competency-assessed unlicensed healthcare workers only in ambulatory-care settings; delegation is limited to specified routine medications and administration routes, excludes controlled substances and emergency medications, and requires the APRN to remain on the premises and immediately available. Certified nurse anesthetists may not delegate anesthesia administration. APRNs may prescribe therapeutically equivalent substitutes for physician-initiated Schedule II stimulants if the physician evaluated the patient within the preceding six months and the APRN treats the same condition, with notice to the original prescriber. APRNs may delegate the calling-in of legend-drug prescriptions to unlicensed ancillary staff, but may not delegate the calling-in of controlled-substance prescriptions. New provisions also allow APRNs to obtain compounded products from outsourcing facilities for administration in the practice setting and prohibit picking up or delivering medications to patients except where otherwise authorized.

The rule adds authority for APRNs employed by an attending hospice to pronounce death and complete and sign death certificates for anticipated deaths of hospice patients who die in specified hospice, nursing-home, or hospital settings. APRNs may also pronounce death and sign death certificates in a hospital when authorized by the hospital medical staff and no physician other than an emergency-department physician is immediately available. Certified nurse midwives receive clarified full-practice authority to evaluate and diagnose patients, order and interpret tests, manage treatment, prescribe and administer Schedule III–V drugs without a collaborative practice agreement, admit and discharge patients when privileged, and complete birth- or death-certificate forms; a collaborative agreement remains required for Schedule II prescribing, and out-of-facility deliveries require a referral and consultation arrangement.

The regulation expands provisions governing full independent practice authority to expressly include clinical nurse specialists alongside certified nurse practitioners. The changes apply to committee actions and complaints, including the committee’s authority to act on, suspend, or revoke a clinical nurse specialist’s certificate while not taking action against the underlying nursing license; hearing and appeal provisions likewise cover clinical nurse specialists.

Eligibility documentation is revised to apply the practice-hour and affidavit requirements to both certified nurse practitioners and clinical nurse specialists, including alternative evidence when a collaborating physician cannot provide an affidavit. The rule also clarifies that applicants may demonstrate qualifying prescriptive-authority practice in another state, territory, or foreign country, and removes redundant nurse-practitioner-only wording. The adopted rule is scheduled to take effect July 1, 2026; the transmittal sheet lists March 13, 2026, as the final public-comment deadline.

The proposed revision to 17 CAR § 122-302 would replace the existing requirement to notify the Arkansas State Board of Nursing when a licensee’s address changes with an explicit requirement for immediate written notification of changes to the licensee’s mailing address, residential address, email address, or telephone number. The Board states that the change is intended to ensure it can communicate effectively with registered nurse practitioners and anticipates no financial impact.

The 30-day public comment period begins February 11, 2026, and written comments are due by March 13, 2026. The public meeting location and time are listed as to be determined; no effective date is specified.

FULL SUMMARY

The proposed revisions to Arkansas State Board of Nursing rules for advanced practice registered nurses (APRN) would require licensees to immediately update the Board in writing when their mailing address, residential address, email address, or telephone number changes. They would also authorize APRNs employed by an attending hospice to complete and sign death certificates and pronounce death for terminally ill patients whose deaths are anticipated and who receive qualifying hospice services, including in hospice inpatient programs or as hospice patients in nursing homes or hospitals. In hospitals, an APRN could do so when authorized by the medical staff and a physician other than an emergency-department physician is not immediately available.

The revisions would clarify that durable medical equipment includes orthotics, prosthetics, and diabetic shoes or inserts. APRNs could delegate specified nursing tasks to qualified, trained, and competency-assessed unlicensed healthcare workers, subject to training, task, setting, medication-class, route, and supervision limits; delegation would be limited to ambulatory care, would exclude controlled substances and emergency medications, and would require the APRN to remain on the premises and immediately available. CRNAs would be expressly prohibited from delegating administration of anesthesia. APRNs could delegate to unlicensed ancillary staff the calling-in of legend-drug prescriptions, but not controlled-substance prescriptions.

The rule would permit an APRN to substitute a therapeutically equivalent medication for a physician-prescribed drug; substitution of a Schedule II stimulant would require notice to the original prescribing physician. APRNs would also be authorized to purchase compounded products from an outsourcing facility for administration in the practice setting, while generally being prohibited from picking up or delivering medications to patients except where otherwise authorized by rule or statute. Certified nurse midwives would receive expressly defined full practice authority to evaluate and diagnose patients, order and interpret diagnostic tests, manage treatment, prescribe Schedule III-V drugs without a collaborative practice agreement or supervision, admit and discharge patients when granted hospital privileges, and complete birth and death certificates. A collaborative agreement would remain required for Schedule II prescribing, and the existing requirement for a prescriptive-authority certificate before prescribing legend drugs, medicines, or therapeutic devices would be removed.

Written comments are due by March 13, 2026; the public comment period begins February 11, 2026. No effective date is specified in the proposal.

FULL SUMMARY

The bill extends the Board of Registered Nursing’s authority, executive-officer provision, and related provisions until January 1, 2031. It replaces the requirement that board meetings occur in northern and southern California with a requirement to meet at least quarterly in geographically diverse locations when practicable. The board must publish its list of approved nursing schools online, apply inspection criteria consistent with the 2020 Nursing Education Approval Guidelines of the National Council of State Boards of Nursing or its successor, and require simulation-based clinical hours to follow specified national best practices or equivalent board-approved standards. Nursing programs may request approval to reduce medical-surgical direct patient-care training to 200 hours when qualifying clinical-placement shortages exist; the bill removes the prior expiration of this authority and establishes related documentation, equivalency, simulation, telehealth, and expedited-approval conditions. It also permits remediation plans for applicants seeking director or assistant-director approval, limits five-year renewal authority to individual faculty approvals, and allows online display of faculty, director, and assistant-director approval status.

The bill expands the statutory practice of nursing to include administering medications ordered by qualifying nurse practitioners and certified nurse-midwives, and medications directed by an advanced practice registered nurse within that nurse’s scope of practice. It removes the requirement that licensing examinations be written and eliminates the provision authorizing supplemental oral or practical examinations. Intervention-program committees must determine whether participants must practice nursing before completing rehabilitation, and nurses whose licenses were revoked by default for failing to submit a notice of defense may petition for reinstatement without a minimum waiting period. Beginning January 1, 2029, registered nurses renewing licenses must submit documentation of required continuing education with their renewal proof. The bill also authorizes certified nurse-midwives and nurse practitioners to obtain furnishing numbers through renewal applications and removes related late-renewal penalty-fee authority.

For nurse practitioners, qualifying transition-to-practice experience may be completed in another state identified by the board; the board must identify qualifying states by January 1, 2028, maintain the list online, and periodically review it. The bill removes minimum fee amounts for nurse-anesthetist certificates and clinical-nurse-specialist applications, temporary certificates, and renewals while retaining maximum amounts. It makes related technical and nonsubstantive changes to nursing licensure and regulation provisions.

FULL SUMMARY

The bill extends the Naturopathic Doctors Act’s repeal date from January 1, 2027, to January 1, 2031. It clarifies that board members’ four-year terms expire four years after appointment and establishes initial staggered terms for Governor-appointed members after the bill’s effective date: two members for two years, two for three years, and three for four years; subsequent appointments are for four-year terms. It also revises eligibility for approved naturopathic medical education programs to permit accreditation by the Council on Naturopathic Medical Education or a substantially equivalent accreditor, or programs housed in an appropriately accredited institution that meet substantially equivalent standards.

The bill authorizes the California Board of Naturopathic Medicine to accept voluntary license cancellations upon written request, unless cancellation would avoid an administrative enforcement action. A canceled license is deemed surrendered and cannot be reinstated; resumption of practice requires a new license. It repeals the obsolete pathway for licensure of certain applicants who graduated before 1986 and submitted applications by December 31, 2007.

The bill creates a board-administered fictitious-name permit system for naturopathic doctors and makes use of an unpermitted fictitious, false, assumed, or other nonpersonal name in public practice communications unprofessional conduct, subject to specified exceptions. Permit applicants and owners must be licensed naturopathic doctors, the practice must be wholly owned and controlled by naturopathic doctors except as otherwise allowed by law, and the name must not be deceptive, misleading, or confusing. Application and renewal fees are set at $100 and $50, respectively. It also makes it a public offense, punishable by up to a $10,000 fine and specified imprisonment, to practice, advertise, or hold oneself out as practicing naturopathic medicine or to diagnose, treat, or prescribe without an authorized license. Persons engaging in otherwise lawful activities, including naturopathy, remain outside the offense only if they comply with specified disclosure, client acknowledgment, and record-retention requirements. Renewal fees are expressly divided between active licenses, which remain subject to the $1,000-to-$1,200 range, and inactive licenses, which cost one-half of the current active-license renewal fee.

FULL SUMMARY

The proposed regulation updates California nurse-practitioner rules to align with Business and Professions Code Sections 2837.103 and 2837.104. It permits qualifying nurse practitioners to seek expanded scope of practice without standardized procedures in specified population-focus categories, including categories whose national certification examinations were retired before January 1, 2017. For practitioners certified under Section 2837.103, the category-specific limitation is removed from the functions that may be performed without standardized procedures, although practice remains limited to group settings; the existing category limitation for Section 2837.104 practitioners is retained. Certification applicants must maintain the applicable national certification, and the regulation authorizes the colloquial designations “103 NP” and “104 NP.”

The proposal removes requirements that applicants who did not complete an academically affiliated nurse-practitioner program demonstrate equivalent education and supervised clinical practice, as well as the separate foreign-education credential-evaluation requirement. For Section 2837.103 certification, applications may be supported by attestations from a physician or surgeon or a nurse practitioner practicing under Section 2837.103 or 2837.104; the prior same-specialty/category and familial- or financial-relationship restrictions are removed, as is the requirement that transition-to-practice experience be in the applicant’s intended category. Active national certification must be maintained and verified to the Board or an employer upon request.

For Section 2837.104 certification, the proposal replaces the prior transition-to-practice attestation framework with a requirement for at least three full-time-equivalent years or 4,600 hours of direct patient-care practice under Section 2837.103 in good standing. Good standing requires a current, active, unrestricted license without Board discipline, including probation, suspension, or public reproval. Eligible direct patient-care hours completed during a Doctor of Nursing Practice program may count if they are in the applicant’s national-certification area, were completed during the doctoral portion of the program, were not credited toward the master’s degree, and are verified by the program director through the Board’s online portal. The applicant must also provide proof of Section 2837.103 Board certification, maintain active national certification, and, within 90 days of Section 2837.104 certification, have a written consultation protocol and referral plan available to patients on request.

For nurse practitioners practicing under Sections 2837.103 or 2837.104, except when working in Department of Corrections and Rehabilitation facilities, the proposal requires a conspicuous public notice in at least 48-point Arial stating that nurse practitioners are licensed and regulated by the Board of Registered Nursing and providing the Board’s telephone number and website. It removes the requirements to verbally tell new patients that the nurse practitioner is not a physician and surgeon, to use specified Spanish phrases, and to advise patients of their right to see a physician and surgeon and the circumstances requiring referral.

FULL SUMMARY

The bill establishes a temporary Graduate Medical Education article requiring the Department of Health Care Access and Information (HCAI), by January 1, 2028, to convene a stakeholder workgroup on California’s graduate medical education capacity, focused on access to residency positions. Participants may include the Medical Board of California, Osteopathic Medical Board of California, California-accredited medical schools, teaching hospitals and health systems with residency programs, physician organizations, medical student/intern/resident organizations, international medical graduate organizations, and consumer and patient advocacy groups.

After the workgroup concludes, HCAI, in consultation with the Medical Board of California, must submit a report to the appropriate legislative committees by July 1, 2028, pursuant to Government Code Section 9795. The report must assess the number and geographic and specialty distribution of residency positions; analyze the gap between applicants and available slots, including in-state and out-of-state applicants; identify expansion barriers such as federal funding, state and institutional financing, regulatory or accreditation requirements, and infrastructure and faculty limitations; evaluate effects on physician practice locations, especially underserved and rural areas; examine barriers facing international medical graduates; assess losses of California graduates to out-of-state residency programs and their likelihood of returning; identify relevant practices from other states or countries; and recommend ways to expand capacity, improve distribution, and reduce entry barriers. It must also consider the feasibility and advisability of allowing non-residency-trained medical graduates to practice under supervision as an alternative to postgraduate training requirements for full licensure.

The article remains in effect only until January 1, 2030, when it is repealed.

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.

FULL SUMMARY

The regulation establishes quantitative methods for designating Colorado geographic areas as state health professional shortage areas for behavioral health, primary care, dental care, and perinatal care. Designations are based on comparing estimated service demand with provider capacity within catchment areas created from census block groups and standard road-travel distances; an area qualifies when supply falls below demand. The rule also establishes parallel Medicaid shortage designations by discipline using Medicaid-enrolled populations, discipline-specific demand rates, and claims data from the Colorado All Payer Claims Database.

For dental designations, demand is calculated at two visits per person annually, while provider supply is based on assigned 12-month productivity rates. For perinatal designations, demand uses five-year average birth records and assumes 12 prenatal visits for low-risk pregnancies and 15 for pregnancies involving individuals younger than 20 or older than 34; these standards may be revised based on clinical guidance and stakeholder input. The regulation defines relevant provider categories, populations, encounters, catchment areas, and data terms, permits comparable data sources when specified sources are unavailable, and generally prioritizes reliable data collected within the preceding year.

The Department must post current regional designation status at least annually, generally on or about July 1. Designation status will be reviewed in 2026 and at least every three years thereafter, may be reviewed more frequently when data and resources permit, and remains effective for 36 months from publication or until replaced by a newer analysis. Because of an incomplete prior filing, the adopted rule will be published in the October 10, 2026 Colorado Register and takes effect October 30, 2026.

The bill adds Colorado Revised Statutes § 22-32-116.5(6.5) to require a statewide high school activities association to permit a physical therapist licensed under title 12, article 285, to conduct a physical examination and provide written clearance when the association requires such an examination and clearance from a health-care provider before a student may play or participate in a team athletic activity.

The act takes effect at 12:01 a.m. on the day after the 90-day period following final adjournment of the General Assembly, specified as August 12, 2026, if adjournment occurs on May 13, 2026. If a referendum petition is filed, the act will take effect only if approved by voters at the November 2026 general election, on the governor’s official proclamation of the vote.

FULL SUMMARY

The bill creates an exception to Colorado’s medical-practice corporation ownership rules for corporations organized solely to provide medical-aesthetic services. One or more physician assistants may own a majority of such a corporation. The corporation may also have as shareholders individuals with active Colorado licenses as estheticians or cosmetologists; licensed practical nurses, registered nurses, or advanced practice registered nurses; or physician assistants. Medical-aesthetic services retain their existing meaning as therapeutic procedures used in aesthetics.

The bill extends professional-conduct requirements to standards applicable to each licensee’s professional practice and authorizes the applicable regulator, in addition to the medical board, to revoke or suspend the license of persons responsible for a corporate violation. It also clarifies that licensees remain personally responsible for acts or omissions causing the corporation to violate applicable professional-conduct standards.

The act is scheduled to take effect at 12:01 a.m. on the day after the 90-day period following final adjournment; assuming adjournment on May 13, 2026, the stated date is August 12, 2026. If a referendum petition is filed, the affected provision takes effect only if approved by voters at the November 2026 general election, on the governor’s official declaration of the vote.

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.

FULL SUMMARY

The regulation establishes five new sections governing Connecticut retired physician licenses. It defines key terms and allows a physician in good standing who has retired from compensated medical practice to convert to a retired physician license by submitting a department application, retirement statement, professional-liability-insurance attestation, certification that services will be uncompensated and comply with scope-of-practice limits, required fees, and any additional information requested. Retired licensees must publicly post or produce the license, meet continuing-education requirements, renew annually during their birth month, and remain subject to applicable laws and disciplinary action.

Practice under the retired physician license is limited to volunteer medical services without monetary compensation. Services must remain within the physician’s competence, based on education, training, and experience, and within the scope of physician practice. A physician whose prior license became void may obtain reinstatement as a retired physician if the prior license was in good standing, became void no more than two years before application, the applicant satisfies applicable continuing-education requirements, and all other retired-license requirements are met. Applicants who do not qualify must use the existing general reinstatement procedures.

A retired physician licensee in good standing may convert to a license for compensated active employment by filing the prescribed application, paying the applicable fee, and documenting volunteer services performed during the preceding two years. A licensee who has not regularly provided volunteer services during that period must instead use the existing general licensure procedures. The proposed regulations implement Public Act 25-96 and establish procedures and eligibility requirements for retired physician licensure.

FULL SUMMARY

The bill changes Delaware’s statutory title for “physician assistant” to “physician associate,” while preserving existing rights and privileges and providing that references to physician assistants include physician associates. It restructures the Regulatory Council accordingly, requires the Council to meet at least quarterly, and requires the Board to approve or disapprove Council regulations within 60 days, after which proposed regulations are deemed approved. The bill also removes the requirement that every physician associate have a collaborative agreement and defines independent practice as practice and prescribing by a physician associate who is not subject to such an agreement.

A Delaware physician associate with more than 6,000 hours of post-graduate clinical practice may apply for independent practice authority. The Council must establish application processes for practice settings with or without a Delaware-licensed physician, including requirements for licensure information, practice location, clinical-hours verification, and—where no Delaware physician is present—training aligned with the associate’s practice areas. Associates granted authority in settings without a Delaware physician must notify the Council before changing practice areas and document appropriate training; the Council must also establish conditions for reapplying after denial of a waiver of the collaborative-agreement requirement. Associates without the required 6,000 hours remain prohibited from independent practice, and those practicing independently must collaborate, consult, or refer as appropriate to the patient’s condition and the associate’s education, experience, and competency.

The bill requires rules addressing physician-associate scope of practice, clinical services, prescribing, telemedicine and telehealth, verification of clinical hours, and independent practice. It authorizes physician associates to bill and receive direct payment for medically necessary services, requires identification as the rendering professional when appropriate, and prohibits insurers and third-party payers from imposing requirements more restrictive than state law or regulation. It adds authority for uncompensated physician-associate care at public or community events without a collaborating physician, establishes the name-change and reimbursement protections, and makes related terminology and eligibility changes throughout the Delaware Code, including recognition of physician associates in health-care, concussion, perinatal, loan-repayment, insurance, utility-protection, transportation, disability-parking, and other statutory provisions. The Act is effective immediately but is to be implemented on the earlier of one year after enactment or Board approval of the Council’s enabling regulations.

The bill authorizes Delaware-licensed physician assistants (PAs), acting under § 1773 of Title 24, to pronounce deaths and complete, certify, and sign medical certifications of death. It adds PAs to the authorized practitioners listed in § 3123 of Title 16 and requires the Physician Assistant Regulatory Council’s rules to address these activities.

It removes registered nurses from the practitioners authorized to complete medical certifications of death when no official death investigation is required. The authorized certifiers in that circumstance are the attending physician, an advanced practice registered nurse acting under § 1902(s) of Title 24, or a PA acting under § 1773. PAs are also added to the list of individuals who may pronounce a death. Related provisions are conformed to require electronic preparation, certification, and signing by the designated practitioners.

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.

FULL SUMMARY

The bill expands the health professionals who may assist with Medical Orders for Scope of Treatment (MOST) Forms to include naturopathic physicians and physician assistants acting under valid delegation agreements. It defines “medically fragile” to include serious or life-limiting illness, advanced frailty, serious or complex chronic conditions, and progressive degenerative conditions. A patient may also qualify when the patient or authorized representative and an authorized health care professional determine that documenting treatment preferences is appropriate, eliminating the prior life-expectancy limitation.

The bill revises MOST Form execution procedures. Patients or authorized representatives must be offered the opportunity to have a health care professional prepare and execute a form, but cannot be required to prepare or sign one. A valid form must be reviewed by an authorized health care professional and signed by both the patient or authorized representative and an authorized health care professional. Completed forms must be uploaded to the patient’s electronic medical record, submitted to the District’s designated health information exchange, and retained as part of the permanent medical record until revoked.

The bill changes the MOST Advisory Committee by authorizing the Department of Health to establish it with providers, experts, and stakeholders designated by the agency director. The committee’s specified functions include reviewing paper and electronic forms, promoting public awareness, recommending professional training and related medical protocols, and performing other assigned MOST-related tasks. It also repeals D.C. Code § 21-2221.14a, changes a requirement in § 21-2221.15 from mandatory to discretionary, and replaces references to an intent to revoke with references to revocation. The act takes effect after mayoral approval or veto override, congressional review, and publication in the District of Columbia Register.

FULL SUMMARY

The District of Columbia Department of Health proposes comprehensive revisions to Title 17 DCMR Chapters 57–60 governing certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), certified nurse practitioners (CNPs), and clinical nurse specialists (CNSs). The rule replaces “certificate” terminology with “license,” updates professional titles, requires a current national certification to obtain and maintain each APRN license, requires applicants to hold a District registered-nurse license and disclose adverse licensing history, and requires licensees to register with and comply with the Prescription Drug Monitoring Program. Licenses generally expire June 30 of even-numbered years, subject to a possible birthdate-based renewal system; inactive licensees may not practice, including by telehealth, and licenses expired more than five years require an initial application. Renewal requires 24 hours of continuing education per two-year period, including two hours on LGBTQ+ topics and 10% in District-designated public-health priorities, with certification potentially satisfying most requirements; the Board may audit compliance and licensees must retain records for at least three years.

The proposal replaces existing scope-of-practice and conduct provisions with role-specific standards, recognizes all four APRN categories as licensed independent practitioners operating under Board-recognized standards, and expressly authorizes functions such as advanced assessment, medical diagnosis, prescribing and modifying drug therapies, diagnostic and therapeutic measures, referrals, and physician-signature functions within authorized activities. It incorporates specified national professional standards, prohibits unsafe drug practices and drug-sample trading, and establishes title protections limiting use of APRN and profession-specific titles to appropriately licensed and certified individuals. The proposal removes “nurse anesthesiologist” from the CRNA titles, while retaining the provision that CRNAs may make medical diagnoses; it also removes a repealed statutory reference and clarifies CRNA authority to order and administer intravenous agents and techniques and to refer pain patients to qualified practitioners without limiting referrals to comparable specialties.

New Sections 5711, 5811, 5911, and 6011 establish parallel requirements for CRNA, CNM, CNP, and CNS prescribing, ordering, administering, or dispensing controlled substances for pain. These activities must serve a legitimate medical purpose, be supported by documented unrelieved pain and a complete history and examination, and comply with applicable District and federal law. Licensees must use a written treatment plan, discuss risks and benefits, adjust and periodically reassess therapy, consider alternative or rehabilitative treatments, monitor compliance, refer or consult for high-risk or complex patients, use written medication agreements where abuse risk or substance-abuse history exists, and maintain detailed accessible records. The proposal also incorporates national nursing-delegation guidelines: APRNs retain accountability, must assess delegatee competence, provide guidance and follow-up, and may not delegate nursing judgment or critical decision-making to nursing assistive or unlicensed assistive personnel. Written comments are due no later than seven days after publication in the District of Columbia Register; adoption is proposed no sooner than 30 days after publication.

The Florida Board of Medicine is developing a proposed change to Rule 64B8-30.001 (Definitions) to define and clarify the meaning of “indirect supervision” and the related duties, and to remove the rule’s sunset provision because it is no longer required. The notice identifies sections 458.309 and 458.347, Florida Statutes, as rulemaking authority and section 458.347 as the law implemented.

A rule-development workshop will be noticed in the next available Florida Administrative Register if requested in writing and the agency head does not determine that a workshop is unnecessary. The preliminary draft, if available, may be obtained without charge from the designated Board of Medicine contact.

The Florida Board of Nursing declined to issue a declaratory statement on whether an advanced practice registered nurse may administer intravenous hydration therapy in a private-practice setting. The Board determined that the petition sought an opinion applicable to all registered nurses rather than addressing a specific, particular person, and therefore voted on August 6, 2026, not to answer it.

FULL SUMMARY

The act modernizes Florida’s regulation of naturopathy by renaming chapter 462 “Naturopathic Medicine” and establishing legislative intent that naturopathy may be freely offered while naturopathic medicine is practiced by licensed naturopathic doctors meeting specified education and training standards. It defines naturopathic medicine to include diagnosis, prevention, and treatment using modalities such as botanical and fungal extracts, clinical nutrition, counseling, dietary supplements, environmental and lifestyle medicine, homeopathy, imaging, laboratory testing, natural substances, physical examination, and physical medicine, consistent with recognized naturopathic doctoral education and principles. The defined practice excludes prescribing or administering legend or prescription drugs other than natural nonpharmacologic substances, surgery, general or spinal anesthesia, radioactive substances, specified high-velocity chiropractic or osteopathic manipulation, acupuncture, and management of labor and delivery, unless the practitioner also holds the relevant separate license. The chapter preserves specified exceptions for other licensed practitioners, supervised students and residents, certain out-of-state or Canadian doctors participating in approved education, religious practice, family remedies, dietary-supplement information, and unlicensed persons using natural therapies or traditional-naturopathy titles without representing themselves as naturopathic doctors.

The act creates the seven-member Board of Naturopathic Medicine within the Department of Health, consisting of four licensed naturopathic doctors, two physicians licensed under chapters 458 or 459, and one member who has never been licensed as a naturopathic doctor, physician, or closely related practitioner. It requires the board and department to adopt implementing rules and prohibits unlicensed practice or use of the titles “doctor of naturopathic medicine,” “naturopathic doctor,” “N.D.,” or “N.M.D.”; violations are second-degree misdemeanors. Licensure by examination requires applicants to be at least 21, hold an accepted bachelor’s degree and naturopathic doctoral degree, demonstrate good moral character, complete background screening, and pass specified national naturopathic licensing examinations. The board may withhold certification while an applicant is under qualifying investigation and may deny certification, impose scope restrictions, or require probationary conditions such as treatment, education, reexamination, or supervision. Licensure by endorsement is authorized under the general endorsement requirements in section 456.0145.

The act revises license administration by requiring biennial renewal, retaining a renewal fee capped at $1,000, requiring at least 60 hours of continuing education per biennium documented through the department’s electronic tracking system, and requiring board rules for inactive-license renewal and reactivation with at least 20 classroom hours of education for each year inactive. It revises disciplinary provisions, transfers authority to deny licensure or impose penalties and establish disciplinary guidelines from the department to the board, and adds or updates grounds including false advertising, failure to report violations, aiding unlicensed practice, unauthorized services, public-health noncompliance, malpractice, practicing beyond competence or legal scope, and violation of chapter 462, chapter 456, or related rules; section 462.17, concerning the prior offense penalty, is repealed. Related statutes are conformed to recognize naturopathic medicine, including telehealth-provider status, public-health disease reporting, professional exemptions, medical-malpractice risk definitions, controlled-substance terminology, and the criminal offense-ranking chart. The act 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.

The bill removes the requirement that a supervising physician notify the Department of Health before delegating prescribing authority to a physician assistant or when changing the assistant’s prescriptive privileges. It also removes the requirement that prescriptions issued by physician assistants include the names of their supervising physicians. These changes apply to physician assistants practicing under chapters 458 and 459.

The bill revises the controlled-substance formulary requirements for physician assistants by allowing a 30-day supply of Schedule II psychiatric mental-health controlled substances while retaining a 7-day limit for other Schedule II controlled substances, with related revisions to restrictions involving patients younger than 18. For advanced practice registered nurses, the formulary must limit psychiatric mental-health controlled substances prescribed to children younger than 18 to a 30-day supply and limit Schedule II controlled substances to a 7-day supply; both limits exclude prescriptions by psychiatric nurses as defined in s. 394.455, with the Schedule II exception applying to psychiatric medications. 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.

The bill creates s. 465.1894, F.S., authorizing a pharmacist to administer medications to a patient during a life-threatening emergency at a Level I, Level II, or pediatric trauma center when directed and delegated by a physician licensed under chapter 458 or 459. The pharmacist must have completed an accredited postgraduate residency program or at least three years of direct patient care in a hospital setting. A trauma center permitting the delegation must maintain records under s. 395.0197(5), including documentation that the pharmacist satisfies these qualifications, and the Board of Pharmacy must adopt implementing rules.

The bill adds a risk-management requirement for Level I, Level II, and pediatric trauma centers that permit delegation under s. 465.1894: they must develop, implement, and continually evaluate procedures, protocols, and systems to permit and comply with pharmacist medication administration during life-threatening emergency events. 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."

FULL SUMMARY

The bill renames Florida Statutes chapter 462 from “Naturopathy” to “Naturopathic Medicine,” establishes legislative findings and statutory distinctions between traditional naturopathy and naturopathic medicine, and creates the Board of Naturopathic Medicine within the Department of Health. The seven-member board must include four Florida-licensed naturopathic doctors, two Florida-licensed physicians, one unaffiliated public member, and at least one member age 60 or older. The bill removes the existing rulemaking restriction that effectively barred most new naturopathic licenses and authorizes the board to adopt implementing rules and initiate discipline.

The bill defines naturopathic medicine to include diagnosis, prevention, and treatment using specified natural and diagnostic modalities consistent with accredited naturopathic education, while expressly excluding prescribing or administering legend or prescription drugs other than natural, nonpharmacologic substances such as vitamin B12; surgery; general or spinal anesthesia; ionizing radioactive substances; specified high-velocity chiropractic or osteopathic manipulation; acupuncture; and labor or delivery management unless the practitioner separately holds the applicable license. Unlicensed practice and use of protected titles or the “N.D.” or “N.M.D.” designations become second-degree misdemeanors. Traditional naturopaths and other unlicensed persons may continue using specified natural therapies and terms such as “naturopath” or “naturopathy” if they do not use protected titles or represent themselves as licensed naturopathic doctors; specified exemptions cover other licensed practitioners, supervised students and residents, educational demonstrations, religious practices, family remedies, and dietary-supplement information.

The bill establishes licensure by examination for applicants who are at least 21, hold qualifying bachelor’s and naturopathic doctoral degrees, satisfy fitness, character, background-screening, and national examination requirements, and are certified by the board. It requires an investigative process, permits a written 90-day licensing delay when the investigation is incomplete and concerns remain, bars certification during certain out-of-state investigations, and authorizes denial, restricted licensure, or probationary licensure with conditions. It also creates licensure by endorsement, requires biennial renewal with a nonrefundable fee capped at $1,000, requires at least 60 hours of continuing education per biennium with electronic tracking, and requires at least 20 classroom hours per year of inactive status for reactivation. The bill replaces the prior continuing-education program and inactive-license provisions, renumbers related sections, repeals section 462.17, removes the former chapter 462 offense from the Criminal Punishment Code ranking chart, makes conforming terminology changes throughout Florida law, and 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.

FULL SUMMARY

The Georgia Board of Nursing proposes a comprehensive reorganization of Chapter 410-11 governing advanced practice registered nurses (APRNs) to align the rules with O.C.G.A. § 43-26-7.1, effective July 1, 2024. The recognized APRN roles would be reduced from five to four—certified nurse-midwife, nurse practitioner, certified registered nurse anesthetist, and clinical nurse specialist—removing clinical nurse specialist–psychiatric/mental health as a separate role. APRNs would be required to identify themselves by role and population designation, and the rule would prohibit practice without current active licensure. The proposal also removes the term “independent management” from the certified nurse-midwife scope provision to clarify that practice remains subject to a nurse protocol agreement.

The proposal consolidates initial licensure requirements into Rule 410-11-.02, including an active Georgia or qualifying multistate RN license, a nonrefundable application fee, accredited graduate-level education with advanced pharmacology, physical assessment, and pathophysiology, role-specific education, current national certification, recent practice/education/reentry evidence, lawful-presence documentation, a criminal-background-check registration, and any information needed to establish eligibility. Rule 410-11-.03 would establish a consolidated reinstatement process requiring current RN licensure, national certification, one of 500 recent APRN practice hours, recent graduate education, or a Board-approved reentry program, with Board discretion to require competency assessments or remedial measures. Rule 410-11-.04 would list seven recognized national certifying organizations, and Rule 410-11-.05 would establish APRN renewal requirements, including renewal by the RN license cycle, a one-month late-renewal period ending February 28 or 29, lapse for nonrenewal, and continuing certification subject to audit.

Rules 410-11-.06 through -.09 would set role-specific scopes and standards for CNMs, nurse practitioners, CRNAs, and CNSs, including specified medical acts performed under nurse protocol agreements; the CRNA provision updates the professional organization’s name to the American Association of Nurse Anesthesiology. Existing rules on examination failure, temporary authority, and unauthorized practice would be repealed or relocated; new unlicensed-practice provisions retain reprimands and fines of $50 per month (up to $250) for two to six months of practice, $75 per additional month for seven to twelve months, and Board-discretionary penalties for practice exceeding one year. Revocation or suspension authority would be relocated to Rule 410-11-.11 and would cover unprofessional conduct, noncompliance with scope and standards, and failure to maintain certification or competency.

The proposal would replace the existing protocol provisions with separate rules under O.C.G.A. §§ 43-34-23 and 43-34-25. Protocols must be written, signed, available upon request, periodically reviewed, updated annually, provide immediate physician consultation, and specify delegated acts and record-review requirements. Under § 43-34-25, Schedule I and II controlled-substance orders generally remain prohibited, while emergency hydrocodone or oxycodone orders would be allowed only for APRNs with at least one year of post-licensure experience and good standing, specific protocol authorization, direct patient evaluation, an initial prescription of no more than five days for patients aged 18 or older, and one hour of relevant continuing education every two years. Drug refills generally could not exceed 12 months, except oral contraceptives, hormone replacement therapy, and prenatal vitamins could be refilled for 24 months; abortion-inducing drugs or devices would be prohibited. The limit would be eight APRNs or equivalent APRN/physician-assistant positions per delegating physician, with specified healthcare-setting exceptions, and Rule 410-11-.14 would be repealed. Written comments are due by close of business August 6, 2026, and the virtual public hearing is scheduled for 4:00 p.m. on August 13, 2026.

FULL SUMMARY

The bill expands Georgia’s physician-assistant framework to include podiatric practice. It authorizes podiatric physicians to supervise physician assistants under board-approved job descriptions and creates definitions for podiatric physicians, primary and alternate supervising podiatric physicians, podiatric physician assistants, and related delegation terms. Physician assistants must be licensed by the Georgia Composite Medical Board and approved to work under a supervising podiatric physician; the State Board of Podiatry Examiners and the Composite Medical Board must coordinate oversight. Job descriptions may be automatically approved in specified circumstances involving substantially similar existing descriptions or changes in supervisors, and supervising physicians or podiatric physicians may designate alternate supervisors subject to board approval and supervision limits.

The bill permits delegation to physician assistants of authority to order controlled substances from a podiatry-board formulary, dangerous drugs, podiatric treatments, and diagnostic studies, as well as authority to handle and distribute professional samples and sign, certify, or endorse podiatric health-care documents. Delegated authority must be included in an approved job description. Physician assistants may dispense dangerous drugs under written dispensing procedures in qualifying charitable, federally funded community-health, or hospital-operated outpatient clinics, where services are free or charges are based solely on ability to pay and do not exceed actual cost. The bill also authorizes specified emergency prescribing of hydrocodone or oxycodone by physician assistants with at least one year of post-licensure clinical experience, limited to directly evaluated patients age 18 or older and an initial supply of no more than five days.

The bill extends to podiatric supervision existing physician-assistant requirements concerning job descriptions, patient records, controlled-substance follow-up at least every three months, continuing education, prescription-form contents, board rules, disciplinary proceedings, sanctions, and notice of assistant utilization. It authorizes the State Board of Podiatry Examiners to suspend or terminate podiatric utilization approval, issue confidential private reprimands, conduct hearings, and notify the Composite Medical Board of disciplinary actions. It also permits physician assistants to provide emergency care under available supervision during emergencies for up to 48 hours or a period established by board guidelines, make delegated pronouncements of death, and perform acts necessary to treat hospital or nursing-home patients in life-threatening situations under standing procedures. Podiatric delegation authority cannot take effect until the Composite Medical Board has licensed a qualifying physician assistant and the chapter’s requirements are satisfied.

The measure inserts “or puberty blocking medications” into the provisions governing prohibited therapies for treating gender dysphoria in minors under Code Sections 31-7-3.5 and 43-34-15.

It adds Code Section 50-1-14, prohibiting expenditure of state funds for health-benefits coverage that includes gender-affirming care, as defined in Code Section 45-18-4. It also prohibits state-owned or state-operated health facilities, and physicians or other healthcare providers employed by state agencies or entities, from providing that care.

The restrictions do not bar individuals, entities, or local governments from purchasing separate coverage or coverage that includes gender-affirming care, or local governments from contracting with nonstate providers, if the coverage is paid entirely with funds not authorized or appropriated by the state. They also do not restrict nonstate health-benefits providers from offering such coverage.

FULL SUMMARY

The bill expands the controlled-substance prescribing authority of advanced practice registered nurses (APRNs) and physician assistants (PAs) under Georgia law. It adds a definition of “stimulant” and authorizes an APRN with at least one year of post-licensure clinical experience, in good standing, and specifically authorized under a nurse protocol agreement to prescribe stimulants after directly evaluating the patient. The APRN must complete one hour of continuing education every two years on the appropriate ordering and use of stimulants. Related cross-references clarify that Schedule I and II controlled-substance exceptions include both the existing emergency hydrocodone/oxycodone authority and the new stimulant authority.

A physician may delegate stimulant-prescribing authority to a PA with at least one year of post-licensure clinical experience and in good standing, provided the authority is included in the PA’s job description and the PA directly evaluated the patient. The bill also removes the requirement that an emergency hydrocodone or oxycodone prescription issued by a PA be for a patient age 18 or older; the remaining specified limits include authorization in the job description, direct patient evaluation, and an initial prescription of no more than a five-day supply. PAs with prescription-order privileges must complete at least three hours of biennial continuing education in relevant pharmaceuticals, plus one additional biennial hour on ordering and using stimulants, hydrocodone, oxycodone, or compounds thereof. Conflicting laws are repealed.

FULL SUMMARY

The bill changes Georgia’s statutory terminology by replacing “chiropractor” and “chiropractors” with “chiropractic physician” and “chiropractic physicians” in Chapter 9 of Title 43 and specified provisions across Titles 9, 14, 31, 33, 40, 43, 44, 48, and 51. Licensed practitioners may continue to use the titles “chiropractor,” “chiropractic physician,” “doctor of chiropractic,” and “D.C.”; use of those titles, or related terms suggesting chiropractic practice, by an unlicensed person is expressly included in the felony penalty provision, which carries a fine of $500 to $5,000, imprisonment for two to five years, or both, with subsequent offenses punished separately.

The bill broadens the temporary sports and performing-arts event exception to cover any person licensed in good standing to practice chiropractic in another U.S. state, territory, jurisdiction, or foreign jurisdiction who is employed or designated by a visiting sports or performing-arts entity. Practice remains limited to the team or event’s members, coaches, and staff, at the designated venue, and to procedures authorized by Georgia law and board rule. Related provisions substitute “chiropractic physician” for “chiropractor” in supervision, educational training, assistance, scope-of-practice, modalities, standards-of-care, prohibited-practice, and supplement-recommendation provisions without changing the stated practice limitations.

Professional corporations may be jointly organized and owned by chiropractic physicians practicing within their lawful scope and physicians practicing within theirs; the prior restriction barring chiropractors from attaching the title “physician” to their names or to the corporation’s name is removed. Conforming terminology changes also apply to provisions concerning professional-malpractice affidavits, professional associations, hospital peer review, smoke-free air, managed care and insurance, disability parking permits, health-care volunteers and advertising, licensure, patient self-referral, occupational-therapy exceptions, medical liens, regulatory fees, health-care liability, hospital-provider relationships, and COVID-19 business-safety definitions. The Act takes effect upon gubernatorial approval or becoming law without approval, and conflicting laws are repealed.

FULL SUMMARY

The bill amends Georgia statutes governing prescribing authority delegated to advanced practice registered nurses (APRNs) and physician assistants (PAs). It adds a definition of “stimulant” covering materials that increase heart rate, breathing, or brain function, as specified by the referenced controlled-substances provision.

For APRNs, the bill authorizes emergency prescription drug orders for stimulants, in addition to hydrocodone, oxycodone, and their compounds, when the authorization is included in the nurse protocol agreement and the APRN has at least one year of post-licensure clinical experience, is in good standing, and has directly evaluated the patient. The permitted initial supply increases from five days to 30 days, and the restriction limiting such orders to patients age 18 or older is removed. Required biennial continuing education is expanded to cover the appropriate ordering and use of stimulants as well as the other specified drugs. In emergency medical services systems covered by the statute, the bill also removes the exclusion for benzodiazepines and Schedule II controlled substances from the applicable drug-ordering authority. Nurse protocol agreements meeting specified existing-equivalency conditions are changed from being automatically deemed “approved” to being automatically deemed “authorized” by the board.

For PAs, the bill expressly includes stimulants among the drugs a physician may delegate them authority to prescribe in emergency situations, subject to the same one-year experience, good-standing, job-description authorization, and direct-patient-evaluation requirements. The initial prescription limit increases from five days to 30 days, and the age-18-or-older restriction is removed. PAs with authority to order stimulants, hydrocodone, oxycodone, or their compounds must complete one additional hour of biennial continuing education on the appropriate ordering and use of those drugs.

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.

FULL SUMMARY

Establishes a three-year pilot program allowing qualified, licensed clinical psychologists to prescribe specified psychotropic medications under the supervision of a physician or psychiatrist. The authority is limited to patients ages 18 through 65 who are receiving care from the psychologist at a federally qualified health center in Kauai County or Hawaii County; psychotropic medications eligible for Medicaid reimbursement remain reimbursable to the extent they otherwise would be if prescribed by a physician or psychiatrist. Narcotics are excluded.

Psychologists must satisfy chapter 465 licensure requirements, complete specialized prescriptive-practice education and training approved by the American Psychological Association and Board of Psychology, pass the Psychopharmacology Examination for Psychologists or an approved equivalent, work for or contract with a qualifying federally qualified health center in one of the two counties, and meet additional board requirements. The Board of Psychology must adopt implementing rules, and the State Health Planning and Development Agency must report to the Legislature no later than 20 days before the 2029 regular session, recommending whether to expand the program, make prescriptive authority permanent statewide, or end the pilot.

The controlled-substances statute is revised to define a “psychologist certified to prescribe” as a board-approved pilot participant who may not request, receive, or sign for professional controlled-substance samples. The definition of “practitioner” is expanded to include such psychologists, registered under section 329-32, when prescribing or dispensing controlled substances within the pilot program’s requirements and limitations; the existing subsequent category is renumbered. The Act takes effect upon approval.

FULL SUMMARY

Establishes a three-year pilot program, administered by the State Health Planning and Development Agency in partnership with the Board of Psychology, allowing qualified Hawaii-licensed clinical psychologists to prescribe psychotropic medications under the supervision of a physician or psychiatrist. Authority is limited to patients ages eighteen through sixty-five receiving treatment from the psychologist at a federally qualified health center in Kauai or Hawaii County; prescriptions are eligible for Medicaid reimbursement to the extent they otherwise would be if issued by a physician or psychiatrist. “Psychotropic medication” includes agents used to diagnose or treat mental and emotional disorders, including controlled substances, but excludes narcotics.

A psychologist may participate only if licensed under Hawaii Revised Statutes chapter 465, has completed specialized prescriptive-practice education and training approved by the American Psychological Association and the Board of Psychology, passed the Psychopharmacology Examination for Psychologists or an equivalent board-approved national examination, is employed by or provides contract services to an eligible federally qualified health center in Kauai or Hawaii County, and satisfies additional board requirements. The Board of Psychology must adopt implementing rules, and the supervising physician or psychiatrist assumes professional responsibility for the psychologist’s psychopharmacology practice.

The State Health Planning and Development Agency must submit findings, recommendations, and any proposed legislation to the Legislature no later than twenty days before the 2029 regular session. The report must recommend whether to expand the program to other underserved areas, make psychologist prescriptive authority permanent statewide, or permanently end the program. The law adds “psychologist certified to prescribe” to the Uniform Controlled Substances Act and adds such a psychologist, if registered under section 329-32 and acting within the pilot program’s requirements and limitations, to the definition of “practitioner” authorized to prescribe and dispense controlled substances; these psychologists may not request, receive, or sign for professional controlled-substance samples. The Act took effect upon approval and became law on July 16, 2026.

Section 338-17.7(a), Hawaii Revised Statutes, is amended to add advanced practice registered nurses to the health care providers who may submit an affidavit supporting issuance of a new birth certificate for a birth registrant whose gender transition is complete and whose new gender does not align with the birth certificate’s sex designation. The provider must be licensed in the United States, have a bona fide provider-patient relationship with the registrant, have treated and evaluated the registrant and reviewed the registrant’s medical history, and attest that the registrant received appropriate clinical treatment for the transition. The change also applies the provider-related certification requirements to advanced practice registered nurses wherever the subsection previously referred to physicians or physician assistants. The Act takes effect July 1, 3000.

FULL SUMMARY

Beginning January 1, 2027, the bill adds a Hawaii Revised Statutes chapter authorizing the governor to enter the Physician Assistant Licensure Compact. The compact creates mutual recognition of qualifying physician-assistant licenses through compact privileges for practice in participating states, while preserving each state’s authority over the practice occurring within its borders, including discipline, controlled-substance prescribing requirements, and applicable jurisprudence requirements. Eligibility requires, among other conditions, an accredited education program, current NCCPA certification, no felony or misdemeanor conviction, no specified controlled-substance-license revocation or suspension, an unrestricted qualifying license, and compliance with adverse-action and reporting requirements.

The compact establishes the PA Licensure Compact Commission as a joint administrative body with authority to adopt binding rules, set fees, administer a nationwide data system, oversee participating-state compliance, and coordinate investigations and enforcement. Participating states must license physician assistants, conduct criminal-background checks, report licensure denials, adverse actions, and significant investigative information, use a recognized national examination, and grant compact privileges to eligible licensees. The compact provides for state and Commission enforcement, deactivation of privileges following adverse action, public rulemaking procedures with emergency-rule authority, dispute resolution, and withdrawal or termination of a state’s participation; the compact takes effect when enacted by the seventh participating state.

Hawaii-specific provisions make payment of annual Commission assessments contingent on legislative appropriation and require the Department of Commerce and Consumer Affairs to include anticipated assessments in its budget request. The State is not required to indemnify Commission personnel or fund binding arbitration without express authorization and appropriation, and arbitration decisions involving the State remain subject to judicial review under state law. The bill appropriates $75,000, or as much as necessary, for fiscal year 2026–2027 to upgrade the Department’s professional and vocational licensing database. The Act otherwise takes effect July 1, 2050, while the compact provisions take effect January 1, 2027.

FULL SUMMARY

The bill establishes a standard definition of “qualified health care provider” for broad use across Hawaii law: a person holding a current, active license or certification under title 19 or title 25 whose legally defined scope of practice authorizes the provision of health care services. It inserts this definition into numerous chapters and replaces narrower references to physicians, nurses, psychologists, physician assistants, advanced practice registered nurses, and other practitioners where a broader provider category is appropriate, while preserving specific professional qualifications where required. The changes are intended to align statutory terminology with each profession’s lawful scope of practice and remove provider-specific barriers without expanding a licensee’s authorized scope of practice.

The bill makes conforming changes across health, education, public assistance, corrections, child welfare, probate, criminal, occupational, and professional licensing laws. Among other changes, it allows qualified providers to perform or certify functions previously limited to specified practitioners; recognizes additional providers in medical examinations, treatment, disability and capacity determinations, emergency and correctional care, blood collection and testing, mental-health and substance-use services, autism treatment, and medical-death determinations; expands certain insurance reimbursement, telehealth, screening, medical-food, chemotherapy, contraceptive, and external-review provisions; and permits physician assistants, advanced practice registered nurses, and pharmacists to serve as prescribers or otherwise participate where the revised provisions authorize them. It also updates the pain patient’s bill of rights by defining “prescriber” to include physicians, physician assistants, advanced practice registered nurses, and pharmacists, and applies related terminology throughout the law.

The bill repeals chapter 309H, the obsolete Hawaii Health Corps. Sections 2 through 197 take effect July 1, 2028; the Act otherwise takes effect January 30, 2050. The amendments to the specified telehealth provisions in sections 112, 147, 165, and 177 remain in force when those sections are reenacted on December 31, 2027.

FULL SUMMARY

The bill establishes a uniform definition of “qualified health care provider” across numerous chapters of the Hawaii Revised Statutes: a person with a current, active license or certification under title 19 or title 25 whose legally defined scope of practice authorizes the relevant health care services. It replaces numerous profession-specific references—often limited to physicians, nurses, or other named professionals—with this broader, scope-of-practice-based standard, while adding or updating definitions and terminology across health, education, professions, corrections, child welfare, probate, and criminal laws. The changes generally authorize qualified providers to perform specified examinations, certifications, treatments, referrals, supervisory functions, reporting, prescribing, and other services only within their lawful scope of practice; they do not independently expand a licensee’s scope or prescriptive authority.

The bill extends eligibility for several activities and protections to additional licensed professionals, including physician assistants, advanced practice registered nurses, pharmacists, psychologists, and other title 19 or title 25 providers. Examples include blood collection and testing, disability and health certifications, emergency and volunteer medical services, mental-health and substance-use treatment, child and adult examinations, guardianship and child-protective proceedings, medical care for minors, determinations of death, and qualified immunity or professional-liability provisions. It also broadens certain professional and program definitions, including “prescriber” in the pain patient’s bill of rights to include physicians, physician assistants, advanced practice registered nurses, and pharmacists; permits covered pain-treatment functions within those professionals’ authority; and adds physician assistants and psychiatric mental-health advanced practice registered nurses to specified custody-evaluator and mental-health roles.

Insurance provisions are revised to recognize qualified providers in covered services, reimbursement, telehealth, medical foods, autism and behavioral-health care, contraception, chemotherapy, mammography referrals, medical-necessity reviews, and medical-malpractice insurance. Health-care claim rules are extended to qualified providers, including written notice at least 30 days before recoupment or offset efforts, a 60-day appeal period, and generally an 18-month limit on recoupment efforts, extended to 72 months for fraud or material misrepresentation, subject to stated exceptions. The bill also repeals the obsolete Hawaii Health Corps and makes conforming substitutions for physician-specific references in additional statutes. It takes effect July 1, 3000; specified telehealth-related provisions are preserved when the affected statutes are reenacted on December 31, 2027.

FULL SUMMARY

Establishes a new Hawaii Revised Statutes chapter regulating surgical assistants. The Hawaii medical board must require licensure for persons practicing medicine or podiatric medicine as surgical assistants, set education, training, examination, application, and supervision standards, and provide temporary and endorsement licensure pathways. Temporary licensure is limited to qualifying recent graduates who have not taken an approved national examination, while endorsement requires an equivalent active license, recent practice, and satisfactory disciplinary history. Licenses must be renewed biennially; continuing medical education and possible random audits begin with the licensing biennium commencing February 1, 2028. The chapter defines direct supervision and surgical assistance, prohibits unlicensed practice, advertising, and use of specified titles, establishes reporting obligations with good-faith civil immunity, authorizes discipline and penalties of up to a $500 fine or six months’ imprisonment, and creates a six-member Surgical Assistant Advisory Committee under the board.

The bill adds specified exceptions to the license requirement for students in approved programs, federal employees, other licensed health workers acting within scope, nurses, physician assistants, and hospital employees performing surgical-assistant duties under direct nursing supervision. It also adds licensed surgical assistants to statutory provisions covering volunteer medical assistance, emergency disaster response personnel, Medicaid prospective-payment reimbursement for qualifying federally qualified health center and rural health clinic services, military-spouse temporary licensure, licensing-related email-address filings, and the definition of “health care provider.”

Additional changes authorize licensed surgical assistants to assist physicians and osteopathic physicians in abortion care; extend reporting requirements for specified violent, suspicious, and serious injuries to surgical assistants; and provide surgical assistants the same statutory civil-liability protections applicable to covered physicians or physician assistants for uncompensated emergency hospital care and automated external defibrillator programs, except for gross negligence or wanton conduct. Surgical assistants are also included within professional-reporting immunity for disclosures of unprofessional conduct or impairment. The Act takes effect upon approval.

FULL SUMMARY

The bill authorizes anonymous prescription labels for medication abortion care when the pregnant person elects that option. The label must use “Medication Abortion Care” instead of the patient’s name; “Seller Name” instead of the seller’s name; “Business Address” instead of the seller’s business address; “000-000-0000” or a comparable indication instead of the seller’s telephone number; and “Practitioner Name” if the seller is not the practitioner. These provisions apply to medication abortion care provided by physicians, osteopathic physicians, physician assistants, and advanced practice registered nurses under the specified statutes.

Section 328-16 is revised to exempt medication abortion care from the prescription-label requirements for the patient’s name, seller information, and practitioner’s name, and to add medication abortion care to the existing statutory exceptions for certain prescription information. Practitioner records concerning medication abortion care may be inspected by the Department of Health or its agents only pursuant to a subpoena issued by a court of competent jurisdiction. Prescription communications and transfers must include the additional medication-abortion-related information required by the revised statute, including the anonymous-label information where applicable.

The bill makes conforming renumbering changes in the abortion-care statutes while retaining existing protections allowing hospitals and individuals to refuse participation in abortion care without liability. It takes effect January 1, 2027.

FULL SUMMARY

Establishes a new Hawaii Revised Statutes chapter governing registered-nurse staffing at hospitals, home-care agencies, adult residential care homes, and expanded adult residential care homes. Beginning January 1, 2026, facilities must maintain specified nurse-to-patient limits on every shift, generally ranging from 1:1 for critical care, operating rooms, conscious sedation, post-anesthesia care, active labor, trauma, burns, coronary care, and acute respiratory care to 4:1 for medical-surgical, rehabilitation, specialty, psychiatric, presurgical, ambulatory surgery, and other specified care; intermediate, emergency, telemetry, observational, and other categories have separate 2:1 or 3:1 limits. The lowest applicable ratio controls, facilities must staff to the highest intensity of care in a unit, and additional nurses must be assigned when required by a registered nurse’s professional judgment. Operating rooms also require at least one scrub assistant per patient.

The bill requires each patient to have an assigned registered nurse at least once per shift, with assignments limited to nurses demonstrating current competency and receiving adequate unit orientation. Facilities may not average staffing levels, count ancillary personnel or non-direct-care nurses toward ratios, require mandatory nurse overtime, use electronic or remote monitoring to satisfy staffing or direct-observation requirements, reduce ancillary staffing to meet nurse ratios, or assign ancillary personnel to tasks requiring nursing judgment, including assessment, care-plan implementation, or medication administration. Facilities must plan for routine census fluctuations. Technology, algorithms, artificial intelligence, and clinical guidelines may not substitute for the nurse’s nursing-process functions, independent judgment, or patient-advocacy role, and nurses may not be penalized for overriding prohibited technology or guidance when professionally justified.

Registered nurses receive an express duty and right to exercise professional judgment, advocate exclusively for patients, and refuse assignments they believe exceed their scope, violate staffing requirements, or cannot be performed safely based on their education, training, or experience. Facilities and responsible personnel may not interfere with that judgment or retaliate against nurses reporting unsafe practices or violations. Facilities must maintain staffing records for at least three years, submit them to the Department of Health with a chief nursing officer’s certification under penalty of perjury, and post and publish records showing patient counts, nurse and ancillary staffing, breaks and relief coverage, and required-versus-actual staffing variances. The department must conduct periodic audits, may order corrective action, investigate complaints, adopt rules, and impose fines of up to $10,000 for violations of the staffing, calculation, assignment, technology, or recordkeeping provisions and up to $25,000 for violations of patient-advocacy protections; each day is a separate offense. The ratios do not apply during a declared state of emergency, although prompt and diligent efforts to maintain them provide a defense to a violation complaint.

The bill authorizes every emergency medical technician licensed and registered in Hawaii to administer buprenorphine after administering an opioid antagonist during an opioid-related drug overdose response.

It requires the Department of Health to adopt rules classifying opioid-related drug overdoses as life-threatening emergencies equivalent to heart attacks and strokes, and to incorporate post-antagonist buprenorphine administration into standard emergency medical services protocols. The protocols must align with national best practices and include coordination with hospitals and treatment providers for patients transitioning to recovery services.

The Department of Health must also allocate resources to train EMTs in buprenorphine administration and coordinate with emergency medical services providers to implement the requirements. The bill changes the existing geographic reference from “Hawaii” to “the State” in the provision authorizing emergency personnel and first responders to administer opioid antagonists. The Act takes effect upon approval.

FULL SUMMARY

The bill requires individual and group accident, health, or sickness insurance policies issued in Hawaii after July 1, 2026, to cover care provided by a participating registered pharmacist acting within the pharmacist’s licensed scope for health maintenance or treatment, but only to the extent the policy covers identical services provided by another health care provider. A participating registered pharmacist is a chapter 461-licensed pharmacist who has contracted with the insurer. The same coverage requirement applies to individual and group hospital or medical service plan contracts, with the pharmacist contracted with the mutual benefit society.

For Medicaid, the bill adds pharmacists to the listed health professionals whose services may qualify for prospective payment system reimbursement when furnished through federally qualified health centers or rural health clinics, subject to the existing eligibility conditions. It also expressly includes pharmacists among individual practitioners whose payment rates are based on the Hawaii Medicaid fee schedule, within applicable federal, Medicare, state appropriation, and billed-amount limits. Pharmacists are additionally included in the statutory definition of “health care provider” for telehealth purposes.

The bill revises the required-benefits provision for health maintenance organizations to include the new pharmacist-coverage provision. The Department of Human Services must seek any necessary federal Medicaid state-plan amendment or waiver to implement the Medicaid provisions. The Act takes effect upon approval, except that the Medicaid provisions take effect upon approval of the Hawaii Medicaid state plan by the Centers for Medicare and Medicaid Services.

The bill expands eligibility to submit the affidavit supporting a new birth certificate for a birth registrant who has completed gender transition. In addition to a United States-licensed physician, a physician assistant or advanced practice registered nurse may submit the affidavit, provided the provider has a bona fide provider-patient relationship, has treated and evaluated the registrant and reviewed the registrant’s medical history, and attests that the registrant received appropriate clinical treatment, completed the transition, and has a new gender that does not align with the sex designation on the birth certificate. The Act takes effect upon approval.

FULL SUMMARY

The bill adds a new Hawaii Revised Statutes chapter authorizing the governor to enter the Nurse Licensure Compact. The compact provides for mutual recognition of multistate RN and LPN/VN licenses among participating states, subject to home-state licensure qualifications, NCLEX passage, criminal-background checks, an active unencumbered license, specified criminal-conviction and alternative-program restrictions, and a valid U.S. Social Security number. Nurses must comply with the practice laws of the state where the client is located and are subject to that state’s licensing board, courts, and laws. The compact also establishes coordinated exchange of licensure, disciplinary, investigative, and alternative-program information; grants party-state boards specified investigative, subpoena, background-check, and enforcement powers; and creates an interstate commission with rulemaking, oversight, dispute-resolution, enforcement, and financing authority.

A new provision requires, beginning July 1, 20__ and annually thereafter, each person employed by a health care facility who holds a multistate nurse license issued by another state to complete demographic-data surveys required by the Board of Nursing. The facility must report the nurse’s employment to the board within 30 days and attest that the nurse completed the required tasks. The bill further authorizes the board to charge different fees to registered nurses and licensed practical nurses holding a multistate license issued by Hawaii. The Act takes effect July 1, 3000, while the compact provision takes effect and becomes binding in Hawaii two years later.

FULL SUMMARY

The proposed rule revises Idaho Medicaid Plan Benefits to align with legislative session laws, CMS and provider feedback, clarify ambiguous provisions, reduce provider burden, and strengthen Department administration and utilization management. It does not create new Medicaid services or increase fees. Major changes include narrowing specified Medicaid background-check coverage to independent CHIS providers, adding conflict-of-interest disclosure and enforcement provisions, including gold-card revocation among available sanctions, revising provider-record access consequences, and updating definitions and provider-agreement requirements.

The proposal updates payment, coverage, and documentation rules across Medicaid programs. It revises reimbursement methodologies and cost-settlement procedures for hospitals, nursing facilities, ICF/IIDs, PCS, and waiver services; adds or clarifies EVV requirements for home health, PCS, attendant care, homemaker, and respite services; changes provider qualification, supervision, training, service-plan, recordkeeping, and reporting requirements for CHIS, therapy, school-based services, DD, A&D waiver, PCS, service coordination, and transition-management providers; and updates coverage limitations for therapies, DMEPOS, hearing aids, preventive health assistance, case management, and other benefits. Nursing facilities and ICF/IIDs receive revised screening, staffing, reporting, special-rate, behavioral-care-unit, and reimbursement provisions, while DSH, swing-bed, distressed-facility, and special-rate methodologies are clarified.

The rule also substantially revises consumer-directed community supports by formalizing participant, support broker, community support worker, fiscal employer agent, circle-of-support, employment-agreement, background-check-waiver, budget, timekeeping, quality-assurance, payroll, tax, reconciliation, and transition requirements. It establishes or revises dual-eligible managed-care provisions for Idaho Medicaid Plus and Medicare/Medicaid Coordinated Plans, including county-based mandatory, passive, and voluntary enrollment; exclusions for Adult DD waiver participants; exemptions for tribal members and pregnant women; and fee-for-service treatment of carved-out services. Public hearings are scheduled for October 16 and October 21, 2026, and written comments are due by October 28, 2026; the proposed text carries July 1, 2026 implementation annotations, but no separate final effective date is stated.

FULL SUMMARY

The proposed rule updates Idaho Board of Nursing requirements to provide for biennial license renewal based on the licensee’s birthdate. It establishes a new birthdate-renewal provision and revises the fee and expiration-date provisions so renewal fees may be aggregated for biennial licensure, replacing the prior fixed August 31 renewal schedule. The fee table is revised to remove the prior odd/even-year expiration dates and update fee categories and statutory citations; the listed maximum fees remain generally unchanged, including renewal fees of up to $90 for registered, practical, and advanced practice nurses and up to $35 for certified medication assistants.

The rule replaces the nurse-apprentice-only licensure exception with separate nurse-apprentice and nurse-intern provisions. A nurse intern must satisfy nurse-apprentice requirements and be entering the final year of an accredited nursing program. Under direct supervision of an Idaho-licensed registered nurse, an intern may perform properly trained and clinically validated nursing procedures, including administration of ordered, fixed-dose or fixed-rate intravenous medications. Interns may not administer blood or blood products, perform procedures on or administer medication through central lines, perform intrathecal or epidural procedures, administer antineoplastic agents or controlled substances, administer titratable or variable-rate intravenous medications, or delegate tasks. Apprentice and intern approval letters may extend for no more than three months after successful completion of the nursing program.

The rule also makes technical corrections to Idaho Code and cross-references throughout the chapter, including the chapter’s legal-authority citation and reinstatement-fee citation. A public hearing is scheduled for September 14, 2026, and written comments must be submitted by September 23, 2026. No effective date is specified in the proposal.

FULL SUMMARY

The bill revises Idaho physician-assistant practice requirements. It replaces detailed collaboration standards with a requirement that a physician assistant collaborate, consult, or refer as necessary to assess and treat patients within the assistant’s education, training, and experience and the community standard of care. The facility or practice determines the degree and nature of collaboration through bylaws, procedures, or a written collaborative practice agreement; physician assistants remain responsible for their care and must obtain professional liability coverage when not otherwise covered. Physician assistants may be employed by nonphysician health care providers, and collaborative practice agreements must be provided to the board upon request.

The bill expressly permits a physician assistant or group of physician assistants to independently own a medical practice, subject to a collaborative practice agreement with a physician and specified collaboration, consultation, or referral requirements. Each physician assistant must have been licensed, registered, or certified as a physician assistant in a U.S. state, territory, or jurisdiction for at least two years before independently owning a practice. It also changes the medical-discipline ground concerning failure to supervise specified practitioners to apply to failure to supervise “health professionals who require supervision.”

For bridge-year physicians, the bill removes the statutory limitation requiring the board’s supervision requirements for limited licensees to be no less stringent than the requirements applicable to physician assistants. The act declares 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.

FULL SUMMARY

The Act establishes new Illinois reporting requirements for sexual or intimate conduct by health professionals. Covered health professionals must report to the Department of Financial and Professional Regulation (DFPR) within 24 hours after witnessing such conduct, developing reasonable cause to believe it occurred, or receiving an allegation from a patient, client, or representative. Exceptions include conduct excluded by DFPR rule, accidental nonsexual intimate conduct without indications of repetition, and conduct reasonably believed to be clinically or professionally justified. Hospital-based reporters may satisfy the duty by reporting to a designated hospital administrator if the hospital confirms within 48 hours that it will investigate; otherwise, the report must be made directly to DFPR. Reports must identify the reporter, subject professional, alleging person, patient or client, alleged acts, timing and location, and relevant supporting or extenuating information. Good-faith reporters and investigators receive broad immunity, retaliation is prohibited, reports remain confidential, and health professionals must report another professional’s willful failure to report.

Reporting organizations—including specified professional entities, licensed facilities, and health-professional placement organizations—must report to DFPR within 24 hours when they begin investigating reportable allegations, terminate or materially restrict a professional’s relationship or privileges after such an allegation, or when a professional resigns or materially changes responsibilities following an allegation. Hospitals may delay reporting temporary suspension or leave during an internal review until the investigation ends or the status exceeds 30 days. Organizations must annually notify covered personnel of voluntary and mandatory reporting options, may continue their own investigations, and may request DFPR status updates and copies of formal complaints, chaperone orders, or disciplinary orders within specified 21-day response periods. County State’s Attorneys must report within five days arrests or charges against a known or suspected health professional involving sexual or intimate conduct, and felony or Class A misdemeanor convictions of such professionals.

The Hospital Licensing Act is revised to require hospitals to post expanded complaint and reporting information, including DFPR reporting instructions and the DFPR website, and to strengthen internal review, patient-safety, documentation, reporting, and log requirements for abuse and reportable conduct. Hospitals must assess allegations within 48 hours, report supported allegations or those requiring further investigation within 24 hours, document unsupported allegations, update reports when evidence changes, and submit logs to the Department twice annually beginning December 31, 2027. DFPR must investigate each report, investigate imminent-danger cases within 24 hours, review logs, provide status updates, maintain final dispositions, and protect patient-identifying information; violations may incur escalating fines of $10,000, $15,000, and $25,000 for successive violations within specified periods.

Across numerous Illinois health-profession licensing statutes—including those governing acupuncture, athletic training, behavioral analysis, clinical psychology, social work, dentistry, dietetics, marriage and family therapy, music therapy, massage therapy, naprapathy, midwifery, medicine, nursing, occupational therapy, optometry, orthotics and prosthetics, pharmacy, physical therapy, physician assistance, podiatry, respiratory care, counseling, sex-offender treatment, speech-language pathology, perfusion, surgical assisting and technology, and genetic counseling—the Act adds failure to report actual or alleged reportable conduct under the new DFPR provision as a disciplinary ground. It also makes related reporting failures grounds for discipline of specified professional corporations and limited-liability entities, and changes the Nurse Practice Act’s mandatory-reporting deadline from 30 to 60 days.

FULL SUMMARY

The bill expands physician assistant practice authority under the Physician Assistant Practice Act. It removes collaboration from the core physician assistant definition and defines physician assistant practice as legal medical services within the assistant’s education, training, experience, and demonstrated competency, including diagnosis, treatment, diagnostic and therapeutic procedures, medical orders, prescribing, dispensing, ordering, administering, and procuring drugs and medical devices. It also removes the requirement that a collaborating physician file Department notice of employment, discharge, or collaboration within 60 days.

A written collaborative agreement remains required for physician assistants generally, but the bill creates an exception for assistants practicing in hospitals, hospital affiliates, federally qualified health centers, and ambulatory surgical treatment centers, and for assistants qualifying for “optimal practice.” New Section 7.9 permits an assistant to practice without a written collaborative agreement after filing a notarized attestation of at least 250 hours of AMA PRA Category 1 or equivalent continuing medical education or training and at least 2,000 hours of clinical experience in the intended field after initial national certification; supporting documentation must be provided upon Department request. Employers may still require such an agreement. Optimal-practice authority covers the full physician assistant practice scope and practice in all settings consistent with the Act, but excludes operative surgery.

New Section 7.8 authorizes physician assistants to prescribe, dispense, order, administer, and procure drugs and medical devices without physician delegation, including Schedule II through V controlled substances. A mid-level practitioner controlled-substances license is required for controlled-substance prescribing. The bill also revises hospital, hospital-affiliate, federally qualified health center, and ambulatory surgical treatment center provisions to recognize physician assistant authority to prescribe, select, order, and administer medications, including controlled substances, subject to applicable clinical privileges and institutional review; assistants in those settings need not obtain a mid-level controlled-substance license to order controlled substances. Corresponding changes to the Illinois Controlled Substances Act recognize physician assistants’ authority under the Physician Assistant Practice Act without delegation and revise the definition and registration rules for mid-level practitioners and prescribers.

The bill removes disciplinary grounds based specifically on exceeding delegated prescriptive authority, practicing without collaboration or delegation notices, entering excessive written collaborative agreements, and repeatedly failing to collaborate. It also makes conforming changes to collaboration, prescriptive-authority, physician-assistant title, and controlled-substance registration provisions.

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.

FULL SUMMARY

The bill changes Illinois requirements governing certified registered nurse anesthetists (CRNAs) in ambulatory surgical treatment centers and hospitals. It removes the prior statutory requirement that anesthesia services be directed by a specially trained or residency-trained physician and removes mandatory anesthesiologist participation in the anesthesia plan and physical presence and availability on the premises. CRNAs must instead seek consultation on the anesthesia plan and patient treatment as appropriate to their expertise, scope of practice, and patient needs. CRNAs with clinical privileges may perform advanced assessment and diagnosis and functions for which they are educationally and experientially prepared, consistent with national professional nursing standards. They may select, order, and administer medications, including controlled substances, and use medical devices for anesthesia and related services under the applicable anesthesia plan and facility policies.

The bill establishes conditions for adequate physician collaboration with CRNAs: the written agreement must promote professional judgment commensurate with the CRNA’s education and experience, be the basis for services, and provide in-person or telecommunications access for consultation, collaboration, and referral. The collaborating anesthesiologist or physician must have anesthesia training and experience consistent with Department rules. In hospitals and ambulatory surgical treatment centers, facility policies may provide alternatives to the prior anesthesiologist-presence requirement. Outside those facilities, CRNAs generally must have a written collaborative agreement with an anesthesiologist, physician, or appropriate podiatric physician; the agreement may address anesthesia-plan approval and on-premises availability but is not required to include those terms. Dental-office CRNA services remain subject to a written collaborative agreement unless the CRNA has full practice authority.

The bill creates full practice authority for an Illinois-licensed CRNA who has national certification and either a professional practice doctorate or a Department-filed notarized attestation of at least 250 hours of relevant continuing education or training and 4,000 hours of relevant clinical experience after national certification. The experience must be completed in collaboration with a physician or a CRNA with full practice authority and documented to the Department, which may accept alternative evidence by rule. A CRNA with full practice authority may practice without a written collaborative agreement in all settings consistent with national certification; prescribe legend drugs and Schedule II through V controlled substances, including benzodiazepines and Schedule II narcotics such as opioids; and obtain Illinois and federal controlled-substance credentials. This authority does not include services legally reserved to physicians.

Conforming changes apply to the Dental Practice Act and Podiatric Medical Practice Act, including exceptions from collaborative-agreement requirements for CRNAs with full practice authority and corresponding changes to anesthesia collaboration standards. The Act takes effect upon becoming law.

FULL SUMMARY

The bill removes physical-presence requirements for anesthesia services in Illinois ambulatory surgical treatment centers and hospitals. In both settings, an anesthesiologist would no longer be required to remain physically present during anesthesia delivery; corresponding alternative policies would no longer be required to mandate a physician’s physical presence. The requirements for participation in the anesthesia plan and availability for diagnosis, consultation, and emergency treatment remain.

The bill makes parallel changes to physician collaboration rules for certified registered nurse anesthetists. An anesthesiologist or physician must participate in formulating or approving orders or guidelines and agree with the anesthesia plan, but the specific requirement to be physically present during anesthesia delivery is removed. The bill also removes the physical-presence requirement applicable to an anesthesiologist, physician, dentist, or podiatric physician when a certified registered nurse anesthetist provides anesthesia services under the Nurse Practice Act.

The provisions continue to require certified registered nurse anesthetists to provide anesthesia under an agreed anesthesia plan and applicable hospital or ambulatory surgical treatment center policies, with anesthesia services ordered by a licensed physician, dentist, or podiatric physician.

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.

FULL SUMMARY

The bill amends the Nurse Practice Act to authorize the Department of Financial and Professional Regulation to establish fees for implementing and enforcing the Act and the Nurse Licensure Compact. Once the Compact takes effect, the Department may set fees for initial multistate-license applications, upgrades from single-state to multistate licenses, and renewals; fees must be at least $150 for an initial multistate license and $125 for biennial renewal.

Illinois ratifies and adopts the Nurse Licensure Compact, allowing eligible registered nurses and licensed practical/vocational nurses holding a multistate license from their home state to practice under a multistate privilege in other party states. Eligibility requires, among other conditions, completion of approved RN or LPN/VN education, passage of the applicable NCLEX examination, an active unencumbered license, required biometric criminal-history checks, no disqualifying felony or nursing-related misdemeanor conviction, no current alternative-program enrollment, compliance with self-disclosure requirements, and a valid Social Security number. Nurses must comply with the practice laws of the state where the client is located; the Compact does not supersede state labor laws, does not apply to advanced practice registered nurses, and preserves access to single-state licenses for nurses who do not reside in a party state.

The bill requires party-state licensing boards to exchange specified licensure, disciplinary, investigative, application-denial, and alternative-program information through a coordinated licensure information system, subject to restrictions on disclosure and expungement. It authorizes adverse action against multistate privileges, including deactivation across party states following home-state discipline, and provides investigative, subpoena, and enforcement authorities. It establishes an Interstate Commission of Nurse Licensure Compact Administrators with rulemaking, oversight, financing, dispute-resolution, and enforcement powers. Compact nurses must complete 20 approved continuing-education hours during each two-year renewal cycle, including mandated-reporter, Alzheimer’s disease, implicit-bias, and sexual-harassment training; employers must provide an opportunity to obtain those hours. On the Compact’s effective date, employers of nurses holding multistate licenses issued by another state must attest to required demographic-data submission and continuing-education completion and report the attestation to the Department within 30 days of employment.

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.

FULL SUMMARY

The bill changes the Illinois Nurse Practice Act’s definition of registered professional nursing practice to state that it is a scientific process founded on a professional body of knowledge, a learned profession based on understanding the human condition across the life span and environment, encompassing all nursing specialties and nursing acts performed using knowledge, judgment, and skills acquired through an approved professional nursing education program.

It revises registered-nurse delegation authority. Registered professional nurses may delegate nursing interventions and tasks to registered professional nurses and licensed practical nurses based on a comprehensive nursing assessment, and may delegate tasks to unlicensed personnel based on that assessment. The assessment must consider the patient’s stability and condition, potential for harm, complexity of the intervention or task, predictability of outcomes, and the delegatee’s competency. The bill removes authority to delegate medication administration to unlicensed personnel in community-based or in-home care settings and prohibits delegation to unlicensed non-nurse personnel of work requiring nursing knowledge, assessment, judgment, inference, or decision-making—including medication administration—or of developing or evaluating a plan of care. It also bars delegation of nursing judgment, comprehensive patient assessment, care-plan development, or care evaluation to licensed or unlicensed personnel, while retaining restrictions against re-delegation by licensed practical nurses and unlicensed personnel.

The RN scope-of-practice provisions are revised to expressly include delegating nursing interventions and tasks to licensed nurses and delegating tasks to unlicensed personnel to implement the plan of care. The Act takes effect upon becoming law.

FULL SUMMARY

The bill removes requirements in the Ambulatory Surgical Treatment Center Act and Hospital Licensing Act that an anesthesiologist remain physically present and available on the premises while anesthesia services are delivered. It also removes “presence” from the required elements of any alternative policy used when 24-hour anesthesiologist availability is lacking, while retaining requirements for participation in and agreement with the anesthesia plan and availability to address emergency medical conditions.

The bill makes corresponding changes to the Medical Practice Act of 1987 by eliminating the requirement that a collaborating anesthesiologist or physician be physically present during delivery of anesthesia services by a certified registered nurse anesthetist. The anesthesiologist or physician must still participate in formulating and approving orders or guidelines, periodically review services, and participate in discussion of and agreement with the anesthesia plan; the operating physician, dentist, or podiatric physician must agree to the plan before services are delivered.

Under the Nurse Practice Act, the bill removes the requirement that an anesthesiologist, physician, dentist, or podiatric physician remain physically present and available on the premises during anesthesia services provided by a certified registered nurse anesthetist. Hospital and ambulatory surgical treatment center policies may establish the applicable alternative arrangements, while the responsible clinician’s participation in and agreement with the anesthesia plan and availability for emergency diagnosis, consultation, and treatment remain required as provided by the revised provisions.

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.