This document includes House Floor Amendments incorporated into the bill on Tue, Feb 26, 2019 at 3:28 PM by ngarrow.
Representative James A. Dunnigan proposes the following substitute bill:




Chief Sponsor: James A. Dunnigan

Senate Sponsor: Curtis S. Bramble


8     General Description:
9          This bill amends provisions relating to the prescriptive authority of certain licensed
10     nurse practitioners.
11     Highlighted Provisions:
12          This bill:
13          ▸     amends definitions;
14          ▸     permits certain licensed nurse practitioners to prescribe a Schedule II controlled
15     substance; and
16          ▸     amends certain requirements for advanced practice nurse practitioners to have
17     prescriptive authority for controlled substances.
18     Money Appropriated in this Bill:
19          None
20     Other Special Clauses:
21          None
22     Utah Code Sections Affected:
23     AMENDS:
24          58-31b-102, as last amended by Laws of Utah 2016, Chapters 26 and 127
25          58-31b-502, as last amended by Laws of Utah 2018, Third Special Session, Chapter 1

26          58-31b-803, as enacted by Laws of Utah 2016, Chapter 127
27          58-31d-103, as last amended by Laws of Utah 2016, Chapter 127

29     Be it enacted by the Legislature of the state of Utah:
30          Section 1. Section 58-31b-102 is amended to read:
31          58-31b-102. Definitions.
32          In addition to the definitions in Section 58-1-102, as used in this chapter:
33          (1) "Administrative penalty" means a monetary fine or citation imposed by the division
34     for acts or omissions determined to constitute unprofessional or unlawful conduct in
35     accordance with a fine schedule established by rule and as a result of an adjudicative
36     proceeding conducted in accordance with Title 63G, Chapter 4, Administrative Procedures Act.
37          (2) "Applicant" means a person who applies for licensure or certification under this
38     chapter by submitting a completed application for licensure or certification and the required
39     fees to the department.
40          (3) "Approved education program" means a nursing education program that is
41     accredited by an accrediting body for nursing education that is approved by the United States
42     Department of Education.
43          (4) "Board" means the Board of Nursing created in Section 58-31b-201.
44          (5) "Consultation and referral plan" means a written plan jointly developed by an
45     advanced practice registered nurse and, except as provided in Subsection 58-31b-803(4), a
46     consulting physician that permits the advanced practice registered nurse to prescribe Schedule
47     II controlled substances in consultation with the consulting physician.
48          (6) "Consulting physician" means a physician and surgeon or osteopathic physician and
49     surgeon licensed in accordance with this title who has agreed to consult with an advanced
50     practice registered nurse with a controlled substance license, a DEA registration number, and
51     who will be prescribing Schedule II controlled substances.
52          (7) "Diagnosis" means the identification of and discrimination between physical and
53     psychosocial signs and symptoms essential to the effective execution and management of
54     health care.
55          (8) "Examinee" means a person who applies to take or does take any examination
56     required under this chapter for licensure.

57          (9) "Licensee" means a person who is licensed or certified under this chapter.
58          (10) "Long-term care facility" means any of the following facilities licensed by the
59     Department of Health pursuant to Title 26, Chapter 21, Health Care Facility Licensing and
60     Inspection Act:
61          (a) a nursing care facility;
62          (b) a small health care facility;
63          (c) an intermediate care facility for people with an intellectual disability;
64          (d) an assisted living facility Type I or II; or
65          (e) a designated swing bed unit in a general hospital.
66          (11) "Medication aide certified" means a certified nurse aide who:
67          (a) has a minimum of 2,000 hours experience working as a certified nurse aide;
68          (b) has received a minimum of 60 hours of classroom and 40 hours of practical training
69     that is approved by the division in collaboration with the board, in administering routine
70     medications to patients or residents of long-term care facilities; and
71          (c) is certified by the division as a medication aide certified.
72          (12) "Pain clinic" means the same as that term is defined in Section 58-1-102.
73          (13) (a) "Practice as a medication aide certified" means the limited practice of nursing
74     under the supervision, as defined by the division by administrative rule, of a licensed nurse,
75     involving routine patient care that requires minimal or limited specialized or general
76     knowledge, judgment, and skill, to an individual who:
77          (i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
78     disability; and
79          (ii) is in a regulated long-term care facility.
80          (b) "Practice as a medication aide certified":
81          (i) includes:
82          (A) providing direct personal assistance or care; and
83          (B) administering routine medications to patients in accordance with a formulary and
84     protocols to be defined by the division by rule; and
85          (ii) does not include assisting a resident of an assisted living facility, a long term care
86     facility, or an intermediate care facility for people with an intellectual disability to self
87     administer a medication, as regulated by the Department of Health by administrative rule.

88          (14) "Practice of advanced practice registered nursing" means the practice of nursing
89     within the generally recognized scope and standards of advanced practice registered nursing as
90     defined by rule and consistent with professionally recognized preparation and education
91     standards of an advanced practice registered nurse by a person licensed under this chapter as an
92     advanced practice registered nurse. Advanced practice registered nursing includes:
93          (a) maintenance and promotion of health and prevention of disease;
94          (b) diagnosis, treatment, correction, consultation, and referral for common health
95     problems;
96          (c) prescription or administration of prescription drugs or devices including:
97          (i) local anesthesia;
98          (ii) Schedule III-V controlled substances; and
99          (iii) Subject to Section 58-31b-803, Schedule II controlled substances[ in accordance
100     with Section 58-31b-803]; or
101          (d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
102     related services upon the request of a licensed health care professional by an advanced practice
103     registered nurse specializing as a certified registered nurse anesthetist, including:
104          (i) preanesthesia preparation and evaluation including:
105          (A) performing a preanesthetic assessment of the patient;
106          (B) ordering and evaluating appropriate lab and other studies to determine the health of
107     the patient; and
108          (C) selecting, ordering, or administering appropriate medications;
109          (ii) anesthesia induction, maintenance, and emergence, including:
110          (A) selecting and initiating the planned anesthetic technique;
111          (B) selecting and administering anesthetics and adjunct drugs and fluids; and
112          (C) administering general, regional, and local anesthesia;
113          (iii) postanesthesia follow-up care, including:
114          (A) evaluating the patient's response to anesthesia and implementing corrective
115     actions; and
116          (B) selecting, ordering, or administering the medications and studies listed in
117     Subsection (14)(d); and
118          (iv) other related services within the scope of practice of a certified registered nurse

119     anesthetist, including:
120          (A) emergency airway management;
121          (B) advanced cardiac life support; and
122          (C) the establishment of peripheral, central, and arterial invasive lines; and
123          (v) for purposes of Subsection (14)(d), "upon the request of a licensed health care
124     professional":
125          (A) means a health care professional practicing within the scope of the health care
126     professional's license, requests anesthesia services for a specific patient; and
127          (B) does not require an advanced practice registered nurse specializing as a certified
128     registered nurse anesthetist to enter into a consultation and referral plan or obtain additional
129     authority to select, administer, or provide preoperative, intraoperative, or postoperative
130     anesthesia care and services.
131          (15) "Practice of nursing" means assisting individuals or groups to maintain or attain
132     optimal health, implementing a strategy of care to accomplish defined goals and evaluating
133     responses to care and treatment. The practice of nursing requires substantial specialized or
134     general knowledge, judgment, and skill based upon principles of the biological, physical,
135     behavioral, and social sciences, and includes:
136          (a) initiating and maintaining comfort measures;
137          (b) promoting and supporting human functions and responses;
138          (c) establishing an environment conducive to well-being;
139          (d) providing health counseling and teaching;
140          (e) collaborating with health care professionals on aspects of the health care regimen;
141          (f) performing delegated procedures only within the education, knowledge, judgment,
142     and skill of the licensee; and
143          (g) delegating nurse interventions that may be performed by others and are not in
144     conflict with this chapter.
145          (16) "Practice of practical nursing" means the performance of nursing acts in the
146     generally recognized scope of practice of licensed practical nurses as defined by rule and as
147     provided in this Subsection (16) by a person licensed under this chapter as a licensed practical
148     nurse and under the direction of a registered nurse, licensed physician, or other specified health
149     care professional as defined by rule. Practical nursing acts include:

150          (a) contributing to the assessment of the health status of individuals and groups;
151          (b) participating in the development and modification of the strategy of care;
152          (c) implementing appropriate aspects of the strategy of care;
153          (d) maintaining safe and effective nursing care rendered to a patient directly or
154     indirectly; and
155          (e) participating in the evaluation of responses to interventions.
156          (17) "Practice of registered nursing" means performing acts of nursing as provided in
157     this Subsection (17) by a person licensed under this chapter as a registered nurse within the
158     generally recognized scope of practice of registered nurses as defined by rule. Registered
159     nursing acts include:
160          (a) assessing the health status of individuals and groups;
161          (b) identifying health care needs;
162          (c) establishing goals to meet identified health care needs;
163          (d) planning a strategy of care;
164          (e) prescribing nursing interventions to implement the strategy of care;
165          (f) implementing the strategy of care;
166          (g) maintaining safe and effective nursing care that is rendered to a patient directly or
167     indirectly;
168          (h) evaluating responses to interventions;
169          (i) teaching the theory and practice of nursing; and
170          (j) managing and supervising the practice of nursing.
171          (18) "Routine medications":
172          (a) means established medications administered to a medically stable individual as
173     determined by a licensed health care practitioner or in consultation with a licensed medical
174     practitioner; and
175          (b) is limited to medications that are administered by the following routes:
176          (i) oral;
177          (ii) sublingual;
178          (iii) buccal;
179          (iv) eye;
180          (v) ear;

181          (vi) nasal;
182          (vii) rectal;
183          (viii) vaginal;
184          (ix) skin ointments, topical including patches and transdermal;
185          (x) premeasured medication delivered by aerosol/nebulizer; and
186          (xi) medications delivered by metered hand-held inhalers.
187          (19) "Unlawful conduct" means the same as that term is defined in Sections 58-1-501
188     and 58-31b-501.
189          (20) "Unlicensed assistive personnel" means any unlicensed person, regardless of title,
190     to whom tasks are delegated by a licensed nurse as permitted by rule and in accordance with
191     the standards of the profession.
192          (21) "Unprofessional conduct" means the same as that term is defined in Sections
193     58-1-501 and 58-31b-502 and as may be further defined by rule.
194          Section 2. Section 58-31b-502 is amended to read:
195          58-31b-502. Unprofessional conduct.
196          (1) "Unprofessional conduct" includes:
197          (a) failure to safeguard a patient's right to privacy as to the patient's person, condition,
198     diagnosis, personal effects, or any other matter about which the licensee is privileged to know
199     because of the licensee's or person with a certification's position or practice as a nurse or
200     practice as a medication aide certified;
201          (b) failure to provide nursing service or service as a medication aide certified in a
202     manner that demonstrates respect for the patient's human dignity and unique personal character
203     and needs without regard to the patient's race, religion, ethnic background, socioeconomic
204     status, age, sex, or the nature of the patient's health problem;
205          (c) engaging in sexual relations with a patient during any:
206          (i) period when a generally recognized professional relationship exists between the
207     person licensed or certified under this chapter and the patient; or
208          (ii) extended period when a patient has reasonable cause to believe a professional
209     relationship exists between the person licensed or certified under the provisions of this chapter
210     and the patient;
211          (d) (i) as a result of any circumstance under Subsection (1)(c), exploiting or using

212     information about a patient or exploiting the licensee's or the person with a certification's
213     professional relationship between the licensee or holder of a certification under this chapter and
214     the patient; or
215          (ii) exploiting the patient by use of the licensee's or person with a certification's
216     knowledge of the patient obtained while acting as a nurse or a medication aide certified;
217          (e) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
218          (f) unauthorized taking or personal use of nursing supplies from an employer;
219          (g) unauthorized taking or personal use of a patient's personal property;
220          (h) knowingly entering into any medical record any false or misleading information or
221     altering a medical record in any way for the purpose of concealing an act, omission, or record
222     of events, medical condition, or any other circumstance related to the patient and the medical or
223     nursing care provided;
224          (i) unlawful or inappropriate delegation of nursing care;
225          (j) failure to exercise appropriate supervision of persons providing patient care services
226     under supervision of the licensed nurse;
227          (k) employing or aiding and abetting the employment of an unqualified or unlicensed
228     person to practice as a nurse;
229          (l) failure to file or record any medical report as required by law, impeding or
230     obstructing the filing or recording of such a report, or inducing another to fail to file or record
231     such a report;
232          (m) breach of a statutory, common law, regulatory, or ethical requirement of
233     confidentiality with respect to a person who is a patient, unless ordered by a court;
234          (n) failure to pay a penalty imposed by the division;
235          (o) prescribing a Schedule II [or III] controlled substance without complying with the
236     requirements in Section 58-31b-803, if applicable;
237          (p) violating Section 58-31b-801;
238          (q) violating the dispensing requirements of Section 58-17b-309 or Chapter 17b, Part
239     8, Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if
240     applicable; and
241          (r) establishing or operating a pain clinic without a consultation and referral plan for
242     Schedule II or III controlled substances.

243          (2) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
244     61a, Utah Medical Cannabis Act, when registered as a qualified medical provider, as that term
245     is defined in Section 26-61a-102, recommending the use of medical cannabis.
246          (3) Notwithstanding Subsection (2), the division, in consultation with the board and in
247     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
248     unprofessional conduct for an advanced practice registered nurse described in Subsection (2).
249          Section 3. Section 58-31b-803 is amended to read:
250          58-31b-803. Limitations on prescriptive authority for advanced practice
251     registered nurses.
252          (1) This section does not apply to an advanced practice registered nurse specializing as
253     a certified registered nurse anesthetist under Subsection 58-31b-102(14)(d).
254          [(2) Except as provided in Subsection (3), an advanced practice registered nurse shall
255     prescribe or administer a Schedule II controlled substance in accordance with a consultation
256     and referral plan.]
257          [(3)] (2) Except as provided [by Subsection] in Subsections (3) and
258     58-31b-502[(18)](1)(r), an advanced practice registered nurse may prescribe or administer a
259     Schedule II controlled substance without a consultation and referral plan [if the advanced
260     practice registered nurse:].
261          [(a) has the lesser of:]
262          [(i) two years of licensure as a nurse practicing advanced practice registered nursing;
263     or]
264          [(ii) 2,000 hours of experience practicing advanced practice registered nursing;]
265          [(b) (i) prior to the first time prescribing or administering a Schedule III controlled
266     substance for chronic pain, or a Schedule II controlled substance to a particular patient, unless
267     treating the patient in a licensed general acute hospital, checks information about the patient in
268     the Controlled Substance Database created in Section 58-37f-201; and]
269          [(ii) periodically, thereafter, checks information about the patient in the Controlled
270     Substance Database created in Section 58-37f-201; and]
271          [(c) follows the health care provider prescribing guidelines for the treatment of an
272     injured worker, developed by the Labor Commission under Title 34A, Chapter 2, Workers'
273     Compensation Act, or Title 34A, Chapter 3, Utah Occupational Disease Act, if:]

274          [(i) the patient is an injured worker; and]
275          [(ii) the Schedule II or III controlled substance is prescribed for chronic pain.]
276          (3) An advanced practice registered nurse described in Subsection (4) may not
277     prescribe or administer a Schedule II controlled substance unless the advanced practice
278     registered nurse prescribes or administers Schedule II controlled substances in accordance with
279     a consultation and referral plan.
280          (4) Subsection (3) applies to an advanced practice registered nurse who:
281          (a) (i) is engaged in independent Ĥ→ solo ←Ĥ practice; and
282          (ii) (A) has been licensed as an advanced practice registered nurse for less than one
283     year; or
284          (B) has less than 2,000 hours of experience practicing as a licensed advanced practice
285     registered nurse; or
286          (b) owns or operates a pain clinic.
287          (5) Notwithstanding Subsection 58-31b-102(5), an advanced practice registered nurse
288     with at least three years of experience as a licensed advanced practice registered nurse may
289     supervise a consultation and referral plan for an advanced practice registered nurse described in
290     Subsection (4)(a).
291          Section 4. Section 58-31d-103 is amended to read:
292          58-31d-103. Rulemaking authority -- Enabling provisions.
293          (1) The division may adopt rules necessary to implement Section 58-31d-102.
294          (2) As used in Article VIII (1) of the Advanced Practice Registered Nurse Compact,
295     "head of the licensing board" means the executive administrator of the Utah Board of Nursing.
296          (3) For purposes of the Advanced Practice Registered Nurse Compact, "APRN" as
297     defined in Article II (1) of the compact includes an individual who is:
298          (a) licensed to practice under Subsection 58-31b-301(2) as an advanced practice
299     registered nurse; or
300          (b) licensed to practice under Section 58-44a-301 as a certified nurse midwife.
301          (4) An APRN practicing in this state under a multistate licensure privilege may only be
302     granted prescriptive authority if that individual can document completion of graduate level
303     course work in the following areas:
304          (a) advanced health assessment;

305          (b) pharmacotherapeutics; and
306          (c) diagnosis and treatment.
307          (5) (a) An APRN practicing in this state under a multistate privilege who seeks to
308     obtain prescriptive authority must:
309          (i) meet all the requirements of Subsection (4) and this Subsection (5); and
310          (ii) be placed on a registry with the division.
311          (b) To be placed on a registry under Subsection (5)(a)(ii), an APRN must:
312          (i) submit a form prescribed by the division;
313          (ii) pay a fee; and
314          (iii) if prescribing a controlled substance:
315          (A) obtain a controlled substance license as required under Section 58-37-6; and
316          (B) that is a Schedule II controlled substance, comply with the requirements of Section
317     58-31b-803, if applicable.