PROPOSED RULES
(Nursing Care Quality Assurance Commission)
Original Notice.
Preproposal statement of inquiry was filed as WSR 00-11-160.
Title of Rule: WAC 246-840 421 How do advanced registered nurse practitioners qualify for prescriptive authority for Schedule II-IV drugs?, 246-840-422 Criteria for joint practice arrangement, 246-840-423 Endorsement of joint practice arrangements for ARNP licensure, 246-840-424 Process for joint practice arrangement termination, 246-840-425 Seventy-two-hour limit, 246-840-426 Education for prescribing Schedule II-IV drugs, and 246-840-427 Jurisdiction.
Purpose: The statute requires the medical and nursing commissions and the Osteopathic Board to jointly adopt rules by consensus on ARNP prescriptive authority joint practice arrangements for expanded prescriptive authority.
Statutory Authority for Adoption: RCW 18.79.240, chapter 64, Laws of 2000, RCW 18.79.320.
Statute Being Implemented: Chapter 18.79 RCW.
Summary: Rules were prepared through meetings with the public and the three commissions/board to implement this legislation.
Reasons Supporting Proposal: These rules incorporate the majority of the concerns expressed and meet the intent.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Terry J. West, P.O. Box 47864, Olympia, WA 98504, (360) 236-4712.
Name of Proponent: Nursing Care Quality Assurance Commission, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The legislation requires joint rule writing by the Nursing Commission, Medical Commission and Board of Osteopathic Physicians and Surgeons. These rules will implement the legislation and outline procedures for applying for expanded prescriptive authority, procedures for establishing a joint practice arrangement and other information. Upon adoption of these rules this will allow qualified advanced registered nurse practitioners to expand their prescriptive authority to include prescribing Schedule II-IV drugs in appropriate situations. This will expand the care options for patients so that they do not need a referral to another health care professional. This will also increase access in rural areas where the only health care professional available may be an advanced registered nurse practitioner who will then have full prescribing authority.
Proposal does not change existing rules. These are all new rules.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
| STANDARD INDUSTRIAL CODE | ECONOMIC ACTIVITY | MINOR COST THRESHOLD |
| 804 | Office of Other Providers | 110.00 |
| • | Completing an application for additional prescribing authority for Schedule II-IV with the Nursing Care Quality Assurance Commission. Application fee is $65.00. |
| • | Completion of a Joint Practice Agreement with a physician. Cost is associated with cost of paper and time to complete the form. Costs are approximately $50.00. |
Does the proposed rule affect both large and small businesses? The Regulatory Fairness Act defines a business as any "entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, that has the purpose of making a profit." The act defines a small business as one that employs less than fifty individuals.
The Department of Health estimated 2,000 ARNPs may choose to be subject to the requirements of the proposed rules. Each practitioner is a small business. Since the proposed rules will only affect individuals, from the perspective of the Regulatory Fairness Act, all affected businesses are small.
Does the proposed rule impose disproportionate cost on small businesses? Since all practitioners affected by the proposed rules meet the definition of small businesses, the rule cannot impose disproportionate costs. Therefore, the department is not obligated to provide regulatory relief.
How did the department involve the public in the development of the proposed rules? Public involvement was solicited through four rules writing workshops throughout the state and on the agenda of the Nursing Care Quality Assurance Commission.
A copy of the statement may be obtained by writing to Terry J. West, Department of Health, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4712, fax (360) 236-4738.
RCW 34.05.328 applies to this rule adoption. These rules are significant under RCW 34.05.328 because they adopt substantive provisions which subject the violator to penalty or sanction and establish, alter or revoke qualification or standard for the issuance, suspension or revocation of a license.
Hearing Location: CenterPoint Corporate Park, The Commons Building, Main Conference Center, 20809 72nd Avenue South, Kent, WA 98032, on June 13, 2001, at 6:30 p.m.
Assistance for Persons with Disabilities: Contact (360) 236-4945 by June 1, 2001, TDD (360) 664-0064, or fax (360) 236-4738.
Submit Written Comments to: Terry J. West, fax (360) 236-4738, (360) 236-4712.
Date of Intended Adoption: June 23, 2001.
April 24, 2001
Paula R. Meyer
Executive Director
OTS-4691.5
NEW SECTION
WAC 246-840-421
How do advanced registered nurse
practitioners qualify for prescriptive authority for Schedule II - IV drugs?
Applicants must:
(1) Hold a valid and unrestricted registered nurse license.
(2) Hold or be eligible for an advanced registered nurse practitioner license with authority for legend drugs and Schedule V drugs. (See also WAC 246-840-410.) As noted in RCW 18.79.250, each advanced registered nurse practitioner prescribes within his or her scope of practice for a particular license specialty.
(3) Have a joint practice arrangement that meets requirements of WAC 246-840-422 with a physician or physicians licensed under chapter 18.71 or 18.57 RCW who holds a license without restrictions related to prescribing scheduled drugs.
(4) Submit a completed application form for Schedule II - IV endorsement on a form provided by the department of health, nursing care quality assurance commission accompanied by a fee as specified in WAC 246-840-990.
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(2) A written agreement that describes how collaboration will occur between the practitioners.
(3) The description of the collaboration will vary according to the relationship between the advanced registered nurse practitioner and physician, but must include a description of:
(a) When the advanced registered nurse practitioner will consult with a physician;
(b) How consultation will occur (e.g., face-to-face, phone, fax, e-mail, etc.);
(c) How consultation will be documented.
(4) Joint practice arrangements may be made with more than one physician.
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(2) A notice of the joint practice arrangement shall be forwarded by the nursing care quality assurance commission to either the medical quality assurance commission or to the board of osteopathic medicine and surgery for review to assure the physician's license is unrestricted. The medical quality assurance commission or the board of osteopathic medicine and surgery will notify the nursing care quality assurance commission in the event a physician who has signed a joint practice arrangement, has a license with restrictions related to prescribing scheduled drugs.
(3) The advanced registered nurse practitioner can only begin prescribing Schedule II - IV drugs after his or her license endorsement has been issued and he or she has obtained the appropriate Drug Enforcement Administration registration.
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(2) The nursing care quality assurance commission will notify either the medical quality assurance commission or the board of osteopathic medicine and surgery that the joint practice arrangement has been terminated.
(3) A joint practice arrangement may be terminated as a result of disciplining action taken by a disciplining authority.
(4) In the event either the advanced registered nurse practitioner or the physician is disciplined, the disciplining authority for the other party will be notified that the joint practice arrangement no longer exists due to disciplinary action.
(5) If an advanced registered nurse practitioner has multiple approved joint practice arrangements and one is terminated, he or she may continue to prescribe Schedule II - IV drugs under the other joint practice arrangement(s).
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(2) The seventy-two-hour limit on dispensing does not apply to prescribing Schedule II - IV drugs.
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