A 4052 — Eliminates certain practice restrictions for advanced practice nurses.

     (3)  [(2)] (b)     the advancedauthorization practicefor nursethe signsmedical theuse nurse'sof owncannabis nameor toissuance theof authorizationwritten instructions for cannabis is in accordance with standing orders or writtenjoint instructionprotocols developed in agreement between a collaborating physician and printsthe advanced practice nurse, or pursuant to the nurse'sspecific namedirection andof certificationa number;physician;

     (4)  [(3)] (c)     the authorizationadvanced orpractice writtennurse instructionsigns isthe datednurse's andown includes the name ofto the qualifyingauthorization patientor andwritten theinstruction name, address, and telephoneprints numberthe ofnurse's thename collaboratingand physician;certification number;

     (5)  [(4)] (d)     the physicianauthorization or written instruction is presentdated orand readilyincludes availablethe throughname electronicof communications;the qualifying patient and the name, address, and telephone number of the collaborating physician;

     (6)  [(5)] the(e) charts and records of qualifying patients treated by the advancedphysician practiceis nursepresent areor periodicallyreadily reviewedavailable bythrough theelectronic collaboratingcommunications; physician and the advanced practice nurse;

     (7) [(6)] (f)     the jointcharts protocolsand developedrecords byof thequalifying collaboratingpatients physiciantreated andby the advanced practice nurse are reviewed,periodically updated,reviewed andby signedthe atcollaborating leastphysician annuallyand bythe bothadvanced parties;practice nurse;

and      (8)  [(7)] (g)  the advancedjoint practiceprotocols nursedeveloped compliesby with the] requirements for authorizing qualifying patients for the medicalcollaborating usephysician of cannabis and forthe issuingadvanced writtenpractice instructionsnurse forare medicalreviewed, cannabisupdated, establishedand pursuantsigned toat P.L.2009,least c.307annually (C.24:6I-1by etboth al.).parties;

and      h.   [(8)] An(h)     the advanced practice nurse maycomplies orderwith medicationsthe requirements for authorizing qualifying patients for the medical use of cannabis and devices,for subjectissuing written instructions for medical cannabis established pursuant to theP.L.2009, followingc.307 conditions:(C.24:6I-1 et al.).

     (1)  (2)  TheSubject advancedto practicethe nurserequirements shallfor issueauthorizing aqualifying prescriptionpatients onfor athe Newmedical Jerseyuse Prescriptionof Blankcannabis inand accordancefor withissuing thewritten provisionsinstructions offor P.L.2003,medical c.280cannabis (C.45:14-40established pursuant to P.L.2009, c.307 (C.24:6I-1 et seq.),al.), andan includeadvanced onpractice thenurse prescriptionwho blankis theauthorized to practice advanced practice nurse’snursing signature,within printeda name,population certificationfocus number,of andfamily patientor information,individual andacross anythe otherlifespan, informationadult requiredgerontology, pursuantpediatrics, towomen’s regulationshealth, adoptedor bybehavioral thehealth Newshall Jerseybe Boardexempt offrom Nursing;subsections b.

     (2)   The advanced practice nurse shall have completed six contact hours of continuing professional education in pharmacology related to controlled substances, including pharmacologic therapy and addictionc. prevention and management, in accordance with regulations adopted by the New Jersey Board of Nursing.  The six contact hours shall be in addition to New Jersey Board of Nursing pharmacology education requirements for advanced practice nurses related to initial certification and recertification of an advanced practice nurse as set forth in regulations adopted by the New Jersey Board of Nursing;

     (3)   The advance practice nurse shall have completed 10 contact hours of continuingthis professionalsection educationand inmay pharmacologyauthorize eachqualifying biennialpatients period,for in accordance with regulations adopted by the Newmedical Jerseyuse Board of Nursing. cannabis Theand 10issue contactwritten hoursinstructions shallfor bemedical incannabis addition to Newregistered Jerseyqualifying Boardpatients ofwithout Nursinga requirementsjoint forprotocol renewalwith of a registeredcollaborating professionalphysician, nursingprovided license,that: as set forth in regulations adopted by the board;

and      (4)  (a)   Anthe advanced practice nurse withhas fewermore than 245,000 months or 2,400 hours of licensed, active, advanced nursing practice in ana initial role shall have a joint protocol with a collaborating provider.  The joint protocol shall be required only with respect to prescribing medications.  An advanced practice nurse subject to this paragraph shall maintain signed and dated copies of all required joint protocols, and shall notify the boardapplicable thatpopulation thefocus; requirements of this paragraph have been met.

     i.    (b) Notwithstanding the provisions of any other law or regulation to the contrary, an advanced practice nurse who is an APN-Anesthesia and who has completed either 24 months or 2,400 hours of licensed, active advanced practice nursing practice providing anesthesiaprimary serviceshealth tocare patients in an initial role shall be authorized to practice as an APN-Anesthesia to the fullest extent of the authorized scope of practice for APN-Anesthesia permitted by the Board of Nursing, without any requirement for supervision by a licensed physician or dentistbehavioral andhealth withoutcare; any requirement that the APN-Anesthesia enter into joint protocols with a licensed physician or dentist.

     j.    (c)   Notwithstanding the provisions of any other law or regulation to the contrary, an advanced practice nurse withis greaternot thanproviding 24health monthscare orservices 2,400in hoursthe area of licensed,general active,obstetrics; advanced nursing practice shall be authorized to practice without a joint protocol with a collaborating provider.

     k.   (d)   Any provision of State law or regulation that requires the signature, stamp, verification, affidavit, or endorsement of a physician shall be deemed to require the signature, stamp, verification, affidavit, or endorsement of a physician or an advanced practice nurse,nurse tois thenot extentproviding consistentelective withaesthetic theor scopecosmetic ofservices; practice of an advanced practice nurse.

and      (e)   the advanced practice nurse, to the extent the advanced practice nurse is providing behavioral health care services, takes appropriate action to facilitate the timely referral, transfer, or admission to a higher level of care in the event the advanced practice nurse determines, based upon clinical judgment, that a patient requires such level of care.  The determination shall be based upon a documented clinical assessment.

     h.    (1)  Pursuant to this subsection, an advanced practice nurse who is authorized to practice advanced practice nursing within a population focus of family or individual across the lifespan, adult gerontology, pediatrics, women’s health, or behavioral health shall be exempt from subsections b.

and c.

of this section and shall be authorized to practice without a joint protocol with a collaborating physician, provided that:

     (a)   the advanced practice nurse has more than 5,000 hours of licensed, active, advanced nursing practice in a role with the applicable population focus;

     (b) the advanced practice nurse is providing primary health care or behavioral health care;

     (c)   the advanced practice nurse is not providing health care services in the area of general obstetrics;

     (d)   the advanced practice nurse is not providing elective aesthetic or cosmetic services;

and      (e)   the advanced practice nurse, to the extent the advanced practice nurse is providing behavioral health care services, takes appropriate action to facilitate the timely referral, transfer, or admission to a higher level of care in the event the advanced practice nurse determines, based upon clinical judgment, that a patient requires such level of care.  The determination shall be based upon a documented clinical assessment.

     (2)  An advanced practice nurse who meets the exemption criteria provided pursuant to paragraph (1) of this subsection may order medications and devices, subject to the following conditions:

     (a)   the advanced practice nurse shall issue a prescription on a New Jersey Prescription Blank in accordance with the provisions of P.L.2003, c.280 (C.45:14-40 et seq.), and include on the prescription blank the advanced practice nurse’s signature, printed name, certification number, and patient information, and any other information required pursuant to regulations adopted by the New Jersey Board of Nursing;

     (b)   the advanced practice nurse shall have completed 14 contact hours of continuing professional education in pharmacology related to controlled substances, including pharmacologic therapy and addiction prevention and management.  Of the 14 contact hours, eight hours shall be in addition to New Jersey Board of Nursing controlled dangerous substance pharmacology education requirements for advanced practice nurses related to initial certification of an advanced practice nurse as set forth in regulations adopted by the New Jersey Board of Nursing at the time of the effective date of P.L.    , c.    (C.        ) (pending before the Legislature as this bill);

     (c)   the advance practice nurse shall have completed 10 contact hours of continuing professional education in pharmacology each biennial period;

     (d)   the advance practice nurse, who is practicing independently, shall be held to the same standard of care as other independent health care practitioners.

     (e)  the advanced practice nurse shall be required to be covered by malpractice liability insurance, or if such liability coverage is not available, by a letter of credit for at least the minimum amount applicable to a licensed physician.  The advance practice nurse shall notify the Board of Nursing of the name and address of the insurance carrier or the institution issuing the letter of credit;

     (f)   if the advanced practice nurse does not provide services to beneficiaries of the Medicare program established pursuant to section 1801 of the Social Security Act (42 U.S.C.

s.1395 et seq.), the advanced practice nurse shall , if applicable, prominently display in the advanced practice nurse’s office an appropriate notice, and inform, in writing, the Board of Nursing;

and      (g)  the advanced practice nurse shall immediately notify the Board of Nursing if the advanced practice nurse is:

     (i)    is incapable, for medical or any other good cause, of discharging the functions of the advanced practice nurse in a manner consistent with the public's health, safety and welfare;

     (ii)   is indicted or convicted of a crime involving moral turpitude or a crime adversely relating to the advanced practice nurse’s practice;

     (iii) is named as a defendant or respondent in a civil, criminal or administrative investigation, complaint or judgment involving alleged malpractice, negligence or misconduct relating to the advanced practice nurse’s practice;

     (iv)  is the subject of any voluntary license or certification surrender or any disciplinary action or order by any state or Federal agency, board or commission, including any order of limitation or preclusion;

or      (v)   fails to maintain or renew any certification which is required by law as a condition of practice or as a condition of license or certification renewal.

     i.  Any provision of State law or regulation that requires the signature, stamp, verification, affidavit, or endorsement of a physician shall be deemed to require the signature, stamp, verification, affidavit, or endorsement of a physician or an advanced practice nurse, to the extent consistent with the scope of practice of an advanced practice nurse.

P.L.2019, c.153, s.47)        4.   4.  Section 1310 of P.L.2017,P.L.1999, c.341c.85 (C.45:11-49.3)(C.45:10-49.2) is amended to read as follows:

     10.  No later than the 180th day after the enactment of P.L.1999, c.85, the Director of the Division of Consumer Affairs in the Department of Law and Public Safety shall adopt standards for the joint protocols required by subsection d.

of section 10 of P.L.1991, c.377 (C.45:11-49), which shall apply to the ordering or prescription of controlled dangerous substances by an advanced practice nurse pursuant to that section.

The standards shall be adopted by regulation in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), provided that such regulation shall not be more restrictive than the provisions of P.L.1991, c.377 (C.45:11-45 et al.).

(cf:

P.L.1999, c.85, s.10)        5.  Section 13 of P.L.2017, c.341 (C.45:11-49.3) is amended to read as follows:

s.823.  [An[An] When applicable, an advanced practice nurse who is authorized to dispense such drugs may do so regardless of whether the advanced practice nurse's collaborating physician has met the training and registration requirements set forth in subsection (g) of 21 U.S.C.

s.823, provided that the joint protocol established by the advanced practice nurse and the collaborating physician include include the collaborating physician's written approval for the advanced practice nurse to dispense the drugs.] drugs.      b.    Notwithstanding any other provision of law or regulation to the contrary, an advanced practice nurse [, under the joint protocol established by the advanced practice nurse and the collaborating physician,] may make the determination as to the medical necessity for services for the treatment of substance use disorder, as provided in P.L.2017, c.28 (C.17:48-6nn et al.), and may prescribe such services.

     b.    Notwithstanding any other provision of law or regulation to the contrary, an advanced practice nurse, under the joint protocol established by the advanced practice nurse and the collaborating physician, may make the determination as to the medical necessity for services for the treatment of substance use disorder, as provided in P.L.2017, c.28 (C.17:48-6nn et al.), and may prescribe such services.

     c.     The provisions of this section regarding joint protocols shall not apply under the circumstances outlined in subsections g.

and h.

of section 10 of P.L.1991, c.

377 (C.45:11-49).

P.L.2017, c.341, s.13)        5.   6.    Section 11 of P.L.1991, c.377 (C.45:11-50) is amended to read as follows:

     a.     To promulgate, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), rules and regulations to effectuate the purposes of [this act,act] P.L.1991, c.377 (C.45:11-45 et al.), except for those subjects of rule-making authority allocated to the Director of the Division of Consumer Affairs pursuant to section 12 of P.L.1991, c.377 (C.45:11-51) or to the Commissioner of Health and Senior Services pursuant to section 13 of P.L.1991, c.377 (C.45:11-52)](C.45:11-52); P.L.1991, c.377 (C.45:11-45 et al.);

     k.  To limit, restrict, deny, suspend or revoke an advanced practice nurse’s licensure, or prescriptive or dispensing authority.

 The board may take disciplinary action for:

     (1)   prescribing, dispensing, administering, or distributing medications in an unsafe manner;

     (2)   prescribing or distributing medications outside the advanced practice nurse’s role or population focus;

or      (3)   prescribing, ordering, procuring, administering, dispensing and furnishing over the counter, legend and controlled substances outside the applicable state and federal laws or regulations.

P.L.1999, c.85, s.8)        6.   7.    (NewSection section) 12 The Board of NursingP.L.1991, andc.377 the(C.45:11-51) Commissioneris ofamended Health shall each adopt, pursuant to theread “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), such rules and regulations as shallfollows: be necessary to implement the provisions of this act.         7.    The following sections are repealed:

                Section12.  The Director of P.L.1999,the c.85Division (C.45:11-49.2);of Consumer Affairs in the Department of Law and Public Safety may receive and shall give due consideration to advice from the Board of Nursing and the State Board of Medical Examiners in adopting standards for the joint protocols required by subsection d.

           of Sectionsection 10 of P.L.1991, c.377 (C.45:11-51);(C.45:11-49).  The standards shall be established by rule adopted by the Director of the Division of Consumer Affairs in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), provided that such rule shall not be more restrictive than the provisions of P.L.1991, c.377 (C.45:11-45 et al.).

and(cf:             Section of P.L.1991, c.377 (C.45:11-52).

 P.L.1991,     c.377, 8.   s.12)  This  act     shall8.  takeSection effect13 on the first day of theP.L.1991, fourthc.377 month(C.45:11-52) nextis followingamended theto dateread ofas enactment.follows:

    STATEMENT        This13.  billThe eliminatesCommissioner practice restrictions for advanced practice nurses (APNs), including restrictions that limit the ability of APNsHealth to[and prescribeSenior medicationsServices] andshall, administerby anesthesia,rule andadopted establishesin newaccordance requirementswith forthe APNs"Administrative toProcedure prescribeAct," medications. P.L.1968,     c.410 The(C.52:14B-1 billet expresslyseq.), providesestablish that, notwithstanding the provisionsperiods of anytime otherwithin lawwhich or regulation to the contrary,charts anand APNrecords with greater than 24 months or 2,400 hours of licensed,the active,patients advancedtreated nursingby practice will be authorized to practice without a joint protocol with a collaborating provider.       With regard to prescribing medications, the bill requires the use of New Jersey Prescription Blanks and satisfying continuing professional education requirements related to pharmacology and prescribing controlled substances.  An APN with fewer than 24 months or 2,400 hours of licensed, active, advanced nursing practice nurse  in an initialinpatient rolesetting willshall be permittedreviewed toby prescribethe medicationadvanced onlypractice ifnurse aand formalthe jointcollaborating protocolphysician, withas arequired physicianby orparagraph experienced(5) advancedof practicesubsection nurseb. is in place.

    of Thesection bill10 revisesof theP.L.1991, requirementsc.377 for(C.45:11-49), APNsprovided to authorize patients for medical cannabis and to issue written instructions for medical cannabis, to provide that thesuch APNrule willshall onlynot be requiredmore torestrictive meetthan the requirementsprovisions setof forthP.L.1991, underc.377 the(C.45:11-45 “Jake Honig Compassionate Use Medical Cannabis Act,” P.L.2009, c.307 (C.24:6I-1 et al.). al.). Those requirements include:

possessing(cf:  activeP.L.1999, Statec.85, s.9)        9.  (New section)   Notwithstanding the provisions of the “Administrative Procedure Act,”  P.L.1968, c.410 (C.52:14B-1 et seq.) to the contrary, the Board of Nursing and federalthe registrationsCommissioner of Health shall adopt, immediately upon filing proper notice with the Office of Administrative Law, regulations necessary to prescribeeffectuate controlledthe dangerouspurposes substances;of this act, including the process by which the Board shall verify the number of hours an advanced practice nurse has completed in order for the advanced practice nurse to practice without a joint protocol pursuant to subsections g.

beingand theh. health care practitioner responsible for the ongoing treatment of a patient's qualifying medical condition;

andof complyingsection with3 variousand othersubsections requirementsa. for issuing written instructions for medical cannabis.

     The bill further provides that every APN who is an APN-Anesthesia and whob. has completed 24 months or 2,400 hours of licensed, active, advanced nursing practice in an initial role will be authorized to practice as an APN-Anesthesia to the full scope of practice for APNs-Anesthesia, without any requirement for supervision by a licensed physician and without any requirement that the APN-Anesthesia enter into joint protocols with a licensed physician.       The bill provides that any State law or regulation that requires the signature or similar endorsement of a physician will be deemed to require the same of an APN, to the extent consistent with an APN’s scope of practice.

    of Thesection bill10,  revisesprovided andthat repealssuch certainrules sectionsshall ofnot lawbe thatmore arerestrictive obviatedthan by the changesprovisions madeof underP.L.1991, thec.377 bill.(C.45:11-45 et al.).

 Such regulations shall be effective for a period not to exceed 18 months from the date of the filing, at which point the Board of Nursing and the Commissioner of Health may thereafter amend, adopt, or readopt the regulations in accordance with the requirements of P.L.1968, c.410 (C.52:14B-1 et seq.).

       10.  This act shall take effect immediately, except that notwithstanding any provision of this P.L.    , c.    (C.        ) (pending before the Legislature as this bill) to the contrary, an advanced practice nurse authorized to prescribe, authorize, or order medications and devices without a joint protocol pursuant to Executive Order No.

13 (2026) shall be authorized to:

     a.  if the advanced practice nurse would have 5,000 hours of licensed, active, advanced nursing practice within 12 months of the effective date of this P.L.    , c.    (C.        ) (pending before the Legislature as this bill), continue practicing without a joint protocol;

or      b.  if the advanced practice nurse would have less than 5,000 hours of licensed, active, advanced nursing practice within 12 months of the effective date of this P.L.    , c.    (C.        ) (pending before the Legislature as this bill), continue practicing without a joint protocol for a period of six months after the effective date of P.L.    , c.    (C.        ) (pending before the Legislature as this bill), after which the advanced practice nurse shall be required to establish a joint protocol with a collaborating physician pursuant to the provisions of section 10 of P.L.1991, c.377 (C.45:11-49) and any hours of licensed, active, advanced nursing practice without a joint protocol shall be counted towards the requirements for practice without a joint protocol with a collaborating physician pursuant to section of P.L.1991, c.377 (C.45:11-49).