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APRN FAQ on the new 2022 Kansas statute changes

Introduction

With the passage of House Bill 2279 by the 2022 Kansas Legislature there is a lot of confusion regarding this new law regarding Advanced Practice Registered Nurses (APRNs). To address the most common questions we receive, we have started this Frequently Asked Questions resource at www.kmsonline.org/APRN. It will be a living document as circumstances develop. 

When does the new APRN law take effect?

Q1: When does the new law take effect, and what is the status of the regulations that implement the changes in the law?

A: The new law took effect July 1, 2022. The process for approving the permanent regulations which implement the new law is underway and will take a few months to be finalized. However, in the meantime, the temporary regulations which had been proposed by the Kansas State Board of Nursing have now taken effect in their entirety. Effective immediately, those regulations eliminate the requirement for written prescribing protocols and collaborative practice agreements (CPAs) for APRNs. The State Rules and Regulations Board on June 30 had rejected four of the proposed regulations which eliminated CPAs, but that same Board held a subsequent meeting on July 18 and reversed course on its earlier decision, approving all of the proposed regulations. The next step in this process is a September 18 public hearing by the Board of Nursing on the permanent regulations.

Can APRNs now practice independently?

Q2:  Can an ARPN now practice independently and, if so, are there any limitations on what they can do?

A: Yes. Actually, APRNs have always been able to practice advanced practice nursing independently, but without a physician-authorized prescribing protocol or a collaborative practice agreement, their practices were somewhat limited in scope. The recent changes in the law and regulations did eliminate the requirement of a physician-authorized prescribing protocol, as well as collaborative practice agreements. APRNs are now able to prescribe drugs (including controlled substances) and durable medical equipment in their practice without having to obtain a written protocol with a physician. The only limitation on prescribing is that APRNs cannot prescribe any drug intended to cause an abortion. The legislation does not explicitly authorize APRNs to perform any other services that constitute the practice of medicine and surgery, and the Kansas State Board of Nursing testified that the changes in the law and regulations made no change to APRN scope of practice. While the nursing board has insisted that APRN scope of practice hasn’t changed, KMS and others have expressed concern that the regulations are unclear and could exceed what was authorized by the new law. This point is likely to be a focus of considerable attention in the public hearing process, as well as any litigation that might eventually result from this process.

Can I still enforce a Collaborative Practice Agreement?

Q3: My legal counsel says that I can no longer enforce a Collaborative Practice Agreement (CPA) because of the new APRN law. Can I still require a CPA or other employment agreement for APRNs in my practice?

A:  The new law and regulations do not prohibit collaborative practice agreements, prescribing protocols, or any other formal practice agreements. It only eliminated the requirement of a prescribing protocol and CPA. Even though the new regulations eliminate the legal requirement for CPAs, there is nothing in the law that would prevent an APRN from entering into a collaborative practice or other practice agreement with a physician, a physician clinic, hospital, or other health care facility. Parties have a right to enter into such contractual arrangements with anyone they employ or contract with, including an APRN. That employment arrangement can utilize a collaborative practice agreement; employment agreement or other practice agreements; written protocols or other formal policies that set out the clinical limitations, scope of practice, terms and conditions of the APRN’s employment, or contractual relationship with the practice or facility.

Can I still delegate authority to an APRN?

Q4: Under the new law, can a physician still supervise or delegate authority to an APRN? How does the new law affect physician-APRN relationships in hospitals or other health care facilities? 

A: Consistent with current practice, a physician may still provide direction, supervision, or delegation of authority to perform acts that constitute the practice of medicine and surgery to an APRN, such as ordering tests, imaging, procedures, or other health care services. All clinical facilities — including physician clinics, hospitals, or other health care facilities — should consider reviewing and establishing clinical policies that identify those services that will continue to require physician direction, supervision, or delegation of authority to an APRN, and those services that the APRN can provide independently, consistent with the facility’s responsibilities to its patients (see Q5 below). 

What does the new law allow APRNs to do without physician oversight?

Q5: Does the legislation allow APRNs to diagnose, treat, and prescribe without any physician direction or oversight?

A. Prior to passage of HB 2279, Kansas law required physician involvement in the form of a prescribing protocol and collaborative practice agreement (CPA) in order for an APRN to diagnose, treat, or prescribe. The only change specifically authorized by HB 2279 was limited to the requirement that — in order to prescribe drugs — an APRN must enter into a written prescribing protocol with a physician. That requirement was the only element which was eliminated by the bill. The legislation was silent on the broader issue of collaborative practice agreements, but the Kansas State Board of Nursing eliminated them with the regulatory changes, it adopted.

The legislation also amended a key provision of the nurse practice act which relates to APRN practice. In the section directing the Kansas State Board of Nursing to adopt regulations relating to APRN practice (K.S.A. 65-1130, subsection (c)), the legislature made it clear that the regulations must be consistent with the nurse practice act. The nurse practice act at K.S.A. 65-1113 subsection (b) defines “diagnosis” in the context of nursing practice means “that identification of and discrimination between physical and psychosocial signs and symptoms essential to effective execution and management of the nursing regimen and shall be construed as distinct from a medical diagnosis.” Additionally, the nurse practice act defines “treatment” as “the selection and performance of those therapeutic measures essential to effective execution and management of the nursing regimen, and any prescribed medical regimen [emphasis added].  

In other words, the nurse practice act still clearly distinguishes between the practice of nursing and the practice of medicine, and — with the exception of prescribing by APRNs — nothing in HB 2279 changes that distinction. For clinics, hospitals, or other health care facilities that require APRNs to have a CPA that sets forth practice parameters including scope of practice, supervision or consultation requirements, signature requirements, record review, consultation requirements, etc. — particularly as it relates to diagnosing or treating patients — it may be prudent to wait to make other changes until the permanent regulations have been formally approved later this year.  

Are APRNs required to be covered by the Stabilization Fund?

Q9: Are APRNs required to be covered by the Health Care Stabilization Fund (HCSF)?

A.  Of the four categories of APRN (nurse practitioner, nurse anesthetist, nurse midwife, and clinical nurse specialist) only nurse anesthetists and nurse midwives are required to be covered by the HCSF. Nurse practitioners and clinical nurse specialists may not be covered by the HCSF, as they are not included in the list of “defined healthcare providers” that are required by law to be covered by the HCSF.