Alabama 2025 Regular Session

Alabama Senate Bill SB124 Compare Versions

Only one version of the bill is available at this time.

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1	1	SB124INTRODUCED
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3	3	SB124
4	4	96AIPPP-1
5	5	By Senator Melson
6	6	RFD: Healthcare
7	7	First Read: 06-Feb-25
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12	12	5 96AIPPP-1 02/05/2025 PMG (L)PMG 2025-603
13	13	Page 1
14	14	First Read: 06-Feb-25
15	15	SYNOPSIS:
16	16	Under existing law, the Joint Committee of the
17	17	State Board of Medical Examiners and the Board of
18	18	Nursing for Advanced Practice Nurses is comprised of
19	19	physicians and nurses. The joint committee recommends
20	20	rules to the State Board of Medical Examiners and the
21	21	Board of Nursing for purposes of regulating the
22	22	collaborative practice of physicians and certified
23	23	registered nurse practitioners and certified nurse
24	24	midwives.
25	25	This bill would revise the membership of the
26	26	joint committee to include two certified registered
27	27	nurse practitioners in active collaborative practice
28	28	and one certified nurse midwife in active collaborative
29	29	practice.
30	30	This bill would increase the per diem of board
31	31	members.
32	32	This bill would also provide procedures for
33	33	rejections by either the State Board of Medical
34	34	Examiners or the State Board of Nursing of a
35	35	recommendation from the joint committee.
36	36	A BILL
37	37	TO BE ENTITLED
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65	65	28 SB124 INTRODUCED
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67	67	TO BE ENTITLED
68	68	AN ACT
69	69	Relating to the Joint Committee of the State Board of
70	70	Medical Examiners and the Board of Nursing for Advanced
71	71	Practice Nurses; to amend Sections 34-21-81 and 34-21-82, Code
72	72	of Alabama 1975; to revise membership of the joint committee
73	73	and the per diem provided to members; and to further provide
74	74	for procedures of the joint committee.
75	75	BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
76	76	Section 1. Sections 34-21-81 and 34-21-82, Code of
77	77	Alabama 1975, are amended to read as follows:
78	78	"§34-21-81
79	79	As used in this article, the following terms shall have
80	80	the following meanings:
81	81	(1) ADVANCED PRACTICE NURSE. A registered nurse who has
82	82	gained additional knowledge and skills through successful
83	83	completion of an organized program of nursing education that
84	84	prepares nurses for advanced practice roles and has been
85	85	certified by the Board of Nursing to engage in the practice of
86	86	advanced practice nursing. There shall be four categories of
87	87	advanced practice nurses: Certified registered nurse
88	88	practitioners (CRNP), certified nurse midwives (CNM),
89	89	certified registered nurse anesthetists (CRNA), and clinical
90	90	nurse specialists (CNS). Certified registered nurse
91	91	practitioners and certified nurse midwives are subject to
92	92	collaborative practice agreements with an Alabama physician.
93	93	Certified registered nurse anesthetists and clinical nurse
94	94	specialists are not subject to collaborative practice
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124	124	specialists are not subject to collaborative practice
125	125	agreements with an Alabama physician and are not subject to
126	126	the requirements of Sections 34-21-82, 34-21-83, and 34-21-85
127	127	to 34-21-92, inclusive, and are prohibited from engaging in
128	128	any of the acts or functions of a certified registered nurse
129	129	practitioner (CRNP) or a certified nurse midwife (CNM) as
130	130	established by this article and rules adopted under this
131	131	article.
132	132	(2) ADVANCED PRACTICE NURSING. The delivery of health
133	133	care services by registered nurses who have gained additional
134	134	knowledge and skills through successful completion of an
135	135	organized program of nursing education that prepares nurses
136	136	for advanced practice roles as certified registered nurse
137	137	practitioners, certified nurse midwives, certified nurse
138	138	anesthetists, and clinical nurse specialists:
139	139	a. Practice as a certified registered nurse
140	140	practitioner (CRNP) means the performance of nursing skills by
141	141	a registered nurse who has demonstrated by certification that
142	142	he or she has advanced knowledge and skills in the delivery of
143	143	nursing services within a health care system that provides for
144	144	consultation, collaborative management, or referral as
145	145	indicated by the health status of the client.
146	146	b. Practice as a certified nurse midwife (CNM) means
147	147	the performance of nursing skills by a registered nurse who
148	148	has demonstrated by certification that he or she has advanced
149	149	knowledge and skills relative to the management of women's
150	150	health care focusing on pregnancy, childbirth, the postpartum
151	151	period, care of the newborn, family planning, and
152	152	gynecological needs of women, within a health care system that
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182	182	gynecological needs of women, within a health care system that
183	183	provides for consultation, collaborative management, or
184	184	referral as indicated by the health status of the client.
185	185	c. Practice as a certified registered nurse anesthetist
186	186	(CRNA) means the performance of or the assistance in any act
187	187	involving the determination, preparation, administration,
188	188	procedural ordering, or monitoring of any drug used to render
189	189	an individual insensible to pain for surgical and other
190	190	therapeutic or diagnostic procedures. The nurse anesthetist is
191	191	qualified in accordance with Section 27-46-3 and is licensed
192	192	by the Board of Nursing and functions under the direction of
193	193	or in coordination with a physician licensed to practice
194	194	medicine, a podiatrist, or a dentist, who is immediately
195	195	available. Nothing in this paragraph shall be construed to
196	196	restrict the authority of a health care facility to adopt
197	197	policies relating to the provision of anesthesia and analgesia
198	198	services.
199	199	d. Practice of clinical nurse specialist (CNS) nursing
200	200	means the performance of nursing skills by a registered nurse
201	201	who, through study and supervised practice at the graduate
202	202	level and as evidenced by certification, has advanced
203	203	knowledge and practice skills in a specialized area of
204	204	practice, except that a clinical nurse specialist may not do
205	205	any of the following:
206	206	1. Perform delegated medical acts or engage in
207	207	collaborative practice as described in this article.
208	208	2. Perform any of the functions of a certified
209	209	registered nurse practitioner or a certified nurse midwife as
210	210	described in this article and the rules adopted under this
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240	240	described in this article and the rules adopted under this
241	241	article, whether or not performed within a collaborative
242	242	practice relationship.
243	243	3. Prescribe drugs of any type. A clinical nurse
244	244	specialist may perform nursing services permitted under this
245	245	subdivision as an independent contractor.
246	246	(3) BOARD OF MEDICAL EXAMINERS. The State Board of
247	247	Medical Examiners established pursuant to Section 34-24-53.
248	248	(4) BOARD OF NURSING. The Board of Nursing established
249	249	under Section 34-21-2.
250	250	(5) COLLABORATION. A formal relationship between one or
251	251	more certified registered nurse practitioners and certified
252	252	nurse midwives and a physician or physicians under which these
253	253	nurses may engage in advanced practice nursing as evidenced by
254	254	written protocols approved in accordance with the requirements
255	255	of this article or exempted in accordance with requirements of
256	256	this article. The term collaboration does not require direct,
257	257	on-site supervision of the activities of a certified
258	258	registered nurse practitioner or a certified nurse midwife by
259	259	the collaborating physician. The term does require such
260	260	professional oversight and direction as may be required by the
261	261	rules of the State Board of Medical Examiners and the Board of
262	262	Nursing.
263	263	(6) COORDINATION WITH. When an anesthesiologist is not
264	264	physically present, the working relationship between a
265	265	physician, a podiatrist, or a dentist and a certified
266	266	registered nurse anesthetist licensed to practice in this
267	267	state. Each contributes his or her respective expertise in the
268	268	provision of patient care, which includes the discussion of
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298	298	provision of patient care, which includes the discussion of
299	299	patient treatment, diagnosis, and consultation.
300	300	(7) JOINT COMMITTEE OF THE STATE BOARD OF MEDICAL
301	301	EXAMINERS AND THE BOARD OF NURSING FOR ADVANCED PRACTICE
302	302	NURSES. The Joint Committee of the State Board of Medical
303	303	Examiners and the Board of Nursing for Advanced Practice
304	304	Nurses shall mean and shall be a committee composed of all of
305	305	the following:
306	306	a. Two physicians licensed to practice medicine in the
307	307	State of Alabama this state.
308	308	b. One registered nurse licensed to practice
309	309	professional nursing in the State of Alabama.
310	310	cb. One licensed physician engaged in a collaborative
311	311	practice with a certified registered nurse practitioner or a
312	312	certified nurse midwife in the State of Alabama this state.
313	313	dc. One Two certified registered nurse practitioner
314	314	practitioners engaged in advanced practice an active
315	315	collaborative practice with a physician in the State of
316	316	Alabama this state.
317	317	ed. One certified nurse midwife engaged in advanced
318	318	practice an active collaborative practice with a physician in
319	319	the State of Alabama this state.
320	320	(8) LEGEND DRUG. Any drug, medicine, chemical, or
321	321	poison bearing on the label the words, "Caution, Federal Law
322	322	prohibits dispensing without prescription" or similar words
323	323	indicating that the drug, medicine, chemical, or poison may be
324	324	sold or dispensed only upon the prescription of a licensed
325	325	practitioner, except that the term legend drug shall not
326	326	include any drug, substance, or compound which is listed in
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356	356	include any drug, substance, or compound which is listed in
357	357	Schedules I through V of the Alabama Uniform Controlled
358	358	Substances Act.
359	359	(9) PHYSICIAN or COLLABORATING PHYSICIAN. A doctor of
360	360	medicine or a doctor of osteopathy licensed to practice
361	361	medicine in Alabama who agrees in writing to practice in
362	362	collaboration with one or more certified registered nurse
363	363	practitioners or certified nurse midwives in accordance with
364	364	the rules adopted by the State Board of Medical Examiners and
365	365	the Board of Nursing.
366	366	(10) PRESCRIBE or PRESCRIBING. The act of issuing a
367	367	written prescription for a legend drug.
368	368	(11) PRESCRIPTION. An order for a legend drug which is
369	369	written and signed by a practitioner authorized by law to
370	370	prescribe and administer such drugs and which is intended to
371	371	be filled, compounded, or dispensed by a pharmacist.
372	372	(12) PROCEDURAL ORDERING. The ordering of the
373	373	anesthesia plan, including the ordering of medications and
374	374	tests before, during, or after analgesia or anesthesia in
375	375	accordance with the anesthesia plan.
376	376	(13) PROTOCOL. A document approved in accordance with
377	377	Section 34-21-87 establishing the permissible functions and
378	378	activities to be performed by certified registered nurse
379	379	practitioners and certified nurse midwives and signed by
380	380	collaborating physicians and any nurse practitioners or nurse
381	381	midwives practicing with those physicians."
382	382	"§34-21-82
383	383	(a)(1) The physician members of the joint committee
384	384	shall be appointed by the State Board of Medical Examiners and
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414	414	shall be appointed by the State Board of Medical Examiners and
415	415	shall serve three-year terms as set out below .
416	416	(2) The registered nurse members of the joint committee
417	417	shall be appointed by the Board of Nursing certified
418	418	registered nurse practitioner members of the joint committee
419	419	shall be appointed by the Nurse Practitioner Alliance of
420	420	Alabama or its successor organization and shall serve
421	421	three-year terms as set out below .
422	422	(3) The certified nurse midwife member of the joint
423	423	committee shall be appointed by the Alabama American College
424	424	of Nurse-Midwives or its successor organization and shall
425	425	serve a three-year term.
426	426	(4) No member shall serve more than two full terms,
427	427	either consecutively or separately.
428	428	(b)(1) In order to stagger the terms of office, the
429	429	Board of Nursing and the State Board of Medical Examiners will
430	430	each appoint to the initial joint committee one member for a
431	431	term of one year, one member for a term of two years, and one
432	432	member for a term of three years. Should the registered nurse
433	433	member serving on September 30, 2025, shall be replaced on
434	434	October 1, 2025, with a certified registered nurse
435	435	practitioner pursuant to subdivision (a)(2) who shall serve an
436	436	initial term of two years, the certified registered nurse
437	437	practitioner serving on September 30, 2025, shall continue to
438	438	serve until October 1, 2026, and the certified nurse midwife
439	439	serving on September 30, 2025, shall be replaced on October 1,
440	440	2025.
441	441	(c) If a vacancy occur occurs on the committee, a
442	442	successor will shall be appointed by the respective appointing
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472	472	successor will shall be appointed by the respective appointing
473	473	authority in subsection (a) to serve the unexpired term.
474	474	(d) The committee shall select one of its members to
475	475	serve as chairperson chair for a one-year term ,.
476	476	(2) The office of chairperson shall
477	477	alternatealternating between a physician member of the
478	478	committee and a nurse member of the committee.
479	479	(3)(e) The committee shall meet annually, or more
480	480	frequently if requested by the State Board of Medical
481	481	Examiners or the Board of Nursing. Members of the committee
482	482	shall receive per diem at a rate of $100 three hundred dollars
483	483	($300) per day or any portion thereof that such a committee
484	484	member shall be in attendance at an official meeting or
485	485	function of the committee and in addition shall receive
486	486	reimbursement for subsistence and travel in accordance with
487	487	state law for each day actively engaged in the duties of their
488	488	offices. The State Board of Medical Examiners shall pay the
489	489	per diem and expenses of the physician members and the Board
490	490	of Nursing shall pay the per diem and expenses of the nurse
491	491	members,each appoints to the joint committee and both boards
492	492	shall furnish necessary clerical and administrative support
493	493	for operation of the committee.
494	494	(f) Rejection of a recommendation from the joint
495	495	committee by either the State Board of Medical Examiners or
496	496	the Board of Nursing shall require a three-fifths majority
497	497	vote by the respective board. If rejected, the respective
498	498	board shall return the recommendations, with proposed changes,
499	499	to the joint committee for reevaluation and reconsideration. "
500	500	Section 2. This act shall become effective on October
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530	530	Section 2. This act shall become effective on October
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