SB124INTRODUCED
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SB124
96AIPPP-1
By Senator Melson
RFD: Healthcare
First Read: 06-Feb-25
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5 96AIPPP-1 02/05/2025 PMG (L)PMG 2025-603
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First Read: 06-Feb-25
SYNOPSIS:
Under existing law, the Joint Committee of the
State Board of Medical Examiners and the Board of
Nursing for Advanced Practice Nurses is comprised of
physicians and nurses. The joint committee recommends
rules to the State Board of Medical Examiners and the
Board of Nursing for purposes of regulating the
collaborative practice of physicians and certified
registered nurse practitioners and certified nurse
midwives.
This bill would revise the membership of the
joint committee to include two certified registered
nurse practitioners in active collaborative practice
and one certified nurse midwife in active collaborative
practice.
This bill would increase the per diem of board
members.
This bill would also provide procedures for
rejections by either the State Board of Medical
Examiners or the State Board of Nursing of a
recommendation from the joint committee.
A BILL
TO BE ENTITLED
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TO BE ENTITLED
AN ACT
Relating to the Joint Committee of the State Board of
Medical Examiners and the Board of Nursing for Advanced
Practice Nurses; to amend Sections 34-21-81 and 34-21-82, Code
of Alabama 1975; to revise membership of the joint committee
and the per diem provided to members; and to further provide
for procedures of the joint committee.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Sections 34-21-81 and 34-21-82, Code of
Alabama 1975, are amended to read as follows:
"§34-21-81
As used in this article, the following terms shall have
the following meanings:
(1) ADVANCED PRACTICE NURSE. A registered nurse who has
gained additional knowledge and skills through successful
completion of an organized program of nursing education that
prepares nurses for advanced practice roles and has been
certified by the Board of Nursing to engage in the practice of
advanced practice nursing. There shall be four categories of
advanced practice nurses: Certified registered nurse
practitioners (CRNP), certified nurse midwives (CNM),
certified registered nurse anesthetists (CRNA), and clinical
nurse specialists (CNS). Certified registered nurse
practitioners and certified nurse midwives are subject to
collaborative practice agreements with an Alabama physician.
Certified registered nurse anesthetists and clinical nurse
specialists are not subject to collaborative practice
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specialists are not subject to collaborative practice
agreements with an Alabama physician and are not subject to
the requirements of Sections 34-21-82, 34-21-83, and 34-21-85
to 34-21-92, inclusive, and are prohibited from engaging in
any of the acts or functions of a certified registered nurse
practitioner (CRNP) or a certified nurse midwife (CNM) as
established by this article and rules adopted under this
article.
(2) ADVANCED PRACTICE NURSING. The delivery of health
care services by registered nurses who have gained additional
knowledge and skills through successful completion of an
organized program of nursing education that prepares nurses
for advanced practice roles as certified registered nurse
practitioners, certified nurse midwives, certified nurse
anesthetists, and clinical nurse specialists:
a. Practice as a certified registered nurse
practitioner (CRNP) means the performance of nursing skills by
a registered nurse who has demonstrated by certification that
he or she has advanced knowledge and skills in the delivery of
nursing services within a health care system that provides for
consultation, collaborative management, or referral as
indicated by the health status of the client.
b. Practice as a certified nurse midwife (CNM) means
the performance of nursing skills by a registered nurse who
has demonstrated by certification that he or she has advanced
knowledge and skills relative to the management of women's
health care focusing on pregnancy, childbirth, the postpartum
period, care of the newborn, family planning, and
gynecological needs of women, within a health care system that
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gynecological needs of women, within a health care system that
provides for consultation, collaborative management, or
referral as indicated by the health status of the client.
c. Practice as a certified registered nurse anesthetist
(CRNA) means the performance of or the assistance in any act
involving the determination, preparation, administration,
procedural ordering, or monitoring of any drug used to render
an individual insensible to pain for surgical and other
therapeutic or diagnostic procedures. The nurse anesthetist is
qualified in accordance with Section 27-46-3 and is licensed
by the Board of Nursing and functions under the direction of
or in coordination with a physician licensed to practice
medicine, a podiatrist, or a dentist, who is immediately
available. Nothing in this paragraph shall be construed to
restrict the authority of a health care facility to adopt
policies relating to the provision of anesthesia and analgesia
services.
d. Practice of clinical nurse specialist (CNS) nursing
means the performance of nursing skills by a registered nurse
who, through study and supervised practice at the graduate
level and as evidenced by certification, has advanced
knowledge and practice skills in a specialized area of
practice, except that a clinical nurse specialist may not do
any of the following:
1. Perform delegated medical acts or engage in
collaborative practice as described in this article.
2. Perform any of the functions of a certified
registered nurse practitioner or a certified nurse midwife as
described in this article and the rules adopted under this
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described in this article and the rules adopted under this
article, whether or not performed within a collaborative
practice relationship.
3. Prescribe drugs of any type. A clinical nurse
specialist may perform nursing services permitted under this
subdivision as an independent contractor.
(3) BOARD OF MEDICAL EXAMINERS. The State Board of
Medical Examiners established pursuant to Section 34-24-53.
(4) BOARD OF NURSING. The Board of Nursing established
under Section 34-21-2.
(5) COLLABORATION. A formal relationship between one or
more certified registered nurse practitioners and certified
nurse midwives and a physician or physicians under which these
nurses may engage in advanced practice nursing as evidenced by
written protocols approved in accordance with the requirements
of this article or exempted in accordance with requirements of
this article. The term collaboration does not require direct,
on-site supervision of the activities of a certified
registered nurse practitioner or a certified nurse midwife by
the collaborating physician. The term does require such
professional oversight and direction as may be required by the
rules of the State Board of Medical Examiners and the Board of
Nursing.
(6) COORDINATION WITH. When an anesthesiologist is not
physically present, the working relationship between a
physician, a podiatrist, or a dentist and a certified
registered nurse anesthetist licensed to practice in this
state. Each contributes his or her respective expertise in the
provision of patient care, which includes the discussion of
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provision of patient care, which includes the discussion of
patient treatment, diagnosis, and consultation.
(7) JOINT COMMITTEE OF THE STATE BOARD OF MEDICAL
EXAMINERS AND THE BOARD OF NURSING FOR ADVANCED PRACTICE
NURSES. The Joint Committee of the State Board of Medical
Examiners and the Board of Nursing for Advanced Practice
Nurses shall mean and shall be a committee composed of all of
the following:
a. Two physicians licensed to practice medicine in the
State of Alabama this state.
b. One registered nurse licensed to practice
professional nursing in the State of Alabama.
cb. One licensed physician engaged in a collaborative
practice with a certified registered nurse practitioner or a
certified nurse midwife in the State of Alabama this state.
dc. One Two certified registered nurse practitioner
practitioners engaged in advanced practice an active
collaborative practice with a physician in the State of
Alabama this state.
ed. One certified nurse midwife engaged in advanced
practice an active collaborative practice with a physician in
the State of Alabama this state.
(8) LEGEND DRUG. Any drug, medicine, chemical, or
poison bearing on the label the words, "Caution, Federal Law
prohibits dispensing without prescription" or similar words
indicating that the drug, medicine, chemical, or poison may be
sold or dispensed only upon the prescription of a licensed
practitioner, except that the term legend drug shall not
include any drug, substance, or compound which is listed in
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include any drug, substance, or compound which is listed in
Schedules I through V of the Alabama Uniform Controlled
Substances Act.
(9) PHYSICIAN or COLLABORATING PHYSICIAN. A doctor of
medicine or a doctor of osteopathy licensed to practice
medicine in Alabama who agrees in writing to practice in
collaboration with one or more certified registered nurse
practitioners or certified nurse midwives in accordance with
the rules adopted by the State Board of Medical Examiners and
the Board of Nursing.
(10) PRESCRIBE or PRESCRIBING. The act of issuing a
written prescription for a legend drug.
(11) PRESCRIPTION. An order for a legend drug which is
written and signed by a practitioner authorized by law to
prescribe and administer such drugs and which is intended to
be filled, compounded, or dispensed by a pharmacist.
(12) PROCEDURAL ORDERING. The ordering of the
anesthesia plan, including the ordering of medications and
tests before, during, or after analgesia or anesthesia in
accordance with the anesthesia plan.
(13) PROTOCOL. A document approved in accordance with
Section 34-21-87 establishing the permissible functions and
activities to be performed by certified registered nurse
practitioners and certified nurse midwives and signed by
collaborating physicians and any nurse practitioners or nurse
midwives practicing with those physicians."
"§34-21-82
(a)(1) The physician members of the joint committee
shall be appointed by the State Board of Medical Examiners and
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shall be appointed by the State Board of Medical Examiners and
shall serve three-year terms as set out below .
(2) The registered nurse members of the joint committee
shall be appointed by the Board of Nursing certified
registered nurse practitioner members of the joint committee
shall be appointed by the Nurse Practitioner Alliance of
Alabama or its successor organization and shall serve
three-year terms as set out below .
(3) The certified nurse midwife member of the joint
committee shall be appointed by the Alabama American College
of Nurse-Midwives or its successor organization and shall
serve a three-year term.
(4) No member shall serve more than two full terms,
either consecutively or separately.
(b)(1) In order to stagger the terms of office, the
Board of Nursing and the State Board of Medical Examiners will
each appoint to the initial joint committee one member for a
term of one year, one member for a term of two years, and one
member for a term of three years. Should the registered nurse
member serving on September 30, 2025, shall be replaced on
October 1, 2025, with a certified registered nurse
practitioner pursuant to subdivision (a)(2) who shall serve an
initial term of two years, the certified registered nurse
practitioner serving on September 30, 2025, shall continue to
serve until October 1, 2026, and the certified nurse midwife
serving on September 30, 2025, shall be replaced on October 1,
2025.
(c) If a vacancy occur occurs on the committee, a
successor will shall be appointed by the respective appointing
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successor will shall be appointed by the respective appointing
authority in subsection (a) to serve the unexpired term.
(d) The committee shall select one of its members to
serve as chairperson chair for a one-year term ,.
(2) The office of chairperson shall
alternatealternating between a physician member of the
committee and a nurse member of the committee.
(3)(e) The committee shall meet annually, or more
frequently if requested by the State Board of Medical
Examiners or the Board of Nursing. Members of the committee
shall receive per diem at a rate of $100 three hundred dollars
($300) per day or any portion thereof that such a committee
member shall be in attendance at an official meeting or
function of the committee and in addition shall receive
reimbursement for subsistence and travel in accordance with
state law for each day actively engaged in the duties of their
offices. The State Board of Medical Examiners shall pay the
per diem and expenses of the physician members and the Board
of Nursing shall pay the per diem and expenses of the nurse
members,each appoints to the joint committee and both boards
shall furnish necessary clerical and administrative support
for operation of the committee.
(f) Rejection of a recommendation from the joint
committee by either the State Board of Medical Examiners or
the Board of Nursing shall require a three-fifths majority
vote by the respective board. If rejected, the respective
board shall return the recommendations, with proposed changes,
to the joint committee for reevaluation and reconsideration. "
Section 2. This act shall become effective on October
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Section 2. This act shall become effective on October
1, 2025.253